Pediatric Orthopaedics — MCQs

Pediatric Orthopaedics Indian Medical PG Practice Questions and MCQs

Question 381: All the following are causes of a painful limp, except which of the following?

A. Slipped femoral epiphysis (SCFE)
B. Tuberculosis (TB) of the hip
C. Perthes disease (Legg-Calvé-Perthes disease)
D. Infantile Coxa Vara (Coxa Vara) (Correct Answer)

Explanation: ***Infantile Coxa Vara (Coxa Vara)*** - **Infantile coxa vara** is a developmental condition characterized by a **reduced femoral neck-shaft angle**, often leading to a painless waddling gait or limp. - While it causes a limp, the limp itself is typically **painless**, distinguishing it from the other conditions listed. *Slipped femoral epiphysis (SCFE)* - **SCFE** involves displacement of the **femoral head** from the neck through the growth plate and is a classic cause of a **painful limp** in adolescents, often associated with obesity. - Patients typically experience **hip, groin, thigh, or knee pain** and may present with a shortened leg with external rotation. *Tuberculosis (TB) of the hip* - **TB of the hip** is a chronic infectious arthritis that causes significant **pain**, swelling, and reduced range of motion, leading to a **painful limp**. - It often presents insidiously with **constitutional symptoms** like fever and weight loss, in addition to localized pain. *Perthes disease (Legg-Calvé-Perthes disease)* - **Perthes disease** is characterized by avascular necrosis of the **femoral head** in children, causing a **painful limp** and restricted hip movement. - The pain typically worsens with activity and improves with rest, and may be referred to the knee or thigh.

Question 382: Which of the following statements is true regarding femoral shaft fractures in infants?

A. Femoral shaft fractures in infants heal rapidly.
B. Traction is usually sufficient for treatment.
C. Child abuse is a common cause of femoral shaft fractures in infants. (Correct Answer)
D. Non-accidental trauma should be considered in the differential diagnosis of femoral shaft fractures in infants.

Explanation: ***Child abuse is a common cause of femoral shaft fractures in infants.*** - **Non-accidental trauma** is a significant cause of femoral shaft fractures in infants, necessitating a high index of suspicion. - The forces required to fracture a healthy infant's femur are substantial, making **accidental trauma** less common than in older children. *Femoral shaft fractures in infants heal rapidly.* - While pediatric fractures generally heal faster than adult fractures, the statement is too broad and doesn't capture the critical context of infant femur fractures. - The primary concern in infant femoral fractures is the etiology (i.e., ruling out child abuse), not solely the healing time. *Traction is usually sufficient for treatment.* - **Pavlik harness** or **spica casting** are common treatment modalities for femoral shaft fractures in infants. - While traction can be part of the initial management, definitive treatment typically involves casting to maintain reduction and allow healing. *Non-accidental trauma should be considered in the differential diagnosis of femoral shaft fractures in infants.* - While true, this statement is less precise than stating that child abuse is a "common cause." - **Child abuse** encompasses non-accidental trauma and highlights the likelihood that such fractures are inflicted.

Question 383: Which of the following statements about Sprengel's deformity is false?

A. Associated with Diastematomyelia
B. Associated with Dextrocardia (Correct Answer)
C. High incidence with Klippel Feil syndrome
D. Associated with Congenital scoliosis

Explanation: ***Associated with Dextrocardia*** - Sprengel's deformity, characterized by an **elevated and undescended scapula**, is not typically associated with **dextrocardia**. Dextrocardia is a congenital heart condition where the heart is pointed towards the right side of the chest. - The congenital abnormalities commonly linked with Sprengel's deformity are primarily musculoskeletal or neurological, not cardiac. *Associated with Diastematomyelia* - Sprengel's deformity can be associated with **diastematomyelia**, a congenital anomaly of the spinal cord where the cord is split longitudinally. - This association highlights the potential for multiple congenital malformations in patients with Sprengel's deformity. *High incidence with Klippel Feil syndrome* - Sprengel's deformity has a **high incidence** of co-occurrence with **Klippel-Feil syndrome**, a condition characterized by congenital fusion of cervical vertebrae. - Both conditions involve developmental abnormalities of the cervical spine and scapula, indicating a common developmental pathway disruption. *Associated with Congenital scoliosis* - **Congenital scoliosis**, a sideways curvature of the spine present at birth, is a known association with Sprengel's deformity. - This connection further emphasizes that Sprengel's deformity often presents as part of a broader spectrum of musculoskeletal and vertebral anomalies.

