Question 1

A 10-year-old girl injured her neck (Slide) after falling and hitting her head. Recommended treatment includes:

Explanation

Orthopedic Prometric Exam Chapter 3 Image

The patient has an anterior compression fracture of C 7, which can be treated by cervicothoracic orthosis. Halo vest immobilization improves control of the head and upper cervical spine but is unnecessary treatment in this patients case. Although an anterior operation is an optional treatment for an anterior compression fracture, it is also unnecessary in this patientâ s case.

Question 2

Which of the following conditions is represented in the radiograph (Slide):

Explanation

This radiograph demonstrates a chance fracture. The posterior elements of the spine are separated, as indicated by the transverse fracture of the transverse processes, pedicles, and lamina. There is no significant element of rotation of the spine.

Question 3

A 15-year-old girl experienced an injury of L1 during a sledding accident (Slide). Her neurologic examination is normal. The best treatment is:

Explanation

This patient has a C hance fracture of L1, which is indicated by the compression of the anterior portion of L1 and the distraction of the posterior portion of L1. A hyperextension cast will not treat the patientâ s C hance fracture completely. Operative treatment is needed to remove residual kyphosis at the thoracolumbar junction. Posterior column compression will also likely reduce the presence of residual kyphosis. Posterior fusion of T12- L2 with pedicle screws results in the best angular correction for a patient with a C hance fracture of L1. T12-L1 with hooks is an optional treatment for patients with a C hance fracture of L1 because residual kyphosis may persist even if the inferior lamina of L1 is intact.

Question 4

Which of the following conditions is represented in this radiograph (Slide) of a childs neck:

Orthopedic Prometric Exam Chapter 3 Image

Explanation

This radiograph indicates a rotatory subluxation of a childâ s neck. Alteration of the cortical ring of the anterior atlas is present and superimposed on the lateral mass of atlas. Increased distance between the anterior atlas and axis is the result of rotation.

Question 5

Which of the following conditions is represented by this computed tomography scan of a cervical spine (Slide):

Explanation

Partial superimposition of C1 on C2 is present in this radiograph. C2 is the portion in the center of the frame. C1 and C 2 would normally be on different cuts of a scan but are superimposed because the atlas overlaps the axis as it falls forward. If an imaginary line is drawn between the vertebral foramena of C 1 and across the body of C 2, an angle will form representing the degree of malrotation, which is approximately 30°.

Question 6

Which of the following conditions is not commonly associated with C hance fractures in children:

Explanation

Chance fractures in children are often associated with blunt contusions to abdominal structures. Blunt contusions to abdominal structures cause renal and intestinal trauma and distraction of the spinal cord and may be associated with dural tearing or neurologic injury. Neurologic injuries occur in fewer than half of children with Chance fractures that have blunt contusions to abdominal structures. Although spinal fractures caused by falls or axial loads can result in multilevel spinal injuries, multilevel spinal injuries do not commonly result from Chance fractures.

Question 7

The lesion indicated in this computed tomography (Slide) most likely represents:

Explanation

This patient has an osteoid osteoma with pain in the lumbar spine where the lesion is located. The patientâ s osteoid osteoma shows hot on a photon emission computed tomography scan and is relieved by nonsteroidal anti- inflammatory agents. Most patients with osteoid osteoma with lesions have them in the posterior region of their vertebrae.

Question 8

Which of the following conditions is represented by this radiograph (Slide) of an infantâ s elbow:

Explanation

This patient has a proximal radioulnar synostosis. Patients with proximal radioulnar synostosis often have dysplasia of the proximal ulna, maldirection of the proximal radius, and cortical continuity of the ulna and radius.

Question 9

Which of the following conditions is represented by this radiograph (Slide):

Orthopedic Prometric Exam Chapter 3 Image

Explanation

This patient has early fragmentation, epiphyseal flattening, metaphyseal lucency and widening, and sclerosis typical of patients with Legg-C alvÃ©- Perthes disease in the early stages. In patients with juvenile rheumatoid arthritis, osteopenia and joint space narrowing are present, whereas in patients with developmental dysplasia, the acetabulum is shallow. C orrect Answer: Legg-Calv-Perthes disease Orthopedic Prometric Exam Chapter 3 Image

Question 10

Which of the following designations best describes this radiograph (Slide):

Explanation

This patient has Herring body involvement of the hip. As a result, this patient has less than a 50% loss of lateral column height and is in the early fragmentation phase. This patient has a Catterall involvement of at least 3. The Stulberg classification is used to rate a patientâ s hip after it has healed.

