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Pediatric Hip MCQs

Practice Set 14 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 261

Topic: Pediatric Hip

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

. Male gender
. African American ethnicity
. Presentation with chronic hip pain
. Concurrent diagnosis of hypothyroidism
. Body mass index in the 90th percentile

Correct Answer & Explanation

. Concurrent diagnosis of hypothyroidism

Explanation

Prophylactic pinning of the contralateral hip in SCFE is strongly indicated in patients with underlying endocrinopathies, such as hypothyroidism, or renal failure. These metabolic conditions carry a significantly higher risk of bilateral involvement compared to idiopathic cases.

Question 262

Topic: Pediatric Hip



A 13-year-old obese male is diagnosed with a stable slipped capital femoral epiphysis (SCFE) of the left hip. Under what circumstance is prophylactic pinning of the contralateral right hip most strongly indicated?

. The patient has a positive family history of SCFE.
. The patient has underlying renal osteodystrophy.
. The patient is pre-menarchal.
. The slipped hip is classified as severe (slip angle > 50 degrees).
. The patient has a BMI over 30.

Correct Answer & Explanation

. The patient has underlying renal osteodystrophy.

Explanation

Prophylactic pinning of the contralateral hip is highly recommended in patients with endocrine disorders (e.g., hypothyroidism) or metabolic bone diseases (e.g., renal osteodystrophy). These underlying conditions significantly increase the risk of bilateral and sequential involvement.

Question 263

Topic: Pediatric Hip

Which of the following is an accepted indication for prophylactic in situ pinning of the contralateral asymptomatic hip in a patient presenting with an acute slipped capital femoral epiphysis (SCFE)?

. Age over 14 years
. Male gender
. Underlying endocrine disorders (e.g., hypothyroidism)
. Obesity alone (>95th percentile BMI)
. Presentation with a chronic slip

Correct Answer & Explanation

. Underlying endocrine disorders (e.g., hypothyroidism)

Explanation

Prophylactic pinning of the contralateral hip in SCFE is highly recommended for patients with endocrinopathies (like hypothyroidism or renal osteodystrophy) or prior radiation therapy. These patients have an exceptionally high risk of bilateral involvement.

Question 264

Topic: Pediatric Hip

A 4-week-old female infant is diagnosed with developmental dysplasia of the hip (DDH) and placed in a Pavlik harness. Two weeks later, she presents with decreased active extension of her knee, though she still kicks her foot. What complication has most likely occurred?

. Avascular necrosis of the femoral head
. Femoral nerve palsy
. Obturator nerve palsy
. Sciatic nerve palsy
. Superior gluteal nerve palsy

Correct Answer & Explanation

. Femoral nerve palsy

Explanation

Femoral nerve palsy is a known complication of extreme hyperflexion in a Pavlik harness, presenting as an inability to actively extend the knee. The harness should be adjusted to decrease the degree of hip flexion or temporarily discontinued.

Question 265

Topic: Pediatric Hip

A 3-month-old girl has a persistent dislocated hip after 4 weeks of Pavlik harness treatment for developmental dysplasia of the hip. What is the most appropriate next step in management?

. Continue Pavlik harness for an additional 4 weeks
. Perform a femoral derotation osteotomy
. Abandon the Pavlik harness and proceed to closed reduction and spica casting
. Immediate open reduction and capsulorrhaphy

Correct Answer & Explanation

. Abandon the Pavlik harness and proceed to closed reduction and spica casting

Explanation

Continuing a Pavlik harness in a persistently dislocated hip beyond 3 to 4 weeks risks 'Pavlik disease' (acetabular damage and avascular necrosis). The harness should be abandoned and the child scheduled for closed reduction and spica casting.

Question 266

Topic: Pediatric Hip

An obese 13-year-old boy presents with right knee pain and a limp. Examination shows obligatory external rotation of the right hip during passive flexion. What is the most appropriate definitive management?

. Observation and protected weight bearing
. Hip spica cast application
. In situ single screw fixation
. Open reduction and complex internal fixation

Correct Answer & Explanation

. In situ single screw fixation

Explanation

The presentation is classic for a Slipped Capital Femoral Epiphysis (SCFE). The standard of care is in situ stabilization with a single, partially threaded cannulated screw to prevent further slippage.

Question 267

Topic: Pediatric Hip

A 6-month-old female is referred for asymmetric thigh folds and limited hip abduction. Which imaging modality is most appropriate to evaluate for developmental dysplasia of the hip (DDH) at this age?

. Ultrasound of the hips
. AP Pelvis radiograph
. MRI of the pelvis
. CT scan of the pelvis
. Fluoroscopic dynamic arthrogram

Correct Answer & Explanation

. AP Pelvis radiograph

Explanation

While ultrasound is the modality of choice for infants under 4 to 6 months, plain AP pelvis radiographs become more reliable at 6 months of age. This is due to the progressive ossification of the femoral head (ossific nucleus).

