Pediatric Orthopaedics Practice Questions

Q: The following gait abnormality is seen in:

Polio. The image shows **foot drop**, characterized by inability to dorsiflex the foot, requiring the patient to lift the leg higher during walking to clear the ground. ***Polio*** - **Polio** commonly causes **flaccid paralysis** affecting anterior horn cells, frequently resulting in foot drop due to weakness of **dorsiflexor muscles**. - This is a well-recognized complication, especially in countries like India where polio cases occurred historically, making it a clinically relevant cause. *Leprosy* - While **leprosy** can affect peripheral nerves including the **common peroneal nerve**, foot drop is a less common presentation compared to other nerve involvement patterns. - More typically seen in **advanced, untreated cases** and is relatively rare compared to other causes of foot drop. *Avascular necrosis Hip* - **Avascular necrosis (AVN) of the hip** causes **antalgic gait** due to hip pain but does not cause foot drop. - It affects the **hip joint** rather than the neural pathways controlling dorsiflexion of the foot. *Spastic hemiplegia* - **Spastic hemiplegia** results in spastic gait patterns with **circumduction**, not the flaccid foot drop pattern shown. - Characterized by **spasticity and hyperreflexia** rather than the flaccid weakness seen in foot drop.

Q: The following X-ray pelvis of a child shows:

Congenital hip dislocation. ***Congenital hip dislocation*** - The X-ray shows the **femoral head** on the right side is located **outside the acetabulum**, indicating congenital hip dislocation. - This condition is also known as **developmental dysplasia of the hip (DDH)** and is characterized by abnormal development of the hip joint. *TB Hip joint* - **Tuberculosis of the hip joint** typically presents with pain, limping, and joint effusion, and can show **joint space narrowing**, **osteolysis**, and **bone destruction** on imaging. - The image clearly shows a dislocated femoral head, not primarily destructive arthritic changes typical of TB. *Battered baby syndrome* - **Battered baby syndrome**, or child abuse, would show signs of **multiple fractures** at various stages of healing, or **metaphyseal corner fractures**. - The image does not display any signs of fractures or other forms of trauma, but rather a developmental abnormality. *Slipped capital femoral epiphysis* - **Slipped capital femoral epiphysis (SCFE)** involves the slippage of the **femoral head** relative to the **femoral neck** through the growth plate. - This condition typically occurs in **adolescents** and shows widening or irregularity of the growth plate and posterior/inferior displacement of the epiphysis, not a complete dislocation of the femoral head from the acetabulum as seen here.

Q: The priority in management of supracondylar fracture of humerus in a child is:

Assessment of neurovascular status. ***Assessment of neurovascular status*** - The **brachial artery** and **median, radial, and ulnar nerves** are at significant risk of injury in a supracondylar humerus fracture, necessitating immediate evaluation. - Undetected neurovascular compromise can lead to severe complications like **Volkmann's ischemic contracture**. *Immobilization* - While important for pain control and preventing further injury, **immobilization** follows the initial neurovascular assessment to ensure no acute circulatory or neurological threats exist. - Improper immobilization without prior neurovascular assessment could worsen an already compromised limb. *Antibiotics* - **Antibiotics** are primarily indicated for **open fractures** to prevent infection, but this question does not specify an open injury. - Their use is not a priority over emergent assessment of limb viability in a closed fracture. *Debridement of wound* - **Debridement** is a surgical procedure reserved for **open fractures** to remove contaminated or devitalized tissue. - It is not relevant in the initial management of a suspected closed supracondylar fracture, where neurovascular assessment is paramount.

Q: The prognosis in reduced or unreduced fractures involving epiphyseal plate is very poor if the fracture line:

Crushes the epiphyseal plate. ***Crushes the epiphyseal plate*** - A crushed epiphyseal plate (Salter-Harris Type V) leads to **irreversible damage to the growth plate**, resulting in almost certain growth arrest and significant limb length discrepancy. - This type of injury directly destroys the proliferative and hypertrophic zones responsible for longitudinal bone growth, making its prognosis exceptionally poor. *Runs along the epiphyseal plate* - This typically describes a Salter-Harris Type I or II fracture, where the fracture line separates the epiphysis from the metaphysis **without damaging the growth plate itself**. - While requiring careful reduction, the prognosis is generally good as long as there is no significant displacement or vascular compromise, and the **growth plate remains viable**. *Crosses the epiphyseal plate* - This description is vague but could refer to a Salter-Harris Type III or IV fracture, which involves **articular surface involvement** and crossing the physis. - While these types have a poorer prognosis than Type I and II due to potential for incongruity and **growth arrest**, they are not as universally dire as a crush injury, provided proper anatomical reduction is achieved. *Extends into epiphysis* - This describes a Salter-Harris Type III fracture, where the fracture line extends from the growth plate into the epiphysis and often involves the **articular cartilage**. - The prognosis is generally good if **anatomical reduction** and fixation are achieved, but there is a risk of growth disturbance and **arthrosis** if displacement is not corrected.

