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Pediatric Hip MCQs

Practice Set 10 of 104

This practice set contains high-yield board review questions covering key concepts in Pediatric Hip. Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.

Question 181

Topic: Pediatric Hip

A 13-year-old obese male complains of a 3-week history of dull, aching groin and knee pain. On examination, as the affected hip is flexed, it obligately rotates externally. Radiographs show a slip of the proximal femoral epiphysis. What is the most appropriate initial management?

. Closed reduction and spica casting
. In situ percutaneous screw fixation
. Open reduction and internal fixation
. Physical therapy and weight loss
. Proximal femoral osteotomy

Correct Answer & Explanation

. In situ percutaneous screw fixation

Explanation

Slipped capital femoral epiphysis (SCFE) is treated primarily with in situ percutaneous screw fixation to prevent further slippage. Closed reduction is contraindicated as it significantly increases the risk of avascular necrosis.

Question 182

Topic: Pediatric Hip

A 13-year-old obese boy presents with knee pain and a limp. On physical examination, as the affected hip is flexed, it obligatorily externally rotates. Radiographs show a widening of the proximal femoral physis with a "slip" of the epiphysis. What is the most severe common complication if this condition is treated with forceful closed reduction?

. Chondrolysis
. Avascular necrosis of the femoral head
. Rapid onset osteoarthritis
. Slipped capital femoral epiphysis of the contralateral hip
. Femoral neck nonunion

Correct Answer & Explanation

. Avascular necrosis of the femoral head

Explanation

Forceful closed reduction of a Slipped Capital Femoral Epiphysis (SCFE) significantly increases the risk of stretching or tearing the retinacular vessels, leading to iatrogenic avascular necrosis of the femoral head.

Question 183

Topic: Pediatric Hip

A 9-year-old girl with a BMI in the 95th percentile presents with right knee pain and an antalgic gait. Radiographs reveal a severe but stable slipped capital femoral epiphysis (SCFE). Given her atypical age for this condition, she is evaluated for an underlying metabolic condition associated with bilateral involvement. Which endocrine disorder is most strongly associated with her presentation?

. Hyperthyroidism
. Hypothyroidism
. Hyperparathyroidism
. Addison disease
. Cushing syndrome

Correct Answer & Explanation

. Hypothyroidism

Explanation

While typical SCFE occurs in overweight adolescents due to mechanical forces, bilateral presentations in atypical age groups (under 10 or over 16 years) strongly suggest an underlying endocrine disorder. Hypothyroidism is the most common endocrinopathy associated with SCFE in this demographic.

Question 184

Topic: Pediatric Hip

A 12-year-old overweight boy presents with a 4-week history of left knee pain and a limp. Examination reveals obligate external rotation of the left hip during passive flexion. Radiographs confirm a Slipped Capital Femoral Epiphysis (SCFE). Which of the following accurately describes the true displacement of the epiphysis relative to the femoral neck?

. Anterior and superior
. Posterior and inferior
. Posterior and superior
. Anterior and inferior
. Medial and superior

Correct Answer & Explanation

. Posterior and inferior

Explanation

In SCFE, the femoral neck typically displaces anteriorly and superiorly relative to the epiphysis. Consequently, the epiphysis itself remains in the acetabulum and relatively displaces posteriorly and inferiorly.

Question 185

Topic: Pediatric Hip

A 6-week-old female infant is being treated with a Pavlik harness for Developmental Dysplasia of the Hip (DDH). During follow-up, the parents report the infant has stopped kicking her legs, and the examiner notes absent active knee extension on the treated side. Which of the following is the most likely cause?

. Avascular necrosis of the femoral head
. Excessive abduction causing obturator nerve palsy
. Hyperflexion causing femoral nerve palsy
. Excessive extension causing sciatic nerve stretch
. Direct pressure from the anterior strap on the peroneal nerve

Correct Answer & Explanation

. Hyperflexion causing femoral nerve palsy

Explanation

Femoral nerve palsy is a known complication of the Pavlik harness, typically caused by excessive flexion of the hip. Treatment involves loosening the anterior straps or temporarily discontinuing the harness until function returns.

Question 186

Topic: Pediatric Hip
A 6-year-old boy is diagnosed with Legg-Calvรฉ-Perthes disease. The treating surgeon uses the Herring lateral pillar classification to determine prognosis. Which radiographic feature defines a Herring Group C classification?
. No involvement of the lateral pillar
. Greater than 50% maintenance of lateral pillar height
. Less than 50% maintenance of lateral pillar height
. Complete extrusion of the femoral head
. Presence of a subchondral crescent sign

Correct Answer & Explanation

. Less than 50% maintenance of lateral pillar height

Explanation

The Herring classification evaluates the height of the lateral pillar of the femoral head during the fragmentation phase. Group C is defined by less than 50% maintenance of the lateral pillar height and carries the worst prognosis.

Question 187

Topic: Pediatric Hip

A 13-year-old obese boy presents with a 3-week history of right thigh and knee pain. Physical examination reveals an obligatory external rotation of the right hip when it is passively flexed. Radiographs confirm a slipped capital femoral epiphysis (SCFE). What is the most appropriate definitive management?

