Menu

Pediatric Hip MCQs

Practice Set 30 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 581

Topic: Pediatric Hip

A 6-week-old female is treated with a Pavlik harness for developmental dysplasia of the hip (DDH). At the 2-week follow-up, the mother notes the child is not kicking the left leg. Examination reveals absent active knee extension on the left. The hips are positioned in 120 degrees of flexion. What is the most likely cause of this finding?

. Obturator nerve palsy due to excessive abduction
. Femoral nerve palsy due to hyperflexion
. Sciatic nerve palsy due to excessive adduction
. Septic arthritis of the hip
. Transient synovitis from harness adjustments

Correct Answer & Explanation

. Femoral nerve palsy due to hyperflexion

Explanation

Femoral nerve palsy is a known complication of the Pavlik harness, typically caused by hyperflexion of the hips (usually >100-110 degrees), which compresses the femoral nerve against the inguinal ligament. The treatment is temporary harness removal or adjustment to reduce flexion, with recovery usually occurring within a few days to weeks.

Question 582

Topic: Pediatric Hip

In a patient diagnosed with a unilateral slipped capital femoral epiphysis (SCFE), which of the following represents the strongest indication for prophylactic in situ pinning of the contralateral, currently asymptomatic hip?

. Patient age of 14 years at initial presentation
. Male gender
. Presentation with an acute (rather than chronic) slip
. Underlying endocrine disorder (e.g., hypothyroidism or panhypopituitarism)
. Grade I slip severity on the primarily affected side

Correct Answer & Explanation

. Underlying endocrine disorder (e.g., hypothyroidism or panhypopituitarism)

Explanation

Prophylactic pinning of the contralateral hip in SCFE is controversial but is strongly indicated in patients with underlying endocrine disorders (hypothyroidism, growth hormone deficiency, renal osteodystrophy) or previous radiation therapy, as these patients have a much higher risk of bilateral disease (up to 100% in some endocrine subgroups) compared to idiopathic cases.

Question 583

Topic: Pediatric Hip

A 12-year-old boy presents with a unilateral slipped capital femoral epiphysis (SCFE). Prophylactic pinning of the contralateral asymptomatic hip is most strongly indicated if the patient has a history of which of the following concomitant conditions?

. Hypothyroidism
. Hyperthyroidism
. Type 1 Diabetes mellitus
. Primary hyperparathyroidism
. Addison's disease

Correct Answer & Explanation

. Hypothyroidism

Explanation

Patients with endocrine disorders, particularly hypothyroidism, panhypopituitarism, and renal osteodystrophy, have a significantly higher risk of developing bilateral SCFE. In these patients, prophylactic pinning of the contralateral hip is strongly recommended.

Question 584

Topic: Pediatric Hip
A 6-year-old boy is diagnosed with Legg-Calvรฉ-Perthes disease. The presence of certain radiographic signs, termed 'head-at-risk' signs by Catterall, suggests a higher likelihood of poor outcomes and extrusion of the femoral head. Which of the following is one of these classic Catterall 'head-at-risk' signs?
. Gage's sign
. Medial subluxation of the femoral head
. Vertical orientation of the physis
. Decreased teardrop distance
. Varus deformity of the femoral neck

Correct Answer & Explanation

. Medial subluxation of the femoral head

Explanation

Catterall described five 'head-at-risk' clinical and radiographic signs in Perthes disease that predict extrusion and a poor outcome. These include: Gage's sign (a V-shaped radiolucency in the lateral portion of the epiphysis and metaphysis), calcification lateral to the epiphysis, lateral subluxation of the femoral head, a horizontal growth plate, and metaphyseal cysts.

Question 585

Topic: Pediatric Hip

A 9-year-old boy presents with right knee pain and a limp. Examination reveals obligate external rotation with hip flexion. Radiographs confirm a slipped capital femoral epiphysis (SCFE). Considering his age, which of the following laboratory tests is most critical?

. Complete blood count and ESR
. HLA-B27
. Thyroid stimulating hormone (TSH) and Free T4
. Serum calcium, phosphate, and alkaline phosphatase
. Antinuclear antibodies (ANA)

Correct Answer & Explanation

. Thyroid stimulating hormone (TSH) and Free T4

Explanation

Atypical SCFE occurs in patients <10 years or >16 years old, or those with bilateral involvement, low weight, or short stature. Hypothyroidism is the most common endocrine disorder associated with atypical SCFE. Evaluation with TSH and Free T4 is mandatory.

