Limping Child

Question 1

If a child <3 y/o presents to a GP practice with a limp, it could be a fracture or soft tissue injury. Which of the following is LEAST likely to have caused this?

1 - toddler’s fracture
2 - child maltreatment
3 - developmental dysplasia of hip
4 - mitochondrial disease

Answer 1

4 - mitochondrial disease

Would present at a very early age and not just with a limp

Question 2

A toddlers fracture is a minimally displaced or undisplaced spiral fracture. Which bone is most commonly affected?

1 - femur
2 - radius
3 - ulnar
4 - tibia

Answer 2

4 - tibia

Question 3

Developmental dysplasia of the hip (DDH) is a congenital or acquired deformation of the hip joint, which affects the development and stability of the acetabulum (hip socket) and proximal femur (thighbone). How common is this?

1 - 1.5 cases per 100,000
2 - 15 cases per 100,000
3 - 150 cases per 100,000
4 - 1500 cases per 100,000

Answer 3

2 - 15 cases per 100,000

Question 4

Developmental dysplasia of the hip (DDH) is a congenital or acquired deformation of the hip joint, which affects the development and stability of the acetabulum (hip socket) and proximal femur (thighbone). Is this more common in males or females?

Answer 4

• females

6:1 ratio

Question 5

Which of the following are risk factors for developing development hip dysplasia?

1 - Family history
2 - Breech presentation
3 - Oligohydramnios (low amniotic fluid)
4 - Swaddling (wrapping up children in blankets)
5 - all of the above

Answer 5

5 - all of the above

Question 6

Developmental dysplasia of the hip (DDH) is generally made in early infancy. Which of the following is NOT a clinical sign of DDH?

1 - Asymmetrical skin folds (uneven thigh or gluteal creases)
2 - Leg length discrepancy
3 - Limited hip abduction
4 - Severe pain in the affected hip

Answer 6

4 - Severe pain in the affected hip

Not typically associated with pain

Question 7

Although developmental dysplasia of the hip (DDH) typically occurs in young infants (<3 years), but if it does occur in older children, which of the following can occur?

1 - Gait abnormalities
2 - Hip pain
3 - Osteoarthritis
4 - All of the above

Answer 7

4 - All of the above

Question 8

In children aged 4-6 months, what would be the imaging of choice to diagnose developmental dysplasia of the hip (DDH)?

1 - MRI
2 - ultrasound
3 - X-ray
4 - CT scan

Answer 8

2 - ultrasound

> 6 months typically have an X-ray

Question 9

Treating developmental dysplasia of the hip (DDH):

• Pavlik harness
• Closed reduction and spica casting
• Open reduction
• Surveillance and follow-up

Question 10

Perthes’ disease, or Legg-Calvé-Perthes, is a childhood orthopaedic condition characterized by idiopathic avascular necrosis of the femoral head. What ages does this typically affect?

1 - <6 months
2 - 4-6 years
3 - 2-10 years
4 - >10 years

Answer 10

2 - 4-6 years

Has an incidence of 2.00 cases per 100,000

Question 11

Perthes’ disease is a childhood orthopaedic condition characterized by idiopathic avascular necrosis of the femoral head. Which of the following are signs of Perthes’ disease?

1 - Hip Pain
2 - Limping (Trendelenburg)
3 - Limited range of motion Affected 4 - Leg length discrepancy
5 - Muscle atrophy
6 - Gait abnormalities
7 - all of the above

Answer 11

Perthes’ disease

Question 12

What is the imaging of choice in a patient with suspected Perthes’ disease?

1 - MRI
2 - Ultrasound
3 - X-ray
4 - CT scan

Answer 12

3 - X-ray

Question 13

Management of Perthes disease includes:

• Conservative management including activity modification and pain management
• Orthotic devices, such as casts or braces
• Surgical management

Question 14

Slipped capital femoral epiphysis (SCFE) a disorder of adolescents in which the growth plate is damaged and the femoral head moves (“slips”) with respect to the rest of the femur. What age does this typically occur in?

1 - <6 months
2 - 4-6 years
3 - 2-10 years
4 - >10 years

Answer 14

4 - >10 years

Typically adolescents

Question 15

Slipped capital femoral epiphysis (SCFE) a disorder of adolescents in which the growth plate is damaged and the femoral head moves (“slips”) with respect to the rest of the femur. Is this more common in boys or girls?

Answer 15

• boys

Specifically overweight/obese boys

Question 16

Which of the following is NOT as clinical feature of Slipped capital femoral epiphysis (SCFE)?

1 - hip, groin, medial thigh or knee pain
2 - loss of internal rotation of the leg in flexion
3 - leg length discrepancy
4 - all of the above

Answer 16

3 - leg length discrepancy

Not common

Question 17

What is the imaging of choice in a patient with suspected Slipped capital femoral epiphysis (SCFE)?

1 - MRI
2 - Ultrasound
3 - X-ray
4 - CT scan

Answer 17

3 - X-ray

Question 18

Which of the following is the most common management for patient with suspected Slipped capital femoral epiphysis (SCFE)?

1 - Conservative management including activity modification and pain management
2 - Orthotic devices, such as casts or braces
3 - Surgery with internal fixation: typically a single cannulated screw placed in the center of the epiphysis

Answer 18

3 - Surgery with internal fixation: typically a single cannulated screw placed in the centre of the epiphysis