Pediatric Orthopaedics Practice Questions

Q: Thurston Holland sign is seen in ?

Type II. ***Type II*** - The **Thurston Holland sign** is characteristic of a **Salter-Harris Type II fracture**, often described as a metaphyseal fragment (the "Thurston Holland fragment") remaining attached to the epiphyseal plate. - This fragment typically occurs at the corner of the **metaphysis**, making the fracture line extend obliquely through the physis and then along the metaphysis. *Type I* - A **Salter-Harris Type I fracture** involves a clean horizontal separation through the **growth plate (physis)** without involving the metaphysis or epiphysis. - No metaphyseal fragment is seen in Type I fractures, distinguishing it from the Thurston Holland sign. *Type III* - **Salter-Harris Type III fractures** extend from the **physis into the epiphysis**, creating an intra-articular fracture involving the joint surface. - These fractures do not involve a metaphyseal fragment, as they solely affect the physis and epiphysis. *Type IV* - **Salter-Harris Type IV fractures** involve a fracture line extending through the **epiphysis, physis, and metaphysis**, effectively dividing the bone into three parts. - While complex, Type IV injuries do not specifically describe the characteristic metaphyseal fragment that defines the Thurston Holland sign.

Q: Which of the following is NOT a common fracture in children?

Fracture of hand. ***Fracture of hand*** - While hand fractures can occur in children, they are generally **less common** compared to fractures of the long bones, especially those of the **upper extremity**, due to the types of activities and falls children typically experience. - The small bones of the hand are often better protected or less frequently exposed to severe direct trauma in routine childhood activities that lead to fractures elsewhere. *Lateral condyle humerus* - This is a common and often challenging fracture in children, particularly affecting those aged 6-10 years. - It usually results from a fall on an **outstretched hand**, with the elbow in extension. *Supracondylar humerus* - This is one of the **most common elbow fractures** in children and is typically due to a fall on an **outstretched hand** with the elbow extended or hyperextended. - Its significance lies in the potential for neurovascular complications due to its proximity to vital structures. *Radius-ulna fracture* - **Forearm fractures** involving the radius, ulna, or both are extremely common in children, often resulting from falls onto an **outstretched hand**. - The **distal radius** is a particularly frequent site of fracture in this age group.

Q: What is the most common structural deformity associated with transient synovitis of the hip?

None of the options. ***None of the options:*** - Transient synovitis of the hip is an inflammatory condition that does not inherently cause a **structural deformity** of the hip joint. - While it causes pain and limited range of motion, these are functional rather than structural changes, and the hip joint's **anatomical structure remains intact**. *Abduction* - Abduction is a **movement**, not a structural deformity. Although the hip may be held in a position of slight abduction to relieve pain, this is a postural adaptation, not a permanent structural change. - Hip abduction contractures can occur in various conditions (e.g., neuromuscular disorders) but are not characteristic of transient synovitis. *Flexion* - Similar to abduction, flexion is a **movement**, not a structural deformity. Patients with transient synovitis often hold the hip in a flexed position (along with abduction and external rotation) for comfort to minimize pressure within the joint capsule. - A fixed flexion deformity can be seen in other conditions like septic arthritis or Legg-Calvé-Perthes disease, but not typically in transient synovitis. *External rotation* - External rotation is also a **movement**, not a structural deformity. Patients may adopt an externally rotated position of the leg to ease pain and reduce intracapsular pressure. - While certain conditions can cause a fixed external rotation (e.g., slipped capital femoral epiphysis), transient synovitis does not lead to this type of structural change.

Q: What splint is used in CTEV after correction?

Dennis Brown splint. ***Dennis Brown splint*** - The **Dennis Brown splint** is specifically designed for maintaining the correction of **clubfoot (CTEV)** in infants to prevent recurrence. - It consists of a bar connecting two shoes that hold the feet in an **external rotation** and **abduction** position. *Bohler-Brown splint* - The **Bohler-Brown splint** is primarily used for the management of **tibial shaft fractures**. - It is a **traction splint** designed to maintain alignment and length of the fractured bone. *Thomas splint* - The **Thomas splint** is typically used for **femoral shaft fractures** to provide traction and reduce muscle spasm. - It is not indicated for the long-term management of clubfoot. *None of the options* - This option is incorrect as the **Dennis Brown splint** is a well-established and a primary splint used for CTEV after correction.

Q: Madelung's deformity is characterized by an abnormality in which bone?

