Fractures in Children — MCQs
What is the most common bone fractured in children?
All of the following statements regarding bone remodeling are TRUE EXCEPT
4 year old child presented to the clinic with a history of fall on outstretched hand. Radiographs revealed a broken anterior cortex with an intact posterior cortex of the radius with an exaggerated bowing of the radius. The fracture sustained is known as -
A 6-year-old child is suspected with supracondylar fracture of right hand, complaining of pain and swelling. X-ray of right elbow was not significant. What is the next best step in this case?
Green stick fracture is
Which fracture results in the 'cubitus varus' deformity?
Tenderness in the anatomist's snuffbox may be observed. Select the type of fracture or dislocation with which it is most likely to be associated (SELECT 1 INJURY)
Blount Disease is involvement of
Proximal humerus fracture which has maximum chances of avascular necrosis
Patellar tendon bearing P.O.P. cast is indicated in the following fracture -
Fractures in Children Indian Medical PG Practice Questions and MCQs
Question 1: 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 2: All of the following statements regarding bone remodeling are TRUE EXCEPT
- A. young children have a greater capacity for remodeling than adults
- B. Remodeling is related to the degree of angulation
- C. angulation in the natural plane of the joint motion will remodel more successfully than angulation outside the plane of joint motion
- D. Injuries involving the epiphyseal plate are more likely to remodel successfully (Correct Answer)
Explanation: ***Injuries involving the epiphyseal plate are more likely to remodel successfully*** - This statement is **FALSE**. Injuries involving the **epiphyseal plate** in children can disrupt normal growth and are **less likely to remodel successfully** compared to metaphyseal fractures, often leading to growth disturbances or angular deformities. - Damage to the growth plate interferes with the physiological process of bone elongation and shaping, making complete restoration of bone architecture via remodeling less probable. *young children have a greater capacity for remodeling than adults* - Young children have a **greater capacity for bone remodeling** due to their active growth plates and higher metabolic bone turnover rates. - This enhanced remodeling allows for significant correction of fracture deformities through growth. *Remodeling is related to the degree of angulation* - The success and extent of bone remodeling in fractures are **directly related to the degree of initial angulation**. Less severe angulation generally remodels more completely than severe angulation. - Significant angulation beyond certain limits may not fully remodel, potentially leading to persistent deformity. *angulation in the natural plane of the joint motion will remodel more successfully than angulation outside the plane of joint motion* - Fractures with **angulation in the plane of joint motion** (e.g., knee angulation in the sagittal plane) tend to remodel more effectively and functionally, as the forces through the joint continue to align the bone. - Angulation **outside the plane of joint motion** (e.g., varus/valgus deformity at the knee) imposes abnormal mechanical stresses and is less likely to remodel to a functional alignment.
Question 3: 4 year old child presented to the clinic with a history of fall on outstretched hand. Radiographs revealed a broken anterior cortex with an intact posterior cortex of the radius with an exaggerated bowing of the radius. The fracture sustained is known as -
- A. Torus Fracture
- B. Greenstick fracture (Correct Answer)
- C. Galleazi Fracture
- D. Monteggia Fracture Dislocation
Explanation: ***Greenstick fracture*** - This fracture type involves a **broken anterior cortex** but an **intact posterior cortex**, leading to an exaggerated bowing of the bone, characteristic of a greenstick fracture. - It occurs predominantly in **children** due to their softer, more flexible bones, which tend to bend rather than fully break when subjected to force like a fall on an outstretched hand. *Torus Fracture* - A torus fracture, or **buckle fracture**, involves compression of the bone leading to a bulging or buckling of the cortex, usually on one side, without a complete break in the bone. - While it occurs in children, it presents as a compression injury and not with a broken cortex and intact posterior cortex with bowing. *Galleazi Fracture* - A Galleazi fracture is a fracture of the **distal radius** with **dislocation of the distal radioulnar joint (DRUJ)**. - This fracture pattern involves two bones and two distinct injuries (fracture and dislocation), which is fundamentally different from the described single-bone incomplete fracture. *Monteggia Fracture Dislocation* - A Monteggia fracture involves a fracture of the **proximal ulna** with **dislocation of the radial head** at the elbow. - This injury also involves two bones and two distinct components (fracture and dislocation) and affects a different anatomical location (ulna and elbow) than described.
