OR12.1 | Congenital Lesions — Practice Quiz

Correct. Ortolani's test: the examiner abducts the flexed hip and the dislocated head reduces with a palpable clunk. The key discriminator is CLUNK (reduction), not a click. Barlow provokes subluxation on adduction.

Ortolani's test detects a palpable clunk (not a click) as the dislocated femoral head is reduced back into the acetabulum on abduction. A 'click' is non-specific; the Ortolani sign is a true clunk indicating reducible DDH.

Recall: Ortolani = 'Out → In' (reducing a dislocated hip). The finding is a CLUNK (palpable reduction), not a non-specific click. Barlow = 'In → Out' (subluxating an unstable but located hip).

Correct. Ultrasound (Graf classification) is the gold standard for DDH < 6 months. The femoral head is cartilaginous and invisible on plain X-ray at this age. USG assesses alpha angle (bony acetabular roof) and beta angle (cartilaginous labrum).

Ultrasound (Graf's method) is the investigation of choice for DDH in infants under 6 months because the femoral head is cartilaginous and not visible on plain X-ray. X-rays become reliable only after ossification of the femoral head capital epiphysis (typically after 4–6 months).

Plain X-ray is unreliable before 4–6 months because the femoral capital epiphysis is not yet ossified. USG is the imaging of choice for infants < 6 months.

Correct. The Pavlik harness maintains hip flexion (~100°) and abduction, which centres the femoral head in the acetabulum and allows dynamic reduction. This stimulates acetabular and femoral head remodelling.

The Pavlik harness maintains the hip in flexion (~100°) and abduction, placing the femoral head against the posterior acetabular wall and stimulating acetabular development. It is the first-line treatment for DDH up to 6 months of age.

The Pavlik harness uses flexion + abduction. Extension or adduction would dislocate the hip or compromise blood supply. Extension risks avascular necrosis of the femoral head.

Correct. Congenital muscular torticollis: SCM fibrosis ('sternomastoid tumour') with ipsilateral tilt and contralateral chin rotation. Stretching physiotherapy is the mainstay. Surgery (bipolar SCM release) if no resolution by 12–18 months.

Congenital muscular torticollis (CMT) presents with SCM fibrosis producing a sternomastoid tumour. The head tilts to the affected side and the chin rotates away. First-line management is stretching physiotherapy; most resolve by 1 year. Surgery (SCM release) is reserved for cases persisting beyond 12–18 months.

The palpable SCM swelling in a neonate is the 'sternomastoid tumour' of congenital muscular torticollis. Stretching physiotherapy resolves >90% by 12 months.

Correct. CTEV deformity: CAVE = Cavus, Adduction (forefoot), Varus (hindfoot), Equinus (plantarflexion). Ponseti method (serial weekly casts → percutaneous Achilles tenotomy → abduction brace FAB) is the gold standard with >95% success.

Congenital Talipes Equinovarus (CTEV/clubfoot) deformity is described by CAVE: Cavus (high arch), forefoot Adduction, hindfoot Varus, hindfoot Equinus. Ponseti method (serial casting starting within days of birth, then percutaneous Achilles tenotomy in ~80%, followed by foot abduction brace) achieves correction in >95% of cases.

Remember CAVE: Cavus, Adduction, Varus, Equinus. The Ponseti method corrects components sequentially (C→A→V then tenotomy for E) and is far superior to extensive surgery.

Correct. AIS with Cobb 25–45° in a skeletally immature patient is managed with bracing (Milwaukee or Boston brace, 18–23 h/day). Bracing arrests progression in ~80% of compliant patients. Surgery is indicated if the curve progresses to > 45–50°.

Adolescent idiopathic scoliosis (AIS): Cobb angle < 20° = observation; 20–45° (skeletally immature) = bracing (Milwaukee/Boston brace worn 18–23 h/day); > 45–50° = surgical correction (posterior spinal fusion). A 32° curve in a growing girl warrants bracing.

Cobb angle thresholds: < 20° = observe; 20–45° in growing adolescent = brace; > 45–50° = surgical fusion. A 32° curve in a growing girl requires bracing, not mere observation or immediate surgery.

Correct. Myelomeningocele: neural tissue (cord + roots) herniates through the posterior spinal defect, causing motor/sensory deficits at and below the level. Orthopaedic deformities depend on the functional level (L3 = knee extension preserved, ambulation possible with AFO).

Myelomeningocele (open spina bifida) presents with posterior spinal arch defects, neural herniation, and segmental neurological deficits (level = lowest intact root). Orthopaedic consequences include paralytic deformities (hip dislocation, equinus, valgus) and the neurological level dictates ambulatory prognosis.

Spina bifida occulta has a bony defect but intact skin and no neural herniation — neurologically normal. Meningocele herniates meninges only. Myelomeningocele herniates cord/roots and causes the deficits described.

Correct. Galeazzi's (Allis') sign: with hips and knees at 90°, the lower knee indicates femoral shortening on that side — in a 6-week-old, this strongly suggests posterior dislocation of the DDH. May be negative in bilateral DDH where both knees appear equal.

Galeazzi's sign (also called Allis' sign) is positive when one knee appears lower than the other with hips and knees flexed to 90°. A positive Galeazzi sign indicates femoral shortening, which in this context suggests the left hip is posteriorly dislocated. It is a static test and may be negative in bilateral DDH.

Galeazzi's sign is the asymmetric knee height test. A positive sign = the affected hip's knee is lower, indicating femoral shortening from posterior dislocation.