Distal radius. ***Distal radius*** - **Madelung's deformity** is primarily characterized by a **malformation of the distal radius**, specifically the physis (growth plate). - This leads to abnormal growth, causing the **radius to shorten and bow** dorsally, resulting in a prominent distal ulna. *Humerus* - The **humerus** is the bone of the upper arm, and abnormalities of this bone are not characteristic of Madelung's deformity. - Conditions affecting the humerus typically involve the shoulder or elbow joint, distinct from the wrist pathology seen in Madelung's. *Proximal ulna* - The **proximal ulna** forms part of the elbow joint, and while the ulna can be affected, the primary abnormality in Madelung's is in the radius. - While the ulna may appear prominent, this is secondary to the radial deformity, not a primary issue of the proximal ulna. *Carpals* - The **carpal bones** are located in the wrist, distal to the radius and ulna, and are not the primary site of deformity in Madelung's. - While wrist motion may be affected, the underlying cause is the abnormal growth of the distal radius, which can then impact carpal alignment.

Q: Which of the following movements is typically restricted in Perthes disease?

Abduction & internal rotation. ***Abduction & internal rotation*** - **Perthes disease** affects the femoral head, leading to pain and stiffness that most commonly restricts **abduction** and **internal rotation** of the hip. - This restriction is an early and consistent clinical finding, often accompanied by a ** Trendelenburg gait** due to gluteal muscle weakness or pain avoidance. *Abduction & external rotation* - While abduction can be restricted, a primary restriction in **external rotation** is less typical in early Perthes disease. - Reduced external rotation is more characteristic of conditions like **slipped capital femoral epiphysis (SCFE)**, especially in older children. *Adduction & internal rotation* - **Adduction** is generally preserved or even increased in Perthes disease as the hip seeks a position of comfort due to pain, making it an unlikely primary restriction. - While internal rotation is restricted, the combination with adduction restriction is not the classical presentation. *Adduction & external rotation* - Neither **adduction** nor **external rotation** are typically the primary hip movements restricted in Perthes disease. - Restriction in adduction is rare, and external rotation is often compensatory or less affected than internal rotation.

Q: What condition is primarily diagnosed using Von Rosen's view?

Congenital dislocation of the hip (CDH). ***Congenital dislocation of the hip (CDH)*** - **Von Rosen's view** is a specialized X-ray projection used specifically to assess for **developmental dysplasia of the hip (DDH)**, also known as CDH, in infants. - This view helps visualize the relationship between the **femoral head** and the **acetabulum** by positioning the infant's hips in extension, abduction, and internal rotation. *Perthes disease* - **Perthes disease** is an avascular necrosis of the femoral head, typically diagnosed with standard **frog-leg lateral** and **AP pelvic X-rays**. - While it affects the hip, Von Rosen's view is not the primary diagnostic imaging for this condition, which usually presents later in childhood. *Congenital Talipes Equinovarus (CTEV)* - **CTEV**, or **clubfoot**, is a deformity of the foot and ankle, not the hip. - It is primarily diagnosed clinically and then confirmed with **AP and lateral X-rays of the foot** to assess bone alignment. *None of the options* - This option is incorrect because **Congenital dislocation of the hip (CDH)** is indeed primarily diagnosed using Von Rosen's view, among other methods.

Q: Green stick fracture is

Incomplete fracture. ***Incomplete fracture*** - A **greenstick fracture** is an **incomplete fracture** where the bone bends and cracks but does not break all the way through. - This type of fracture commonly occurs in children because their bones are more flexible and softer than adult bones. *Fracture in adults* - While adults can experience various types of fractures, a **greenstick fracture** is rare in adults due to their more rigid and brittle bones. - Adult bones tend to sustain **complete fractures** or other complex fracture patterns instead of bending partially. *Complete fracture* - A **complete fracture** denotes a break in the bone that severs it into two or more distinct pieces. - **Greenstick fractures** are by definition incomplete, meaning the bone is still partially intact. *Fracture spine* - A **spinal fracture** specifically refers to a break in one or more vertebrae in the spinal column. - While spinal fractures can be complete or incomplete, the term **greenstick fracture** is not typically used to describe fractures of the spine.

Q: In neglected cases of CTEV, which joints are fused?