Question 4: A 6-year-old child is suspected with supracondylar fracture of right hand, complaining of pain and swelling. X-ray of right elbow was not significant. What is the next best step in this case?
- A. Cast
- B. Closed reduction with K wire fixation
- C. Compare with X-ray of left hand (Correct Answer)
- D. Closed reduction and slab
Explanation: ***Compare with X-ray of left hand*** - In pediatric elbow injuries, a seemingly **normal X-ray** in the presence of strong clinical suspicion (pain, swelling, suspected supracondylar fracture) often warrants a comparison view of the contralateral unaffected limb. - This helps identify subtle findings like **epiphyseal separations** or **minimally displaced fractures** that might otherwise be missed due to the developing osseous structures in children. *Cast* - Applying a cast without definitive diagnosis or clear radiographic evidence of a fracture can lead to **unnecessary immobilization** and potential complications if no fracture is present, or inadequate treatment if a specific type of fracture requires reduction. - While immobilization is appropriate for confirmed fractures, it's not the **initial diagnostic step** when X-rays are inconclusive. *Closed reduction with K wire fixation* - This is an **invasive procedure** reserved for **displaced or unstable fractures** after a clear diagnosis has been established. - Performing this without a confirmed and characterized fracture is inappropriate and carries risks of **iatrogenic injury** and complications. *Closed reduction and slab* - Similar to casting, this is a treatment for **confirmed fractures**, typically for acute, stable, or minimally displaced fractures that can be managed non-surgically after a reduction. - It is not a diagnostic step and should not be performed when initial imaging is **inconclusive** and the exact nature of the injury is unknown.
Question 5: Green stick fracture is
- A. Fracture in adults
- B. Complete fracture
- C. Fracture spine
- D. Incomplete fracture (Correct Answer)
Explanation: ***Incomplete fracture*** - A **greenstick fracture** is an **incomplete fracture** where the bone bends and cracks but does not break all the way through. - This type of fracture commonly occurs in children because their bones are more flexible and softer than adult bones. *Fracture in adults* - While adults can experience various types of fractures, a **greenstick fracture** is rare in adults due to their more rigid and brittle bones. - Adult bones tend to sustain **complete fractures** or other complex fracture patterns instead of bending partially. *Complete fracture* - A **complete fracture** denotes a break in the bone that severs it into two or more distinct pieces. - **Greenstick fractures** are by definition incomplete, meaning the bone is still partially intact. *Fracture spine* - A **spinal fracture** specifically refers to a break in one or more vertebrae in the spinal column. - While spinal fractures can be complete or incomplete, the term **greenstick fracture** is not typically used to describe fractures of the spine.
Question 6: Which fracture results in the 'cubitus varus' deformity?
- A. Olecranon fracture
- B. Lateral condylar fracture
- C. Supracondylar fracture of humerus (Correct Answer)
- D. Radial head fracture
Explanation: ***Supracondylar fracture of humerus*** - This fracture, especially in children, can lead to **malunion** and subsequent **cubitus varus deformity**, also known as **gunstock deformity**. - The varus angulation occurs due to the medial displacement and rotation of the distal fragment, causing the forearm to deviate medially when the elbow is extended. *Olecranon fracture* - While it affects the elbow joint, an olecranon fracture typically results in loss of **extensor mechanism function** and potentially **elbow instability**, but not primarily cubitus varus. - The deformity associated with an olecranon fracture is usually a prominence of the olecranon or a loss of elbow extension. *Lateral condylar fracture* - A lateral condylar fracture can lead to **cubitus valgus** due to premature epiphyseal closure of the humeral capitellum and continued growth of the medial condyle. - It does not characteristically cause a cubitus varus deformity. *Radial head fracture* - Radial head fractures primarily affect forearm rotation and elbow stability, often leading to **pain with pronation and supination**. - They are not a direct cause of cubitus varus or valgus deformity of the elbow.
