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Pediatric Hip MCQs

Practice Set 60 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 1181

Topic: Pediatric Hip

A 28-year-old female presents with anterior groin pain that is exacerbated by sitting in a low chair. An AP pelvis radiograph is obtained.

The radiograph demonstrates the anterior rim of the acetabulum crossing over the posterior rim in the superior aspect of the joint. This specific radiographic finding is most strongly associated with which of the following pathomorphologies?

. Coxa profunda
. Cam-type femoroacetabular impingement
. Acetabular retroversion
. Excessive femoral anteversion
. Developmental dysplasia of the hip (DDH)

Correct Answer & Explanation

. Acetabular retroversion

Explanation

The finding described is the 'crossover sign,' which is the hallmark radiographic indicator of acetabular retroversion. In a normal acetabulum (anteverted), the anterior rim line lies medial to the posterior rim line. When the anterior rim crosses lateral to the posterior rim, it indicates focal or global retroversion, leading to anterior overcoverage and pincer-type femoroacetabular impingement.

Question 1182

Topic: Pediatric Hip

A 12-year-old obese male presents with an unstable left slipped capital femoral epiphysis (SCFE). Which of the following is an absolute indication for prophylactic pinning of the contralateral hip?

. Obesity (BMI > 95th percentile)
. Age less than 10 years at presentation
. Endocrine disorder such as hypothyroidism
. Family history of SCFE
. Male sex

Correct Answer & Explanation

. Endocrine disorder such as hypothyroidism

Explanation

Prophylactic pinning of the contralateral hip is strongly indicated in patients with underlying endocrine or metabolic disorders (e.g., hypothyroidism). These conditions carry an extremely high risk of bilateral involvement.

Question 1183

Topic: Pediatric Hip

On a pelvic radiograph of a 6-month-old female with developmental dysplasia of the hip, the proximal femoral metaphysis is located superior to Hilgenreiner's line and lateral to Perkin's line. What is the interpretation of Shenton's line in this patient?

. It will be continuous and intact
. It will be broken
. It evaluates the anterior-posterior displacement
. It is formed by the superior border of the obturator foramen and the lateral border of the ilium
. It is only visible on a frog-leg lateral view

Correct Answer & Explanation

. It will be broken

Explanation

Shenton's line is a radiographic arc drawn along the inferior border of the superior pubic ramus and the medial border of the proximal femur. In a dislocated hip, Shenton's line is disrupted or broken.

Question 1184

Topic: Pediatric Hip
A 7-year-old boy is diagnosed with Legg-Calvé-Perthes disease. According to the Herring classification, he has >50% loss of height of the lateral pillar. What is his Herring classification and corresponding prognosis?
. Herring Group A; Excellent prognosis
. Herring Group B; Good prognosis with containment
. Herring Group C; Poor prognosis, high risk of aspherical head
. Herring Group B/C; Intermediate prognosis
. Herring Group D; Severely delayed bone age

Correct Answer & Explanation

. Herring Group C; Poor prognosis, high risk of aspherical head

Explanation

The Herring classification assesses the remaining height of the lateral pillar of the femoral head. Group C indicates >50% loss of lateral pillar height and carries a poor prognosis, frequently resulting in an aspherical head.

Question 1185

Topic: Pediatric Hip

A 12-year-old obese boy is diagnosed with a severe, chronic slipped capital femoral epiphysis (SCFE) on the left side. What is the primary indication for prophylactic in situ pinning of the contralateral asymptomatic hip?

. Body mass index > 95th percentile
. Open triradiate cartilage
. Southwick slip angle > 50 degrees on the affected side
. Presence of underlying endocrine disorder
. Age < 10 years

Correct Answer & Explanation

. Presence of underlying endocrine disorder

Explanation

The presence of an underlying endocrine disorder (e.g., hypothyroidism) or renal failure is an absolute indication for prophylactic pinning of the contralateral hip in SCFE due to the high risk of bilateral involvement.

Question 1186

Topic: Pediatric Hip

Which of the following conditions is considered an absolute contraindication to metal-on-metal hip resurfacing arthroplasty?

. Male gender
. End-stage osteoarthritis
. Chronic renal failure
. Body mass index > 35
. History of Legg-Calve-Perthes disease

Correct Answer & Explanation

. Chronic renal failure

Explanation

Hip resurfacing utilizes metal-on-metal bearings which release cobalt and chromium ions. Chronic renal failure is an absolute contraindication because these metal ions are primarily excreted by the kidneys, risking severe systemic toxicity.

Question 1187

Topic: Pediatric Hip

A 4-month-old infant with developmental dysplasia of the hip (DDH) is being treated with a Pavlik harness. The parents incorrectly tighten the anterior straps, resulting in hyperflexion of the hips beyond 120 degrees. This positioning most significantly increases the risk of which complication?

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

Correct Answer & Explanation

. Femoral nerve palsy

Explanation

Hyperflexion of the hips in a Pavlik harness can severely compress the femoral nerve against the inguinal ligament, leading to a transient femoral nerve palsy. Excessive abduction, conversely, is the primary risk factor for avascular necrosis of the femoral head.