Question 384: All are true about Klippel-Feil syndrome EXCEPT:

A. Bilateral neck webbing
B. Low hair line
C. Bilateral shortening of sternocleidomastoid (Correct Answer)
D. Restriction of neck movements

Explanation: ***Bilateral shortening of sternocleidomastoid*** - While Klippel-Feil syndrome affects neck mobility, **shortening of the sternocleidomastoid** muscles is not a diagnostic feature and would typically be associated with congenital torticollis rather than Klippel-Feil syndrome directly. - The primary characteristic of Klippel-Feil is the **fusion of cervical vertebrae**, leading to a classic triad of symptoms. *Bilateral neck webbing* - **Neck webbing**, also known as pterygium colli, can be a feature of Klippel-Feil syndrome, contributing to the appearance of a short neck. - This is often a result of abnormal skin folds and can be associated with other genetic syndromes as well. *Low hair line* - A **low posterior hairline** is one of the classic triad of symptoms associated with Klippel-Feil syndrome, indicating a short neck. - This clinical sign helps in the physical examination diagnosis of the condition. *Restriction of neck movements* - Due to the **fusion of cervical vertebrae**, patients with Klippel-Feil syndrome commonly experience significant **restriction of neck movements**. - This reduced range of motion is a cardinal symptom and part of the classic triad.

Question 385: Which one of the following is the most ideal treatment for a displaced fracture of the lateral condyle of the humerus in a 7-year-old child?

A. Open reduction and internal fixation (Correct Answer)
B. Open reduction with plaster immobilization
C. Closed reduction with plaster immobilization
D. All of the above

Explanation: ***Open reduction and internal fixation*** - **Displaced lateral condyle fractures** in children require **anatomical reduction** and stable fixation to prevent complications like **non-union** and **cubitus valgus deformity**. - **Internal fixation** provides the necessary stability for healing and allows for earlier mobilization, which is crucial for elbow joint function. *Open reduction with plaster immobilization* - While it achieves open reduction, relying solely on **plaster immobilization** after reducing a displaced fracture of the lateral humeral condyle in a child often leads to **loss of reduction**. - This method does not provide adequate stability for this type of fracture, increasing the risk of **displacement** and **malunion**. *Closed reduction with plaster immobilization* - **Closed reduction** is typically attempted only for **minimally displaced** or **undisplaced fractures** of the lateral condyle. - Given that the fracture is described as **displaced**, closed reduction is unlikely to achieve and maintain an adequate anatomical alignment.

Question 386: Cubitus varus is most commonly seen in:

A. Rickets
B. Malunited supracondylar fracture
C. Post-inflammatory epiphyseal damage
D. Fracture of the lateral condyle of the humerus (Correct Answer)

Explanation: ***Fracture of the lateral condyle of the humerus*** - A fracture of the **lateral condyle of the humerus** that goes untreated or is improperly treated is a common cause of **cubitus varus** due to growth disturbance of the lateral physis. - This type of fracture often leads to **growth arrest** or **asymmetrical growth** of the distal humerus, resulting in an angular deformity. *Rickets* - **Rickets** is a metabolic bone disease characterized by defective bone mineralization, primarily affecting rapidly growing bones. - While rickets can cause various bone deformities, including bowing of the legs (genu varum), it does not directly lead to **cubitus varus** in the elbow through a specific mechanism. *Malunited supracondylar fracture* - A **malunited supracondylar fracture** of the humerus is the most common cause of **cubitus varus** deformity. - This occurs due to rotational or angular malalignment causing the distal fragment to unite in an altered position. *Post-inflammatory epiphyseal damage* - **Post-inflammatory epiphyseal damage** can lead to altered growth and angular deformities, but it is a less common and less specific cause of **cubitus varus** compared to a malunited supracondylar fracture or lateral condyle fracture. - This type of damage can result from conditions like **septic arthritis**, but its association with cubitus varus is secondary to growth plate disruption.

Question 387: Pediatric patient with an upper humerus lytic lesion and cortical thinning, which among the following is not a treatment modality?

A. Curettage and bone grafting
B. Steroids
C. Sclerosant (Correct Answer)
D. Radiotherapy

Explanation: ***Sclerosant*** - While sclerosants can be used in some vascular lesions or cysts, they are **not a standard or primary treatment modality for an upper humerus lytic lesion** with cortical thinning, which often represents a bone cyst or benign tumor. - Their mechanism of action involves **inducing fibrosis and closing off vascular structures**, which isn't the main goal for common lytic bone lesions in children. *Curettage and bone grafting* - This is a very common and effective treatment for **benign lytic bone lesions** like **unicameral bone cysts (UBCs)** or aneurysmal bone cysts (ABCs). - **Curettage** removes the diseased tissue, and **bone grafting** (autograft or allograft) fills the defect, promoting healing and stability. *Steroids* - **Intralesional steroid injection** is a recognized treatment for **unicameral bone cysts (UBCs)**, especially in actively growing lesions in children. - Steroids help **reduce inflammation and promote resolution** of the cyst lining, often leading to bone healing. *Radiotherapy* - While radiotherapy is used for malignant bone tumors, it is **generally avoided for benign lytic lesions in children** due to concerns about long-term risks like growth disturbance and secondary malignancy. - It might be considered in **recalcitrant or aggressive benign lesions** where other treatments have failed, but it is not a first-line treatment.

