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Pediatric Hip MCQs

Practice Set 78 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 1541

Topic: Pediatric Hip

A 13-year-old boy undergoes in situ single-screw pinning for a stable Slipped Capital Femoral Epiphysis (SCFE). Six months later, he develops progressive loss of hip motion, severe pain, and marked joint space narrowing on radiographs. What is the most likely diagnosis?

. Osteonecrosis of the femoral head
. Chondrolysis
. Implant failure
. Deep surgical site infection
. Femoroacetabular impingement

Correct Answer & Explanation

. Osteonecrosis of the femoral head

Explanation

Chondrolysis is a severe complication of SCFE characterized by acute cartilage necrosis and profound joint space narrowing. It is strongly associated with unrecognized pin penetration into the hip joint during fixation.

Question 1542

Topic: Pediatric Hip

A 32-year-old female presents with symptomatic developmental dysplasia of the hip. Radiographs demonstrate an open triradiate cartilage, a lateral center-edge angle of 15 degrees, and minimal osteoarthritis (Toennis grade 1). Which pelvic osteotomy is most appropriate?

. Salter osteotomy
. Pemberton osteotomy
. Chiari osteotomy
. Bernese periacetabular osteotomy (PAO)
. Shelf arthroplasty

Correct Answer & Explanation

. Salter osteotomy

Explanation

The Bernese Periacetabular Osteotomy (PAO) is the treatment of choice for symptomatic adult DDH with closed triradiate cartilage and minimal osteoarthritis. It allows extensive multiplanar correction while preserving the posterior column.

Question 1543

Topic: Pediatric Hip
A 12-year-old boy with Legg-Calvรฉ-Perthes disease presents in the fragmentation stage. Radiographs reveal >50% collapse of the lateral pillar (Herring Lateral Pillar Type C). What is the expected outcome and recommended treatment approach?
. Excellent outcome with observation only
. Good outcome with abduction bracing
. Poor outcome regardless of surgical containment
. Excellent outcome with immediate hip arthroscopy
. Spontaneous resolution with minimal residual deformity

Correct Answer & Explanation

. Poor outcome regardless of surgical containment

Explanation

Lateral Pillar Type C (>50% collapse) in an older child (>8 years of age) carries a poor prognosis. Studies have shown that surgical containment in this specific high-risk group yields little clinical or radiographic improvement compared to non-operative treatment.

Question 1544

Topic: Pediatric Hip

A 4-month-old infant is being treated with a Pavlik harness for developmental dysplasia of the hip (DDH). At a follow-up visit, the mother notes that the child is no longer kicking the affected leg. Examination reveals an inability to actively extend the knee. Which of the following is the most likely cause?

. Avascular necrosis of the femoral head
. Obturator nerve palsy
. Femoral nerve palsy
. Sciatic nerve palsy
. Ischemic contracture of the quadriceps

Correct Answer & Explanation

. Avascular necrosis of the femoral head

Explanation

Hyperflexion of the hip in a Pavlik harness can lead to compression and temporary paralysis of the femoral nerve. This typically resolves spontaneously once the harness is adjusted to reduce the degree of hip flexion or temporarily removed.

Question 1545

Topic: Pediatric Hip

An obese 13-year-old boy is diagnosed with a stable left slipped capital femoral epiphysis (SCFE). The surgeon is debating whether to prophylactically pin the contralateral, asymptomatic right hip. If prophylactic pinning is performed, which of the following is the most likely complication associated with this specific intervention?

. Avascular necrosis of the femoral head
. Chondrolysis
. Infection
. Subtrochanteric fracture
. Premature osteoarthritis

Correct Answer & Explanation

. Avascular necrosis of the femoral head

Explanation

Prophylactic pinning of the contralateral hip in SCFE is controversial due to procedural risks. The most significant specific risk of the pinning itself, particularly if the start point is below the lesser trochanter, is creating a stress riser that leads to a subtrochanteric femur fracture.

