MCQs – Hip 2

Modern Study Review (AI-Generated)

High-Yield Summary

Pediatric hip fractures are a staple of the Royal College exam, focusing heavily on the Delbert classification and age-based treatment thresholds. The Delbert system categorizes fractures by location (I-IV) and femoral head position (A = dislocated, B = reduced), which directly influences prognosis and management. The critical clinical decision hinges on fracture type and patient age, especially regarding the use of internal fixation versus conservative treatment. While exams emphasize classification-guided fixation, modern practice increasingly prioritizes physeal preservation and individualized surgical indications in unstable or older children.

High-Yield Decision Matrix

Active Recall Q&A

Q: What are the four types of fractures in the Delbert classification for pediatric hip fractures?
A: I – transphyseal, II – transcervical, III – basicervical, IV – intertrochanteric.
Related Pearl: Transphyseal fractures (Type I) carry the highest risk of avascular necrosis due to disruption of the blood supply through the physis.

Q: What do the suffixes A and B indicate in the Delbert classification?
A: A indicates the femoral head is dislocated; B indicates the femoral head is reduced.
Related Pearl: Dislocated femoral heads (A suffix) require urgent reduction to minimize complications and generally have worse outcomes.

Q: How should a transcervical fracture in a 6-year-old be managed?
A: Closed reduction and internal fixation, ideally stopping fixation short of the physis.
Related Pearl: Preserving the physis reduces the risk of growth disturbance and long-term deformity in young children.

Q: What is the preferred treatment for intertrochanteric fractures in children?
A: Traction followed by spica casting is standard; internal fixation is considered if the child is ?8 years old, the fracture is unstable, or in multitrauma cases.
Related Pearl: Older children tolerate surgical fixation better, and unstable fractures require stabilization to prevent malunion and functional impairment.

Classic Clinical Notes

• A 6 year old with a transcervical fracture – closed reduction and internal fixation.
• The Delbert classification goes from I to IV with A and B suffixes to indicate if the head is reduced or dislocated (A = dislocated, B = reduced). So the classification is:
• I – transphyseal (with head dislocated (IA) or head reduced (IB))
• II – transcervical (with head dislocated (IIA) or head reduced (IIB))
• III – basicervical (with head dislocated (IIIA) or head reduced (IIIB))
• IV – intertrochanteric (with head dislocated (IVA) or head reduced (IVB))
• If you can, stop the internal fixation short of the physis.
• The intertrochanteric fractures are often treated with traction then spica casting, but in an 8 year old or unstable fracture or multitrauma – consider fixing.

Last Updated on January 25, 2026 by Christian Veillette