Slipped Capital Femoral Epiphysis — MCQs
AVN of femoral head is most common in-
Von-Rosen's sign is positive in which of the following conditions?
All of the following are examples of traction epiphysis except which of the following?
A 70-year-old physiologically fit male presents with severe hip pain after a fall. X-ray reveals a displaced femoral neck fracture. What is the most appropriate management option?
A 33-year-old male presents with complaints of pain in the left hip. On examination, there is flexion and external rotation of the left lower limb, with a 7 cm shortening of the left lower limb. A gluteal mass is palpable, which moves with the movement of the femoral shaft. What is the most probable diagnosis?
Following are the common sites of Avascular necrosis, EXCEPT:
A 10-year-old obese boy was referred to the emergency department with a history of hip pain. He was observed to be limping and complained of severe pain. Which of the following investigations is least appropriate for this condition?
All the following are causes of a painful limp, except which of the following?
The image shows a pediatric fracture involving the growth plate. Which classification system and stage best describes this fracture?
Open reduction (OR) is not required in which fracture?
Slipped Capital Femoral Epiphysis Indian Medical PG Practice Questions and MCQs
Question 1: AVN of femoral head is most common in-
- A. Intracapsular fracture neck of femur (Correct Answer)
- B. Extracapsular fracture neck of femur
- C. Fracture shaft humerus
- D. Subtrochanteric fracture
Explanation: ***Intracapsular fracture neck of femur*** - **Intracapsular fractures** disrupt the blood supply to the femoral head, particularly the **retinacular arteries**, leading to **avascular necrosis (AVN)**. - The femoral head receives most of its blood supply from within the capsule, making it highly susceptible to **ischemia** when these vessels are damaged. *Extracapsular fracture neck of femur* - These fractures occur **outside the joint capsule**, preserving the critical retinacular arterial blood supply to the femoral head. - While they can lead to other complications, **avascular necrosis** is rare because the blood flow to the femoral head is largely uninterrupted. *Fracture shaft humerus* - This type of fracture involves the **upper arm bone** and has no direct anatomical or vascular connection to the femoral head. - It does not interfere with the blood supply to the femoral head, and thus, **AVN of the femoral head** is not a complication. *Subtrochanteric fracture* - **Subtrochanteric fractures** occur in the proximal femur, but **below the trochanters** and outside the joint capsule. - Like extracapsular fractures, they typically do not compromise the **retinacular arteries** supplying the femoral head, making AVN an unlikely complication.
Question 2: 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 3: All of the following are examples of traction epiphysis except which of the following?
- A. Tubercles of humerus.
- B. Posterior tubercle of talus. (Correct Answer)
- C. Trochanters of femur.
- D. Tibial tuberosity.
Explanation: ***Posterior tubercle of talus*** - The posterior tubercle of the **talus** is not typically considered a traction epiphysis because it's an integral part of the talar body, involved in joint articulation rather than being a site of significant muscle or ligament attachment pulling on a separate ossification center. - While the **flexor hallucis longus** tendon grooves its surface, its primary function and development are not driven by the tensile forces characteristic of traction epiphyses. *Tubercles of humerus* - The **greater and lesser tubercles of the humerus** are classic examples of **traction epiphyses**. - They serve as insertion sites for the **rotator cuff muscles** (supraspinatus, infraspinatus, teres minor, and subscapularis), where strong repetitive pulling forces stimulate their development. *Trochanters of femur* - The **greater and lesser trochanters of the femur** are well-known examples of **traction epiphyses**. - They provide points of attachment for powerful hip and thigh muscles, such as the **gluteal muscles** (greater trochanter) and **iliopsoas** (lesser trochanter), which exert significant traction forces during growth. *Tibial tuberosity* - The **tibial tuberosity** is a prominent example of a **traction epiphysis**. - It serves as the insertion point for the **patellar ligament**, transmitting the force of the **quadriceps femoris** muscle, making it subject to repetitive traction during growth and development.
Question 4: A 70-year-old physiologically fit male presents with severe hip pain after a fall. X-ray reveals a displaced femoral neck fracture. What is the most appropriate management option?