Question 11

In which stage of Legg-Calva-Perthes disease is this patient:

Explanation

This patient is in the end of the fragmentation phase of Legg-Calv-Perthes disease. Note the extreme flattening of the head and the lateral fragmentation.

Question 12

All of the following conditions are indicated by this radiograph (Slide) of a patient with Legg- Calv-Perthes disease except:

Explanation

The hip of this patient with Legg-C alvÃ©-Perthes disease has undergone epiphyseal flattening and premature (primarily lateral) physeal arrest. The femoral head has regrown with an enlarged width. The radiograph shows elements of coxa magna, coxa brevis, trochanteric overgrowth, and coxa plana. Coxa vara is not present.

Question 13

A 5-year-old girl is evaluated for Legg-Calva-Perthes disease. She is in the fragmentation phase, and rotation is 10° internal and 15° external. Her epiphyseal extrusion index is 15%. Recommended treatment includes:

Explanation

The patients restricted range of motion is normal for a patient in the fragmentation phase of Legg-Calva-Perthe disease. The patiens degree of epiphyseal extrusion is not extreme. Observation is the most appropriate course of treatment.

Question 14

What is the risk of hip arthroplasty for 50-year-old patients with Legg-C alva-Perthes disease:

Explanation

Long-term study has shown that 50% of 50-year-old patients with Legg-C alva-Perthes disease will have degenerative changes in their hips significant enough to make them candidates for hip arthroplasty.

Question 15

Which of the following descriptions reflects all transverse-plane factors affecting the position of the patientâ s foot during gait:

Explanation

The foot-progression angle is a reflection of all transverse-plane factors affecting the position of the patientâ s foot during gait.

Question 16

In which of the following conditions is a Trendelenburgâ s gait unlikely to occur:

Explanation

Patients with complications that cause pain around their hips or that decrease the abductor strength of their hips may develop a Trendelenburgs gait.

Question 17

In which muscle does Elys test detect spasticity or contracture:

Explanation

Elys test is performed while the patient is prone and his or her hip is at maximal extension. Elys test is positive if flexion of the patients knee causes the patientâ s hip to flex. A positive Elys test indicates spasticity or contracture of the rectus femoris.

Question 18

Stahelis test is designed to detect hip flexion contracture. Which of the following tests also detects hip flexion contracture:

Explanation

Staheliâ s test and the Thomas test are designed to detect hip flexion contracture. Staheliâ s test is performed with a patient in the prone position. The lumbar lordosis is eliminated by flexing a patientâ s hips, and then gradually extending the affected hip. The Thomas test is performed with a patient in the supine position. The lumbar lordosis is minimized by flexing a patientâ s hips forward, allowing the affected hip to go into extension.

Question 19

Which of the following conditions has the highest rate of bilaterality:

Explanation

Slipped capital femoral epiphysis has a bilaterality rate of 25% to 40%. Legg-Calva-Perthes disease, developmental dysplasia of the hip, discoid lateral meniscus, and fibular hemimelia have bilateral rates of less than 20%.

Question 20

In which pattern does the most common presentation of Trevorâ s disease occur:

Explanation

Trevors disease, also known as dysplasia epiphysialis hemimelia, refers to epiphyseal osteochondromas. Epiphyseal osteochondromas are usually few in number and are more common on the distal and medial portions of the epiphysis of one lower extremity.

Question 21

Which of the following is the most common level of the fulcrum of normal cervical spine motion in a 4-year-old child?

Explanation

In children under 8 years of age, the fulcrum of cervical spine motion is located at C2-C3. In adults, it transitions to C5-C6, explaining the higher incidence of upper cervical injuries in young children.

Question 22

A 6-year-old boy presents with torticollis and neck stiffness 2 weeks after undergoing a tonsillectomy. Radiographs show atlantoaxial rotatory subluxation. What is the most appropriate initial management?

Explanation

This is Grisel syndrome. The initial treatment for atlantoaxial rotatory subluxation present for less than 1 month involves admission, cervical halter traction, muscle relaxants, and anti-inflammatory medications.

Question 23

A 7-year-old child develops transient paraplegia following a motor vehicle collision. Initial trauma radiographs and CT of the spine are normal. What is the most likely diagnosis?

Explanation

SCIWORA is a pediatric condition where spinal cord injury occurs without fractures or dislocations on plain films or CT. MRI is required to evaluate the spinal cord for edema or hemorrhage.

