Pediatric Orthopaedics — MCQs

Pediatric Orthopaedics Indian Medical PG Practice Questions and MCQs

Question 371: In elbow, osteochondritis usually involves

A. Olecranon
B. Trochlea
C. Radial head
D. Capitulum (Correct Answer)

Explanation: ***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.

Question 372: Congenital pseudoarthrosis is seen in which of the following?

A. Hip joint
B. Femur
C. Radius - ulna
D. Tibia (Correct Answer)

Explanation: ***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.

Question 373: Atrophic champagne glass pelvis is seen in which condition?

A. Cretinism
B. Osteomalacia
C. Rickets
D. Achondroplasia (Correct Answer)

Explanation: ***Achondroplasia*** - The **champagne glass pelvis** appearance, characterized by a flattened, widened iliac bone and a narrow sacrosciatic notch, is a classic radiographic sign of achondroplasia. - This pelvic shape is a consequence of abnormal **endochondral ossification**, which is the primary defect in achondroplasia. *Cretinism* - **Cretinism** (congenital hypothyroidism) primarily affects bone maturation and growth rather than bone shape, leading to features like delayed epiphyseal fusion and severe growth retardation. - While bone abnormalities occur, they typically don't include the specific champagne glass pelvis associated with achondroplasia. *Osteomalacia* - **Osteomalacia** is characterized by defective mineralization of newly formed bone, leading to soft, weak bones prone to bowing and fractures. - It does not cause an atrophic champagne glass pelvis; rather, it results in generalized bone pain, muscle weakness, and often pseudofractures. *Rickets* - **Rickets** is the childhood form of osteomalacia, where vitamin D deficiency leads to impaired mineralization of growing bone and cartilage. - It typically causes features like bowed legs, rachitic rosary, and widened growth plates, but not the specific pelvic deformity seen in achondroplasia.

Question 374: Which is the most common elbow fracture in children?

A. Supracondylar fracture (Correct Answer)
B. Olecranon fracture
C. Medial epicondyle fracture
D. Lateral condyle fracture

Explanation: ***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.

Question 375: What is the most common bone fractured in children?

A. Fracture of the distal radius
B. Fracture of the supracondylar humerus
C. Fracture of the radius/ulna
D. Fracture of the clavicle (Correct Answer)

Explanation: ***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.

Question 376: Blount's disease is associated with all of the following, except:

A. External tibial torsion (can occur in some cases)
B. Genu varum (tibia vara)
C. Genu recurvatum (hyperextension of the knee) (Correct Answer)
D. Internal tibial torsion (common in Blount's disease)

Explanation: ***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 377: Fracture of the femur in young children (2-5 years) is typically treated by:

A. Gallow's splint
B. Open reduction (surgical intervention)
C. Closed reduction & splintage (Correct Answer)
D. Intramedullary nailing (surgical fixation)

Explanation: ***Closed reduction & splintage*** - In young children (2-5 years), **femur fractures** are often treated non-operatively with **closed reduction** and immediate application of a **hip spica cast** or other splintage. - This approach takes advantage of the excellent **bone remodeling potential** in young children, allowing for good functional outcomes. *Open reduction (surgical intervention)* - **Open reduction** is generally reserved for open fractures, - It is also indicated for fractures with associated neurovascular injury, compartment syndrome, or in older children where non-operative management has failed. *Gallow's splint* - The **Gallow's splint** (also known as Bryant's traction) involves suspending both legs vertically, and is typically used for **femur fractures in infants younger than 1 year** due to the risk of vascular compromise or compartment syndrome in older or heavier children. - It is not the primary treatment for children aged 2-5 years. *Intramedullary nailing (surgical fixation)* - **Intramedullary nailing** is a surgical option, usually considered for **femur fractures in older children** (typically 6 years and above) or adolescents. - It provides stable fixation but is generally avoided in very young children due to potential damage to the **growth plates** or complications related to implant size.