Question 1188

Topic: Pediatric Hip

In a child diagnosed with Legg-Calve-Perthes disease, which of the following is clinically recognized as the most important prognostic factor for long-term hip joint survival?

. Gender of the patient
. Age at the onset of symptoms
. Family history of the disease
. Patient's body mass index
. Sidedness of hip involvement

Correct Answer & Explanation

. Age at the onset of symptoms

Explanation

Age at the onset of symptoms is the most significant prognostic factor in Legg-Calve-Perthes disease. Children who develop the condition before the age of 6 to 8 years have a significantly better prognosis due to a greater remaining potential for biological remodeling.

Question 1189

Topic: Pediatric Hip

Prophylactic pinning of the contralateral, asymptomatic hip is most strongly indicated in a patient with a slipped capital femoral epiphysis (SCFE) who presents with which of the following concurrent conditions?

. Body mass index greater than the 95th percentile
. An underlying endocrine disorder such as hypothyroidism
. Age greater than 14 years at presentation
. African American descent
. Male gender

Correct Answer & Explanation

. An underlying endocrine disorder such as hypothyroidism

Explanation

Prophylactic pinning of the contralateral hip is highly recommended in patients with SCFE associated with an underlying endocrine disorder or metabolic condition (e.g., hypothyroidism, renal osteodystrophy). These patients have an exceptionally high risk of developing bilateral disease.

Question 1190

Topic: Pediatric Hip

In a 12-year-old boy undergoing in situ pinning for a slipped capital femoral epiphysis (SCFE), the surgeon must avoid the terminal branches of the medial femoral circumflex artery. These crucial retinacular vessels typically penetrate the proximal femur at which anatomic location?

. Inferomedial aspect of the femoral neck
. Posterosuperior aspect of the femoral neck
. Anterolateral aspect of the femoral neck
. Ligamentum teres
. Lesser trochanter

Correct Answer & Explanation

. Posterosuperior aspect of the femoral neck

Explanation

The primary blood supply to the femoral head comes from the lateral epiphyseal artery, a terminal branch of the medial femoral circumflex artery. These vessels penetrate the capsule and enter the bone at the posterosuperior aspect of the femoral neck.

Question 1191

Topic: Pediatric Hip
A 26-year-old male hockey player presents with chronic groin pain exacerbated by hip flexion and internal rotation. Radiographs reveal a prominent alpha angle of 75 degrees on the modified Dunn view. This radiographic finding is characteristic of which pathology?
. Pincer impingement
. Cam impingement
. Acetabular dysplasia
. Slipped capital femoral epiphysis
. Legg-Calvé-Perthes disease

Correct Answer & Explanation

. Cam impingement

Explanation

An increased alpha angle (typically >50-55 degrees) indicates an aspherical femoral head-neck junction. This is the anatomical hallmark of Cam-type femoroacetabular impingement (FAI).

Question 1192

Topic: Pediatric Hip

A 13-year-old boy presents with severe groin pain and inability to bear weight on his right leg after a minor fall 2 days ago. Radiographs reveal an unstable slipped capital femoral epiphysis (SCFE). To minimize the risk of avascular necrosis, what is the most appropriate management?

. Immediate closed reduction and spica casting.
. Delayed in situ single-screw fixation to allow swelling to subside.
. Urgent joint decompression and single-screw fixation.
. Skeletal traction for 2 weeks followed by percutaneous pinning.
. Multiple-pass pinning across the physis to ensure maximal stability.

Correct Answer & Explanation

. Urgent joint decompression and single-screw fixation.

Explanation

Unstable SCFE (inability to bear weight) carries a high risk of avascular necrosis. Current evidence supports urgent stabilization with joint capsulotomy (decompression) or an open reduction via a modified Dunn approach to relieve intracapsular pressure and preserve blood supply.

Question 1193

Topic: Pediatric Hip
An 8-year-old boy presents with a painless limp and is diagnosed with Legg-Calvé-Perthes disease. Radiographs reveal that the lateral pillar of the femoral head is maintained at 60% of its normal height. According to the Herring classification, what is his group and recommended management?
. Group A; observation and symptomatic management.
. Group B; surgical containment is recommended given his age.
. Group C; surgical containment is recommended regardless of age.
. Group C; observation, as surgical outcomes are poor.
. Group B/C border; physical therapy and non-weight-bearing bracing.

Correct Answer & Explanation

. Group B; surgical containment is recommended given his age.

Explanation

A lateral pillar height of 60% places the patient in Herring Group B (50-100% maintenance). For children 8 years and older at the time of onset, Group B hips show significantly better outcomes with surgical containment compared to conservative management.

Question 1194

Topic: Pediatric Hip

A 4-week-old girl is being treated with a Pavlik harness for developmental dysplasia of the left hip. At her 2-week follow-up, she is noted to have decreased active extension of the left knee and an absent patellar reflex. What is the most likely cause of this finding?