Question 1546

Topic: Pediatric Hip

In a 7-year-old boy diagnosed with Legg-Calve-Perthes disease, which of the following radiographic classifications is most prognostic for final hip outcome and guides surgical decision-making?

. Catterall classification
. Salter-Thompson classification
. Herring Lateral Pillar classification
. Waldenstrom stages
. Stulberg classification

Correct Answer & Explanation

. Catterall classification

Explanation

The Herring Lateral Pillar classification assesses the height of the lateral aspect of the capital femoral epiphysis during the fragmentation stage. It is the most reliable prognostic indicator for long-term hip sphericity.

Question 1547

Topic: Pediatric Hip

A 4-month-old infant is treated with a Pavlik harness for Developmental Dysplasia of the Hip (DDH). The mother notes that the child is no longer actively extending the knee on the treated side. What is the most likely cause?

. Sciatic nerve palsy from excessive flexion
. Obturator nerve palsy from excessive abduction
. Femoral nerve palsy from hyperflexion
. Ischemic necrosis of the femoral head
. Harness slippage causing knee subluxation

Correct Answer & Explanation

. Sciatic nerve palsy from excessive flexion

Explanation

Femoral nerve palsy is a known complication of the Pavlik harness, typically caused by excessive hip flexion pressing the nerve against the inguinal ligament. The harness must be removed or adjusted immediately to allow nerve recovery.

Question 1548

Topic: Pediatric Hip

A 12-year-old boy presents with a stable Slipped Capital Femoral Epiphysis (SCFE) of the left hip. Which of the following is an established indication for prophylactic pinning of the asymptomatic contralateral hip?

. Age greater than 14 years
. African American ethnicity
. Presence of an underlying endocrine disorder
. Body mass index (BMI) > 95th percentile
. Radiographic evidence of closure of the triradiate cartilage

Correct Answer & Explanation

. Age greater than 14 years

Explanation

Prophylactic pinning of the contralateral hip in SCFE is highly recommended for patients with endocrine disorders (e.g., hypothyroidism) or those presenting at a very young age (<10 years), as they have a significantly higher risk of bilateral involvement.

Question 1549

Topic: Pediatric Hip

A 12-year-old boy with renal osteodystrophy presents with a limp and hip pain. Radiographs confirm a unilateral slipped capital femoral epiphysis (SCFE). Which of the following is the most appropriate management regarding the contralateral hip?

. Observation with clinical follow-up
. Prophylactic in situ pinning
. Spica cast immobilization
. Bilateral proximal femoral osteotomies
. Observation with serial MRI

Correct Answer & Explanation

. Observation with clinical follow-up

Explanation

Prophylactic pinning of the contralateral hip is highly recommended in patients with endocrine or metabolic disorders (e.g., renal osteodystrophy, hypothyroidism) due to the high risk of bilateral SCFE. Routine prophylactic pinning in idiopathic cases remains controversial.

Question 1550

Topic: Pediatric Hip

A 2-year-old girl is diagnosed with developmental dysplasia of the hip (DDH) after presenting with a painless limp. Which of the following is the most appropriate definitive management?

. Application of a Pavlik harness
. Closed reduction and spica casting
. Open reduction with possible pelvic or femoral osteotomy
. Observation until age 4, then corrective osteotomy
. Botulinum toxin injection into the adductors

Correct Answer & Explanation

. Application of a Pavlik harness

Explanation

In children aged 18 months to 3 years with late-diagnosed DDH, open reduction is usually required, often supplemented with a pelvic osteotomy (e.g., Salter) or femoral shortening osteotomy. The Pavlik harness is indicated for infants under 6 months.

Question 1551

Topic: Pediatric Hip

A 12-year-old obese male presents with acute left groin pain and inability to bear weight after a minor fall. Radiographs demonstrate a slipped capital femoral epiphysis (SCFE). He is classified as having an unstable SCFE. What is the most common severe complication associated with this specific classification?