Question 378: A 15-year-old girl complains of anterior knee pain that increases when going upstairs and getting up after prolonged sitting. The most probable diagnosis is:

A. Chondromalacia Patellae (Correct Answer)
B. Plica syndrome
C. Bipartite patellae
D. Patellofemoral arthritis

Explanation: ***Chondromalacia Patellae*** * This condition is characterized by the **softening and breakdown of the cartilage** on the undersurface of the patella. * **Anterior knee pain** exacerbated by activities that load the patellofemoral joint, such as climbing stairs and prolonged sitting, is a classic presentation, especially in young active individuals. *Plica syndrome* * **Plica syndrome** involves irritation or inflammation of a synovial fold (plica) in the knee joint. * While it can cause anterior knee pain, it often presents with a **snapping or popping sensation** and can be caused by trauma, which is not mentioned here. *Bipartite patellae* * **Bipartite patella** is a congenital condition where the patella fails to completely fuse into a single bone. * It is often **asymptomatic** and discovered incidentally; when symptomatic, pain is usually more constant and localized to the upper outer quadrant of the patella, rather than activity-dependent. *Patellofemoral arthritis* * **Patellofemoral arthritis** involves degenerative changes of the cartilage in the patellofemoral joint, similar to chondromalacia. * However, it is typically seen in **older individuals** and is less likely to be the primary diagnosis in a 15-year-old girl, although chondromalacia patellae can predispose to it later in life.

Question 379: A 6-year-old boy presents with a painful limp, tenderness in the femoral triangle, and some limitation of hip movements. The X-ray is normal. What is the next investigation?

A. MRI (Correct Answer)
B. CT scan
C. Arthroscopy
D. Bone scan

Explanation: ***MRI*** - An **MRI** is the most sensitive imaging modality for detecting early changes in bone marrow and soft tissues, such as **avascular necrosis of the femoral head** (Legg-Calvé-Perthes disease), which can present with a painful limp and normal initial X-rays. - It can visualize bone edema, cartilage irregularities, and effusions that are not apparent on plain radiographs. *CT scan* - While useful for detailed bone anatomy, a **CT scan** exposes the child to significant **radiation** and is less effective than MRI for detecting early soft tissue and bone marrow changes in conditions like Perthes disease. - It is often reserved for complex fracture assessments or when MRI is contraindicated. *Arthroscopy* - **Arthroscopy** is an **invasive surgical procedure** used for direct visualization, diagnosis, and treatment of joint problems. - It is not a primary diagnostic investigation for a painful limp with a normal X-ray, as less invasive imaging like MRI should be performed first. *Bone scan* - A **bone scan** (scintigraphy) is sensitive for detecting increased **metabolic activity** in bone, such as in infections or tumors, but it is less specific than MRI for detailed anatomical changes in early Perthes disease. - It involves radiation exposure and may not provide the detailed soft tissue information needed to differentiate various causes of a painful hip.

Question 380: The malunion of a supracondylar fracture of the humerus most commonly leads to:

A. Cubitus varus (Correct Answer)
B. Cubitus valgus
C. Extension deformity
D. Flexion deformity

Explanation: ***Cubitus varus*** - A **supracondylar fracture** malunion often results in posterior and medial displacement of the distal fragment, leading to a **loss of the carrying angle** or even its reversal, known as **cubitus varus** or **gunstock deformity**. - This characteristic deformity is the most common and recognizable long-term complication of improperly healed supracondylar humerus fractures. *Flexion deformity* - While some limitation of extension can occur, a pure **flexion deformity** is not the most common or defining malunion pattern for supracondylar fractures. - The primary angular deformity is typically in the coronal plane (varus) rather than the sagittal plane (flexion/extension). *Cubitus valgus* - **Cubitus valgus** is an increased carrying angle, where the forearm deviates laterally, and is relatively rare after supracondylar fracture malunion. - It is more commonly associated with **lateral condyle fractures** or physeal injuries. *Extension deformity* - An **extension deformity** would imply an increase in the normal extension of the elbow, which is not a common consequence of supracondylar fracture malunion. - The typical angular malunion involves either varus or, less commonly, some degree of flexion contracture.

Practice by Chapter

Developmental Dysplasia of Hip

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Clubfoot

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Pediatric Fractures

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Growth Plate Injuries

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Legg-Calvé-Perthes Disease

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Slipped Capital Femoral Epiphysis

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Pediatric Spine Deformities

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Cerebral Palsy: Orthopaedic Aspects

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Neuromuscular Disorders in Children

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Pediatric Bone and Joint Infections

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Limb Length Discrepancies

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Orthopedic Manifestations of Genetic Disorders

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