Question 24

When evaluating a lateral cervical radiograph of a 5-year-old child following minor trauma, anterior displacement of C2 on C3 of 3 mm is noted. Which of the following radiographic lines is most helpful to differentiate physiologic pseudosubluxation from true injury?

Explanation

Swischuk's line (spinolaminar line of C1 to C3) helps differentiate physiologic pseudosubluxation of C2 on C3 from a true injury. If the line passes within 2 mm of the posterior arch of C2, it is considered physiologic.

Question 25

A 10-year-old boy sustains a flexion-distraction injury of the lumbar spine (Chance fracture) while wearing a lap belt. Which associated injury must be specifically evaluated for?

Explanation

Chance fractures in children are highly associated with intra-abdominal injuries, particularly hollow viscus injuries like bowel perforations, due to the fulcrum of the lap belt over the abdomen.

Question 26

A 12-year-old gymnast complains of chronic low back pain. Radiographs reveal a bilateral pars interarticularis defect at L5 with a 60% anterior slip of L5 on S1. What is the most appropriate definitive management?

Explanation

Symptomatic high-grade spondylolisthesis (>50% slip) in a growing child is an indication for surgical stabilization. An in situ posterolateral L5-S1 fusion is the standard of care to prevent progression and relieve symptoms.

Question 27

A 2-year-old child presents with refusal to walk, low-grade fever, and irritability. Laboratory tests show an ESR of 65 mm/hr and normal WBC count. MRI reveals abnormal signal in the L4-L5 disc space and adjacent endplates. What is the most common causative organism?

Explanation

Pediatric discitis most commonly affects children under 5. Staphylococcus aureus is the most frequent organism isolated when a pathogen is identified, although blood cultures are often negative.

Question 28

A newborn is evaluated for a short, webbed neck and limited cervical range of motion. Radiographs show multiple fused cervical vertebrae. Which organ system requires routine screening in this patient?

Explanation

Klippel-Feil syndrome is associated with renal anomalies in about 30% of cases, necessitating a screening renal ultrasound. Cardiovascular and hearing abnormalities are also common.

Question 29

Which of the following measurements is considered normal for the atlanto-dens interval (ADI) on a lateral cervical radiograph in a 6-year-old child?

Explanation

In children, an ADI of up to 4-5 mm is considered normal due to increased ligamentous laxity. In adults, the normal upper limit is 3 mm.

Question 30

A 13-year-old boy presents with severe back pain radiating down his right leg after lifting a heavy box. Straight leg raise is positive. Radiographs are normal. What condition acts as the pediatric equivalent of a disc herniation and must be considered?

Explanation

An apophyseal ring fracture (slipped vertebral apophysis) occurs when the cartilaginous ring avulses from the vertebral body. It acts like a hard disc herniation in adolescents.

Question 31

A 5-year-old with Down syndrome is undergoing screening prior to participating in the Special Olympics. Flexion-extension cervical spine radiographs show an ADI of 6 mm. He is asymptomatic and neurologically intact. What is the recommendation?

Explanation

An ADI > 4.5 mm in a patient with Down syndrome indicates atlantoaxial instability. If asymptomatic, they should be restricted from contact sports and high-risk activities, but surgery is not immediately indicated.

Question 32

A 3-year-old child with achondroplasia presents with delayed walking and hyperreflexia in the lower extremities. What is the most critical anatomical area to evaluate?

Explanation

Infants and young children with achondroplasia are at high risk for foramen magnum stenosis. This can cause cervicomedullary compression, resulting in hyperreflexia, sleep apnea, and potentially sudden death.

Question 33

A 14-year-old girl with neurofibromatosis type 1 is diagnosed with scoliosis. Her curve is short-segment and sharply angulated. Which radiographic finding suggests a dystrophic type of curve with a high risk of progression?

Explanation

Dystrophic scoliosis in NF-1 is characterized by short, sharp curves, penciling of ribs, dural ectasia, and severe vertebral scalloping. These curves have a high rate of progression and pseudarthrosis.

Question 34

In a 9-year-old child, an os odontoideum is noted incidentally on cervical spine radiographs. It has smooth cortical margins. What best distinguishes it from an acute type II odontoid fracture?

Explanation

Os odontoideum is characterized by smooth, corticated margins and an associated hypertrophied anterior arch of C1. This helps distinguish it from an acute fracture, which typically lacks corticated edges and C1 remodeling.

