Pediatric Orthopaedics — MCQs

Pediatric Orthopaedics Indian Medical PG Practice Questions and MCQs

Question 361: Thurston Holland sign is seen in ?

A. Type II (Correct Answer)
B. Type I
C. Type III
D. Type IV

Explanation: ***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.

Question 362: Which of the following is NOT a common fracture in children?

A. Supracondylar humerus
B. Fracture of hand (Correct Answer)
C. Radius-ulna fracture
D. Lateral condyle humerus

Explanation: ***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.

Question 363: What splint is used in CTEV after correction?

A. Bohler-Brown splint
B. Thomas splint
C. Dennis Brown splint (Correct Answer)
D. None of the options

Explanation: ***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.

Question 364: Von-Rosen's sign is positive in which of the following conditions?

A. Perthe's disease
B. SCFE
C. CTEV
D. Developmental Dysplasia of the Hip (DDH) (Correct Answer)

Explanation: ***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.

Question 365: What is the most common structural deformity associated with transient synovitis of the hip?

A. Abduction
B. Flexion
C. External rotation
D. None of the options (Correct Answer)

Explanation: ***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.

Question 366: What is the characteristic upper limb deformity seen in Erb's palsy?

A. Adduction and lateral rotation of arm
B. Adduction and medial rotation of arm (Correct Answer)
C. Abduction and lateral rotation of arm
D. Abduction and medial rotation of arm

Explanation: ***Adduction and medial rotation of arm*** - Erb's palsy, resulting from injury to the **upper brachial plexus** (C5-C6 nerve roots), primarily affects the **deltoid**, **supraspinatus**, **infraspinatus**, and **biceps** muscles. - The unopposed action of unaffected muscles, such as the **pectoris major** and **latissimus dorsi**, leads to the characteristic **waiter's tip position**, involving **adduction** and **medial rotation** of the arm. *Adduction and lateral rotation of arm* - This position would imply weakness of the **pectoralis major** and **latissimus dorsi** and stronger activity of the **infraspinatus** and **teres minor**, which is contrary to the muscle deficits in Erb's palsy. - **Lateral rotation** of the arm is typically impaired in Erb's palsy due to weakness of the **infraspinatus** and **teres minor**. *Abduction and lateral rotation of arm* - **Abduction** is severely impacted in Erb's palsy due to paralysis of the **deltoid** and **supraspinatus**. - This position would suggest intact function of muscles that are explicitly weakened or paralyzed in Erb's palsy. *Abduction and medial rotation of arm* - While **medial rotation** can be a component of the deformity, **abduction** is a movement that is significantly impaired in Erb's palsy, making this option incorrect. - The inability to abduct the arm is a hallmark of the condition due to weakness of the **deltoid** and **supraspinatus**.

Question 367: Which of the following movements is typically restricted in Perthes disease?

A. Abduction & internal rotation (Correct Answer)
B. Abduction & external rotation
C. Adduction & internal rotation
D. Adduction & external rotation

Explanation: ***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.

Question 368: What is the primary pathology associated with Congenital Dislocation of the Hip (CDH)?

A. Large head of femur
B. Shallow acetabulum (Correct Answer)
C. Excessive retroversion
D. Coxa vara deformity

Explanation: ***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 369: What condition is primarily diagnosed using Von Rosen's view?

A. Congenital dislocation of the hip (CDH) (Correct Answer)
B. Perthes disease
C. Congenital Talipes Equinovarus (CTEV)
D. None of the options

Explanation: ***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.

Question 370: What is a Pulled Elbow?

A. Subluxation of proximal radio ulnar joint
B. Complete separation of the elbow joint
C. No injury present
D. Partial dislocation of the radial head (Correct Answer)

Explanation: ***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.

Practice by Chapter

Developmental Dysplasia of Hip

Practice Questions

Clubfoot

Practice Questions

Pediatric Fractures

Practice Questions

Growth Plate Injuries

Practice Questions

Legg-Calvé-Perthes Disease

Practice Questions

Slipped Capital Femoral Epiphysis

Practice Questions

Pediatric Spine Deformities

Practice Questions

Cerebral Palsy: Orthopaedic Aspects

Practice Questions

Neuromuscular Disorders in Children

Practice Questions

Pediatric Bone and Joint Infections

Practice Questions

Limb Length Discrepancies

Practice Questions

Orthopedic Manifestations of Genetic Disorders

Practice Questions

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