Pediatric Orthopaedic Scored and 1
Recorded Self-Assessment Examination 2025
,Question V1 Vof V100
Figures V1 Vand V2 Vare Vthe Vradiographs Vof Van V11-year-old Vgirl Vwho Vis Vhaving Vright Velbow Vpain Vafter
V“trying Vto Vbeat Vup Va Vsnowman.” VShe Vcannot Vextend Vher Velbow, Vhas Vpoint Vtenderness Vto
Vpalpation Vover Vthe Vproximal Vulna. VHer Vunderlying Vcondition Vis Vassociated Vwith Va Vmutation Vin
Vwhich Vgene?
A. Fibroblast Vgrowth Vfactor Vreceptor V3 V(FGFR3)
B. Diastrophic Vdysplasia Vsulfate Vtransporter V(DTDST)
C. COL1A1, VCOL1A2
D. COL2A1
R:C
V
This Vpatient Vhas Va Vfracture Vof Vthe Volecranon, Vwhich Vis Va Vcommon Vinjury Vseen Vin Vchildren Vwith
Vosteogenesis Vimperfecta V(OI), Vparticularly Vtype V1 VOI. VThe Vgenetic Vabnormality Vin VOI Vis Veither
Vautosomal Vdominant Vor Vrecessive, Vwith Va Vmutation Vin Vcollagen Vtype V1, Vaffecting VCOL1A1 Vand
VCOL1A2 Vgenes. VFGFR3 Vmutations Vare Vassociated Vwith Vachondroplasia. VDTDST Vmutations Vare
Vseen Vin Vdiastophic Vdysplasia. VCOL2A1 Vmutations Vare Vseen Vin Vspondyloepiphyseal Vdysplasia
V(SED), VKniest Vdysplasia, Vand VStickler Vsyndrome.
Question V2 Vof V100
Figures V1 Vthrough V3 Vare Vthe Vradiographs Vof Va V7-year-old Vgirl Vwho Vsustained Vcomplex
Vorthopaedic Vinjuries Vfalling Vfrom Van Vall-terrain Vvehicle. VShe Vunderwent Vsuccessful Vtreatment,
Vwhich Vhealed Vall Vof Vthe Vinjuries Vwith Vno Vevidence Vof Vavascular Vnecrosis Vor Vphyseal Varrest Vof
Vthe Vright Vproximal Vfemur, Vbut Vcomplete Vphyseal Varrest Vof Vthe Vdistal Vfemur Vis Vnoted V12 Vmonths
Vpost-injury. VShe Vreturns Vat Vage V13 Vyears Vcomplaining Vof Vleg-length Vdiscrepancy V(LLD). VBone
Vage Vis Vage V13. VBased Von Vher Vpredicted Vleg Vlength Vdiscrepancy Vat Vmaturity, Vwhich Vprocedure
Vis Vmost Vappropriate?
A. Contralateral Vclosed Vfemoral Vshortening
B. Limb Vlengthening Vwith Vdistraction Vosteogenesis
C. Open VPhemister Vepiphysiodesis Vof Vthe Vcontralateral Vfemur
D. Guided Vgrowth Vepiphysiodesis Vof Vthe Vcontralateral Vdistal Vfemur
R: VB
,distal Vfemur Vphysis Vis Vresponsible Vfor V9 Vmm Vof Vlongitudinal Vgrowth Vper Vyear. VShe Vis Vexpected Vto
Vreach Vskeletal Vmaturity Vat Vage V14 V years. VHer Vprojected VLLD Vat Vmaturity Vis V~6 Vcm. VA Vlimb Vlength
Vdiscrepancy Vof V>5 Vcm Vis Vtypically Vtreated Vwith Vdistraction Vosteogenesis Vof Vthe Vshort Vlimb. VClosed
Vfemoral Vshortening V>5 Vcm Vmay Vresult Vin Vquadriceps Vinsufficiency. VAn Vaccommodative Vshoe Vlift Vwould
Vbe Vuseful Vfor Van VLLD V<2-2.5 Vcm. VPhemister Vis Van Vopen Vtechnique Vfor Vphyseal Vablation Vby Vremoving Va
Vsegment Vof Vbone Vand Vreinserting Vit Vin Va Vflipped Vposition. VGuided Vgrowth Vepiphysiodesis Vusing Vstaples
Vor Veight Vplates Vplaced Vat Vthe Vdistal Vfemur Vis Valso Van Voption; Vhowever, Vgiven Vher Vremaining Vgrowth,
Vneither VPhemister, Vnor Vguided Vgrowth Vtechniques Vwill Vprovide Vsufficient Vcorrection.