Question 35

A 6-year-old boy presents with torticollis following a mild upper respiratory infection. He holds his head tilted to the right and rotated to the left. Radiographs reveal an atlantoaxial rotatory subluxation. According to the Fielding and Hawkins classification, a Type 1 injury is characterized by:

Explanation

Fielding and Hawkins Type 1 is rotatory fixation with no anterior displacement (pivot on the odontoid), representing the most common type. The transverse ligament remains intact.

Question 36

A 7-year-old boy is brought to the emergency department after a motor vehicle accident. Lateral cervical spine radiographs show a 3 mm anterior displacement of C2 on C3. Swischuk's line is evaluated to differentiate physiologic pseudosubluxation from true injury. Swischuk's line is drawn between the:

Explanation

Swischuk's line is drawn from the spinolaminar line of C1 to C3. If the spinolaminar line of C2 is >2 mm anterior to this line, it indicates a true subluxation rather than physiologic pseudosubluxation.

Question 37

A 14-year-old male gymnast presents with chronic low back pain exacerbated by extension.

Imaging reveals a grade II isthmic spondylolisthesis at L5-S1. Conservative management has failed after 6 months. The most appropriate surgical treatment is:

Explanation

For symptomatic grade I or II isthmic spondylolisthesis failing conservative care, an in situ L5-S1 posterior spinal fusion is the standard surgical treatment. Pars repairs are generally reserved for young patients with pars defects but no significant slip.

Question 38

A 3-year-old girl is diagnosed with congenital scoliosis due to a fully unsegmented bar with a contralateral hemivertebra. Which of the following is the most appropriate next step in evaluation to rule out associated anomalies?

Explanation

Congenital scoliosis is highly associated with VACTERL anomalies. Routine screening must include a renal ultrasound (genitourinary anomalies in 20-30%) and an echocardiogram (cardiac anomalies in 10-15%).

Question 39

A 12-year-old girl is diagnosed with adolescent idiopathic scoliosis. Her physical examination reveals a right thoracic prominence. Which of the following parameters represents a widely accepted indication for initiating Boston brace treatment?

Explanation

Bracing is indicated in growing children (Risser 0-2, premenarchal) with curves between 25 and 45 degrees. A curve of 30 degrees in a Risser 1 patient falls perfectly within these bracing parameters.

Question 40

A 4-year-old boy with Down syndrome is brought in for screening. Lateral cervical spine flexion-extension radiographs are obtained. Which of the following atlanto-dens intervals (ADI) is the threshold indicating potential atlantoaxial instability in this pediatric patient?

Explanation

In children, an atlanto-dens interval (ADI) greater than 5 mm is considered abnormal and indicates atlantoaxial instability. In adults, the normal threshold is stricter at >3 mm.

Question 41

A 15-year-old boy complains of mid-back pain. Lateral radiographs show a thoracic kyphosis of 55 degrees with anterior wedging of 3 consecutive vertebrae. What is the minimum degree of wedging per vertebra required to diagnose classic Scheuermann's disease (Sorensen criteria)?

Explanation

Sorensen criteria for classic Scheuermann's kyphosis require anterior wedging of at least 5 degrees in three or more consecutive vertebrae. This is usually accompanied by Schmorl's nodes and endplate irregularities.

Question 42

A 6-year-old boy presents with transient bilateral lower extremity weakness after a severe hyper-extension injury of the neck during a trampoline fall. Radiographs and CT scan of the cervical spine are normal. What is the most appropriate next step in imaging?

Explanation

The patient has suspected Spinal Cord Injury Without Radiographic Abnormality (SCIWORA), which is common in children due to spinal column elasticity. An MRI is the modality of choice to evaluate the spinal cord for edema or hemorrhage.

Question 43

During the evaluation of a 6-month-old infant with an infantile idiopathic scoliosis curve of 25 degrees, the Rib-Vertebra Angle Difference (RVAD) of Mehta is measured. What RVAD value indicates a high risk for curve progression?

Explanation

An RVAD of greater than 20 degrees is highly indicative of a progressive curve in infantile idiopathic scoliosis. Non-progressive curves typically have an RVAD of less than 20 degrees.

Question 44

A 6-year-old boy presents with transient bilateral lower extremity weakness after a high-speed motor vehicle collision. Initial radiographs and CT of the cervical and thoracolumbar spine are completely normal. What is the most appropriate next step in management?

Explanation

SCIWORA (Spinal Cord Injury Without Radiographic Abnormality) is common in children due to spinal column elasticity. MRI is the modality of choice to evaluate for occult spinal cord edema, hemorrhage, or ligamentous injury.