. Closed reduction and spica casting
. In situ single cannulated screw fixation
. Immediate subtrochanteric osteotomy
. Open reduction and internal fixation with multiple pins
. Prolonged bed rest and skeletal traction

Correct Answer & Explanation

. In situ single cannulated screw fixation

Explanation

In situ fixation with a single, centrally placed, partially threaded cannulated screw is the gold standard definitive treatment for a stable slipped capital femoral epiphysis.

Question 188

Topic: Pediatric Hip

A 13-year-old obese male presents with a painful limp and obligatory external rotation of the hip during flexion. He is diagnosed with a slipped capital femoral epiphysis (SCFE). Which blood supply to the femoral head is most at risk in this condition?

. Artery of the ligamentum teres
. Inferior gluteal artery
. Medial femoral circumflex artery
. Lateral femoral circumflex artery
. Obturator artery

Correct Answer & Explanation

. Medial femoral circumflex artery

Explanation

The lateral epiphyseal vessels, which are terminal branches of the medial femoral circumflex artery (MFCA), supply the majority of the femoral head. These vessels are highly vulnerable to stretching or kinking in SCFE, risking avascular necrosis.

Question 189

Topic: Pediatric Hip

In an 8-month-old female undergoing attempted closed reduction for developmental dysplasia of the hip (DDH), the surgeon encounters a block to concentric reduction. Which of the following is considered a primary intra-articular anatomic block to reduction in this condition?

. Inverted limbus (labrum)
. Contracted gluteus maximus
. Laxity of the round ligament
. Elongated transverse acetabular ligament
. Hypoplastic ligamentum teres

Correct Answer & Explanation

. Inverted limbus (labrum)

Explanation

Common intra-articular obstacles to closed reduction in DDH include an inverted limbus (labrum), hypertrophied pulvinar, a tight/constricted transverse acetabular ligament, and a hypertrophied ligamentum teres.

Question 190

Topic: Pediatric Hip

A 13-year-old obese boy undergoes in situ pinning for a stable, left-sided slipped capital femoral epiphysis (SCFE). Which of the following is the strongest indication for prophylactic pinning of the contralateral asymptomatic hip?

. Patient age over 15 years
. Male gender
. Presentation with thigh pain instead of knee pain
. Presence of an endocrine disorder such as hypothyroidism
. Slip angle greater than 50 degrees on the affected side

Correct Answer & Explanation

. Presence of an endocrine disorder such as hypothyroidism

Explanation

Prophylactic pinning of the contralateral hip in SCFE is highly recommended in patients with endocrine disorders (e.g., hypothyroidism, renal osteodystrophy) due to a significantly higher risk of bilateral involvement. Age less than 10 years at presentation is another strong indication.

Question 191

Topic: Pediatric Hip

An obese 13-year-old boy undergoes in-situ percutaneous pinning for a stable slipped capital femoral epiphysis (SCFE). Which of the following is the most common long-term complication associated with this condition?

. Avascular necrosis of the femoral head
. Chondrolysis
. Femoroacetabular impingement
. Nonunion
. Leg length discrepancy

Correct Answer & Explanation

. Femoroacetabular impingement

Explanation

The most common long-term complication after in-situ pinning of a SCFE is cam-type femoroacetabular impingement (FAI) due to the residual prominent anterior metaphysis. Avascular necrosis is more commonly seen in unstable SCFE.

Question 192

Topic: Pediatric Hip

A 6-week-old female infant is diagnosed with developmental dysplasia of the hip (DDH). Ultrasound confirms a dislocated right hip that is reducible. She is prescribed a Pavlik harness. Which of the following nerve palsies is most commonly associated with excessive hip flexion in this device?

. Obturator nerve
. Sciatic nerve
. Femoral nerve
. Superior gluteal nerve
. Lateral femoral cutaneous nerve

Correct Answer & Explanation

. Femoral nerve

Explanation

Femoral nerve palsy is the most common nerve injury associated with the Pavlik harness and occurs when the hips are maintained in hyperflexion. This manifests as an inability to actively extend the knee, requiring harness adjustment.

Question 193

Topic: Pediatric Hip

A 13-year-old obese male presents with a 3-week history of vague right knee pain and a limp. Physical examination reveals an antalgic gait and obligatory external rotation of the right hip during passive flexion. Which of the following is the most appropriate initial diagnostic imaging?

. Anteroposterior (AP) radiograph of the right knee
. MRI of the right hip
. Anteroposterior (AP) and frog-leg lateral radiographs of the pelvis
. Ultrasound of the right hip
. CT scan of the pelvis with 3D reconstruction

Correct Answer & Explanation

. Anteroposterior (AP) and frog-leg lateral radiographs of the pelvis

Explanation

The clinical presentation is highly suspicious for Slipped Capital Femoral Epiphysis (SCFE), which often presents with referred knee pain. AP and frog-leg lateral radiographs of the pelvis are the gold standard for initial diagnosis, allowing comparison of both hips.

