A0s
AMERICAN B ACADEMY B OF B ORTHOPAEDIC B SURGEONS
Your BSource B for BLifelong B Orthopaedic BLearning
Pediatric B
Orthopedic
Answer Book B
, 2025 B Pediatric B Orthopaedic B Examination B Answer B Book
B· B 7
Figure BB 1a Figure BB 1b
Question BB1
A BB5-year-old BBboy B B has B B had B B a BBlimp BBfor BBthe B B past BB4 B B weeks BBwith BBintermittent BBpain B B at
BBthe B B foot. B B He BBremains BBnormally B B active BBand B B has BBno BBhistory B B of BBtrauma. B B He BBhas
BBno BBfevers, B B rashes, B B or BBswelling. B B Examination BBreveals BBtenderness BBat BBthe BBmid-dorsum BBof
BBthe BBfoot BBmedially. B B Radiographs BBare BBseen BBin B B Figures B B 1a BBand B B l BBb. B B Treatment
BBshould BBinclude BBwhich BBof BBthe BBfollowing?
1. MRl BBof BBthe BBfoot BB with BB gadolinium
2. Open B B biopsy BB of BB the B B lesion
3. Needle BB aspiration B B and BB culture, B B followed B B by BBantibiotic BB treatment
4. Observation BBor BBan BBorthotic BBarch BBsupport
5. Steroid BBinjection BBof BBthe
BBlesion BBPREFERRED BBRESPONSE:
BB4
DISCUSSION: BBOsteochondrosis BBof BBthe BBtarsal BBnavicular BBis BBmost BBcommonly BBidentified
BBbetween BBthe BBages BBof BB2 BBand BB9 BByears. B B The BBcondition BBis BBbenign BBand BBself BBlimited
BBin BBnature. B B In BBpatients BBwith BBsevere BBpain, BBa BBperiod BBof BBcasting BBmay BBbe BBwarranted,
BBbut BBotherwise BBmanagement BBusually BBconsists BBof BBobservation BBor BBa BBsupportive BBorthotic.
REFERENCES: BBDiGiovanni BBCW, BBPatel BBA, BBCalfee BBR, BBet BBal: BBOsteonecrosis BBin BBthe BBfoot.
BB JAmBBAcad BBOrthop BBSurg BB2007; BB15 BB:208-217.
Williams BBGA, BBCowell BBHR: BBKohler's BBdisease BBof BBthe BBtarsal BBnavicular. BB Clin BBOrthop
BBRelat BBRes B B 198 BB1; BB158:53- BB58.
,8 B B American BAcademy Bof BOrthopaedic
•
B Surgeons
Figure BB 2
Question BB2
A BB3 BB-year-old B B girl B B has B B had B B pain B B and B B swelling B B in BBher B B left B B thigh B B for B B the B B past B B 3
BB weeks. B B Her BBmother B B states B B she BBhas B B had B B a BBtemperature B B as B B high B B as B B 100.4
BB degrees BBF BB (38 B B degrees B B C) B B and B B a BBweight B B loss B B of BB5 B B pounds. B B A B B CBC BBshows BBa
BBWBC B B count BBof BB11 B B ,000/mm3 BB, B B an BBerythroc BByte BB sedimentation BBrate BB of BB13 B B mmlh,
BB and B B a B B C-reactive BBprotein B B of BB0.3. B B A BBradiograph BB is BB shown B B in B B Figure B B B B What
B B is B B the B B next B B step B B in B B management?