Question V3 Vof V100
A V13-year-old Vboy Vis Vcomplaining Vof Velbow Vand Vwrist Vpain Vfollowing Va Vfall Voff Va Vbike. VRadiographs
Vare Vtaken Vin Vthe Vemergency Vdepartment V(Figures V1 Vthrough V4). VThe Vwrist Vinjury Vis Vunstable, Vand Vthe
Vpatient Vis Vtaken Vto Vthe Voperating Vroom Vfor Vclosed Vreduction Vand Vpinning Vof Vthe Vdistal Vradius Vfracture,
Vclosed Vtreatment Vof Vthe Vproximal Vfractures. VSubsequent Vto Vsurgery, Vthe Vpatient Vis Vnoted Vto Vhave
Vincreased Virritability Vand Vprogressively Vrequires Vmore VIV Vpain Vmedication Vthroughout Vthe Vnight. VHe Vis
Vanxious, Vargumentative, Vand Vrefuses Vto Vcomply Vwith Vneurovascular Vassessments Vof Vhis Vupper
extremity. VWhat Vis Vthe Vbest Vnext Vstep Vin Vtreatment Vfor Vthis Vpatient?
V
A. Provide Vdiazepam V(Valium) Vfor Vanxiety Vand Vmuscle Vspasms
B. Continue Vwith Vice, Velevation, Vanti-inflammatory Vdrugs Vto Vimprove Vpain Vand Vswelling
C. Measure Vcompartment Vpressures Vwithin Vthe Vvolar Vand Vdorsal Vforearm Vcompartments
D. Return Vto Vthe Voperating Vroom Vfor Vemergent Vvolar Vand Vdorsal Vcompartment Vfasciotomies
R: VD
This Vpatient Vis Vmanifesting Vthe Vsigns Vof Vacute Vcompartment Vsyndrome V(ACS). VIn Vthe Vpediatric
Vpopulation, Vthe V5 VP's Vare Vless Vreliable Vsigns Vof VACS. VInstead, Vpediatric Vpatients Vmanifest Vincreasing
Vanalgesic Vrequirements, Vagitation, Vand Vanxiety Vin Vthe Vevolution Vof VACS. VGiven Vthis Vpatient's Vclinical
Vsigns Vand Vrisk Vfactors Vfor Vdeveloping VACS V(increased Vage/adolescence, Vmale Vpredominance, Vmultiple
Vfractures Vwithin Van Vextremity), Vthe Vappropriate Vtreatment Vis Vto Vproceed Vwith Vemergent Vforearm
Vfasciotomies.
Administering Vdiazepam V(Valium) Vfor Vthe Vanxiety Vonly Vmasks Vthe Vunderlying Vcondition, Vwhich Vmay
Vresult Vin Va Vpoorer Vprognosis Vif Vthe Vdiagnosis Vis Vfurther Vdelayed. VProviding Vice Vand Velevation Vmay Vbe
Vuseful Vto Vdiminish Vswelling Vand Vpain, Vbut Vwill Vnot Vsuccessfully Vtreat Vthe Vcompartment Vsyndrome.
VImportantly, Vthe Vdiagnosis Vof VACS Vis Vprimarily Va Vclinical Vone. VMeasuring Vcompartment Vpressures Vmay
Vbe Vmore Vuseful Vto Vhelp Vconfirm Vor Vrule Vout Vthe Vdiagnosis Vin Van Vobtunded Vchild Vor Vone Vwith Vsevere
Vmental/communication Vdifficulty.
, Question V4 Vof V100
Figure V1 Vand V2 Vare Vthe Vradiographs Vof Va V5-year-old Vgirl Vwho Vis Vbeing Vevaluated Vfor Vback Vpain Vand
Vintermittent Vheadaches. VHer Vparents Vdeny Vany Vinjury, Vchanges Vin Vbowel Vor Vbladder Vfunction, Vor
Vsignificant Vfamily Vhistory. VHer Vneurological Vexam Vis Vnormal. VWhat Vis Vthe Vbest Vnext Vstep Vin Vher
management?
