Fractures and dislocations: upper limb: 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: upper limb

Sample item

A child in a cast for a supracondylar fracture develops severe forearm pain, swollen tense fingers and pain on passive finger extension within hours, with a palpable radial pulse. What is the immediate next step?

AElevate the limb and give oral analgesiaBRemove the cast and padding down to skin and reassessCStart low molecular weight heparinDOrder an angiogram before any intervention

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

The answer and the reasoning

B. Remove the cast and padding down to skin and reassess

This is impending compartment syndrome with Volkmann ischaemia, and tight casts are a recognised cause. Release all circumferential dressings at once, and proceed to fasciotomy if there is no relief.

Option by option

A. Elevate the limb and give oral analgesia
Elevation and oral analgesia delay decompression while muscle dies.
B. Remove the cast and padding down to skin and reassess (correct)
Correct. Releasing the constricting cast is the first and most urgent action.
C. Start low molecular weight heparin
Anticoagulation does not treat raised compartment pressure and increases bleeding.
D. Order an angiogram before any intervention
An angiogram delays treatment, and the pulse is present because pulses are lost late.

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, Remove the cast and padding down to skin and reassess. This is impending compartment syndrome with Volkmann ischaemia, and tight casts are a recognised cause.

Why is "Elevate the limb and give oral analgesia" not the answer?

Elevation and oral analgesia delay decompression while muscle dies.

Why is "Start low molecular weight heparin" not the answer?

Anticoagulation does not treat raised compartment pressure and increases bleeding.

Why is "Order an angiogram before any intervention" not the answer?

An angiogram delays treatment, and the pulse is present because pulses are lost late.

What concept does this question test?

It tests Fractures and dislocations: upper limb in Orthopaedics. Release all circumferential dressings at once, and proceed to fasciotomy if there is no relief.

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 Fractures and dislocations: upper limb?

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.