1. Biopsy B B and BBculture B B of BBthe B B lesion
2. MRI B B of BB the B B left B B femur
3. IV BB antibiotics B B for B B 6 BB weeks
4. Incision BB and BB drainage B B of BBthe B B left BB femur
5. Repeat BB radiograph BB in B B 3 BB months
P BBREFERRED B B RE BBSPONBBSE: B B 2
DI BBSCU BBSSION: BB The B B history BBand B B laboratory B B studies B B indicate BB that B B this B B is BB not BB an
BB infection. B B A BBlesion B B in B B this BBlocation B B and B B in B B this B B age B B group B B is BB likely BB a
B B Ewing's B B sarcoma. B B The B B presentation B B is B B usually B B a B B painful B B mass. BB About B B 20% B B of
BBpatients B B have BB a B B fever. B B The BB radiograph BB shows BB a B B typical B B mottled, BB permeative
BB lesion BBwith BBperiosteal B B reaction. B B B B An BB MRIscan BB should BB be B B obtained B B to B B further
BB evaluate BB the B B soft-tissue B B mass. B B B B Staging B B of B B the B B lesion B B should B B take B B place B B before
BBbiopsy, B B which B B should BBbe B B done B B by BBthe BBsurgeon B B who B B would BBbe B B perfo BBrming BBthe
BB next BB stage BB of BBsurgical BB treatment, BB ideally BB an BB orthopaedic BB oncologist.
REFE BBRENCE BBS: BB Gibbs BB CP BB Jr, B B Weber B B K, B B Scarborough B B MT: B B Malignant B B bone
B B tumors BB. B B Instr B B Course B B Lect BB2002;5 BB 1 BB:4 BB1 BB3-428.
Meyer BB IS, BB Nadel B B HR, BB Marina BB N, B B et BB al: B B Imaging B B guidelines B B for BB children
BB with BB Ewing B B s BBarcoma B B and BBosteosarcoma: B B A B B report B B from B B the B B Children's
B B Oncology B B Group B B Bone B B Tumor B B Committee. B B B B Pediatr BB Blood BBCancer BB2008;5 BB 1 BB:
BB1 6 3 - 1 BB70 BB. BB
, 2025 B Pediatric B Orthopaedic B Examination B Answer B Book
B· B 9
Figure BB3
Question BB 3
A BB9-year-old BBgirl BBhas BBhad BBbilateral BBknee BBand BBleg BBpain BBfor BBthe BBpast BB2 BByears. B B The
BBfamily BBhas BBnoted BBincreasing BBdeformity BBin BBboth BBlower BBextremities. B B She BBis BBless BBthan
BBthe BBfifth BBpercentile BBfor BBheight. B B Examination BBreveals BBbilateral BBfemoral BBbowing, BBmild
BBmedial-lateral BBlaxity BBof BBthe BBknees, BBand BBthe BBdeformities BBshown BBin BBthe BBradiograph
BBseen BBin BBFigure BB3. B B What BBis BBthe BBmost BBlikely BBdiagnosis?
1. Renal B B osteodystrophy
2. Diastrophic B B dysplasia
3. Metaphyseal B B dysplasia
4. Osteogenesis BBimperfecta
5. Fibrous B B dysplasia
PREFERRED B B RESPONSE: BB BB1
DISCUSSION: BBThe BBwidening, BBbowing, BBand BBcupping BBof BBthe BBphyses BBindicate BBsome
BBform BBof BBmetabolic BBbone BBdisease; BBtherefore, BBthe BBmost BBlikely BBdiagnosis BBis BBrenal
BBosteodystrophy. B B The BBage BBof BBonset BBmakes
X- linked BBhypophosphatemic BBrickets BBless BBlikely. B B The BBground BBglass BBlesions BBand
BBwidening BBof BBthe BBmedullary BBcanal BBcharacteristic B B of BBfibrous BBdysplasia B B are BBnot BBpresent.
B B There B B are BBno BBfractures BBcreating BBthe BBdeformities BBindicating BBosteogenesis BBimperfecta.
B B There BBis BBan BBasymmetry BBof BBthe BBdeformities BBthat BBmakes BB diastrophic BBdysplasia BBless
BBlikely.
REFERENCES: BBGoldberg BBMJ, BBYassir BBW, BBSadeghi-NejadBBA: BBClinical BBanalysis BBof BBshort
BBstature. B B J BBPediatr BBOrthop BB2002;22:690-696.
Parmar BBVS, BBStanitski BBDF, BBStanitski BBCL: BBInterpretation BBof BBradiographs BBin BBa BBpediatric
BBlimb BBdeformity BBpractice: BBDo BBradiologists BBcontribute? B B J BBPediatr BBOrthop B B 1999;
BB19:732-734.