V
A. Physical Vtherapy
B. Observation
C. MRI Vof Vthe Ventire Vspine
D. Thoracolumbar Vsacral Vorthosis V(TLSO)
R: VC
This Vis Va V5-year-old Vgirl Vwith Va Vnew Vdiagnosis Vof Vscoliosis, Vhaving Van Visolated Vright Vthoracic Vcurve.
VThis Vis Vconsidered Vjuvenile Vonset Vidiopathic Vscoliosis, Vwhich Vpresents Vbetween Vthe Vages Vof V3-9 Vyears
Vold. VThe Vinitial Vradiographs Vshow Va Vcurve Vmeasuring V41°. VAny Vcurve V>20° Vin Va Vpatient Vwith Vearly
Vonset Vscoliosis Vshould Vundergo VMRI Vof Vthe Ventire Vspine Vto Vassess Vfor Vintraspinal Vpathology, Vwith Van
Vaverage Vof V20% Vof Vpatients Vhaving Vunderlying Vdiagnoses, Vi.e. VArnold-Chiari, Vsyringomyelia.
VObservation Vor VTLSO Vbracing Vmay Vbe Vindicated; Vhowever, Van VMRI Vis Vstill Vthe Vfirst Vline Vof
Vmanagement Vin Vthis Vpatient. VPhysical Vtherapy Vmay Vbe Vuseful Vfor Vadjunct Vtreatment, Vbut Vthe VMRI Vis Vstill
Vrequired Vat Vthis Vstage Vof Vevaluation Vand Vdiagnosis.
Question V5 Vof V100
Figure V1 Vis Vthe Vradiograph Vof Va V4-year-old Vgirl Vwho Vis Vbeing Vevaluated Vfor Vgenu Vvarum. VShe Vhas Va
Vfamily Vhistory Vof Vbowed Vlegs Vand Vshort Vstature. VShe Vhas Va Vmutation Vin Vthe VPHEX Vgene. VIdentify Vthe
Vlaboratory Vstudies Vmost Vconsistent Vwith Vthis Vdiagnosis.
Recorded Self-Assessment Examination 2025
,Question V1 Vof V100
Figures V1 Vand V2 Vare Vthe Vradiographs Vof Van V11-year-old Vgirl Vwho Vis Vhaving Vright Velbow Vpain Vafter
V“trying Vto Vbeat Vup Va Vsnowman.” VShe Vcannot Vextend Vher Velbow, Vhas Vpoint Vtenderness Vto
Vpalpation Vover Vthe Vproximal Vulna. VHer Vunderlying Vcondition Vis Vassociated Vwith Va Vmutation Vin
Vwhich Vgene?
A. Fibroblast Vgrowth Vfactor Vreceptor V3 V(FGFR3)
B. Diastrophic Vdysplasia Vsulfate Vtransporter V(DTDST)
C. COL1A1, VCOL1A2
D. COL2A1
R:C
V
This Vpatient Vhas Va Vfracture Vof Vthe Volecranon, Vwhich Vis Va Vcommon Vinjury Vseen Vin Vchildren Vwith
Vosteogenesis Vimperfecta V(OI), Vparticularly Vtype V1 VOI. VThe Vgenetic Vabnormality Vin VOI Vis Veither
Vautosomal Vdominant Vor Vrecessive, Vwith Va Vmutation Vin Vcollagen Vtype V1, Vaffecting VCOL1A1 Vand
VCOL1A2 Vgenes. VFGFR3 Vmutations Vare Vassociated Vwith Vachondroplasia. VDTDST Vmutations Vare
Vseen Vin Vdiastophic Vdysplasia. VCOL2A1 Vmutations Vare Vseen Vin Vspondyloepiphyseal Vdysplasia
V(SED), VKniest Vdysplasia, Vand VStickler Vsyndrome.