Question 45

A 5-year-old child presents after a mild fall. The lateral cervical radiograph shows 3 mm of anterior displacement of C2 on C3.

Which of the following radiographic measurements best differentiates physiological pseudosubluxation from a true traumatic injury?

Explanation

Swischuk's line is drawn connecting the anterior aspect of the C1 and C3 posterior arches. If this line passes more than 2 mm anterior to the anterior cortex of the posterior arch of C2, it indicates true pathology rather than physiological pseudosubluxation.

Question 46

A 7-year-old girl presents with torticollis and neck pain 1 week after a severe viral pharyngitis. Her head is tilted to the right and rotated to the left. Dynamic CT confirms atlantoaxial rotatory subluxation (Grisel's syndrome). What is the most appropriate initial treatment?

Explanation

Grisel's syndrome is non-traumatic AARS secondary to retropharyngeal inflammation. Initial treatment involves soft tissue relaxation, anti-inflammatories, and halter traction, followed by cervical bracing once the subluxation is reduced.

Question 47

A 14-year-old boy incidentally undergoes cervical spine radiographs which reveal a well-corticated, round ossicle separated from a hypoplastic dens by a wide gap, lying cranial to the superior articular facets of the axis. What is the most likely diagnosis?

Explanation

Os odontoideum is characterized by a smooth, well-corticated ossicle separated from the base of the dens. It is distinct from an acute Type II fracture, which typically presents with irregular, non-corticated fracture margins.

Question 48

A 12-year-old girl is involved in a severe motor vehicle accident wearing a lap belt. Radiographs demonstrate the injury shown.

What associated injury must be urgently ruled out?

Explanation

The image represents a Chance fracture, a flexion-distraction injury highly associated with lap belt use. Approximately 40-50% of these pediatric patients have concurrent intra-abdominal injuries, most commonly hollow viscus perforations.

Question 49

A 45-year-old man dives into a shallow pool and sustains an axial load injury to his cervical spine. CT reveals a burst fracture of C1. According to the Rule of Spence, what radiographic finding indicates incompetence of the transverse atlantal ligament?

Explanation

The Rule of Spence dictates that if the combined lateral mass overhang of C1 on C2 is greater than 6.9 mm on an AP open-mouth odontoid view, the transverse atlantal ligament is likely ruptured.

Question 50

A 65-year-old man with pre-existing cervical spondylosis falls forward, striking his chin. He presents with profound motor weakness in his upper extremities but can move his legs against gravity. Proprioception and pain sensation are diminished but present. What is the most likely diagnosis?

Explanation

Central cord syndrome typically occurs after a hyperextension injury in a stenotic cervical spine. It causes disproportionately greater motor impairment in the upper extremities compared to the lower extremities because cervical motor tracts are located more centrally.

Question 51

A 50-year-old man with longstanding Ankylosing Spondylitis suffers a low-energy fall. He complains of severe back pain but is neurologically intact. Initial plain radiographs of the spine are inconclusive. What is the most appropriate next step in management?

Explanation

Patients with Ankylosing Spondylitis are at high risk for highly unstable, occult spinal fractures even from minor trauma. CT or MRI of the whole spine is mandatory to rule out a fracture and prevent delayed catastrophic neurological decline.

Question 52

A patient sustains a transverse fracture of the sacrum through the central canal (Denis Zone III). Which of the following is the most likely neurological complication associated with this specific zone of injury?

Explanation

Denis Zone III fractures involve the central sacral canal. They carry the highest risk of neurologic injury (up to 57%), predominantly presenting as saddle anesthesia, sexual dysfunction, and bowel/bladder dysfunction.

Question 53

In a neurologically intact patient with a thoracolumbar burst fracture, which of the following features most strongly indicates the need for operative stabilization?

Explanation

In the Thoracolumbar Injury Classification and Severity Score (TLICS), a disrupted posterior ligamentous complex (PLC) indicates a highly unstable injury. This structural failure typically requires operative stabilization even without neurological deficits.

Question 54

A 12-year-old pedestrian is struck by a car. Lateral cervical radiograph shows a basion-dental interval (BDI) of 14 mm. Which of the following interventions is absolutely CONTRAINDICATED in the initial management of this patient?

Explanation

The patient has atlanto-occipital dissociation (AOD), representing complete cranio-cervical instability. Cervical traction is strictly contraindicated as it can cause catastrophic over-distraction and brainstem injury.