Question 586

Topic: Pediatric Hip

A 3-year-old girl is newly diagnosed with unilateral developmental dysplasia of the hip (DDH). The hip is dislocated and reducible. What is the most appropriate primary treatment?

. Pavlik harness
. Closed reduction and spica casting
. Open reduction with concomitant pelvic and/or femoral osteotomy
. Observation until age 5 followed by salvage osteotomy
. Injections of botulinum toxin and bracing

Correct Answer & Explanation

. Open reduction with concomitant pelvic and/or femoral osteotomy

Explanation

In a child older than 18-24 months of age, closed reduction is usually unsuccessful due to soft tissue contractures and adaptive bony changes. The standard of care for a 3-year-old with DDH is open reduction, often combined with a pelvic osteotomy and/or a femoral shortening osteotomy to relieve tension and provide stability.

Question 587

Topic: Pediatric Hip

Which of the following clinical scenarios is the strongest indication for prophylactic in situ pinning of the contralateral asymptomatic hip in a patient presenting with a unilateral slipped capital femoral epiphysis (SCFE)?

. A 14-year-old male with a BMI in the 95th percentile
. A 10-year-old female with primary hypothyroidism
. A 12-year-old male with a positive family history of SCFE
. A 15-year-old male with a slip angle of 60 degrees
. A 13-year-old female with an acute-on-chronic slip

Correct Answer & Explanation

. A 10-year-old female with primary hypothyroidism

Explanation

Endocrine disorders (such as hypothyroidism, panhypopituitarism, and renal osteodystrophy) carry an exceptionally high risk of bilateral SCFE, sometimes approaching 100%. Prophylactic pinning of the contralateral hip is strongly indicated in patients with underlying endocrinopathies, history of pelvic radiation therapy, or those presenting at an unusually young age (<10 years).

Question 588

Topic: Pediatric Hip

A 4-month-old infant with developmental dysplasia of the hip (DDH) is being treated with a Pavlik harness. The parents adjusted the harness themselves, placing the hips in extreme hyperflexion. Which of the following complications is the infant at the highest risk of developing?

. Avascular necrosis of the femoral head
. Femoral nerve palsy
. Sciatic nerve palsy
. Obturator nerve palsy
. Inferior dislocation of the hip

Correct Answer & Explanation

. Femoral nerve palsy

Explanation

Improper use of the Pavlik harness can lead to significant complications. Extreme hyperflexion of the hips can compress the femoral nerve against the inguinal ligament, leading to a femoral nerve palsy, which manifests clinically as an absence of active knee extension. Avascular necrosis is typically associated with excessive forced abduction.

Question 589

Topic: Pediatric Hip

In a patient presenting with a unilateral Slipped Capital Femoral Epiphysis (SCFE), which of the following is the strongest indication for prophylactic in situ pinning of the contralateral asymptomatic hip?

. Age older than 14 years at initial presentation
. Male sex
. An underlying endocrine disorder (e.g., hypothyroidism)
. Grade I (mild) slip on the affected side
. Presence of a metaphyseal blanch sign of Steel

Correct Answer & Explanation

. An underlying endocrine disorder (e.g., hypothyroidism)

Explanation

Prophylactic pinning of the contralateral hip in unilateral SCFE is highly recommended in patients with an underlying endocrine disorder (e.g., hypothyroidism, renal osteodystrophy) or a history of radiation therapy. These patients have a significantly elevated risk (>50%) of developing a bilateral slip. Younger age (<10 years) is also an indication.

Question 590

Topic: Pediatric Hip

A 5-year-old girl with an untreated late developmental dysplasia of the hip (DDH) undergoes an open reduction. During the procedure, the surgeon performs a femoral shortening osteotomy. What is the primary biomechanical and clinical rationale for incorporating this femoral shortening?

. Correct excessive femoral anteversion
. Reduce soft tissue tension to prevent avascular necrosis (AVN)
. Correct an associated coxa vara deformity
. Eliminate the need for a concomitant pelvic osteotomy
. Facilitate closure of the redundant joint capsule

Correct Answer & Explanation

. Reduce soft tissue tension to prevent avascular necrosis (AVN)

Explanation

In older children (typically >3 years) with high DDH dislocations, closed or isolated open reduction forces the femoral head into the true acetabulum under high tension due to contracted soft tissues. This dramatically elevates joint contact pressures, severely increasing the risk of avascular necrosis (AVN) of the femoral head. A femoral shortening osteotomy safely decompresses the joint, facilitates reduction without tension, and preserves the blood supply.