Question 194

Topic: Pediatric Hip

A 4-month-old female infant is found to have asymmetric thigh skin folds and limited hip abduction on the left side. An ultrasound confirms a dislocated left hip with an alpha angle of 40 degrees. What is the standard first-line management?

. Reassurance and follow-up in 3 months
. Closed reduction and spica casting
. Application of a Pavlik harness
. Open reduction and Dega osteotomy
. Varus derotational osteotomy of the proximal femur

Correct Answer & Explanation

. Application of a Pavlik harness

Explanation

For Developmental Dysplasia of the Hip (DDH) in an infant under 6 months of age, the Pavlik harness is the primary standard of care. It maintains the hip in flexion and abduction to allow for natural remodeling of the acetabulum.

Question 195

Topic: Pediatric Hip

In a 12-year-old boy presenting with a unilateral slipped capital femoral epiphysis (SCFE), which of the following is considered an absolute indication for prophylactic pinning of the contralateral hip?

. Age over 14
. Male sex
. Underlying endocrine disorder
. Modified Southwick angle less than 30 degrees
. Obesity greater than 99th percentile

Correct Answer & Explanation

. Underlying endocrine disorder

Explanation

Endocrine disorders, such as hypothyroidism or renal osteodystrophy, are strong indications for prophylactic pinning of the contralateral asymptomatic hip due to a very high risk of bilateral SCFE involvement.

Question 196

Topic: Pediatric Hip

A 4-month-old girl with developmental dysplasia of the hip (DDH) has been treated in a Pavlik harness for 3 weeks. Examination reveals an inability to actively extend her knee on the affected side. What is the most likely cause of this complication?

. Femoral nerve palsy due to excessive hip flexion
. Sciatic nerve palsy due to excessive hip abduction
. Obturator nerve palsy due to excessive internal rotation
. Transient synovitis
. Avascular necrosis of the femoral head

Correct Answer & Explanation

. Femoral nerve palsy due to excessive hip flexion

Explanation

Femoral nerve palsy is a recognized complication of the Pavlik harness if the hip is positioned in excessive hyperflexion. The harness must be adjusted or removed to resolve the compression and allow nerve recovery.

Question 197

Topic: Pediatric Hip

A 13-year-old obese male presents with right groin pain and a limp. Radiographs confirm a stable slipped capital femoral epiphysis (SCFE). During in situ pinning with a single cannulated screw, which complication is most likely if the screw is placed in the anterosuperior quadrant of the femoral head?

. Chondrolysis
. Avascular necrosis (AVN)
. Femoral neck fracture
. Implant failure
. Labral tear

Correct Answer & Explanation

. Avascular necrosis (AVN)

Explanation

Placement of the screw in the anterosuperior quadrant of the femoral head risks penetration of the joint space and injury to the lateral epiphyseal vessels, leading to avascular necrosis. Screws should ideally be placed in the center-center position.

Question 198

Topic: Pediatric Hip

An infant is being treated with a Pavlik harness for Developmental Dysplasia of the Hip (DDH). At the two-week follow-up, the mother notes the child is no longer actively extending the knee on the treated side. What is the most appropriate next step in management?

. Continue the harness as this is a normal finding
. Increase the flexion straps to 120 degrees
. Discontinue the harness temporarily and observe
. Switch to rigid spica casting
. Obtain an immediate MRI of the lumbar spine

Correct Answer & Explanation

. Discontinue the harness temporarily and observe

Explanation

Loss of active knee extension indicates a femoral nerve palsy, the most common nerve injury associated with Pavlik harness use due to hyperflexion. The harness must be temporarily discontinued to allow the nerve to recover.

Question 199

Topic: Pediatric Hip

A 13-year-old obese male presents with a 4-week history of left knee pain and an antalgic gait. Examination reveals obligatory external rotation of the left hip upon flexion. Radiographs confirm a stable slipped capital femoral epiphysis (SCFE). What is the primary reason to perform single-screw in situ fixation over multiple-screw fixation?

. Decreased risk of chondrolysis
. Decreased risk of avascular necrosis
. Decreased risk of joint penetration
. Increased biomechanical stability
. Prevention of contralateral slip

Correct Answer & Explanation

. Decreased risk of joint penetration

Explanation

Single-screw fixation is the standard of care for a stable SCFE. Compared to multiple screws, a single screw provides adequate stability while significantly decreasing the risk of inadvertent joint penetration and subsequent chondrolysis.

Question 200

Topic: Pediatric Hip

Which of the following categories of slipped capital femoral epiphysis (SC FE) is associated with the highest rate of bilaterality:

. Idiopathic SC FE
. Renal failure
. Radiation therapy
. Hypothyroidism
. Growth hormone deficiency

Correct Answer & Explanation

. Renal failure

Explanation

Renal failure is associated with the highest risk (90%) of bilaterality. By contrast, idiopathic SC FE has a 20% risk of bilaterality initially and a further 10% to 20% risk until maturity.

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