Fractures and dislocations: window in a plaster cast: 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 · Fractures and dislocations: window in a plaster cast

Sample item

Two days after a below-knee cast for a tibial fracture, a patient has a constant burning pain over the heel that is not relieved by elevation. The pain is localised to a single spot. What is the most likely problem and action?

ADeep vein thrombosis; start anticoagulants without examinationBPressure ulcer under the cast; cut a window or remove the cast to inspectCNormal healing pain; give more analgesia and continueDNerve regeneration; reassure

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

The answer and the reasoning

B. Pressure ulcer under the cast; cut a window or remove the cast to inspect

A localised burning pain under a cast that does not ease suggests skin necrosis from pressure over a bony prominence such as the heel. The cast should be windowed or removed and the skin examined, because unnoticed pressure sores can become deep infections.

Option by option

A. Deep vein thrombosis; start anticoagulants without examination
Thrombosis causes calf swelling and tenderness and not a focal heel burn, and anticoagulants are not started blindly.
B. Pressure ulcer under the cast; cut a window or remove the cast to inspect (correct)
Correct. Localised persistent burning pain means pressure injury, so the area must be inspected.
C. Normal healing pain; give more analgesia and continue
Fracture pain is usually diffuse and improves with elevation and rest.
D. Nerve regeneration; reassure
Nerve regeneration is not a feature two days after a cast is applied.

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 B, Pressure ulcer under the cast; cut a window or remove the cast to inspect. A localised burning pain under a cast that does not ease suggests skin necrosis from pressure over a bony prominence such as the heel.

Why is "Deep vein thrombosis; start anticoagulants without examination" not the answer?

Thrombosis causes calf swelling and tenderness and not a focal heel burn, and anticoagulants are not started blindly.

Why is "Normal healing pain; give more analgesia and continue" not the answer?

Fracture pain is usually diffuse and improves with elevation and rest.

Why is "Nerve regeneration; reassure" not the answer?

Nerve regeneration is not a feature two days after a cast is applied.

What concept does this question test?

It tests Fractures and dislocations: window in a plaster cast in Orthopaedics. The cast should be windowed or removed and the skin examined, because unnoticed pressure sores can become deep infections.

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 Fractures and dislocations: window in a plaster cast?

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.