Question 591

Topic: Pediatric Hip

A 9-year-old girl presents with left groin pain and a limp. Examination reveals obligate external rotation of the left hip during passive flexion. Radiographs confirm a severe left slipped capital femoral epiphysis (SCFE). Which of the following patient factors represents the strongest recognized indication for prophylactic in-situ pinning of her contralateral, asymptomatic right hip?

. Body Mass Index >95th percentile
. Female gender
. Underlying endocrine disorder (e.g., hypothyroidism)
. Age older than 12 years
. Presence of a positive Drehmann sign

Correct Answer & Explanation

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

Explanation

Prophylactic pinning of the contralateral hip in SCFE is highly indicated in patients with underlying endocrine or systemic disorders (e.g., hypothyroidism, growth hormone deficiency, renal osteodystrophy) because they have an exceedingly high risk (up to 100%) of developing bilateral disease. Other strong indications include prior therapeutic pelvic radiation and distinctly young age at presentation (males < 10, females < 8).

Question 592

Topic: Pediatric Hip

In a 7-year-old boy diagnosed with Legg-Calve-Perthes disease, radiographs demonstrate that the lateral pillar of the femoral head maintains 65% of its original height. According to the Herring Lateral Pillar Classification, which group does this represent?

. Group A
. Group B
. Group B/C
. Group C
. Group D

Correct Answer & Explanation

. Group B

Explanation

According to the Herring Lateral Pillar Classification: Group A has no loss of lateral pillar height. Group B maintains >50% lateral pillar height. Group B/C is a border group at exactly or near 50%. Group C maintains <50% lateral pillar height. 65% falls squarely into Group B.

Question 593

Topic: Pediatric Hip

A 6-week-old infant is being treated with a Pavlik harness for developmental dysplasia of the hip (DDH). The parents report that the child has stopped kicking the affected leg. On examination, the knee lacks active extension, but ankle motion is intact. What is the most likely cause?

. Obturator nerve palsy due to excessive abduction
. Femoral nerve palsy due to excessive hyperflexion
. Sciatic nerve palsy due to excessive extension
. Common peroneal nerve palsy due to strap compression
. Avascular necrosis of the femoral head

Correct Answer & Explanation

. Femoral nerve palsy due to excessive hyperflexion

Explanation

Femoral nerve palsy is a known complication of the Pavlik harness, typically caused by excessive hyperflexion of the hips, which compresses the femoral nerve against the inguinal ligament. It presents with absent active knee extension. The harness should be adjusted or temporarily discontinued.

Question 594

Topic: Pediatric Hip

A 12-year-old boy presents with a left-sided Slipped Capital Femoral Epiphysis (SCFE) and undergoes in situ pinning. Prophylactic pinning of the contralateral right hip is most strongly indicated in which of the following scenarios?

. The patient has an underlying endocrine disorder, such as hypothyroidism.
. The patient is classified as having a severe slip (>50 degrees) on the left.
. The patient is an obese male with no other comorbidities.
. The patient is older than 14 years of age at presentation.
. The slip is acute rather than chronic.

Correct Answer & Explanation

. The patient has an underlying endocrine disorder, such as hypothyroidism.

Explanation

Prophylactic pinning of the contralateral hip in SCFE is highly controversial but is strongly indicated in patients with a high risk of bilateral disease. The highest risk group includes patients with endocrine disorders (e.g., hypothyroidism, renal osteodystrophy, growth hormone deficiency) or those undergoing prior radiation therapy, as the risk of contralateral slip can approach 100%. Age < 10 or > 16 is also higher risk, but endocrine disorder is the strongest absolute indication.

Question 595

Topic: Pediatric Hip

An infant with developmental dysplasia of the hip (DDH) is placed in a Pavlik harness. Hyperflexion of the hips beyond 120 degrees in the harness is most commonly associated with which of the following complications?

. Avascular necrosis of the femoral head
. Inferior dislocation of the hip
. Femoral nerve palsy
. Obturator nerve palsy
. Sciatic nerve palsy

Correct Answer & Explanation

. Femoral nerve palsy

Explanation

Hyperflexion of the hip in a Pavlik harness risks compression of the femoral nerve against the inguinal ligament, leading to femoral nerve palsy. Excessive abduction, on the other hand, significantly increases the risk of avascular necrosis of the femoral head.

Question 596

Topic: Pediatric Hip

Prophylactic pinning of the contralateral asymptomatic hip in a patient with a unilateral Slipped Capital Femoral Epiphysis (SCFE) is most strongly indicated in which of the following scenarios?