Question 388: A 3-year-old patient reports painless progressive bilateral facial swellings. The tentative diagnosis is

A. Cherubism (Correct Answer)
B. Monostotic fibrous dysplasia
C. Polyostotic fibrous dysplasia
D. Central giant cell granuloma

Explanation: ***Cherubism*** - This genetic condition characteristically presents in **early childhood** (age 2-5 years) with **painless, bilateral swelling of the jaws**. - The distinctive clinical feature is the **"cherubic" facial appearance** due to bilateral expansion of the mandible and maxilla. *Monostotic fibrous dysplasia* - This condition is typically **unilateral** and affects a **single bone**, presenting as a localized swelling rather than bilateral facial involvement. - While it can manifest in childhood, its presentation of a solitary bone lesion doesn't match the described bilateral facial swellings. *Polyostotic fibrous dysplasia* - This form of fibrous dysplasia involves **multiple bones** and may present with facial asymmetry or swelling, often accompanied by **pathological fractures** and **skin pigmentation (café-au-lait spots)**. - While it can affect facial bones, the classic **bilateral, symmetrical, progressive facial swelling** described is more indicative of Cherubism. *Central giant cell granuloma* - This is a **benign intraosseous lesion** that can occur in the jaws but is typically **unilateral** and presents as a localized swelling, often causing **pain** or paresthesia. - It does not usually present with the **bilateral, progressive facial swelling** characteristic of Cherubism.

Question 389: A 10-year-old boy presenting with cubitus varus deformity and a history of trauma 3 months prior, on clinical examination, has preserved the normal relationship of the three bony points of the elbow. What is the most probable diagnosis?

A. Old unreduced elbow dislocation
B. Malunited intercondylar fracture of the humerus
C. Malunited supracondylar fracture of the humerus (Correct Answer)
D. Non-union of lateral condylar fracture of the humerus

Explanation: ***Malunited supracondylar fracture of the humerus*** - A malunited **supracondylar fracture** is the most common cause of **cubitus varus** deformity, also known as gunstock deformity, in children, which results from the medial displacement and internal rotation of the distal fragment. - The **normal relationship of the three bony points** (medial epicondyle, lateral epicondyle, and olecranon) is preserved because the fracture is usually extra-articular and the trochlea and capitellum maintain their normal relationship with the ulna and radius. *Old unreduced elbow dislocation* - An **elbow dislocation** would disrupt the normal anatomical relationship between the radius, ulna, and humerus, leading to an **abnormal relationship of the three bony points** of the elbow. - While it can cause deformity, it typically presents with obvious joint incongruity and significant functional limitations that would be evident on examination. *Malunited intercondylar fracture of the humerus* - An **intercondylar fracture** involves the articular surface of the humerus, suggesting an intra-articular injury. - Such a fracture, even if malunited, would likely disrupt the **normal alignment of the trochlea and capitellum** with the olecranon and radial head, thus altering the relationship of the three bony points. *Non-union of lateral condylar fracture of the humerus* - A **non-union of a lateral condylar fracture** can lead to progressive valgus deformity (cubitus valgus) or instability, not typically cubitus varus. - While it affects the elbow joint, the primary issue is joint instability and changes in the carrying angle, not the varus deformity described with preserved bony point relationships.

Question 390: Clavicle is absent in which of the following conditions?

A. Osteogenesis imperfecta
B. Cleidocranial dysostosis (Correct Answer)
C. Fibrous dysplasia
D. Osteopetrosis

Explanation: ***Cleidocranial dysostosis*** [1] - Characterized by the **absence of clavicles**, leading to wide-set shoulders, which is a hallmark feature of this condition. - It is a genetic disorder due to mutations in the **RUNX2** gene [1], impacting bone development. *Osteogenesis imperfecta* - Known as "brittle bone disease," primarily affecting **collagen production**, leading to fragile bones. - Does not typically involve **clavicular absence**; clavicles are usually present, though they may be brittle. *Osteopetrosis* - A condition marked by **abnormal bone density** due to osteoclast dysfunction, leading to dense yet fragile bones. - The clavicles remain intact, although may show **thickening** rather than absence. *Fibrous dysplasia* - Characterized by **replacement of normal bone with fibrous tissue**, leading to bone deformities or fractures. - The clavicle is usually preserved, although it can be affected by **expansile lesions** in some cases. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, p. 1186.

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

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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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