Menu

Pediatric Hip MCQs

Practice Set 3 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 41

Topic: Pediatric Hip
A 6-year-old boy presents with a painless limp of 3 months' duration. Radiographs demonstrate sclerosis and fragmentation of the femoral head. Measurement reveals the lateral pillar height is 60% of normal. What is the appropriate Herring classification?
. Herring A
. Herring B
. Herring C
. Catterall I
. Salter-Thompson A

Correct Answer & Explanation

. Herring B

Explanation

The Herring (lateral pillar) classification for Legg-Calvé-Perthes disease is based on the height of the lateral pillar of the femoral head on the AP radiograph. A height of >50% but <100% indicates Herring B, whereas less than 50% indicates Herring C.

Question 42

Topic: Pediatric Hip

A 13-year-old obese boy presents with right knee pain and a limp. On examination, obligate external rotation of the right hip is noted during passive flexion.

What is the most appropriate initial treatment?

. In situ single screw fixation
. Bilateral spica casting
. Open reduction and internal fixation
. Proximal femoral osteotomy
. Observation and physical therapy

Correct Answer & Explanation

. In situ single screw fixation

Explanation

The clinical presentation is classic for a slipped capital femoral epiphysis (SCFE). The gold standard treatment for a stable SCFE is in situ fixation with a single cannulated screw to prevent further slippage.

Question 43

Topic: Pediatric Hip

A 4-year-old girl is evaluated for a persistent limp. Radiographs demonstrate late-presenting developmental dysplasia of the hip (DDH) with a fully dislocated femoral head.

What is the most appropriate definitive management?

. Pavlik harness application
. Closed reduction and spica casting
. Open reduction with pelvic and femoral osteotomies
. Traction followed by bracing
. Femoral head resection

Correct Answer & Explanation

. Open reduction with pelvic and femoral osteotomies

Explanation

In a child older than 2-3 years, conservative measures and closed reduction are highly likely to fail. Open reduction combined with pelvic (to correct acetabular dysplasia) and femoral (to correct excessive anteversion) osteotomies is typically required.

Question 44

Topic: Pediatric Hip

A 13-year-old obese boy presents with thigh pain and obligatory external rotation with hip flexion. He is diagnosed with a slipped capital femoral epiphysis (SCFE). Which of the following is an absolute indication for prophylactic pinning of the contralateral asymptomatic hip?

. Age greater than 14 years
. Underlying endocrine disorder
. Body mass index above the 95th percentile
. Female gender
. Severe initial slip angle

Correct Answer & Explanation

. Underlying endocrine disorder

Explanation

Prophylactic pinning of the contralateral hip in SCFE is strongly recommended for patients with an underlying endocrine disorder (e.g., hypothyroidism, renal osteodystrophy) due to the very high risk of bilateral involvement. Age less than 10 or open triradiate cartilage are also considered risk factors for bilateral slips.

Question 45

Topic: Pediatric Hip

Which of the following disease processes is demonstrated in the radiograph (Slide):

. Pigmented villonodular synovitis
. Slipped capital femoral epiphysis
. Developmental dysplasia of the hip
. Legg-C alve-Perthes disease
. Multiple epiphyseal dysplasia

Correct Answer & Explanation

. Legg-C alve-Perthes disease

Explanation

The left femoral epiphysis shows avascular changes characteristic of Legg-C alve-Perthes disease without slippage. Although developmental dysplasia of the hip may also be complicated by avascular changes, the femoral neck and acetabulum would manifest more longstanding growth alterations as well. The contralateral hip would be symmetric in patients with multiple epiphyseal dysplasia.

Question 46

Topic: Pediatric Hip

A 7-year-old boy is diagnosed with Legg-Calve-Perthes disease.

Which of the following radiographic findings is considered a "head-at-risk" sign described by Catterall?

. Subchondral fracture line covering >50% of epiphysis
. Central pillar collapse
. Gage sign
. Acetabular dysplasia
. Premature physeal closure

Correct Answer & Explanation

. Gage sign

Explanation

Gage sign is a V-shaped radiolucency in the lateral epiphysis and adjacent metaphysis. It represents a Catterall "head-at-risk" sign in Legg-Calve-Perthes disease, indicating a potential for a poor outcome.

Question 47

Topic: Pediatric Hip

A 13-year-old obese boy underwent in situ pinning for a stable slipped capital femoral epiphysis (SCFE) 6 months ago. He now complains of progressive hip stiffness and pain. Radiographs reveal a narrowed joint space with periarticular osteopenia. What is the most likely cause of this complication?

. Avascular necrosis (AVN)
. Implant failure
. Chondrolysis
. Septic arthritis
. Femoroacetabular impingement

Correct Answer & Explanation

. Chondrolysis

Explanation

Chondrolysis is a known complication of SCFE characterized by progressive joint space narrowing and stiffness. It is strongly associated with unrecognized pin penetration into the joint space.

