Pediatric Hip MCQs

An 11-year-old boy presents with a unilateral stable slipped capital femoral epiphysis (SCFE). His medical history is significant for panhypopituitarism, for which he receives growth hormone replacement. After treating the affected hip, what is the most appropriate management for the asymptomatic contralateral hip?

A 14-month-old girl presents with a painless limp since she began walking. Radiographs demonstrate a dislocated left hip. On the AP pelvis radiograph, displacement of the femoral head lateral to which of the following radiographic lines indicates abnormal lateralization?

A 12-year-old boy with a BMI in the 98th percentile presents with a 3-month history of ill-defined knee pain. The knee examination is unremarkable, but the affected hip exhibits obligate external rotation during passive flexion. Which radiographic finding on the AP pelvis is most characteristic of this condition?

A 2-year-old girl with neglected developmental dysplasia of the hip is scheduled for an open reduction via an anterior (Smith-Petersen) approach. Which of the following structures is NOT considered a primary anatomic obstacle to reduction in this condition?

A 14-year-old girl is 6 months post-operative from in situ pinning of a stable slipped capital femoral epiphysis (SCFE). She now presents with a stiff, painful hip. Examination reveals significant global restriction of range of motion. Radiographs demonstrate severe joint space narrowing, but the hardware is well-seated without joint penetration. What is the most likely diagnosis?

A 4-week-old female infant, born breech, has a normal clinical hip examination. A screening ultrasound reveals an alpha angle of 45 degrees and a beta angle of 65 degrees. Based on the Graf classification, what is the most appropriate next step in management?

A 9-month-old infant is undergoing a closed reduction and spica casting for developmental dysplasia of the hip (DDH). Intraoperatively, the surgeon establishes Ramsey's "safe zone" to minimize the risk of complications. This safe zone is defined by the arc of motion between the angle of maximum abduction and the angle of:

A 13-year-old obese boy presents with severe left hip pain and inability to bear weight after a minor fall 2 days ago. Radiographs show a posterior and inferior displacement of the proximal femoral epiphysis. According to the Loder classification, what is the primary determinant of a poor prognosis in this patient?

A 12-year-old boy with chronic renal failure presents with a stable right slipped capital femoral epiphysis (SCFE). Which of the following is the strongest indication for prophylactic pinning of the contralateral, asymptomatic hip in this patient?

A 14-year-old boy complains of vague right knee pain for 3 months. Hip examination reveals that as the right hip is passively flexed, it obligately moves into external rotation and abduction. This clinical finding is most consistent with which of the following diagnoses?

A 15-year-old boy is evaluated for worsening hip stiffness and pain 6 months after in situ pinning of a slipped capital femoral epiphysis (SCFE). Radiographs reveal concentric narrowing of the hip joint space to less than 3 mm and subchondral sclerosis. What is the most likely cause of these findings?

A newborn girl with arthrogryposis multiplex congenita is found to have bilateral rigid, high-riding hip dislocations. Unlike typical developmental dysplasia of the hip (DDH), what is the most appropriate initial management for her hip pathology?

A 12-year-old boy presents with an acute, unstable slipped capital femoral epiphysis (SCFE). The surgeon is planning surgical fixation. Which of the following maneuvers is strictly contraindicated during the surgical positioning and fixation of this patient?

During a closed reduction of a developmental dysplasia of the hip (DDH) under general anesthesia, an arthrogram is performed. The hip reduces in flexion and abduction but re-dislocates when adducted past 40 degrees of abduction. The hip cannot be safely abducted past 55 degrees due to significant adductor tension. Which of the following best describes this situation?

A 6-week-old female infant is currently being treated with a Pavlik harness for Developmental Dysplasia of the Hip (DDH). At her 2-week follow-up, the ultrasound reveals that the left hip remains dislocated. During the physical examination, you note that she has an absent patellar reflex on the left side and decreased spontaneous extension of the left knee. What is the most appropriate next step in management?

During an open reduction of a late-presenting Developmental Dysplasia of the Hip (DDH) via a medial (Ludloff) approach, several anatomical structures blocking reduction can be accessed. Which of the following pathological obstacles to reduction CANNOT be adequately addressed through this approach?

A 4-week-old female infant with a breech presentation history is referred for a developmental dysplasia of the hip (DDH) ultrasound. When obtaining a standard Graf coronal view, the sonographer must ensure a standard plane is captured. Which bony landmark must be clearly visualized to confirm a true standard coronal view?

A 3-month-old female infant is being treated with a Pavlik harness for developmental dysplasia of the hip (DDH). During her 2-week follow-up, the parents report she has stopped kicking her left leg. On examination, there is an absence of active knee extension on the left, but she flexes the hip and moves the toes spontaneously. What is the most appropriate next step in management?

A 24-month-old girl presents with a painless limp. Examination demonstrates a positive Trendelenburg sign on the left.

Radiographs confirm a dislocated left hip with a false acetabulum and severe acetabular dysplasia. What is the most appropriate initial treatment?

A 10-year-old boy presents with a stable slipped capital femoral epiphysis (SCFE) of the right hip. Under which of the following conditions is prophylactic pinning of the contralateral, asymptomatic hip most strongly indicated?