Pediatric Orthopaedics Practice Questions

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: Von-Rosen's sign is positive in which of the following conditions?

Developmental Dysplasia of the Hip (DDH). ***Developmental Dysplasia of the Hip (DDH)*** - **Von-Rosen's sign** is a clinical test used to detect **instability or dislocation** of the hip in newborns, a hallmark of DDH. - The test involves placing the infant **supine with hips flexed to 90 degrees**, then **externally rotating and abducting** the hips while applying gentle longitudinal traction; positive if abduction is limited to **less than 60 degrees**. *Perthe's disease* - This condition involves **avascular necrosis of the femoral head** in children, typically presenting with a limp and hip pain, not congenital instability. - Diagnosis is usually made by X-rays showing **sclerosis and fragmentation** of the femoral head, not by Von-Rosen's sign. *SCFE* - **Slipped Capital Femoral Epiphysis (SCFE)** is a condition where the femoral head epiphysis displaces from the femoral neck, common in adolescents. - Patients typically present with **hip or knee pain** and a characteristic external rotation of the affected limb, which is not detected by Von-Rosen's sign. *CTEV* - **Congenital Talipes Equinovarus (CTEV)**, or **clubfoot**, is a deformity of the foot and ankle, involving plantarflexion and inversion. - This condition affects the foot, not the hip, rendering tests for hip instability like Von-Rosen's sign irrelevant.

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: 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: 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 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.

Q: Fairbank triangle is seen in

Congenital coxa vara. ***Congenital coxa vara*** - The Fairbank triangle refers to a radiographic sign seen in **congenital coxa vara**, which helps in diagnosing the condition. - It is a triangular metaphyseal fragment at the inferomedial femoral neck associated with an inverted Y-shaped physeal defect in congenital coxa vara. *CDH* - **Congenital developmental dysplasia of the hip (CDH)** involves abnormal development of the hip joint. - While it can lead to hip deformities, the **Fairbank triangle** is not a specific diagnostic sign for CDH. *Perthe's disease* - **Perthe's disease** is an avascular necrosis of the femoral head, typically affecting children. - Radiographic findings include **sclerosis**, **fragmentation**, and later flattening of the femoral head, but not the Fairbank triangle. *SCFE* - **Slipped capital femoral epiphysis (SCFE)** is characterized by a posterior and inferior displacement of the femoral head epiphysis from the metaphysis. - Radiographic signs include the **Klein's line**, but the Fairbank triangle is not associated with SCFE.

Q: Which of the following statements is true regarding supracondylar fractures of the humerus?

Extension type most common. **Extension type most common** - **Extension-type supracondylar fractures** account for the vast majority (about 95%) of all supracondylar humerus fractures. - This type typically results from a fall on an **outstretched hand** with the elbow in extension, forcing the distal fragment posteriorly. *More common in adults* - **Supracondylar fractures of the humerus** are predominantly observed in children, especially between 5 and 10 years of age. - They are the **most common elbow fracture in children**, making this statement incorrect. *Flexion type is less common than extension type* - While flexion-type fractures do occur, they are significantly less common, representing only about 5% of all supracondylar fractures. - This type typically results from a direct blow to the posterior aspect of the elbow, with the distal fragment displaced anteriorly. *Both types are equally common* - As established, extension-type fractures are far more prevalent than flexion-type fractures, making them not equally common. - The significant disparity in incidence confirms that this statement is incorrect.

Q: What is a Pulled Elbow?

Partial dislocation of the radial head. ***Partial dislocation of the radial head*** - A pulled elbow, also known as **nursemaid's elbow**, specifically refers to a **subluxation of the radial head** from the annular ligament. - This injury typically occurs in young children when their arm is suddenly pulled or jerked, causing the **radial head** to slip out of the **annular ligament**. *Complete separation of the elbow joint* - A complete separation of the elbow joint would involve a **full dislocation** of the humeroulnar or humeroradial joints, a much more severe injury than a pulled elbow. - This would present with more significant deformity and instability compared to the subtle presentation of a pulled elbow. *Subluxation of proximal radio ulnar joint* - While the injury involves the radius and ulna, the specific subluxation in a pulled elbow is that of the **radial head** at the **humero-radial joint**, not primarily the proximal radio-ulnar joint itself. - The focus is on the annular ligament's integrity around the radial head, rather than direct forces acting on the proximal radio-ulnar articulation. *No injury present* - A pulled elbow is a recognized and common **pediatric orthopedic injury** requiring intervention to reduce the radial head. - The child will typically present with pain, refusal to use the affected arm, and a characteristic holding posture.

Question 1

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 2

Von-Rosen's sign is positive in which of the following conditions?

Accepted Answer

Developmental Dysplasia of the Hip (DDH)

Answer

Perthe's disease

Answer

SCFE

Answer

CTEV

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

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 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 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

Question 8

Fairbank triangle is seen in

Accepted Answer

Congenital coxa vara

Answer

SCFE

Answer

Perthe's disease

Answer

CDH

Question 9

Which of the following statements is true regarding supracondylar fractures of the humerus?

Accepted Answer

Extension type most common

Answer

Flexion type is less common than extension type

Answer

Both types are equally common

Answer

More common in adults

Question 10

What is a Pulled Elbow?

Accepted Answer

Partial dislocation of the radial head

Answer

Subluxation of proximal radio ulnar joint

Answer

Complete separation of the elbow joint

Answer

No injury present

Pediatric Orthopaedics — MCQs

Pediatric Orthopaedics — MCQs

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