4. Pediatrics MCQs

A 6-month-old girl presents for follow-up of a dislocated left hip. She had been treated with a Pavlik harness for 6 weeks starting at 1 month of age, which failed to reduce the hip.

What is the next most appropriate step in management?

An 8-year-old boy presents with a 2-month history of right hip pain and a limp. Radiographs demonstrate fragmentation of the capital femoral epiphysis with lateral subluxation consistent with Legg-Calvé-Perthes disease. Which of the following is considered the most significant prognostic factor for long-term hip outcome in this patient?

A 12-year-old boy with a BMI of 32 presents with severe left hip pain and inability to bear weight after a minor fall. Radiographs show an acute-on-chronic slipped capital femoral epiphysis (SCFE). During discussion of treatment, prophylactic pinning of the contralateral hip is considered. In which of the following scenarios is prophylactic pinning of the contralateral hip most strongly indicated?

An 8-year-old boy with spastic quadriplegic cerebral palsy (GMFCS Level V) is evaluated for hip surveillance. His migration percentage on an AP pelvis radiograph is 45% bilaterally. He has no pain, but hip abduction is limited to 20 degrees bilaterally. What is the most appropriate management?

A 2.5-year-old obese boy presents with progressive left-sided genu varum.

Radiographs demonstrate a metaphyseal-diaphyseal angle (MDA) of 18 degrees with early medial metaphyseal beaking. What is the most appropriate initial management?

A 2-year-old boy who was successfully treated for idiopathic right clubfoot with the Ponseti method presents with a recurrent deformity. Examination shows dynamic supination of the foot during the swing phase of gait and fixed equinus of 10 degrees. The parents report poor compliance with the abduction brace. What is the most appropriate surgical management?

A 14-year-old boy sustains an ankle injury while playing soccer.

Radiographs and a CT scan reveal a displaced Salter-Harris III fracture of the anterolateral distal tibia with a 3 mm articular step-off. Which of the following best describes the pathomechanics of this specific fracture pattern?

A 13-year-old girl presents with left ankle pain and swelling following a twisting injury while playing soccer.

Radiographs reveal a Salter-Harris III fracture of the anterolateral aspect of the distal tibial epiphysis. What is the primary deforming force and associated anatomical structure responsible for this specific fracture pattern?

A 6-year-old boy sustains a severe extension-type supracondylar humerus fracture. On initial presentation, his hand is pale and pulseless.

He is immediately taken to the operating room. After successful closed reduction and percutaneous pinning, the hand remains pale and pulseless. A warming blanket is applied and the arm is slightly lowered, but there is no improvement after 15 minutes. What is the most appropriate next step in management?

An 8-year-old boy presents with a painless limp that has progressively worsened over the past 3 months.

Radiographs confirm Legg-Calvé-Perthes disease in the fragmentation stage. The surgeon classifies the hip using the Herring Lateral Pillar classification. According to this system, which of the following radiographic criteria defines a Lateral Pillar Type B?

A 12-year-old boy with a BMI in the 99th percentile presents to the emergency department with acute severe left groin pain after a minor slip.

He refuses to bear weight on the left leg, even with the assistance of crutches. Radiographs demonstrate a slipped capital femoral epiphysis (SCFE). According to the Loder classification, this clinical presentation is associated with a significantly increased risk of which of the following complications?

A 4-year-old boy presents for follow-up of a right idiopathic clubfoot that was treated in infancy with the Ponseti method.

His parents report he walks with a persistent inward turn of the foot. Examination reveals correctable forefoot adductus, a neutral hindfoot, and dynamic supination of the foot during the swing phase of gait. What is the most appropriate next step in management?

A 2-year-old girl is undergoing an open reduction for developmental dysplasia of the hip (DDH) via a medial approach.

The surgeon encounters several obstacles preventing concentric reduction of the femoral head into the true acetabulum. Which of the following structures is considered an extracapsular obstacle to reduction?

A 7-year-old child with a known mutation in the COL1A1 gene presents with worsening anterolateral bowing of both femurs and a history of four prior low-energy femoral fractures.

The family requests a durable surgical solution to prevent future fractures and correct the deformity. Which of the following is considered the gold-standard surgical technique for this patient?

A 15-year-old boy presents with progressive bowing of his left lower extremity, a waddling gait, and medial knee pain. His body mass index is 38. Standing full-length radiographs reveal a severe varus deformity of the proximal tibia, internal tibial torsion, and a procurvatum deformity. The mechanical axis falls medial to the medial compartment of the knee. What is the most appropriate definitive management for this patient?

A 12-year-old boy is brought to the emergency department unable to bear weight on his right leg after a minor slip. He reports a 4-week history of dull, intermittent right thigh pain prior to the fall. Anteroposterior and frog-leg lateral radiographs demonstrate a severe right slipped capital femoral epiphysis (SCFE). Which of the following approaches is most strongly supported by recent literature to minimize the risk of avascular necrosis (AVN) in this unstable slip?

A 6-week-old female infant is undergoing treatment with a Pavlik harness for developmental dysplasia of the left hip (DDH). At the routine two-week follow-up, the mother notes that the infant is no longer actively kicking her left leg. On examination, the infant cries with passive movement, lacks active extension of the left knee, but retains normal toe and ankle movements. The patellar reflex is absent on the left. What is the most appropriate next step in management?

A 6-year-old boy sustains a completely displaced, extension-type supracondylar fracture of the humerus. On initial evaluation, the hand is pink but the radial pulse is absent. He is taken emergently to the operating room, where a closed reduction and percutaneous pinning are successfully performed. Postoperatively, the fracture alignment is excellent, the hand remains warm with a capillary refill of less than 2 seconds, and oxygen saturation on the index finger is 99%; however, the radial pulse remains non-palpable. What is the most appropriate next step in management?

A 3-year-old boy presents with a relapsed right idiopathic clubfoot. He was initially treated successfully with the Ponseti method, including an Achilles tenotomy. He now walks with a dynamic supination of the foot during the swing phase of gait and has a fixed varus deformity of the hindfoot. Passive correction of the hindfoot is not possible. What is the most appropriate next step in management?

A 4-year-old girl with spastic quadriplegic cerebral palsy is evaluated in the orthopedic clinic. She is entirely dependent for mobility and utilizes a custom manual wheelchair for transport. She is classified as Gross Motor Function Classification System (GMFCS) Level V. Based on current hip surveillance guidelines, what is her approximate lifetime risk of developing hip displacement (migration percentage >30%), and what is the recommended frequency for radiographic screening?