Pediatric Orthopaedics Practice Questions

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

Associated with Dextrocardia. ***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.

Q: All are true about Klippel-Feil syndrome EXCEPT:

Bilateral shortening of sternocleidomastoid. ***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.

Q: Cubitus varus is most commonly seen in:

Fracture of the lateral condyle of the humerus. ***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.

Q: 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?

Open reduction and internal fixation. ***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.

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

Sclerosant. ***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.

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

Cherubism. ***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.

Q: 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?

Malunited supracondylar fracture of the humerus. ***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.

Q: Clavicle is absent in which of the following conditions?

Cleidocranial dysostosis. ***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.

Q: All are true regarding congenital talipes equinovarus (CTEV) except:

Increased dorsiflexion. ***Increased dorsiflexion*** - Congenital talipes equinovarus (CTEV), or **clubfoot**, is characterized by an **equinus deformity**, meaning the foot is pointing downwards, thus having significantly **reduced dorsiflexion**. - **Increased dorsiflexion** would imply the foot can be brought closer to the shin, which is directly opposite to the characteristic presentation of CTEV. *Hindfoot varus* - **Hindfoot varus** is a characteristic component of CTEV, where the heel is turned inward. - This inward turning of the heel contributes to the overall deformity and is one of the four main components of a clubfoot. *Cavus* - **Cavus** refers to a high arch in the foot, which is another defining feature of CTEV. - This exaggerated arch contributes to the rigidity and complex nature of the deformity. *Forefoot adduction* - **Forefoot adduction** means the front part of the foot is turned inward towards the body's midline, which is a key component of CTEV. - This inward deviation contributes to the 'club' shape of the foot and is often described as metatarsus adductus within the overall deformity.

Question 1

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

Accepted Answer

Child abuse is a common cause of femoral shaft fractures in infants.

Answer

Femoral shaft fractures in infants heal rapidly.

Answer

Traction is usually sufficient for treatment.

Answer

Femoral shaft fractures in non-ambulatory infants are most commonly caused by accidental mechanisms such as falls.

Question 2

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

Accepted Answer

Associated with Dextrocardia

Answer

Associated with Diastematomyelia

Answer

High incidence with Klippel Feil syndrome

Answer

Associated with Congenital scoliosis

Question 3

All are true about Klippel-Feil syndrome EXCEPT:

Accepted Answer

Bilateral shortening of sternocleidomastoid

Answer

Bilateral neck webbing

Answer

Low hair line

Answer

Restriction of neck movements

Question 4

Cubitus varus is most commonly seen in:

Accepted Answer

Fracture of the lateral condyle of the humerus

Answer

Rickets

Answer

Malunited supracondylar fracture

Answer

Post-inflammatory epiphyseal damage

Question 5

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?

Accepted Answer

Open reduction and internal fixation

Answer

Open reduction with plaster immobilization

Answer

Closed reduction with plaster immobilization

Answer

All of the above

Question 6

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

Accepted Answer

Sclerosant

Answer

Curettage and bone grafting

Answer

Steroids

Answer

Radiotherapy

Question 7

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

Accepted Answer

Cherubism

Answer

Monostotic fibrous dysplasia

Answer

Polyostotic fibrous dysplasia

Answer

Central giant cell granuloma

Question 8

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?

Accepted Answer

Malunited supracondylar fracture of the humerus

Answer

Old unreduced elbow dislocation

Answer

Malunited intercondylar fracture of the humerus

Answer

Non-union of lateral condylar fracture of the humerus

Question 9

Clavicle is absent in which of the following conditions?

Accepted Answer

Cleidocranial dysostosis

Answer

Osteogenesis imperfecta

Answer

Fibrous dysplasia

Answer

Osteopetrosis

Question 10

All are true regarding congenital talipes equinovarus (CTEV) except:

Accepted Answer

Increased dorsiflexion

Answer

Hindfoot varus

Answer

Cavus

Answer

Forefoot adduction

Pediatric Orthopaedics — MCQs

Pediatric Orthopaedics — MCQs

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