Question 55

A 14-year-old boy presents with a 6-month history of worsening mid-back pain that is particularly severe at night and relieved by ibuprofen. Examination reveals a painful structural scoliosis. What is the most likely anatomic location of the primary pathology?

Explanation

The clinical presentation is classic for an osteoid osteoma of the spine. These lesions typically arise in the posterior elements (pedicles, facets, lamina) and frequently cause a secondary painful, rigid scoliosis.

Question 56

A 30-year-old man is involved in a high-speed MVC. Cervical spine CT demonstrates 25% anterior translation of C5 on C6. What is the most likely mechanism that produced this specific injury pattern?

Explanation

The radiographic finding of 25% anterior translation is classic for a unilateral facet dislocation. This injury is typically caused by a flexion-rotation mechanism, whereas bilateral facet dislocations (usually >50% translation) result from hyperflexion.

Question 57

A 40-year-old laborer complains of lower neck pain after forcefully shoveling dirt. Radiographs reveal an isolated avulsion fracture of the C7 spinous process. What is the recommended treatment?

Explanation

A Clay Shoveler's fracture is a stable avulsion fracture of a lower cervical spinous process. It does not compromise the structural stability of the cervical spine and is treated symptomatically.

Question 58

A 15-year-old male gymnast complains of chronic low back pain worsened by extension. Oblique radiographs demonstrate a 'collar on the Scottie dog' sign at L5. What anatomical structure is defective?

Explanation

The 'collar on the Scottie dog' sign seen on oblique lumbar radiographs represents a defect or fracture in the pars interarticularis, which is the hallmark of isthmic spondylolysis.

Question 59

When interpreting pediatric cervical spine radiographs, it is important to distinguish fractures from normal development. At what age does the basilar synchondrosis (between the odontoid process and the body of C2) typically fuse?

Explanation

The basilar synchondrosis separates the dens from the body of C2 and typically fuses between 5 and 7 years of age. Before it fuses, this normal anatomical feature can easily be mistaken for a Type II odontoid fracture.

Question 60

A 5-year-old boy presents to the emergency department after a minor fall. Lateral cervical radiographs reveal a 3 mm anterior displacement of C2 on C3. Which of the following radiographic methods is best used to differentiate physiologic pseudosubluxation from true pathologic subluxation?

Explanation

Swischuk's line is drawn from the anterior aspect of the posterior arch of C1 to the anterior aspect of the posterior arch of C3. In physiologic pseudosubluxation, the anterior aspect of the posterior arch of C2 should be within 1.5 to 2 mm of this line.

Question 61

A 6-year-old girl presents with persistent torticollis for two weeks following severe pharyngitis. Radiographs and CT scan confirm atlantoaxial rotatory subluxation (AARS) without neurologic deficits. What is the most appropriate initial management?

Explanation

Grisel's syndrome is a non-traumatic atlantoaxial rotatory subluxation associated with head or neck infections. For AARS present for 1-4 weeks, initial management typically involves cervical traction to achieve reduction followed by rigid bracing.

Question 62

An 8-year-old boy is brought to the trauma bay after a motor vehicle collision. He was wearing a lap-only seatbelt. Lateral lumbar spine radiograph reveals a fracture line propagating horizontally through the spinous process, pedicles, and posterior vertebral body of L2. What is the most commonly associated concomitant injury?

Explanation

Chance fractures (flexion-distraction injuries) in children wearing lap belts have a very high association with intra-abdominal hollow viscus injuries. A thorough abdominal evaluation is mandatory in these patients.

Question 63

A 3-year-old child sustains a neck injury after falling from a playground structure. Radiographs show a displaced fracture through the base of the dens. This fracture typically occurs through which of the following structures?

Explanation

In children under 7 years of age, odontoid fractures typically occur through the dentocentral synchondrosis, which is the cartilaginous junction between the dens and the body of C2. It generally fuses between ages 5 and 7.

Question 64

A 14-year-old high school football player experiences transient bilateral upper and lower extremity weakness lasting 15 minutes after making a spear tackle. Radiographs show no fracture, but the Torg-Pavlov ratio is measured at 0.7. What is the most appropriate next step in management?

Explanation

Transient quadriparesis with a low Torg-Pavlov ratio (< 0.8) indicates congenital cervical stenosis. An MRI is required to evaluate the spinal cord for contusion, edema, or disc herniation before considering clearance to return to play.

Orthopedic Prometric MCQs - Chapter 3 Part 1

Orthopedic Prometric MCQs - Chapter 3 Part 11

Orthopedic Prometric MCQs - Chapter 3 Part 11

Chapter Index