Paediatric orthopaedics: epiphysiodesis: practice question

A Orthopaedics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Orthopaedics · Paediatric orthopaedics: epiphysiodesis

Sample item

A 10-year-old boy has a projected leg length discrepancy of 3.5 cm at skeletal maturity from a previous femoral growth disturbance. Which procedure is an appropriate way of equalising lengths?

AShoe raise only, never surgeryBFemoral lengthening by 10 cmCAmputation of the shorter limbDEpiphysiodesis of the longer limb at the appropriate time

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Epiphysiodesis of the longer limb at the appropriate time

Epiphysiodesis arrests growth of the physis of the longer leg and is suited to predicted discrepancies of about 2 to 5 cm when timed correctly. Larger discrepancies need lengthening procedures. Timing depends on skeletal age and the remaining growth of the physes.

Option by option

A. Shoe raise only, never surgery
A shoe raise is one option for smaller discrepancies, but surgery is not excluded at this size.
B. Femoral lengthening by 10 cm
A lengthening of 10 cm is excessive and exceeds the discrepancy.
C. Amputation of the shorter limb
Amputation of a functional limb is not appropriate for this discrepancy.
D. Epiphysiodesis of the longer limb at the appropriate time (correct)
Correct. Timed epiphysiodesis of the longer limb treats a discrepancy in the 2 to 5 cm range.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is D, Epiphysiodesis of the longer limb at the appropriate time. Epiphysiodesis arrests growth of the physis of the longer leg and is suited to predicted discrepancies of about 2 to 5 cm when timed correctly.

Why is "Shoe raise only, never surgery" not the answer?

A shoe raise is one option for smaller discrepancies, but surgery is not excluded at this size.

Why is "Femoral lengthening by 10 cm" not the answer?

A lengthening of 10 cm is excessive and exceeds the discrepancy.

Why is "Amputation of the shorter limb" not the answer?

Amputation of a functional limb is not appropriate for this discrepancy.

What concept does this question test?

It tests Paediatric orthopaedics: epiphysiodesis in Orthopaedics. Larger discrepancies need lengthening procedures. Timing depends on skeletal age and the remaining growth of the physes.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Paediatric orthopaedics: epiphysiodesis?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.