Fracture complications: pulseless pink hand: 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 · Fracture complications: pulseless pink hand

Sample item

A 5-year-old with a displaced extension-type supracondylar fracture has an absent radial pulse, but the hand is warm, pink and has brisk capillary refill. What is the most appropriate next step?

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

The answer and the reasoning

A. Urgent gentle closed reduction with fixation, then reassess perfusion

A pulseless but well-perfused hand often reflects arterial kinking or spasm at the fracture, and reduction frequently restores flow. If the hand becomes or stays white and cold after reduction, the vessel is explored. Delaying reduction for angiography or leaving the fracture displaced prolongs ischaemia.

Option by option

  • A. Urgent gentle closed reduction with fixation, then reassess perfusion (correct)

    Correct. Reduction and fixation come first, and perfusion is then reassessed.

  • B. Immediate surgical exploration of the brachial artery before any reduction

    Exploration is reserved for a cold white hand or perfusion that fails to return after reduction.

  • C. Immediate fasciotomy of the forearm

    Fasciotomy is for established compartment syndrome and is not the first step for a perfused hand.

  • D. Observation in a plaster slab with hourly pulse checks only

    Leaving the fracture displaced risks continuing arterial compromise.

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.

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Questions about this Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is A, Urgent gentle closed reduction with fixation, then reassess perfusion. A pulseless but well-perfused hand often reflects arterial kinking or spasm at the fracture, and reduction frequently restores flow.

Why is "Immediate surgical exploration of the brachial artery before any redu…" not the answer?

Exploration is reserved for a cold white hand or perfusion that fails to return after reduction.

Why is "Immediate fasciotomy of the forearm" not the answer?

Fasciotomy is for established compartment syndrome and is not the first step for a perfused hand.

Why is "Observation in a plaster slab with hourly pulse checks only" not the answer?

Leaving the fracture displaced risks continuing arterial compromise.

What concept does this question test?

It tests Fracture complications: pulseless pink hand in Orthopaedics. If the hand becomes or stays white and cold after reduction, the vessel is explored. Delaying reduction for angiography or leaving the fracture displaced prolongs ischaemia.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. 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 Fracture complications: pulseless pink hand?

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.