Q: Kohler's disease is avascular necrosis of :

Navicular. ***Navicular*** - **Kohler's disease** specifically refers to **osteochondrosis** or **avascular necrosis** of the **navicular bone** in the foot. - It primarily affects **children** and is characterized by pain and tenderness over the medial aspect of the foot. *First metatarsal head* - Avascular necrosis of the first metatarsal head is known as **Freiberg's infraction**. - This condition typically affects **adolescent girls** and causes pain in the forefoot, especially during weight-bearing. *Capitellum of humerus* - Avascular necrosis of the capitellum of the humerus is called **Panner's disease**. - It is an **osteochondrosis** that primarily affects **young athletes** involved in repetitive overhead activities, leading to elbow pain and stiffness. *Lunate* - Avascular necrosis of the lunate bone in the wrist is known as **Kienbock's disease**. - This condition typically affects **adults** and is associated with wrist pain, stiffness, and weakness.

Q: Identify the condition shown in the given X-ray: ![img-63.jpeg](img-63.jpeg)

Osgood-Schlatter disease. ***Osgood-Schlatter disease*** - The X-ray shows fragmentation and irregularity of the **tibial tuberosity**, which is characteristic of Osgood-Schlatter disease. - This condition typically affects adolescents undergoing rapid growth spurts and presents with **pain and swelling** at the tibial tuberosity. *Tibial tuberosity fracture* - This usually involves a **clear fracture line** and displacement of the tibial tuberosity. - It is typically caused by a **sudden, forceful contraction** of the quadriceps muscle. *Lateral epicondyle of femur* - The X-ray shows changes at the **tibial tuberosity**, not the lateral epicondyle of the femur. - The lateral epicondyle is located at the **distal end of the femur**, near the knee joint. *Gerdy's tubercle fracture* - Gerdy's tubercle is the insertion point of the **iliotibial band** on the lateral aspect of the proximal tibia. - Fractures here are **rare** and would present differently on X-ray compared to the observed tibial tuberosity changes.

Q: Fracture at which site affects the longitudinal growth of a bone?

Epiphyseal plate. ***Epiphyseal plate*** - The **epiphyseal plate**, also known as the **growth plate**, is a cartilaginous disc responsible for the **longitudinal growth** of long bones. - A fracture in this region can damage the **chondrocytes** and disrupt the normal ossification process, potentially leading to **growth arrest** or limb length discrepancies. *Diaphysis* - The **diaphysis** is the **shaft** or central part of a long bone. - While a fracture here can cause pain and instability, it typically does not directly affect the **longitudinal growth** potential of the bone. *Epiphysis* - The **epiphysis** is the end part of a long bone, initially separated from the main bone by cartilage but later fused with it. - Although it contains the epiphyseal plate in growing individuals, a fracture to the epiphysis itself (excluding the growth plate) primarily affects the **joint surface** and stability, rather than longitudinal growth directly. *Metaphysis* - The **metaphysis** is the transitional zone between the diaphysis and the epiphysis, adjacent to the growth plate. - While fractures in this area can be close to the growth plate, a metaphyseal fracture generally does not directly damage the **growth plate cartilage** to the same extent as a fracture through the plate itself, making its impact on longitudinal growth less direct or severe.

Q: A 10-year-old boy presents with the physical findings shown in the image, characterized by inward angulation of the elbows. What is the most likely diagnosis?

Cubitus varus deformity. ***Cubitus varus deformity*** - The image clearly illustrates an **inward angulation of the elbow** (gunstock deformity), which is characteristic of **cubitus varus**. This often occurs after a supracondylar fracture of the humerus that heals with malunion. - This deformity typically results in a decreased or reversed carrying angle of the elbow. *Madelung deformity* - This is a rare congenital anomaly characterized by **dorsal and radial bowing of the distal radius** and premature fusion of the ulnar physis. - It primarily affects the wrist, leading to a visible prominence of the distal ulna and carpal bone subluxation, which is not depicted in the elbow region in the image. *Nursemaid's elbow* - This is a common injury in young children where the **radial head is subluxated** from the annular ligament, often due to a sudden pull on the forearm. - It presents as acute pain and refusal to use the arm, but does not involve a chronic structural deformity or angulation of the elbow joint as shown in the image. *Klippel-Feil syndrome* - This is a rare congenital disorder characterized by the **fusion of two or more cervical vertebrae**. - Its primary manifestations are a short neck, low posterior hairline, and restricted neck movement, with no direct involvement or deformity of the elbow joint itself.