- A. Hemiarthroplasty (Correct Answer)
- B. Total hip replacement
- C. Conservative management with physical therapy
- D. Corticosteroid injection
Explanation: ***Hemiarthroplasty*** - For an **elderly patient** (70-year-old) with a **femoral neck fracture** and good physiological status, hemiarthroplasty is often the preferred choice. - It involves replacing the **femoral head and neck** with a prosthesis, allowing for early mobilization and reducing the risk of avascular necrosis. *Conservative management with physical therapy* - This approach is generally **not suitable for displaced femoral neck fractures** in the elderly due to high risks of **non-union** and **avascular necrosis**. - Prolonged bed rest associated with conservative management can lead to complications such as **pneumonia**, **deep vein thrombosis**, and **pressure ulcers** in elderly patients. *Total hip replacement* - While an option for femoral neck fractures, **total hip replacement** is typically reserved for **younger patients**, those with **pre-existing arthritis**, or those with **better bone quality**. - It involves replacing both the **femoral head and the acetabular cup**, a more complex procedure than hemiarthroplasty. *Corticosteroid injection* - **Corticosteroid injections** are used for **inflammatory joint conditions** and pain relief, **not for fracture management**. - They have **no role in stabilizing a fractured femoral neck** and would not address the mechanical instability or bone healing required.
Question 5: A 33-year-old male presents with complaints of pain in the left hip. On examination, there is flexion and external rotation of the left lower limb, with a 7 cm shortening of the left lower limb. A gluteal mass is palpable, which moves with the movement of the femoral shaft. What is the most probable diagnosis?
- A. Anterior dislocation of hip
- B. Central fracture dislocation
- C. Posterior dislocation
- D. Pipkin's type 4 fracture (Correct Answer)
Explanation: ***Pipkin's type 4 fracture*** - This fracture involves a **femoral head fracture** combined with a **hip dislocation**. The described findings of flexion, external rotation, shortening, and a palpable gluteal mass, which moves with the femoral shaft, are classic signs of a **femoral head fracture-dislocation**, often categorized as a Pipkin type. - The gluteal mass moving with the femoral shaft indicates that the **femoral head** is displaced and can be palpated, which is consistent with a **femoral head fracture** that has dislocated. *Anterior dislocation of hip* - An **anterior hip dislocation** typically presents with the limb in **flexion, abduction, and external rotation**, but it usually involves lengthening rather than shortening due to the head being displaced anteriorly. - There would typically not be a palpable gluteal mass, and the degree of shortening described (7 cm) is more consistent with a complex injury like a fracture-dislocation. *Central fracture dislocation* - A **central fracture dislocation** involves the femoral head pushing through the **acetabulum into the pelvis**. This usually presents with a **shortened and internally rotated limb**, and pain, but not typically a palpable gluteal mass or the specific flexion and external rotation described. - While there is shortening, the mechanism of injury and the palpable mass are not consistent with the femoral head being displaced into the pelvic cavity. *Posterior dislocation* - A **posterior hip dislocation** presents with the limb in **flexion, adduction, and internal rotation**, often with significant shortening. - Although it causes shortening, the patient presents with **external rotation**, not internal rotation, differentiating it from a posterior dislocation. The palpable gluteal mass is also not a typical finding in a pure posterior dislocation without an associated fracture.
Question 6: Following are the common sites of Avascular necrosis, EXCEPT:
- A. Head of the femur
- B. The body of talus
- C. Patella (Correct Answer)
- D. Proximal half of scaphoid
Explanation: ***Patella*** - The patella is rarely affected by **avascular necrosis (AVN)** due to its robust and redundant blood supply, making it an exception to common AVN sites. - While patellar fractures can compromise local blood flow, spontaneous or atraumatic AVN of the patella is exceedingly uncommon compared to other skeletal sites. *Head of the femur* - The **femoral head** is the most common site for **avascular necrosis** due to its precarious blood supply, especially after trauma (e.g., hip dislocation, femoral neck fracture) or in systemic conditions. - Its blood supply relies heavily on the **medial circumflex femoral artery**, which can be easily disrupted. *The body of talus* - The **talus** is highly susceptible to **avascular necrosis**, particularly after fractures or dislocations, as its blood supply enters through a limited number of soft tissue attachments. - The **body of the talus** receives a significant portion of its blood supply from vessels that can be easily compromised by injury. *Proximal half of scaphoid* - The **proximal pole of the scaphoid** is notoriously prone to **avascular necrosis** following scaphoid fractures because its blood supply enters primarily from the distal pole. - A disruption of blood flow (e.g., via the **dorsal carpal branch** of the radial artery) due to a fracture can lead to **non-union** and AVN of the proximal fragment.
Question 7: A 10-year-old obese boy was referred to the emergency department with a history of hip pain. He was observed to be limping and complained of severe pain. Which of the following investigations is least appropriate for this condition?