AMERICAN B ACADEMY B OF B ORTHOPAEDIC B SURGEONS
Your BSource B for BLifelong B Orthopaedic BLearning
Pediatric B
Orthopedic
Answer Book B
, 2025 B Pediatric B Orthopaedic B Examination B Answer B Book
B· B 7
Figure BB 1a Figure BB 1b
Question BB1
A BB5-year-old BBboy B B has B B had B B a BBlimp BBfor BBthe B B past BB4 B B weeks BBwith BBintermittent BBpain B B at
BBthe B B foot. B B He BBremains BBnormally B B active BBand B B has BBno BBhistory B B of BBtrauma. B B He BBhas
BBno BBfevers, B B rashes, B B or BBswelling. B B Examination BBreveals BBtenderness BBat BBthe BBmid-dorsum BBof
BBthe BBfoot BBmedially. B B Radiographs BBare BBseen BBin B B Figures B B 1a BBand B B l BBb. B B Treatment
BBshould BBinclude BBwhich BBof BBthe BBfollowing?
1. MRl BBof BBthe BBfoot BB with BB gadolinium
2. Open B B biopsy BB of BB the B B lesion
3. Needle BB aspiration B B and BB culture, B B followed B B by BBantibiotic BB treatment
4. Observation BBor BBan BBorthotic BBarch BBsupport
5. Steroid BBinjection BBof BBthe
BBlesion BBPREFERRED BBRESPONSE:
BB4
DISCUSSION: BBOsteochondrosis BBof BBthe BBtarsal BBnavicular BBis BBmost BBcommonly BBidentified
BBbetween BBthe BBages BBof BB2 BBand BB9 BByears. B B The BBcondition BBis BBbenign BBand BBself BBlimited
BBin BBnature. B B In BBpatients BBwith BBsevere BBpain, BBa BBperiod BBof BBcasting BBmay BBbe BBwarranted,
BBbut BBotherwise BBmanagement BBusually BBconsists BBof BBobservation BBor BBa BBsupportive BBorthotic.
REFERENCES: BBDiGiovanni BBCW, BBPatel BBA, BBCalfee BBR, BBet BBal: BBOsteonecrosis BBin BBthe BBfoot.
BB JAmBBAcad BBOrthop BBSurg BB2007; BB15 BB:208-217.
Williams BBGA, BBCowell BBHR: BBKohler's BBdisease BBof BBthe BBtarsal BBnavicular. BB Clin BBOrthop
BBRelat BBRes B B 198 BB1; BB158:53- BB58.
,8 B B American BAcademy Bof BOrthopaedic
•
B Surgeons
Figure BB 2
Question BB2
A BB3 BB-year-old B B girl B B has B B had B B pain B B and B B swelling B B in BBher B B left B B thigh B B for B B the B B past B B 3
BB weeks. B B Her BBmother B B states B B she BBhas B B had B B a BBtemperature B B as B B high B B as B B 100.4
BB degrees BBF BB (38 B B degrees B B C) B B and B B a BBweight B B loss B B of BB5 B B pounds. B B A B B CBC BBshows BBa
BBWBC B B count BBof BB11 B B ,000/mm3 BB, B B an BBerythroc BByte BB sedimentation BBrate BB of BB13 B B mmlh,
BB and B B a B B C-reactive BBprotein B B of BB0.3. B B A BBradiograph BB is BB shown B B in B B Figure B B B B What
B B is B B the B B next B B step B B in B B management?