Question V2 Vof V100
Figures V1 Vthrough V3 Vare Vthe Vradiographs Vof Va V7-year-old Vgirl Vwho Vsustained Vcomplex
Vorthopaedic Vinjuries Vfalling Vfrom Van Vall-terrain Vvehicle. VShe Vunderwent Vsuccessful Vtreatment,
Vwhich Vhealed Vall Vof Vthe Vinjuries Vwith Vno Vevidence Vof Vavascular Vnecrosis Vor Vphyseal Varrest Vof
Vthe Vright Vproximal Vfemur, Vbut Vcomplete Vphyseal Varrest Vof Vthe Vdistal Vfemur Vis Vnoted V12 Vmonths
Vpost-injury. VShe Vreturns Vat Vage V13 Vyears Vcomplaining Vof Vleg-length Vdiscrepancy V(LLD). VBone
Vage Vis Vage V13. VBased Von Vher Vpredicted Vleg Vlength Vdiscrepancy Vat Vmaturity, Vwhich Vprocedure
Vis Vmost Vappropriate?
A. Contralateral Vclosed Vfemoral Vshortening
B. Limb Vlengthening Vwith Vdistraction Vosteogenesis
C. Open VPhemister Vepiphysiodesis Vof Vthe Vcontralateral Vfemur
D. Guided Vgrowth Vepiphysiodesis Vof Vthe Vcontralateral Vdistal Vfemur
R: VB
,distal Vfemur Vphysis Vis Vresponsible Vfor V9 Vmm Vof Vlongitudinal Vgrowth Vper Vyear. VShe Vis Vexpected Vto
Vreach Vskeletal Vmaturity Vat Vage V14 V years. VHer Vprojected VLLD Vat Vmaturity Vis V~6 Vcm. VA Vlimb Vlength
Vdiscrepancy Vof V>5 Vcm Vis Vtypically Vtreated Vwith Vdistraction Vosteogenesis Vof Vthe Vshort Vlimb. VClosed
Vfemoral Vshortening V>5 Vcm Vmay Vresult Vin Vquadriceps Vinsufficiency. VAn Vaccommodative Vshoe Vlift Vwould
Vbe Vuseful Vfor Van VLLD V<2-2.5 Vcm. VPhemister Vis Van Vopen Vtechnique Vfor Vphyseal Vablation Vby Vremoving Va
Vsegment Vof Vbone Vand Vreinserting Vit Vin Va Vflipped Vposition. VGuided Vgrowth Vepiphysiodesis Vusing Vstaples
Vor Veight Vplates Vplaced Vat Vthe Vdistal Vfemur Vis Valso Van Voption; Vhowever, Vgiven Vher Vremaining Vgrowth,
Vneither VPhemister, Vnor Vguided Vgrowth Vtechniques Vwill Vprovide Vsufficient Vcorrection.
Question V3 Vof V100
A V13-year-old Vboy Vis Vcomplaining Vof Velbow Vand Vwrist Vpain Vfollowing Va Vfall Voff Va Vbike. VRadiographs
Vare Vtaken Vin Vthe Vemergency Vdepartment V(Figures V1 Vthrough V4). VThe Vwrist Vinjury Vis Vunstable, Vand Vthe
Vpatient Vis Vtaken Vto Vthe Voperating Vroom Vfor Vclosed Vreduction Vand Vpinning Vof Vthe Vdistal Vradius Vfracture,
Vclosed Vtreatment Vof Vthe Vproximal Vfractures. VSubsequent Vto Vsurgery, Vthe Vpatient Vis Vnoted Vto Vhave
Vincreased Virritability Vand Vprogressively Vrequires Vmore VIV Vpain Vmedication Vthroughout Vthe Vnight. VHe Vis
Vanxious, Vargumentative, Vand Vrefuses Vto Vcomply Vwith Vneurovascular Vassessments Vof Vhis Vupper
extremity. VWhat Vis Vthe Vbest Vnext Vstep Vin Vtreatment Vfor Vthis Vpatient?
