CPEN CPEN Orthopedic and Musculoskeletal Emergencies 2 — Questions and Answers
Question 1: Which assessment finding indicates vascular compromise in a child with a lower extremity fracture?
- Mild swelling at the fracture site
- Absent or diminished distal pulses with pallor and coolness (Correct answer)
- Moderate bruising along the fracture line
- Capillary refill of 2 seconds
Correct answer: Absent or diminished distal pulses with pallor and coolness
Absent or diminished distal pulses combined with pallor and cool skin distal to a fracture indicates arterial injury requiring immediate intervention.
Question 2: A 12-year-old male presents with knee pain and a visible bump just below the knee. He is an avid basketball player. What is the most likely diagnosis?
- Septic arthritis of the knee
- Osgood-Schlatter disease (Correct answer)
- Meniscal tear
- Patellar dislocation
Correct answer: Osgood-Schlatter disease
Osgood-Schlatter disease is caused by traction apophysitis at the tibial tubercle insertion of the patellar tendon, common in active adolescents during growth spurts.
Question 3: What is the purpose of a long arm splint versus a circumferential cast in the acute management of a pediatric fracture?
- A cast provides better pain control
- A splint allows for swelling while reducing compartment syndrome risk (Correct answer)
- A cast is always preferred for unstable fractures acutely
- A splint is only used for open fractures
Correct answer: A splint allows for swelling while reducing compartment syndrome risk
Splints are preferred acutely because they accommodate post-injury swelling and reduce the risk of iatrogenic compartment syndrome from a circumferential cast.
Question 4: A 7-year-old presents with acute limp and hip pain. Which condition requires urgent orthopedic evaluation due to risk of avascular necrosis?
- Toxic synovitis
- Septic arthritis of the hip (Correct answer)
- Legg-Calvé-Perthes disease only
- Minor muscle strain
Correct answer: Septic arthritis of the hip
Septic arthritis of the hip is a surgical emergency because elevated intra-articular pressure and bacterial enzymes can rapidly destroy the femoral head vascularity, causing avascular necrosis.
Question 5: Which Kocher criteria combination most strongly predicts septic arthritis versus transient synovitis in a child with a painful hip?
- Low-grade fever and mild pain only
- Fever, non-weight-bearing, elevated ESR, and elevated WBC (Correct answer)
- Elevated ESR with normal WBC and no fever
- Weight-bearing with moderate pain and mild fever
Correct answer: Fever, non-weight-bearing, elevated ESR, and elevated WBC
The Kocher criteria (fever, non-weight-bearing, ESR >40, WBC >12,000) predict septic arthritis; all four positive criteria carry >99% probability of septic arthritis.
Question 6: Which position of comfort is typically seen in a child with septic arthritis of the hip?
- Hip extended and internally rotated
- Hip flexed, abducted, and externally rotated (Correct answer)
- Hip fully adducted and extended
- Knee flexed with hip in neutral
Correct answer: Hip flexed, abducted, and externally rotated
Children with septic arthritis of the hip hold the joint in flexion, abduction, and external rotation to maximize joint space volume and reduce intra-articular pressure.
CPEN CPEN Orthopedic and Musculoskeletal Emergencies 2
Which assessment finding indicates vascular compromise in a child with a lower extremity fracture?