. Chondrolysis
. Femoroacetabular impingement
. Avascular necrosis (AVN)
. Premature physeal closure
. Osteoarthritis

Correct Answer & Explanation

. Chondrolysis

Explanation

By definition, an unstable SCFE is one in which the patient cannot bear weight even with crutches. This instability significantly increases the risk of disrupting the epiphyseal blood supply, leading to avascular necrosis rates as high as 50%.

Question 1552

Topic: Pediatric Hip

A 13-year-old overweight boy presents with a limp and vague knee pain. Upon physical examination, passive flexion of the affected hip results in obligate external rotation and abduction. What is this sign called, and what is the most likely diagnosis?

. Galeazzi sign; Developmental Dysplasia of the Hip
. Drehmann sign; Slipped Capital Femoral Epiphysis
. Trendelenburg sign; Legg-Calve-Perthes disease
. Stinchfield test; Femoroacetabular Impingement
. Ober test; Iliotibial Band Syndrome

Correct Answer & Explanation

. Galeazzi sign; Developmental Dysplasia of the Hip

Explanation

The Drehmann sign is the obligate external rotation and abduction of the hip during passive flexion, classically seen in Slipped Capital Femoral Epiphysis (SCFE) due to the altered biomechanics from the posterior and inferior slip of the proximal femoral epiphysis.

Question 1553

Topic: Pediatric Hip

A newborn female undergoes screening for Developmental Dysplasia of the Hip (DDH). The examiner adducts the hip while applying posterior force, resulting in a palpable clunk as the hip dislocates. Which test was performed, and what does it establish?

. Ortolani maneuver; confirms the hip is dislocated but reducible
. Ortolani maneuver; confirms the hip is dislocatable
. Barlow maneuver; confirms the hip is dislocated but reducible
. Barlow maneuver; confirms the hip is dislocatable
. Galeazzi test; confirms apparent leg length discrepancy

Correct Answer & Explanation

. Ortolani maneuver; confirms the hip is dislocated but reducible

Explanation

The Barlow maneuver attempts to dislocate a reduced hip by adduction and posterior pressure (assessing if it is 'dislocatable'). The Ortolani maneuver reduces an already dislocated hip by abduction and anterior pressure (assessing if it is 'reducible').

Question 1554

Topic: Pediatric Hip

A 13-year-old obese male presents with a slipped capital femoral epiphysis (SCFE) of the left hip. He undergoes in situ percutaneous pinning. According to the modified Oxford bone age score, which of the following is the strongest indication for prophylactic pinning of the asymptomatic right hip?

. Modified Oxford score of 26
. Chronological age greater than 14 years
. Modified Oxford score of 16
. Presence of knee pain rather than hip pain
. Male gender

Correct Answer & Explanation

. Modified Oxford score of 26

Explanation

The modified Oxford bone age score assesses skeletal maturity based on the pelvis and proximal femur. A score of 16 (the lowest score) indicates open triradiate cartilage and significant remaining growth potential. This strongly correlates with a high risk of developing a contralateral SCFE, making it a primary indication for prophylactic pinning.

Question 1555

Topic: Pediatric Hip

A 4-month-old female is diagnosed with Developmental Dysplasia of the Hip (DDH). She is currently being treated in a Pavlik harness. During a follow-up ultrasound, the alpha angle is measured. What does the alpha angle represent, and what is considered a normal value indicating a mature hip?

. The depth of the bony acetabular roof; normal is >60 degrees
. The coverage provided by the cartilaginous labrum; normal is <55 degrees
. The anterior inclination of the acetabulum; normal is >50 degrees
. The depth of the bony acetabular roof; normal is <43 degrees
. The amount of femoral head uncoverage; normal is >60 degrees

Correct Answer & Explanation

. The depth of the bony acetabular roof; normal is >60 degrees

Explanation

On a coronal infant hip ultrasound using the Graf method, the alpha angle measures the concavity and depth of the bony acetabular roof relative to the straight ilium. An alpha angle of greater than 60 degrees is considered normal (Type I hip). The beta angle relates to the cartilaginous roof.