V
A. Provide Vdiazepam V(Valium) Vfor Vanxiety Vand Vmuscle Vspasms
B. Continue Vwith Vice, Velevation, Vanti-inflammatory Vdrugs Vto Vimprove Vpain Vand Vswelling
C. Measure Vcompartment Vpressures Vwithin Vthe Vvolar Vand Vdorsal Vforearm Vcompartments
D. Return Vto Vthe Voperating Vroom Vfor Vemergent Vvolar Vand Vdorsal Vcompartment Vfasciotomies
R: VD
This Vpatient Vis Vmanifesting Vthe Vsigns Vof Vacute Vcompartment Vsyndrome V(ACS). VIn Vthe Vpediatric
Vpopulation, Vthe V5 VP's Vare Vless Vreliable Vsigns Vof VACS. VInstead, Vpediatric Vpatients Vmanifest Vincreasing
Vanalgesic Vrequirements, Vagitation, Vand Vanxiety Vin Vthe Vevolution Vof VACS. VGiven Vthis Vpatient's Vclinical
Vsigns Vand Vrisk Vfactors Vfor Vdeveloping VACS V(increased Vage/adolescence, Vmale Vpredominance, Vmultiple
Vfractures Vwithin Van Vextremity), Vthe Vappropriate Vtreatment Vis Vto Vproceed Vwith Vemergent Vforearm
Vfasciotomies.
Administering Vdiazepam V(Valium) Vfor Vthe Vanxiety Vonly Vmasks Vthe Vunderlying Vcondition, Vwhich Vmay
Vresult Vin Va Vpoorer Vprognosis Vif Vthe Vdiagnosis Vis Vfurther Vdelayed. VProviding Vice Vand Velevation Vmay Vbe
Vuseful Vto Vdiminish Vswelling Vand Vpain, Vbut Vwill Vnot Vsuccessfully Vtreat Vthe Vcompartment Vsyndrome.
VImportantly, Vthe Vdiagnosis Vof VACS Vis Vprimarily Va Vclinical Vone. VMeasuring Vcompartment Vpressures Vmay
Vbe Vmore Vuseful Vto Vhelp Vconfirm Vor Vrule Vout Vthe Vdiagnosis Vin Van Vobtunded Vchild Vor Vone Vwith Vsevere
Vmental/communication Vdifficulty.
, Question V4 Vof V100
Figure V1 Vand V2 Vare Vthe Vradiographs Vof Va V5-year-old Vgirl Vwho Vis Vbeing Vevaluated Vfor Vback Vpain Vand
Vintermittent Vheadaches. VHer Vparents Vdeny Vany Vinjury, Vchanges Vin Vbowel Vor Vbladder Vfunction, Vor
Vsignificant Vfamily Vhistory. VHer Vneurological Vexam Vis Vnormal. VWhat Vis Vthe Vbest Vnext Vstep Vin Vher
management?
V
A. Physical Vtherapy
B. Observation
C. MRI Vof Vthe Ventire Vspine
D. Thoracolumbar Vsacral Vorthosis V(TLSO)
R: VC
This Vis Va V5-year-old Vgirl Vwith Va Vnew Vdiagnosis Vof Vscoliosis, Vhaving Van Visolated Vright Vthoracic Vcurve.
VThis Vis Vconsidered Vjuvenile Vonset Vidiopathic Vscoliosis, Vwhich Vpresents Vbetween Vthe Vages Vof V3-9 Vyears
Vold. VThe Vinitial Vradiographs Vshow Va Vcurve Vmeasuring V41°. VAny Vcurve V>20° Vin Va Vpatient Vwith Vearly
Vonset Vscoliosis Vshould Vundergo VMRI Vof Vthe Ventire Vspine Vto Vassess Vfor Vintraspinal Vpathology, Vwith Van
Vaverage Vof V20% Vof Vpatients Vhaving Vunderlying Vdiagnoses, Vi.e. VArnold-Chiari, Vsyringomyelia.
VObservation Vor VTLSO Vbracing Vmay Vbe Vindicated; Vhowever, Van VMRI Vis Vstill Vthe Vfirst Vline Vof
Vmanagement Vin Vthis Vpatient. VPhysical Vtherapy Vmay Vbe Vuseful Vfor Vadjunct Vtreatment, Vbut Vthe VMRI Vis Vstill
Vrequired Vat Vthis Vstage Vof Vevaluation Vand Vdiagnosis.
Question V5 Vof V100
Figure V1 Vis Vthe Vradiograph Vof Va V4-year-old Vgirl Vwho Vis Vbeing Vevaluated Vfor Vgenu Vvarum. VShe Vhas Va
Vfamily Vhistory Vof Vbowed Vlegs Vand Vshort Vstature. VShe Vhas Va Vmutation Vin Vthe VPHEX Vgene. VIdentify Vthe
Vlaboratory Vstudies Vmost Vconsistent Vwith Vthis Vdiagnosis.