Question 7: Tenderness in the anatomist's snuffbox may be observed. Select the type of fracture or dislocation with which it is most likely to be associated (SELECT 1 INJURY)
- A. Navicular (scaphoid) fracture (Correct Answer)
- B. Monteggia's deformity
- C. Greenstick fracture
- D. Spiral fracture
Explanation: ***Navicular (scaphoid) fracture*** - Tenderness in the **anatomical snuffbox** is a classic and highly indicative sign of a **scaphoid fracture**. - The scaphoid bone forms the floor of the anatomical snuffbox, and injury to this bone often results from a fall on an **outstretched hand**. *Monteggia's deformity* - This injury involves a fracture of the **proximal ulna** with an associated **dislocation of the radial head**. - It presents with pain and deformity in the forearm, not typically isolated tenderness in the anatomical snuffbox. *Greenstick fracture* - A greenstick fracture is an **incomplete fracture** where one side of the bone is broken and the other is bent, commonly seen in children. - It does not specifically manifest with tenderness in the anatomical snuffbox, as it can occur in various bones. *Spiral fracture* - A spiral fracture occurs when a bone is broken by a **twisting force**, creating a helical pattern. - While it can occur in various long bones, it is not specifically associated with tenderness in the anatomical snuffbox.
Question 8: Blount Disease is involvement of
- A. Distal femur
- B. Distal tibia
- C. Proximal tibia (Correct Answer)
- D. Proximal femur
Explanation: ***Proximal tibia*** - Blount disease, also known as **tibia vara**, is a growth disorder affecting the **tibia** (shin bone) in children. - It specifically involves the **medial physis of the proximal tibia**, leading to abnormal growth in this area and resulting in a **bow-legged** deformity. *Distal femur* - Malformations or growth disturbances of the **distal femur** are typically associated with conditions like genu valgum (**knock-knees**) or other angular deformities originating higher up in the leg. - Blount disease's primary pathology does not originate from the distal femur. *Distal tibia* - Conditions affecting the **distal tibia** can lead to ankle deformities or foot problems. - Blount disease is distinctly a problem of the knee region, not the ankle. *Proximal femur* - Problems in the **proximal femur** are commonly associated with conditions like Legg-Calvé-Perthes disease or developmental dysplasia of the hip. - While these can also cause gait abnormalities, Blount disease's characteristic bowing deformity originates from the tibia.
Question 9: Proximal humerus fracture which has maximum chances of avascular necrosis
- A. One part
- B. Two part
- C. Three part
- D. Four part (Correct Answer)
Explanation: ***Four part fracture*** - A **four-part proximal humerus fracture** typically involves displacement of the humeral head, greater tuberosity, lesser tuberosity, and humeral shaft. - This extensive displacement significantly disrupts the **blood supply** to the humeral head, specifically the **arcuate artery** and its branches, leading to a high risk of **avascular necrosis**. *One part fracture* - A **one-part fracture** indicates that the fracture fragments are minimally displaced (<1 cm or <45° angulation). - The **blood supply** to the humeral head remains largely intact, resulting in a very low risk of avascular necrosis. *Two part fracture* - A **two-part fracture** involves displacement of one major fragment (e.g., surgical neck or tuberosity) from the humeral head. - While there is some disruption, the overall risk of **avascular necrosis** is lower compared to more complex fractures. *Three part fracture* - A **three-part fracture** involves separate displacement of the humeral head and two tuberosities. - This fracture pattern causes more significant disruption to the **vascularity** of the humeral head than two-part fractures but generally less than four-part fractures.
Question 10: Patellar tendon bearing P.O.P. cast is indicated in the following fracture -
- A. Patella
- B. Medial malleolus
- C. Femur
- D. Tibia (Correct Answer)
Explanation: ***Tibia*** - A **patellar tendon bearing (PTB) cast** is specifically designed for certain **tibial shaft fractures** to allow early weight-bearing. - The cast bears weight through the **patellar tendon**, flared condyles, and calf soft tissues, bypassing the fractured tibia. *Patella* - Fractures of the **patella** are typically treated with immobilization in an **extension cast** or surgical fixation, depending on the fracture pattern. - A PTB cast is not suitable for patella fractures as it would place direct pressure on the injured patella and prevent weight-bearing through the tendon. *Medial malleolus* - Fractures of the **medial malleolus**, part of the ankle, often require **short leg casts** or surgical fixation. - These fractures are managed by immobilizing the ankle, and a PTB cast is not appropriate for this type of injury. *Femur* - **Femur fractures** are major orthopedic injuries that are most often treated with **surgical intramedullary nailing**. - Due to the large forces involved, they are not typically managed with casting, certainly not a PTB cast, which is designed for lower leg rather than thigh injuries.
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