- A. MRI of the hip
- B. CT scan of hip
- C. USG of hip (Correct Answer)
- D. X-ray of the hip
Explanation: ***USG of hip*** - An **ultrasound (USG)** of the hip is generally not the primary imaging modality for diagnosing conditions like **slipped capital femoral epiphysis (SCFE)**, which is suggested by the patient's presentation. - While USG can detect effusions or synovitis, it provides poor visualization of bony structures and the physeal plate, which are crucial for diagnosing SCFE. *X-ray of the hip* - **X-rays** (AP and frog-leg lateral views) are the **initial and most important imaging study** for diagnosing SCFE. - They effectively visualize the **epiphyseal displacement** relative to the metaphysis and are sufficient for diagnosis in most cases. *MRI of the hip* - **MRI** is highly sensitive for detecting early or subtle SCFE, especially when X-rays are inconclusive. - It can evaluate the **physeal edema**, chondral changes, and avascular necrosis, providing more detailed information than X-rays. *CT scan of hip* - A **CT scan** provides excellent bony detail and can precisely assess the **degree of physeal slip** and femoral head deformity. - It may be used for surgical planning, especially in complex cases or when the slip is difficult to assess with X-rays.
Question 8: 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 9: The image shows a pediatric fracture involving the growth plate. Which classification system and stage best describes this fracture?
- A. Gartland 3
- B. Salter Harris 3 (Correct Answer)
- C. Gartland 2
- D. Salter Harris 2
Explanation: ***Salter Harris 3*** - The image shows a **fracture extending from the epiphyseal surface down through the growth plate (physis) and exiting through the epiphysis** into the joint. This configuration is characteristic of a Salter-Harris type III fracture. - Salter-Harris Type III fractures disrupt the **articular cartilage** and can have a poorer prognosis due to potential joint incongruity and growth disturbance if not properly reduced. *Gartland 3* - The **Gartland classification** is specifically used for **supracondylar fractures of the humerus** in children, which is a different type of fracture involving the distal humerus metaphysis, not typically the growth plate itself in this manner. - Gartland type 3 refers to a **completely displaced supracondylar fracture** with no cortical contact, involving the metaphysis proximal to the growth plate. *Gartland 2* - **Gartland type 2** describes a **displaced supracondylar fracture** with an intact posterior cortex, also referring to a fracture of the distal humerus metaphysis, not a trans-growth plate fracture. - This classification is not applicable to the image which clearly depicts a fracture involving the epiphysis and physis. *Salter Harris 2* - A **Salter-Harris type II fracture** involves the **physis and extends into the metaphysis**, creating a triangular fragment known as the "Thurston Holland sign." - In the provided image, the fracture line clearly extends into the **epiphysis**, not just the metaphysis, distinguishing it from a Salter-Harris type II.
Question 10: Open reduction (OR) is not required in which fracture?
- A. Fracture of the patella
- B. Fracture of the outer one-third of the radius (Correct Answer)
- C. Displaced fracture of the olecranon
- D. Fracture of the condyle of the humerus
Explanation: ***Fracture of the outer one-third of the radius*** - Fractures of the **outer one-third of the radius** (distal radius fractures) often can be managed with **closed reduction and casting** if stable and adequately reduced. - While some unstable distal radius fractures require OR, many stable patterns, especially those with minimal displacement or good alignment after closed manipulation, do not. *Fracture of the patella* - Many patellar fractures lead to significant **extensor mechanism disruption**, necessitating OR with **tension band wiring** or screw fixation to restore quadriceps function. - Displaced patellar fractures, especially transverse ones, require surgical fixation to prevent extensor lag and **nonunion**. *Displaced fracture of the olecranon* - Displaced olecranon fractures disrupt the **triceps mechanism** and compromise elbow stability, almost always requiring **open reduction and internal fixation (ORIF)**, typically with tension band wiring. - Without surgical repair, a displaced olecranon fracture can lead to significant loss of extension strength and **nonunion**. *Fracture of the condyle of the humerus* - Fractures of the humeral condyle, particularly in children, often require OR due to the risk of **avascular necrosis** (especially lateral condyle) and the need for **precise anatomical reduction** to prevent joint incongruity and cubitus varus/valgus deformities. - Intra-articular and displaced condylar fractures almost invariably require surgical intervention to ensure harmonious joint function and prevent long-term complications like **stiffness and deformity**.
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