Calcaneocuboid, talonavicular, and talocalcaneal joints. ***Calcaneocuboid, talonavicular, and talocalcaneal joints*** - In neglected cases of **clubfoot (CTEV)**, a **triple arthrodesis** is performed to correct the deformity. - This procedure involves the fusion of the **subtalar (talocalcaneal)**, **talonavicular**, and **calcaneocuboid joints** to provide a stable, plantigrade foot. *Tibiotalar, calcaneocuboid, and talonavicular joints* - The **tibiotalar joint (ankle joint)** is generally preserved in triple arthrodesis for CTEV to maintain ankle motion. - Fusing the tibiotalar joint would significantly **reduce ankle dorsiflexion and plantarflexion**, leading to a stiff ankle. *None of the above joints* - This option is incorrect because the fusion of specific joints is a recognized surgical treatment for severe, neglected CTEV. - **Triple arthrodesis** is a well-established procedure for correcting rigid foot deformities. *Ankle joint, calcaneocuboid, and talonavicular joints* - As mentioned, fusion of the **ankle joint (tibiotalar joint)** is generally avoided in triple arthrodesis for CTEV to preserve functional ankle motion. - The goal is to stabilize the foot while retaining as much articulation as possible in the ankle itself.

Q: What is the primary pathology associated with Congenital Dislocation of the Hip (CDH)?

Shallow acetabulum. ***Shallow acetabulum*** - A **shallow or dysplastic acetabulum** is the primary pathological feature in CDH, leading to an unstable or dislocated femoral head. - This anatomical abnormality prevents the femoral head from seating properly, causing **instability** and potential **dislocation**. *Large head of femur* - While femoral head abnormalities can occur, a **disproportionately large femoral head** is not the primary or most common pathological feature causing CDH. - The issue primarily lies with the **acetabular socket** rather than the size of the femoral head itself. *Excessive retroversion* - **Femoral retroversion** (backward twisting of the femoral neck relative to the femoral condyles) can be a contributing factor or an associated finding, but it is not the primary anatomical defect. - The principal pathology is the **inadequate containment** of the femoral head by a poorly formed acetabulum. *Coxa vara deformity* - **Coxa vara** is a deformity where the angle between the head and shaft of the femur is decreased. - While it can be associated with or contribute to hip instability in some conditions, it is not the primary or defining pathological feature of CDH.

Question 1

Thurston Holland sign is seen in ?

Accepted Answer

Type II

Answer

Type I

Answer

Type III

Answer

Type IV

Question 2

Which of the following is NOT a common fracture in children?

Accepted Answer

Fracture of hand

Answer

Supracondylar humerus

Answer

Radius-ulna fracture

Answer

Lateral condyle humerus

Question 3

What is the most common structural deformity associated with transient synovitis of the hip?

Accepted Answer

None of the options

Answer

Abduction

Answer

Flexion

Answer

External rotation

Question 4

What splint is used in CTEV after correction?

Accepted Answer

Dennis Brown splint

Answer

Bohler-Brown splint

Answer

Thomas splint

Answer

None of the options

Question 5

Madelung's deformity is characterized by an abnormality in which bone?

Accepted Answer

Distal radius

Answer

Humerus

Answer

Proximal ulna

Answer

Carpals

Question 6

Which of the following movements is typically restricted in Perthes disease?

Accepted Answer

Abduction & internal rotation

Answer

Abduction & external rotation

Answer

Adduction & internal rotation

Answer

Adduction & external rotation

Question 7

What condition is primarily diagnosed using Von Rosen's view?

Accepted Answer

Congenital dislocation of the hip (CDH)

Answer

Perthes disease

Answer

Congenital Talipes Equinovarus (CTEV)

Answer

None of the options

Question 8

Green stick fracture is

Accepted Answer

Incomplete fracture

Answer

Fracture in adults

Answer

Complete fracture

Answer

Fracture spine

Question 9

In neglected cases of CTEV, which joints are fused?

Accepted Answer

Calcaneocuboid, talonavicular, and talocalcaneal joints

Answer

Tibiotalar, calcaneocuboid, and talonavicular joints

Answer

None of the above joints

Answer

Ankle joint, calcaneocuboid, and talonavicular joints

Question 10

What is the primary pathology associated with Congenital Dislocation of the Hip (CDH)?

Accepted Answer

Shallow acetabulum

Answer

Large head of femur

Answer

Excessive retroversion

Answer

Coxa vara deformity

Pediatric Orthopaedics — MCQs

Pediatric Orthopaedics — MCQs

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