Question 48

Topic: Pediatric Hip

A 3-year-old girl is diagnosed with a neglected unilateral developmental dysplasia of the hip (DDH).

The femoral head is dislocated superiorly. What is the most appropriate surgical management?

. Closed reduction and spica casting
. Open reduction with adductor tenotomy alone
. Open reduction, femoral shortening osteotomy, and pelvic osteotomy
. Pavlik harness application
. Proximal femoral focal deficiency reconstruction

Correct Answer & Explanation

. Open reduction, femoral shortening osteotomy, and pelvic osteotomy

Explanation

In children over 2 to 3 years old with a high dislocation, open reduction typically requires a concurrent femoral shortening osteotomy to reduce pressure on the femoral head and a pelvic osteotomy for adequate acetabular coverage.

Question 49

Topic: Pediatric Hip

In a patient diagnosed with a unilateral slipped capital femoral epiphysis (SCFE), which of the following is an absolute indication for prophylactic pinning of the contralateral asymptomatic hip?

. Age greater than 14 years
. Presentation with a stable slip
. Presence of an endocrine disorder such as hypothyroidism
. Obesity with a BMI in the 90th percentile
. Family history of SCFE

Correct Answer & Explanation

. Presence of an endocrine disorder such as hypothyroidism

Explanation

Endocrine disorders (such as hypothyroidism, renal osteodystrophy, or growth hormone deficiency) significantly increase the risk of bilateral SCFE. Prophylactic pinning of the contralateral hip is highly recommended in these cases.

Question 50

Topic: Pediatric Hip

A 6-week-old female infant is placed in a Pavlik harness for a dislocated left hip (Ortolani positive). After 3 weeks of strict full-time harness wear, ultrasound shows the hip remains persistently dislocated. What is the most appropriate next step in management?

. Continue the Pavlik harness for another 3 weeks
. Transition to a rigid abduction orthosis (e.g., Ilfeld splint)
. Perform an open reduction immediately
. Abandon the harness and perform closed reduction with spica casting
. Perform a varus derotational osteotomy

Correct Answer & Explanation

. Abandon the harness and perform closed reduction with spica casting

Explanation

Failure to reduce a dislocated hip after 3 weeks in a Pavlik harness is an indication to abandon the harness to prevent 'Pavlik harness disease' (posterior acetabular wear). The next step is typically closed reduction and spica casting under anesthesia.

Question 51

Topic: Pediatric Hip

A 12-year-old obese boy presents to the emergency department unable to bear weight on his right leg after a minor fall. Radiographs confirm a severe, unstable slipped capital femoral epiphysis (SCFE). Which blood supply to the femoral head is most at risk of injury in this acute, unstable scenario?

. Artery of the ligamentum teres
. Descending branch of the lateral circumflex femoral artery
. Ascending cervical branches of the medial circumflex femoral artery
. Inferior gluteal artery
. Pudendal artery

Correct Answer & Explanation

. Ascending cervical branches of the medial circumflex femoral artery

Explanation

The medial circumflex femoral artery (MCFA) provides the primary blood supply to the femoral head via its ascending cervical branches. In an unstable SCFE, these extraosseous vessels are tethered and highly susceptible to rupture or occlusion, leading to osteonecrosis.

Question 52

Topic: Pediatric Hip

According to the Herring Lateral Pillar classification for Legg-Calve-Perthes disease, a hip in which the lateral pillar maintains between 50% and 100% of its original height is classified as:

. Type A
. Type B
. Type B/C border
. Type C
. Type D

Correct Answer & Explanation

. Type C

Explanation

In the Herring classification, Type A has no lateral pillar involvement. Type B maintains >50% lateral pillar height. Type C has <50% height maintained, portending a worse prognosis.

Question 53

Topic: Pediatric Hip

A 12-year-old boy weighing 90 kg presents with acute on chronic left knee and groin pain. He is unable to bear weight. Radiographs show a posterior and inferior displacement of the proximal femoral epiphysis. What is the most serious complication associated with the appropriate initial surgical treatment of this condition?

. Chondrolysis
. Avascular necrosis (AVN)
. Leg length discrepancy
. Femoroacetabular impingement
. Infection

Correct Answer & Explanation

. Avascular necrosis (AVN)

Explanation

The clinical picture describes an unstable slipped capital femoral epiphysis (SCFE). Unstable SCFE has a high risk of avascular necrosis (AVN), which can occur naturally or be exacerbated by surgical reduction and fixation.

Question 54

Topic: Pediatric Hip

A 6-week-old female infant is treated with a Pavlik harness for a dislocated left hip. After 3 weeks of strict harness wear, ultrasound reveals that the hip remains persistently dislocated. What is the most appropriate next step in management?