Question 1556

Topic: Pediatric Hip

A 21-year-old collegiate wrestler suffers an anterior shoulder dislocation. An MRI arthrogram reveals an avulsion of the anterior labrum along with the anterior band of the inferior glenohumeral ligament (IGHL). The labrum remains attached to the intact periosteum, which is stripped medially down the glenoid neck. What is the eponym for this specific lesion?

. Bankart lesion
. ALPSA lesion
. Perthes lesion
. GLAD lesion
. HAGL lesion

Correct Answer & Explanation

. Bankart lesion

Explanation

A Perthes lesion is an avulsion of the anterior labrum and IGHL where the medial scapular periosteum remains intact but is stripped off the bone. Because it is non-displaced, it can heal in its anatomic position but remains patulous, often leading to a false-negative MRI if the joint is not adequately distended. An ALPSA involves medial displacement and 'rolling up' of the labrum.

Question 1557

Topic: Pediatric Hip

During a newborn examination, the pediatrician flexes the infant's hips and knees to 90 degrees. The examiner then gently abducts the hips while applying an anteriorly directed force on the greater trochanters. A palpable "clunk" is felt. What does this positive test indicate?

. Reduction of a dislocated hip
. Dislocation of a reduced hip
. Normal developing hip variant
. Femoral head epiphyseal slip
. Acetabular dysplasia without instability

Correct Answer & Explanation

. Reduction of a dislocated hip

Explanation

The Ortolani maneuver is an active reduction test for developmental dysplasia of the hip (DDH). The palpable clunk occurs as the subluxated or dislocated femoral head slips over the posterior acetabular rim and reduces into the acetabulum.

Question 1558

Topic: Pediatric Hip

An obese 13-year-old boy presents with right knee pain and a limp. During the physical examination of the hip in the supine position, the hip passively goes into obligatory external rotation as it is flexed. What is the most likely diagnosis based on this physical finding?

. Legg-Calve-Perthes disease
. Slipped capital femoral epiphysis
. Developmental dysplasia of the hip
. Transient synovitis
. Septic arthritis

Correct Answer & Explanation

. Legg-Calve-Perthes disease

Explanation

The Drehmann sign is the obligatory external rotation of the hip during passive flexion. This is a hallmark physical examination finding for Slipped Capital Femoral Epiphysis (SCFE) due to the altered geometry of the displaced proximal femur.

Question 1559

Topic: Pediatric Hip

A 12-year-old boy presents with an acute-on-chronic left slipped capital femoral epiphysis (SCFE). Which of the following is considered a definitive indication for prophylactic in situ pinning of the contralateral, currently asymptomatic right hip?

. Male gender
. Obesity with a BMI > 95th percentile
. Hypothyroidism
. Age greater than 14 years at presentation
. African-American descent

Correct Answer & Explanation

. Male gender

Explanation

Endocrine disorders, such as hypothyroidism or renal osteodystrophy, are established indications for prophylactic pinning of the contralateral hip in patients presenting with a unilateral SCFE due to the significantly higher risk of bilateral involvement. The other options are risk factors for SCFE but do not serve as absolute indications for prophylactic contralateral pinning.

Question 1560

Topic: Pediatric Hip

A 4-month-old female is being treated with a Pavlik harness for developmental dysplasia of the hip (DDH). At her follow-up appointment, she is noted to have decreased active extension of the left knee. The harness is removed. Which nerve is most likely compressed, and what is the primary cause?

. Sciatic nerve due to excessive abduction
. Obturator nerve due to excessive adduction
. Femoral nerve due to excessive flexion
. Lateral femoral cutaneous nerve due to poor strap padding
. Tibial nerve due to inadequate ankle positioning

Correct Answer & Explanation

. Sciatic nerve due to excessive abduction

Explanation

Femoral nerve palsy is the most common nerve palsy associated with Pavlik harness treatment and is caused by hyperflexion of the hip, causing the nerve to be compressed against the inguinal ligament. It clinically presents as a loss of active knee extension. Treatment involves immediate adjustment or temporary removal of the harness.

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