. Avascular necrosis of the femoral head.
. Femoral nerve palsy from excessive hip flexion.
. Sciatic nerve palsy from excessive hip extension.
. Obturator nerve palsy from excessive hip abduction.
. Iatrogenic septic arthritis.

Correct Answer & Explanation

. Femoral nerve palsy from excessive hip flexion.

Explanation

Femoral nerve palsy is a known complication of the Pavlik harness, typically caused by hyperflexion of the hip compressing the nerve against the inguinal ligament. Management involves temporary removal or loosening of the anterior straps.

Question 1195

Topic: Pediatric Hip

A 12-year-old obese boy presents with acute left hip pain and inability to bear weight after a minor fall. Radiographs show a severe slipped capital femoral epiphysis. He is unable to walk even with crutches. What is the most significant complication associated with this specific presentation compared to a patient who can bear weight?

. Chondrolysis
. Avascular necrosis
. Premature osteoarthritis
. Limb length discrepancy
. Infection

Correct Answer & Explanation

. Avascular necrosis

Explanation

An unstable SCFE is defined by the inability to bear weight. This presentation carries a significantly higher risk of avascular necrosis (up to 47%) compared to stable SCFE.

Question 1196

Topic: Pediatric Hip

A 6-week-old infant is being treated with a Pavlik harness for a dislocated left hip. After 4 weeks of strict full-time wear, ultrasound shows the hip remains persistently dislocated. What is the most severe complication of continuing the Pavlik harness in this scenario?

. Avascular necrosis of the femoral head
. Femoral nerve palsy
. Acetabular dysplasia
. Posterior acetabular wall damage
. Knee flexion contracture

Correct Answer & Explanation

. Posterior acetabular wall damage

Explanation

Prolonged use of a Pavlik harness in a persistently dislocated hip causes posterior acetabular wear ('Pavlik disease'). The harness should be discontinued after 3 to 4 weeks if reduction is not achieved.

Question 1197

Topic: Pediatric Hip
Which of the following is the most significant risk factor for a poor clinical outcome in Legg-Calvé-Perthes disease?
. Male gender
. Obesity
. Age at onset greater than 8 years
. Bilateral involvement
. Delayed bone age

Correct Answer & Explanation

. Age at onset greater than 8 years

Explanation

Age at onset is the single most important prognostic factor in Legg-Calvé-Perthes disease. Children older than 8 years have less remodeling potential and a higher risk of early osteoarthritis.

Question 1198

Topic: Pediatric Hip

A 12-year-old boy with a BMI in the 95th percentile undergoes in situ pinning of a left stable slipped capital femoral epiphysis (SCFE). Which of the following is the strongest clinical or radiographic predictor for determining the risk of a contralateral slip, warranting prophylactic pinning?

. Initial slip angle greater than 50 degrees
. Modified Oxford bone age corresponding to open triradiate cartilage
. Male sex and African American descent
. A decreased femoral neck-shaft angle (coxa vara)
. Duration of symptoms greater than 6 months prior to presentation

Correct Answer & Explanation

. Modified Oxford bone age corresponding to open triradiate cartilage

Explanation

The status of the triradiate cartilage (modified Oxford bone age) is the strongest predictor of bilateral SCFE. Patients with an open triradiate cartilage or younger chronological age (typically <10 years) are at the highest risk for developing a contralateral slip.

Question 1199

Topic: Pediatric Hip

A 5-week-old female with an irreducible developmental dysplasia of the hip (DDH) is treated with a Pavlik harness. At her 3-week ultrasound follow-up, the hip remains dislocated. What is the most appropriate next step in management?

. Continue the Pavlik harness for an additional 3 weeks
. Add a secondary abduction brace over the Pavlik harness
. Discontinue the Pavlik harness and perform a closed reduction and spica casting
. Immediate open reduction and capsulorrhaphy
. Administer Botulinum toxin to the hip adductors and resume the Pavlik harness

Correct Answer & Explanation

. Discontinue the Pavlik harness and perform a closed reduction and spica casting

Explanation

Failure to achieve reduction in a Pavlik harness after 3 to 4 weeks is an indication to abandon the harness to prevent 'Pavlik disease' (acetabular erosion) and transition to a closed reduction and spica casting, or alternatively, trial a rigid abduction orthosis.

Question 1200

Topic: Pediatric Hip

An 11-year-old girl with primary hypothyroidism presents with unilateral groin pain and a limp. Radiographs demonstrate a mild slipped capital femoral epiphysis (SCFE) of the symptomatic hip. What is the most appropriate management?

. Observe and prescribe non-weight-bearing with crutches
. In situ pinning of the symptomatic hip only
. In situ pinning of the symptomatic hip and prophylactic pinning of the contralateral hip
. Spica casting
. Open reduction and internal fixation of the symptomatic hip

Correct Answer & Explanation

. In situ pinning of the symptomatic hip and prophylactic pinning of the contralateral hip

Explanation

Patients with endocrine disorders, such as hypothyroidism, have a significantly higher risk of bilateral SCFE. Prophylactic pinning of the contralateral asymptomatic hip is strongly indicated to prevent subsequent displacement.

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