Question 268

Topic: Pediatric Hip

A 12-year-old boy presents with left hip pain and an obligate external rotation of the hip with flexion. Radiographs confirm a mild left slipped capital femoral epiphysis (SCFE). Which of the following is the strongest indication for prophylactic pinning of the contralateral asymptomatic hip?

. Male gender
. Age greater than 14 years
. Underlying endocrinopathy (e.g., hypothyroidism)
. Severity of the left SCFE slip
. Body mass index in the 85th percentile

Correct Answer & Explanation

. Underlying endocrinopathy (e.g., hypothyroidism)

Explanation

Prophylactic pinning of the contralateral hip in SCFE is strongly recommended for patients with underlying endocrinopathies, radiation therapy, or renal failure. These systemic conditions present an exceptionally high risk for bilateral involvement.

Question 269

Topic: Pediatric Hip

A 13-year-old obese male presents with a 4-week history of right groin pain and a worsening limp. Physical examination reveals an obligate external rotation of the hip during passive flexion. Radiographs demonstrate posterior and inferior displacement of the proximal femoral epiphysis. What is the standard of care for this condition?

. Closed reduction and spica casting
. In situ percutaneous pinning
. Open reduction and internal fixation
. Proximal femoral osteotomy
. Observation and non-weight bearing

Correct Answer & Explanation

. In situ percutaneous pinning

Explanation

The standard of care for a stable Slipped Capital Femoral Epiphysis (SCFE) is in situ fixation, typically utilizing a single cannulated screw. Attempting a closed reduction significantly increases the risk of avascular necrosis of the femoral head.

Question 270

Topic: Pediatric Hip

A 13-year-old obese boy presents with a 3-week history of right groin pain and an obligatory external rotation of the hip when the hip is flexed. What is the most appropriate initial treatment?

. Closed reduction and spica casting
. In situ pinning with a single cannulated screw
. Open reduction and internal fixation
. Proximal femoral osteotomy
. Observation and physical therapy

Correct Answer & Explanation

. In situ pinning with a single cannulated screw

Explanation

The presentation is classic for a slipped capital femoral epiphysis (SCFE). The standard of care is immediate in situ pinning with a single, centrally placed cannulated screw to prevent further slippage.

Question 271

Topic: Pediatric Hip

A 13-year-old obese boy presents with left thigh pain and an obligatory external rotation of the hip during flexion. Radiographs confirm a slipped capital femoral epiphysis (SCFE). Which of the following is the most significant risk factor for the development of chondrolysis in this patient?

. In situ pinning with a single screw
. Unrecognized joint penetration by the hardware
. Prophylactic pinning of the contralateral hip
. Preoperative weight-bearing status
. Body mass index > 99th percentile

Correct Answer & Explanation

. Unrecognized joint penetration by the hardware

Explanation

Unrecognized intra-articular hardware penetration is a well-documented and highly significant risk factor for chondrolysis following SCFE fixation. Proper fluoroscopic evaluation using the approach-withdrawal technique is crucial to avoid this complication.

Question 272

Topic: Pediatric Hip

A 6-week-old female infant is undergoing treatment for developmental dysplasia of the hip (DDH) with a Pavlik harness. During a follow-up visit, the mother notes that the infant is no longer actively extending her knee on the affected side. What is the most appropriate next step in management?

. Adjust the anterior straps to increase hip flexion
. Immediate surgical open reduction
. Remove the harness and transition to a rigid spica cast
. Loosen or remove the harness temporarily
. Order an urgent MRI of the lumbar spine

Correct Answer & Explanation

. Loosen or remove the harness temporarily

Explanation

The infant is demonstrating signs of a femoral nerve palsy, a known complication of hyperflexion in a Pavlik harness. The most appropriate immediate management is to loosen the anterior straps or temporarily remove the harness until nerve function recovers.

Question 273

Topic: Pediatric Hip

A 12-year-old obese boy presents with a stable slipped capital femoral epiphysis (SCFE) of the left hip. The surgeon plans in situ fixation with a single partially threaded cannulated screw. To avoid the most common complication leading to chondrolysis, which of the following is the most sensitive intraoperative imaging technique to ensure the screw has not penetrated the joint?

. Fluoroscopic anteroposterior and true lateral views
. Fluoroscopic in-out-in technique
. Anteroposterior pelvis radiograph
. Approach-withdrawal technique on fluoroscopy
. Intraoperative arthrography

Correct Answer & Explanation

. Approach-withdrawal technique on fluoroscopy

Explanation

The approach-withdrawal technique using live fluoroscopy while rotating the hip is the most sensitive method to detect unrecognized screw penetration in SCFE fixation. Standard orthogonal views possess blind spots that can obscure a prominent screw tip.

