Fractures (including non-accidental injury) and growth plate injuries and their sequelae

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QUESTION 1 OF 7

You are starting night shift and received a call from a ward nurse about a 9-year-old boy who had open reduction of a Grade 3 Gartland supracondylar elbow fracture earlier than day. The nurse tells you the boy appears anxious and would like you to prescribe stronger and regular morphine.
Your next course of action will be to:

 

QUESTION ID: 1044

1. Arrange theatre for urgent surgical decompression of compartment syndrome
2. Ask your junior member to review and prescribe
3. Prescribe the requested analgesia electronically to avoid delay
4. Reassure that pain is expected and add muscle relaxant to calm the child
5. Review the child urgently and remove splint and dressing
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QUESTION 2 OF 7

A 7-year-old child sustains a lateral mass fracture of the right elbow.
What is the most likely late onset functional deficit?

QUESTION ID: 1068

1. A. Inability to abduct the thumb
2. B. Inability to adduct the thumb
3. C. Loss of forearm supination
4. D. Loss of thumb IPJ flexion
5. E. Weakness of wrist extension
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QUESTION 3 OF 7

A 13 years old male presented to the ED with an ankle fracture following a football injury. The foot is neurovascularly intact,an isolated closed injury.A CT was performed (Figure 1).

Hussian .png

 

Figure 1.CT scan coronal and sagittal views
Concerning this injury all the following statements are TRUE except

QUESTION ID: 1251

1. An epiphyseal screw is used in cases where there is displacement beyond 2 mm and should be placed parallel to the physis
2. Angular deformity can be a consequence of the potential ensuing growth arrest of the fibula
3. Angular deformity can be a consequence of the potential ensuing growth arrest of the tibia
4. Because of the pattern of distal tibia physeal closure patients presentings with such fractures are generally older than those presenting with a Tillaux fracture
5. If total growth arrest occurs in this patient then he would have a leg length discrepancy of 9-12 mm according to the rule of thumb for growth.
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QUESTION 4 OF 7

109.A 3-year-old is brought by his parents with a femoral shaft fracture, treatment with a cast is decided.
Which of the following is most appropriate?

QUESTION ID: 2253

1. Abdominal pain and vomiting after applying the cast should raise concern of a condition that is seen after scoliosis correction surgery
2. If the angular alignment changes in the cast on the one week check x ray then the treatment is removal of the cast and application of external fixator or IM flexible nails
3. In cases of loss of femoral height applying the cast in 90 ° hip flexion and 90 °knee flexion is recommended to achieve adequate closed reduction
4. It is advisable that the cast is applied in valgus in the AP plane but only minimal anterior bow is tolerated in the lateral view
5. The amount of shortening that is accepted is related to the age and the relative growth potential at the femoral physes.
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QUESTION 5 OF 7

111.An 8-year-old male presents with the following presentation of the elbow , he describes having a previous fracture to his elbow
Which of the following is the most appropriate answer:

8. An 8-year-old male presents with the following presentation of the elbow .jpg

QUESTION ID: 2255

1. Acute correction of a similar deformity secondary to an infection of the distal humerus is different to the acute correction of such deformity due to a fracture
2. As the patient is 8 years old the deformity is likely to improve and remodel
3. The aim of any intervention is primarily to improve function especially achieving full extension and full pronation
4. The deformity is, in most of the cases, due to failure to adequately reduce the fracture initially and fixation in a position with suboptimal alignment on the distal humerus column views
5. The previous injury is likely to be an extension type injury of the distal humerus with an inter-condylar split leading to lateral migration of the lateral condyle and the visible lateral prominence
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QUESTION 6 OF 7

113.An 11-year old male presents with the fracture on the left and the 6 month follow up x rays are as  showed on the right.
Which if the following is most appropriate:

Answer B- If the abnormality is at the centre.jpg

QUESTION ID: 2257

1. Expected growth of less than 2 years (at the time of follow up) is an indication for surgical intervention while growth modulation is still possible
2. If the abnormality is at the centre of the physis then a metaphyseal window might be needed
3. The radiologic findings suggest that the injury was to the hypertrophic zone of the physis
4. The surgical approach is a direct anterior distal tibia approach (intermuscular plane EHL-EDL) to access the abnormality at the different parts if the physis
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QUESTION 7 OF 7

118.You see a patient with a proximal tibia metaphyseal fracture in the fracture clinic
Concerning this injury.

BC 5 Medium.jpeg

QUESTION ID: 3284

1. Children can often develop a varus deformity following this fracture (Cozen phenomenon).
2. If the child develops a valgus deformity (Cozen phenomenon) then a varus producing osteotomy is normally performed prior to completion of growth.
3. The valgus deformity normally corrects itself by 1-2 years.
4. These are classified as toddler fractures in the young.
5. These fractures do not result in deformity due to the excellent metaphyseal blood supply.
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