All are true regarding congenital talipes equinovarus (CTEV) except:
Q392
Von Rosen splint is used for?
Q393
A 15-year-old boy with Marfan syndrome is experiencing back pain, and on examination, he has a curvature of his thoracic spine to the left. Which of the following is the most appropriate next step in management?
Pediatric Orthopaedics Indian Medical PG Practice Questions and MCQs
Question 391: All are true regarding congenital talipes equinovarus (CTEV) except:
A. Hindfoot varus
B. Cavus
C. Increased dorsiflexion (Correct Answer)
D. Forefoot adduction
Explanation: ***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 392: Von Rosen splint is used for?
A. congenital displacement of hip (Correct Answer)
B. ctev
C. fracture of shaft of femur
D. paralytic poliomyelitis
Explanation: ***congenital displacement of hip***
- The **Von Rosen splint** is a specific orthopedic device used for the early management of **congenital displacement of the hip**, also known as **developmental dysplasia of the hip (DDH)**.
- It maintains the hip in a position of **flexion and abduction**, which helps to reduce and stabilize the dislocated or subluxated femoral head within the acetabulum.
*ctev*
- **CTEV (Congenital Talipes Equinovarus)**, or clubfoot, is a deformity of the foot and ankle, not the hip.
- It is typically treated with the **Ponseti method** involving serial casting, followed by a foot abduction brace.
*fracture of shaft of femur*
- A fracture of the **shaft of the femur** in a child or infant usually requires immobilization with a **traction splint** (e.g., Bryant's traction) or a **spica cast**, depending on age and fracture type.
- The Von Rosen splint is not designed to stabilize long bone fractures.
*paralytic poliomyelitis*
- **Paralytic poliomyelitis** causes muscle weakness and paralysis, which can lead to various musculoskeletal deformities as a late sequela, but it is not a congenital hip displacement.
- Management focuses on supportive care, physiotherapy, and potentially surgical correction of established deformities, not a primary splint for acute hip dislocation.
Question 393: A 15-year-old boy with Marfan syndrome is experiencing back pain, and on examination, he has a curvature of his thoracic spine to the left. Which of the following is the most appropriate next step in management?
A. a prophylactic surgical procedure
B. imaging studies (X-rays) to assess curvature
C. mechanical back bracing
D. a vigorous exercise program (Correct Answer)
Explanation: ***A vigorous exercise program***
- For **mild scoliosis** in adolescents, especially those with Marfan syndrome, a **vigorous exercise program** can help strengthen core muscles and maintain spinal stability.
- This approach aims to improve posture, reduce pain, and potentially slow the progression of the curvature without invasive interventions.
*Imaging studies (X-rays) to assess curvature*
- While imaging is essential for diagnosing and monitoring scoliosis, it is usually performed as part of the initial workup and regularly thereafter to track progression. It is not the "most appropriate next step" for management when symptoms like back pain and a visible curvature already exist, suggesting further evaluation and action are needed beyond just imaging.
- The question implies a need for a management step based on the existing findings, not further diagnostic confirmation of the curvature itself, which is already an observed clinical finding.
*Mechanical back bracing*
- **Mechanical back bracing** is typically considered for moderate to severe scoliosis, usually with curves exceeding 20-25 degrees, especially in growing adolescents. The patient's specific curve magnitude is not mentioned, and for mild curves, bracing might be overly aggressive as an initial step.
- Marfan syndrome patients may have increased spinal flexibility and connective tissue laxity, which can make bracing less effective or even uncomfortable compared to standard scoliosis patients.
*A prophylactic surgical procedure*
- **Surgical intervention** for scoliosis is generally reserved for severe curves (typically >40-50 degrees) or curves that show significant progression despite conservative management. Given that the patient is experiencing back pain and has an observed curvature, starting with a prophylactic surgical procedure is overly aggressive without first attempting conservative measures.
- Surgical risks and complications are significant, making it a last resort after other less invasive options have been considered or failed.