Q: Identify the condition shown in the given X-ray:

Osgood-Schlatter disease. ***Correct Answer: Osgood-Schlatter disease*** - The X-ray shows characteristic **fragmentation** and **irregularity** of the **tibial tuberosity**, which is pathognomonic for Osgood-Schlatter disease. - This condition commonly affects **adolescents** during periods of rapid growth, causing **anterior knee pain** that worsens with activity. - The radiographic findings demonstrate chronic **traction apophysitis** at the insertion of the **patellar tendon**. *Incorrect: Tibial tuberosity fracture* - An acute tibial tuberosity fracture would show a **distinct fracture line** with possible displacement, rather than the chronic fragmentation pattern seen here. - This type of fracture typically results from **sudden forceful quadriceps contraction** and presents with acute onset of severe pain. *Incorrect: Gerdy's tubercle fracture* - Gerdy's tubercle is located on the **lateral aspect of the proximal tibia**, serving as the insertion point for the **iliotibial band**. - A fracture at this location would not explain the **anterior tibial tuberosity changes** visible in this X-ray image. *Incorrect: Lateral epicondyle of femur* - The lateral epicondyle of the femur is located at the **distal end of the femur**, not at the tibial tuberosity where the radiographic changes are visible. - Pathology at the lateral epicondyle would not cause the **tibial tuberosity fragmentation** seen in this X-ray.

Q: The image shows a pediatric fracture involving the growth plate. Which classification system and stage best describes this fracture?

Salter Harris 3. ***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 1

The following gait abnormality is seen in:

Accepted Answer

Polio

Answer

Avascular necrosis Hip

Answer

Spastic hemiplegia

Answer

Leprosy

Question 2

The following X-ray pelvis of a child shows:

Accepted Answer

Congenital hip dislocation

Answer

TB Hip joint

Answer

Battered baby syndrome

Answer

Slipped capital femoral epiphysis

Question 3

The priority in management of supracondylar fracture of humerus in a child is:

Accepted Answer

Assessment of neurovascular status

Answer

Immobilization

Answer

Antibiotics

Answer

Debridement of wound

Question 4

The prognosis in reduced or unreduced fractures involving epiphyseal plate is very poor if the fracture line:

Accepted Answer

Crushes the epiphyseal plate

Answer

Runs along the epiphyseal plate

Answer

Crosses the epiphyseal plate

Answer

Extends into epiphysis

Question 5

Kohler's disease is avascular necrosis of :

Accepted Answer

Navicular

Answer

First metatarsal head

Answer

Capitellum of humerus

Answer

Lunate

Question 6

Identify the condition shown in the given X-ray:
![img-63.jpeg](img-63.jpeg)

Accepted Answer

Osgood-Schlatter disease

Answer

Lateral epicondyle of femur

Answer

Tibial tuberosity fracture

Answer

Gerdy's tubercle fracture

Question 7

Fracture at which site affects the longitudinal growth of a bone?

Accepted Answer

Epiphyseal plate

Answer

Diaphysis

Answer

Epiphysis

Answer

Metaphysis

Question 8

A 10-year-old boy presents with the physical findings shown in the image, characterized by inward angulation of the elbows. What is the most likely diagnosis?

Accepted Answer

Cubitus varus deformity

Answer

Madelung deformity

Answer

Nursemaid's elbow

Answer

Klippel-Feil syndrome

Question 9

Identify the condition shown in the given X-ray:

Accepted Answer

Osgood-Schlatter disease

Answer

Tibial tuberosity fracture

Answer

Gerdy's tubercle fracture

Answer

Lateral epicondyle of femur

Question 10

The image shows a pediatric fracture involving the growth plate. Which classification system and stage best describes this fracture?

Accepted Answer

Salter Harris 3

Answer

Gartland 3

Answer

Gartland 2

Answer

Salter Harris 2

Pediatric Orthopaedics — MCQs

Pediatric Orthopaedics — MCQs

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