Pediatric Orthopaedics Practice Questions

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 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: In elbow, osteochondritis usually involves

Capitulum. ***Capitulum*** - The **capitulum** of the humerus is the most common site for **osteochondritis dissecans (OCD)** in the elbow, especially in throwing athletes and gymnasts. - This condition involves an avascular necrosis of the subchondral bone leading to a detachment of a cartilage fragment. *Olecranon* - The **olecranon** is part of the ulna and is more commonly affected by **stress fractures** or **bursitis**, not typically osteochondritis. - While it articulates with the trochlea, it does not bear the primary compressive forces that lead to osteochondritis in the same way the capitulum does. *Trochlea* - The **trochlea** of the humerus articulates with the trochlear notch of the ulna and is less frequently involved in primary osteochondritis compared to the capitulum. - Pathologies here are more likely related to **instability** or **fractures**. *Radial head* - The **radial head** articulates with the capitulum and is more prone to **fractures** or degenerative changes like **osteoarthritis**. - While it can be affected by **osteochondral lesions**, the capitulum is the classic site for elbow osteochondritis dissecans.

Q: Tardy ulnar nerve palsy is specifically associated with which type of fracture?

Lateral condyle fracture of the humerus. ***Lateral condyle fracture of the humerus*** - This fracture, especially in children, can lead to **cubitus valgus deformity** as a long-term complication if it heals incorrectly. - The resulting **valgus angulation** at the elbow abnormally stretches the ulnar nerve behind the medial epicondyle, causing **tardy ulnar nerve palsy** years after the initial injury. *Medial condyle fracture of the humerus* - While close to the ulnar nerve, medial condyle fractures are more likely to cause **immediate nerve damage** due to direct impingement, rather than delayed or "tardy" palsy from chronic stretching. - Complications typically involve varus deformity, which does not commonly stretch the ulnar nerve in the same manner as valgus. *Fracture of the humeral shaft* - This type of fracture is more commonly associated with **radial nerve injury** (e.g., wrist drop), especially in fractures of the mid-shaft. - It does not typically lead to long-term deformities at the elbow that would cause **delayed ulnar nerve compression**. *Fracture of the radial shaft* - Radial shaft fractures (e.g., Monteggia, Galeazzi) primarily affect the **radial nerve** or the **posterior interosseous nerve**. - They do not directly involve the elbow joint in a manner that would cause **tardy ulnar nerve palsy**.

Q: What is the most common complication of lateral condyle humerus fracture?

Nonunion. ***Nonunion*** - The lateral condyle is an **epiphyseal apophysis**, meaning it's a secondary ossification center that doesn't contribute to longitudinal bone growth, and it is covered by **cartilage**, limiting the contact area between fracture fragments. - Due to the cartilage covering, the periosteal blood supply is compromised leading to difficulty in healing, making **nonunion the most common complication**. *Malunion* - While **malunion** can occur, it is less common than nonunion in lateral condyle fractures due to the specific anatomy and blood supply of the lateral condyle. - **Growth disturbances** or **cubitus valgus** can result from malunion, but nonunion remains the primary concern. *Vascular injury and compromise (VIC)* - **Vascular injuries** are rare due to the relatively intact soft tissue envelope around the fracture site. - The main vessels are not typically in close proximity to the fracture line of the lateral condyle. *Median nerve injury* - The **median nerve** courses anterior to the elbow joint, more medially. - It is rarely affected by lateral condyle fractures, which are on the lateral aspect of the distal humerus.

Q: Congenital pseudoarthrosis is seen in which of the following?

Tibia. ***Tibia*** - **Congenital pseudoarthrosis** is most commonly found in the **tibia**, presenting as a false joint due to a failure of proper bone healing. - It often correlates with **neurofibromatosis type 1**, where a segment of the bone fails to ossify correctly. *Hip joint* - **Congenital pseudoarthrosis** does not typically manifest in the hip joint; rather, conditions like **congenital hip dysplasia** are more common. - This condition involves an abnormal development of the hip socket and femoral head, leading to instability or dislocation. *Femur* - While congenital pseudoarthrosis can rarely occur in the **femur**, it is significantly less common than in the tibia. - Femur involvement typically presents differently, often with **shortening** or bowing, without forming a false joint as seen in the tibia. *Radius - ulna* - **Congenital pseudoarthrosis** in the radius or ulna is rare and is more commonly associated with conditions like **neurofibromatosis** or other skeletal dysplasias. - It often leads to forearm deformation and functional impairment, distinct from the typical presentation in the tibia.

Q: Which is the most common elbow fracture in children?