Question 274

Topic: Pediatric Hip
A 13-year-old obese male presents with progressive left groin and knee pain. On physical examination, as his left hip is passively flexed, it obligatorily deviates into external rotation. What is the most likely diagnosis?
. Legg-Calvé-Perthes disease
. Slipped capital femoral epiphysis
. Transient synovitis
. Developmental dysplasia of the hip
. Femoral neck stress fracture

Correct Answer & Explanation

. Slipped capital femoral epiphysis

Explanation

Obligatory external rotation with passive hip flexion is a hallmark clinical sign of slipped capital femoral epiphysis (SCFE). The disorder is most common in overweight, adolescent males.

Question 275

Topic: Pediatric Hip

A 13-year-old obese male presents with a 2-month history of groin pain and an obligatory external rotation of the thigh during passive hip flexion. Following fixation of the affected hip, which of the following is the most robust indication for prophylactic pinning of the contralateral hip?

. The presence of an asymptomatic cam-type femoroacetabular impingement
. A low modified Oxford bone age score indicating skeletal immaturity
. Bilateral limitation of internal rotation on physical examination alone
. Routine policy for all male patients with this condition
. A body mass index (BMI) at the 85th percentile

Correct Answer & Explanation

. A low modified Oxford bone age score indicating skeletal immaturity

Explanation

The patient has a Slipped Capital Femoral Epiphysis (SCFE). Prophylactic pinning of the contralateral hip is heavily considered in patients at high risk for a subsequent slip, which includes skeletal immaturity (low modified Oxford bone age score) and endocrine disorders.

Question 276

Topic: Pediatric Hip

A 13-year-old obese male presents with left thigh pain and a limp for 3 weeks. An AP pelvis radiograph is evaluated.

On physical examination, what is the most likely finding when the affected hip is passively flexed?

. Obligatory internal rotation
. Obligatory external rotation
. Increased passive abduction
. Reflexive knee extension
. Audible hip crepitus

Correct Answer & Explanation

. Obligatory external rotation

Explanation

Slipped Capital Femoral Epiphysis (SCFE) classically presents with obligatory external rotation of the thigh during passive hip flexion. This occurs due to the relative posterior and inferior displacement of the proximal femoral epiphysis.

Question 277

Topic: Pediatric Hip

A 12-year-old obese boy presents with progressive left groin and knee pain. Radiographs demonstrate a stable slipped capital femoral epiphysis (SCFE). Which of the following is an established indication for prophylactic in situ pinning of the asymptomatic contralateral hip?

. Male sex
. Patient age greater than 14 years
. Presence of an underlying endocrine disorder
. Body mass index > 95th percentile
. Presence of a metaphyseal blanch sign of Steel

Correct Answer & Explanation

. Presence of an underlying endocrine disorder

Explanation

Prophylactic pinning of the contralateral hip in SCFE is recommended for patients with underlying endocrine disorders (e.g., hypothyroidism, renal osteodystrophy) due to an exceptionally high risk of bilateral involvement. Age less than 10 years or open triradiate cartilage are also common indications.

Question 278

Topic: Pediatric Hip

An 11-year-old obese male presents with left groin pain and an obligatory external rotation of the hip during passive flexion. Radiographs confirm a slipped capital femoral epiphysis (SCFE). Prophylactic pinning of the contralateral asymptomatic hip is most strongly indicated in patients with which of the following underlying conditions?

. Asthma
. Hypothyroidism
. Scoliosis
. Attention deficit hyperactivity disorder
. Type 1 Diabetes Mellitus

Correct Answer & Explanation

. Hypothyroidism

Explanation

Prophylactic pinning of the contralateral hip is highly recommended for patients with underlying endocrine disorders, such as hypothyroidism or renal osteodystrophy. These conditions significantly increase the risk of a contralateral slip.

Question 279

Topic: Pediatric Hip

A 3-month-old female is being treated with a Pavlik harness for developmental dysplasia of the hip. At a follow-up visit, the mother notes that the child is no longer actively extending the knee on the treated side. This complication is most likely due to which of the following positioning errors?

. Excessive hip flexion
. Excessive hip extension
. Excessive hip adduction
. Excessive knee flexion
. Inadequate hip abduction

Correct Answer & Explanation

. Excessive hip flexion

Explanation

Femoral nerve palsy is a known complication of the Pavlik harness, typically caused by excessive hip flexion. It presents as an inability to actively extend the knee and usually resolves with adjustment of the harness.

Question 280

Topic: Pediatric Hip

A 13-year-old obese male presents with acute-on-chronic left knee pain and an inability to bear weight. Radiographs confirm a slipped capital femoral epiphysis (SCFE). Which of the following is the most significant risk factor for the development of avascular necrosis (AVN) in this patient?

. Patient obesity
. Instability of the slip
. Severity of the slip angle
. Use of a single screw for fixation
. Patient age at presentation

Correct Answer & Explanation

. Instability of the slip

Explanation

Instability of a SCFE, defined as the inability to bear weight even with crutches, is the most significant predictor for the development of AVN. The rate of AVN in unstable SCFE can be as high as 20-50%.

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