1. Biopsy B B and BBculture B B of BBthe B B lesion
2. MRI B B of BB the B B left B B femur
3. IV BB antibiotics B B for B B 6 BB weeks
4. Incision BB and BB drainage B B of BBthe B B left BB femur
5. Repeat BB radiograph BB in B B 3 BB months
P BBREFERRED B B RE BBSPONBBSE: B B 2
DI BBSCU BBSSION: BB The B B history BBand B B laboratory B B studies B B indicate BB that B B this B B is BB not BB an
BB infection. B B A BBlesion B B in B B this BBlocation B B and B B in B B this B B age B B group B B is BB likely BB a
B B Ewing's B B sarcoma. B B The B B presentation B B is B B usually B B a B B painful B B mass. BB About B B 20% B B of
BBpatients B B have BB a B B fever. B B The BB radiograph BB shows BB a B B typical B B mottled, BB permeative
BB lesion BBwith BBperiosteal B B reaction. B B B B An BB MRIscan BB should BB be B B obtained B B to B B further
BB evaluate BB the B B soft-tissue B B mass. B B B B Staging B B of B B the B B lesion B B should B B take B B place B B before
BBbiopsy, B B which B B should BBbe B B done B B by BBthe BBsurgeon B B who B B would BBbe B B perfo BBrming BBthe
BB next BB stage BB of BBsurgical BB treatment, BB ideally BB an BB orthopaedic BB oncologist.
REFE BBRENCE BBS: BB Gibbs BB CP BB Jr, B B Weber B B K, B B Scarborough B B MT: B B Malignant B B bone
B B tumors BB. B B Instr B B Course B B Lect BB2002;5 BB 1 BB:4 BB1 BB3-428.
Meyer BB IS, BB Nadel B B HR, BB Marina BB N, B B et BB al: B B Imaging B B guidelines B B for BB children
BB with BB Ewing B B s BBarcoma B B and BBosteosarcoma: B B A B B report B B from B B the B B Children's
B B Oncology B B Group B B Bone B B Tumor B B Committee. B B B B Pediatr BB Blood BBCancer BB2008;5 BB 1 BB:
BB1 6 3 - 1 BB70 BB. BB
, 2025 B Pediatric B Orthopaedic B Examination B Answer B Book
B· B 9
Figure BB3
Question BB 3
A BB9-year-old BBgirl BBhas BBhad BBbilateral BBknee BBand BBleg BBpain BBfor BBthe BBpast BB2 BByears. B B The
BBfamily BBhas BBnoted BBincreasing BBdeformity BBin BBboth BBlower BBextremities. B B She BBis BBless BBthan
BBthe BBfifth BBpercentile BBfor BBheight. B B Examination BBreveals BBbilateral BBfemoral BBbowing, BBmild
BBmedial-lateral BBlaxity BBof BBthe BBknees, BBand BBthe BBdeformities BBshown BBin BBthe BBradiograph
BBseen BBin BBFigure BB3. B B What BBis BBthe BBmost BBlikely BBdiagnosis?
1. Renal B B osteodystrophy
2. Diastrophic B B dysplasia
3. Metaphyseal B B dysplasia
4. Osteogenesis BBimperfecta
5. Fibrous B B dysplasia
PREFERRED B B RESPONSE: BB BB1
DISCUSSION: BBThe BBwidening, BBbowing, BBand BBcupping BBof BBthe BBphyses BBindicate BBsome
BBform BBof BBmetabolic BBbone BBdisease; BBtherefore, BBthe BBmost BBlikely BBdiagnosis BBis BBrenal
BBosteodystrophy. B B The BBage BBof BBonset BBmakes
X- linked BBhypophosphatemic BBrickets BBless BBlikely. B B The BBground BBglass BBlesions BBand
BBwidening BBof BBthe BBmedullary BBcanal BBcharacteristic B B of BBfibrous BBdysplasia B B are BBnot BBpresent.
B B There B B are BBno BBfractures BBcreating BBthe BBdeformities BBindicating BBosteogenesis BBimperfecta.
B B There BBis BBan BBasymmetry BBof BBthe BBdeformities BBthat BBmakes BB diastrophic BBdysplasia BBless
BBlikely.
REFERENCES: BBGoldberg BBMJ, BBYassir BBW, BBSadeghi-NejadBBA: BBClinical BBanalysis BBof BBshort
BBstature. B B J BBPediatr BBOrthop BB2002;22:690-696.
Parmar BBVS, BBStanitski BBDF, BBStanitski BBCL: BBInterpretation BBof BBradiographs BBin BBa BBpediatric
BBlimb BBdeformity BBpractice: BBDo BBradiologists BBcontribute? B B J BBPediatr BBOrthop B B 1999;
BB19:732-734.