Supracondylar fracture. ***Supracondylar fracture*** - These fractures account for 60-70% of all elbow fractures in children, making them the **most common type**. - They typically occur from a **fall onto an outstretched hand (FOOSH)**, leading to hyperextension of the elbow and forces exerted on the distal humerus. *Lateral condyle fracture* - While common, these fractures are less frequent than supracondylar fractures, typically comprising about 15-20% of elbow fractures in children. - They usually result from a direct blow or **varus stress** to the elbow. *Medial epicondyle fracture* - These fractures are less common than supracondylar fractures, often occurring in older children or adolescents during sports activities due to **valgus stress** or muscle avulsion. - They are frequently associated with elbow dislocation. *Olecranon fracture* - Olecranon fractures are relatively rare in children compared to other elbow fractures, often resulting from a direct blow or fall. - They typically involve the **proximal ulna** and are less common than fractures involving the distal humerus.

Q: What is the most common bone fractured in children?

Fracture of the clavicle. ***Fracture of the clavicle*** - The clavicle is the **most commonly fractured bone in children**, especially during falls onto an outstretched hand or direct trauma. - Its subcutaneous location and an **S-shape** make it prone to injury. *Fracture of the distal radius* - While common, especially in older children or adolescents, **distal radius fractures** are not as frequent as clavicle fractures across all pediatric age groups. - These fractures often result from a **fall onto an outstretched hand** (FOOSH). *Fracture of the supracondylar humerus* - **Supracondylar humerus fractures** are common in children, particularly between ages 5 and 7 years, usually due to falls. - However, they are associated with more potential complications (like **nerve or vascular injury**) but are less common overall than clavicle fractures. *Fracture of the radius/ulna* - **Fractures of the midshaft radius and/or ulna** are common in children but often require more significant trauma compared to clavicle fractures. - These often present as **greenstick or torus fractures** in younger children.

Q: Blount's disease is associated with all of the following, except:

Genu recurvatum (hyperextension of the knee). ***Genu recurvatum (hyperextension of the knee)*** - Blount's disease is primarily characterized by **genu varum** (bowing of the legs) due to abnormal growth of the proximal tibia. - **Genu recurvatum** is not a typical feature or associated deformity of Blount's disease. *Genu varum (tibia vara)* - This is the **hallmark deformity** of Blount's disease, involving an inward bowing of the leg predominantly at the knee. - It results from a growth disturbance in the **medial portion of the proximal tibial physis**. *External tibial torsion (can occur in some cases)* - While less common than internal torsion, **external tibial torsion** can sometimes be a secondary or associated deformitry in complex cases of Blount's disease, especially with progressive bowing. - It involves an outward twisting of the tibia relative to the femur. *Internal tibial torsion (common in Blount's disease)* - **Internal tibial torsion** is a frequently observed deformity in patients with Blount's disease. - It results in an inward rotation of the lower leg, contributing to the overall malalignment alongside the genu varum.

Question 1

Green stick fracture is

Accepted Answer

Incomplete fracture

Answer

Fracture in adults

Answer

Complete fracture

Answer

Fracture spine

Question 2

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 3

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 4

In elbow, osteochondritis usually involves

Accepted Answer

Capitulum

Answer

Olecranon

Answer

Trochlea

Answer

Radial head

Question 5

Tardy ulnar nerve palsy is specifically associated with which type of fracture?

Accepted Answer

Lateral condyle fracture of the humerus

Answer

Medial condyle fracture of the humerus

Answer

Fracture of the humeral shaft

Answer

Fracture of the radial shaft

Question 6

What is the most common complication of lateral condyle humerus fracture?

Accepted Answer

Nonunion

Answer

Malunion

Answer

Vascular injury and compromise (VIC)

Answer

Median nerve injury

Question 7

Congenital pseudoarthrosis is seen in which of the following?

Accepted Answer

Tibia

Answer

Hip joint

Answer

Femur

Answer

Radius - ulna

Question 8

Which is the most common elbow fracture in children?

Accepted Answer

Supracondylar fracture

Answer

Olecranon fracture

Answer

Medial epicondyle fracture

Answer

Lateral condyle fracture

Question 9

What is the most common bone fractured in children?

Accepted Answer

Fracture of the clavicle

Answer

Fracture of the distal radius

Answer

Fracture of the supracondylar humerus

Answer

Fracture of the radius/ulna

Question 10

Blount's disease is associated with all of the following, except:

Accepted Answer

Genu recurvatum (hyperextension of the knee)

Answer

External tibial torsion (can occur in some cases)

Answer

Genu varum (tibia vara)

Answer

Internal tibial torsion (common in Blount's disease)

Pediatric Orthopaedics — MCQs

Pediatric Orthopaedics — MCQs

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