. A 13-year-old obese male with an acute-on-chronic slip
. A 12-year-old female with a mild idiopathic slip
. A 14-year-old male with a history of minor hip trauma
. A 9-year-old male with panhypopituitarism and a slip angle of 40 degrees
. A 15-year-old athlete with a stable unilateral slip

Correct Answer & Explanation

. A 9-year-old male with panhypopituitarism and a slip angle of 40 degrees

Explanation

Prophylactic pinning of the contralateral hip is indicated in patients at high risk for a subsequent contralateral slip. Risk factors include underlying endocrine disorders (e.g., panhypopituitarism, hypothyroidism, renal osteodystrophy), prior radiation therapy, and atypical age of presentation (younger than 10 or older than 16 years).

Question 597

Topic: Pediatric Hip

An 11-year-old girl with renal osteodystrophy presents with a symptomatic left slipped capital femoral epiphysis (SCFE). Radiographs confirm a moderate slipped epiphysis on the left. The right hip is currently asymptomatic and radiographically normal. What is the most appropriate management of the right hip?

. Observation with clinical follow-up every 6 months
. Prophylactic in situ pinning
. Bilateral spica cast application
. MRI of the right hip to rule out pre-slip
. Wait for closure of the triradiate cartilage before intervening

Correct Answer & Explanation

. Prophylactic in situ pinning

Explanation

Prophylactic pinning of the contralateral asymptomatic hip is highly recommended in patients with endocrine or metabolic disorders (e.g., hypothyroidism, renal osteodystrophy) and those who have undergone previous pelvic radiation, due to an exceedingly high risk (approaching 50-100%) of developing a subsequent slip.

Question 598

Topic: Pediatric Hip

An 18-month-old girl presents with a painless limp. Examination reveals a positive Galeazzi sign and asymmetric thigh folds. Radiographs confirm a completely dislocated left hip with an acetabular index of 38 degrees. What is the most appropriate next step in management?

. Pavlik harness application
. Closed reduction and spica casting
. Open reduction, pelvic osteotomy, and spica casting
. Observation until age 3, then varus derotational osteotomy
. Abduction bracing for 6 months

Correct Answer & Explanation

. Open reduction, pelvic osteotomy, and spica casting

Explanation

In a child aged 18 months or older with Developmental Dysplasia of the Hip (DDH), conservative measures usually fail. Because there is significant acetabular dysplasia (acetabular index of 38 degrees), open reduction combined with a pelvic osteotomy (e.g., Salter or Pemberton) is necessary to improve anterolateral coverage, followed by spica casting.

Question 599

Topic: Pediatric Hip

A 12-year-old girl is diagnosed with a unilateral slipped capital femoral epiphysis (SCFE) of the left hip. The parents inquire about the risk to the contralateral, currently asymptomatic right hip. Which of the following patient factors is the strongest predictor of a future contralateral slip and represents the best indication for prophylactic in-situ pinning?

. Female gender
. Open triradiate cartilage
. Presentation with acute-on-chronic SCFE
. Obesity (BMI > 95th percentile)
. Patient age older than 14 years

Correct Answer & Explanation

. Open triradiate cartilage

Explanation

The risk of developing a contralateral SCFE is closely linked to skeletal immaturity. An open triradiate cartilage is a well-established and powerful radiographic marker of significant remaining skeletal growth and is one of the strongest predictors for the development of a subsequent contralateral slip. A modified Oxford Bone Age score can also be utilized. While obesity is a risk factor for initial SCFE, bone age/skeletal maturity (e.g., open triradiate cartilage) is the specific metric most heavily weighed when deciding on prophylactic pinning.

Question 600

Topic: Pediatric Hip

Which of the following patients diagnosed with a unilateral slipped capital femoral epiphysis (SCFE) is most strongly indicated for prophylactic in situ pinning of the contralateral asymptomatic hip?

. A 12-year-old boy with a BMI in the 85th percentile
. A 10-year-old boy with primary hypothyroidism
. A 14-year-old boy with a positive family history of SCFE
. A 13-year-old girl with an acute-on-chronic SCFE
. A 15-year-old boy with a posterior sloping angle of 10 degrees

Correct Answer & Explanation

. A 10-year-old boy with primary hypothyroidism

Explanation

Prophylactic pinning of the contralateral hip in SCFE is highly recommended for patients with underlying endocrine disorders (e.g., hypothyroidism, renal osteodystrophy, growth hormone deficiency) and for patients presenting at a very young age (males <12 years, females <10 years). These patients have a significantly increased risk of developing bilateral disease.

Test Yourself

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

On this Page