. Continue the Pavlik harness for another 3 weeks
. Tighten the anterior straps to increase flexion
. Transition to a rigid abduction orthosis (e.g., Ilfeld splint)
. Perform an arthrogram, closed reduction, and spica casting
. Perform an open reduction and pelvic osteotomy

Correct Answer & Explanation

. Perform an arthrogram, closed reduction, and spica casting

Explanation

Failure to reduce a dislocated hip after 3 weeks of Pavlik harness wear is an indication to abandon the harness to avoid Pavlik harness disease (posterior acetabular wear). The next step is a closed reduction and spica casting.

Question 55

Topic: Pediatric Hip

A 13-year-old boy presents with progressive right hip pain and stiffness 6 months after in situ pinning of a stable slipped capital femoral epiphysis. Examination reveals significant restriction of all hip motions, particularly internal rotation and abduction. Radiographs show symmetric narrowing of the joint space. What is the most likely diagnosis?

. Avascular necrosis
. Chondrolysis
. Hardware failure
. Septic arthritis
. Heterotopic ossification

Correct Answer & Explanation

. Chondrolysis

Explanation

Chondrolysis is characterized by acute or insidious onset of pain, stiffness, and symmetric joint space narrowing (typically <3 mm) after SCFE. It may be associated with unrecognized screw penetration into the joint.

Question 56

Topic: Pediatric Hip
A 6-year-old boy presents with a painless limp. Radiographs reveal fragmentation and sclerosis of the proximal femoral epiphysis. According to the lateral pillar classification for Legg-Calvé-Perthes disease, which radiographic finding constitutes a Group C categorization?
. No involvement of the lateral pillar
. >50% maintained height of the lateral pillar
. <50% maintained height of the lateral pillar
. Complete collapse of the medial pillar
. Subchondral fracture (crescent sign) involving <50% of the epiphysis

Correct Answer & Explanation

. <50% maintained height of the lateral pillar

Explanation

In the Herring lateral pillar classification of Perthes disease, Group C involves <50% maintenance of the lateral pillar height. This group has a poor prognosis and a higher risk of aspherical healing.

Question 57

Topic: Pediatric Hip

A 12-year-old obese male presents with a 3-week history of left groin pain and a limp. Physical examination reveals obligate external rotation of the left hip during passive flexion. Based on the clinical presentation and image provided, what is the most appropriate initial management for this stable deformity?

. Closed reduction and spica casting
. Percutaneous in situ single-screw fixation
. Open reduction and Dunn osteotomy
. Proximal femoral varus osteotomy
. Observation with non-weight-bearing

Correct Answer & Explanation

. Percutaneous in situ single-screw fixation

Explanation

The patient has a stable Slipped Capital Femoral Epiphysis (SCFE). The gold standard treatment is in situ fixation with a single percutaneous screw to prevent further slippage.

Question 58

Topic: Pediatric Hip
An 8-year-old boy presents with a painless limp of 4 months duration. Anteroposterior pelvis radiograph demonstrates fragmentation of the capital femoral epiphysis with >50% loss of lateral pillar height. According to the Herring Lateral Pillar classification, what group does this represent?
. Group A
. Group B
. Group B/C
. Group C
. Group D

Correct Answer & Explanation

. Group C

Explanation

In the Herring Lateral Pillar classification for Legg-Calvé-Perthes disease, Group C is defined by >50% collapse of the lateral pillar height. This indicates a poor prognosis.

Question 59

Topic: Pediatric Hip



An obese 12-year-old boy presents with left knee pain and inability to bear weight. Radiographs show a displaced proximal femoral epiphysis. According to the Loder classification, what is the primary risk associated with this specific presentation?

. Chondrolysis
. Osteonecrosis of the femoral head
. Femoroacetabular impingement
. Nonunion
. Premature physeal closure

Correct Answer & Explanation

. Osteonecrosis of the femoral head

Explanation

The inability to bear weight, even with crutches, defines an unstable slipped capital femoral epiphysis (SCFE) in the Loder classification. Unstable SCFE carries a high risk of osteonecrosis, approaching 47% in some series.

Question 60

Topic: Pediatric Hip
A 13-year-old boy underwent in situ pinning of a stable slipped capital femoral epiphysis (SCFE) with a single cannulated screw. Postoperatively, he develops severe stiffness, loss of motion, and global joint space narrowing (< 3 mm) on radiographs without osteonecrosis. What is the most likely diagnosis?
. Septic arthritis
. Chondrolysis
. Femoroacetabular impingement
. Unrecognized unstable slip
. Avascular necrosis

Correct Answer & Explanation

. Chondrolysis

Explanation

Chondrolysis is characterized by acute articular cartilage destruction, presenting with stiffness and joint space narrowing (<3 mm). It is highly associated with unrecognized hardware penetration into the joint space.

Test Yourself

Switch to an interactive, timed exam simulation to truly master this topic.

On this Page