Paediatric Orthopaedics

Topics in this chapter

• Paediatric Hip Disorders
• Paediatric Foot Deformities
• Paediatric Knee And Growth Disorders
• Paediatric Metabolic Bone Disease
• Neuromuscular And Spinal Disorders
• Paediatric Musculoskeletal Infections
• Paediatric Fractures And Vascular Complications

Practice questions

1. Question 1Q-F8BCA2

   A 3-year-old child is brought by his parents with a painless limp. Examination reveals a positive Trendelenburg sign on the right side, limited abduction and internal rotation of the right hip, and apparent shortening of the right lower limb. What is the most appropriate initial diagnostic investigation of choice for this child?

   1. A.Anteroposterior radiograph of the pelvis
   2. B.Magnetic resonance imaging (MRI) of both hips
   3. C.Ultrasonography of the hips
   4. D.CT scan of the pelvis with 3D reconstruction
   See the answer and solution
2. Question 2Q-86E97B

   An 18-month-old child is brought to the orthopaedics outpatient department with bilateral intoeing and bowing of the legs. On examination, there is physiological genu varum, but the intercondylar distance is 8 cm, and wrists show widening and metaphyseal cupping and fraying on radiographs. Serum calcium is low-normal, serum phosphate is low, and alkaline phosphatase is markedly elevated. Which of the following is the pathognomonic histological finding in the growth plate of this condition?

   1. A.Disorganized columnar arrangement of chondrocytes with unmineralized osteoid accumulation
   2. B.Premature closure of the epiphysis due to avascular necrosis
   3. C.Hypertrophy of the resting zone without changes in the proliferative zone
   4. D.Replacement of bone marrow elements by fibrous connective tissue
   See the answer and solution
3. Question 3Q-83CA37

   A 12-year-old obese boy presents with a 3-week history of a dull, aching left hip pain radiating to the knee, with no history of trauma. He walks with an antalgic, externally rotated gait. On examination, passive flexion of the left hip automatically results in external rotation. What is the most definitive diagnostic view to confirm the diagnosis on plain radiography?

   1. A.Anteroposterior view of the pelvis in internal rotation
   2. B.Cleaves (frog-leg lateral) view of both hips
   3. C.Lauenstein view in maximum abduction
   4. D.False-profile view of Lequesne
   See the answer and solution
4. Question 4Q-C84567

   A 6-year-old boy presents with a 2-month history of painless limp and restricted movements of the right hip, particularly abduction and internal rotation. Radiography shows sclerosis, fragmentation, and flattening of the right femoral head. Bone scintigraphy confirms avascular necrosis of the femoral epiphysis. What is the primary therapeutic goal in the management of this patient?

   1. A.Immediate open reduction and internal fixation with dynamic hip screw
   2. B.Containment of the femoral head within the acetabulum to prevent deformation
   3. C.Complete bed rest with bilateral skeletal traction until complete re-ossification
   4. D.High-dose oral bisphosphonates to reverse epiphyseal resorption
   See the answer and solution
5. Question 5Q-B2BCD6

   A newborn infant is evaluated for foot deformities. The right foot exhibits severe equinus at the ankle, varus of the hindfoot, adduction of the forefoot, and cavus of the midfoot. The medial crease is deep, and the heel feels empty on palpation. The clinician initiates the Ponseti method. Which of the following is the correct sequence of correction of deformities in this method?

   1. A.Cavus -> Varus -> Adduction -> Equinus
   2. B.Cavus -> Adduction -> Varus -> Equinus
   3. C.Equinus -> Varus -> Adduction -> Cavus
   4. D.Adduction -> Cavus -> Varus -> Equinus
   See the answer and solution