The parents of a 7-year-old with a completely displaced supracondylar fracture and a well-perfused hand refuse the advised closed reduction and pinning under anaesthesia. They want to take him to a traditional bonesetter in their village. What is the most appropriate response of the treating doctor?

Explain the risks in their language, apply a safe slab and document informed refusal

Discharge the child at once without a splint or written record

Operate anyway, since a minor's treatment does not need the parents' consent

Inform the police that the parents are endangering the child's life

A 9-year-old boy is brought to the casualty of a Kolkata hospital after a fall on his outstretched hand. The elbow is swollen and painful. On examination, the tip of the olecranon and the two humeral epicondyles still form an isosceles triangle with the elbow flexed. Which injury is most likely?

Supracondylar fracture of the humerus

Displaced fracture of the olecranon

Posterior dislocation of the elbow

Displaced lateral condyle fracture

Fractures and their classifications and complications

35 NEET-PG practice questions on Fractures and their classifications and complications, part of Orthopaedics. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Easy
A 7-year-old girl had a supracondylar fracture of the left humerus treated in plaster a year ago. Her parents now notice that when she straightens the left elbow, the forearm angles towards the midline instead of slightly outwards. Which deformity has developed?
1. AFixed flexion deformity
2. BCubitus varus
3. CVolkmann ischaemic contracture
4. DCubitus valgus
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Answer: B · Cubitus varus
Malunion is the commonest complication of a supracondylar fracture, and the usual result is cubitus varus ('gunstock deformity'), from medial tilt and rotation of the distal fragment. The normal carrying angle is lost or reversed, so the forearm points inwards. It is mainly a cosmetic problem and is corrected, if needed, by a supracondylar corrective osteotomy. Volkmann ischaemic contracture is the most serious early complication, from brachial artery injury and forearm compartment syndrome.
- A: Fixed flexion is loss of extension, not a change in the carrying angle.
- C: Volkmann contracture affects the forearm flexors and fingers, not the elbow angle.
- D: Cubitus valgus follows a lateral condyle fracture and can cause tardy ulnar nerve palsy.
Question 2 · Medium
The parents of a 7-year-old with a completely displaced supracondylar fracture and a well-perfused hand refuse the advised closed reduction and pinning under anaesthesia. They want to take him to a traditional bonesetter in their village. What is the most appropriate response of the treating doctor?
1. ADischarge the child at once without a splint or written record
2. BOperate anyway, since a minor's treatment does not need the parents' consent
3. CInform the police that the parents are endangering the child's life
4. DExplain the risks in their language, apply a safe slab and document informed refusal
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Answer: D · Explain the risks in their language, apply a safe slab and document informed refusal
For a child, valid consent comes from the parents, and they may refuse after being properly informed. The doctor's duty is to explain in a language they understand what the fracture is, what the operation involves, and the real risks of refusing: redisplacement, Volkmann ischaemic contracture from tight splinting, nerve injury and cubitus varus. If they still refuse, a well-padded slab in a safe position is applied, warning signs of compartment syndrome are explained, and the refusal is documented with their signatures and a witness. Leaving the door open to return builds trust and often brings the child back.
- A: Discharging without a splint or record abandons the child and leaves the doctor without protection.
- B: Operating without consent on a non-emergency case is assault, even on a minor.
- C: Refusal of advised elective treatment after counselling is not by itself a police matter.
Question 3 · Easy
An 11-year-old girl falls from a cycle onto her outstretched hand. The wrist X-ray shows separation through the distal radial growth plate, with a small triangular fragment of metaphysis attached to the displaced epiphysis. What type of injury is this?
1. ASalter-Harris type III
2. BSalter-Harris type I
3. CSalter-Harris type IV
4. DSalter-Harris type II
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Answer: D · Salter-Harris type II
A fracture through the physis that exits through the metaphysis, carrying a triangular metaphyseal fragment (the Thurston Holland fragment), is Salter-Harris type II, the commonest physeal injury. Types I and II do not cross the germinal layer of the physis, so they usually heal well with closed reduction and a cast and rarely disturb growth. Types III and IV cross the physis into the joint and need accurate, often open, reduction. Type V is a crush injury of the physis with a poor prognosis.
- A: Type III passes through the physis and then the epiphysis into the joint.
- B: Type I is a separation through the physis without any metaphyseal or epiphyseal fragment.
- C: Type IV crosses metaphysis, physis and epiphysis in one line.
Question 4 · Medium
A 9-year-old boy is brought to the casualty of a Kolkata hospital after a fall on his outstretched hand. The elbow is swollen and painful. On examination, the tip of the olecranon and the two humeral epicondyles still form an isosceles triangle with the elbow flexed. Which injury is most likely?
1. ADisplaced fracture of the olecranon
2. BPosterior dislocation of the elbow
3. CSupracondylar fracture of the humerus
4. DDisplaced lateral condyle fracture
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Answer: C · Supracondylar fracture of the humerus
The three bony points of the elbow (the medial and lateral epicondyles and the tip of the olecranon) form a triangle in flexion and lie in a line in extension. In a supracondylar fracture the break is above the epicondyles, so all three points move together and the relationship is preserved. In posterior dislocation the olecranon moves away from the epicondyles, and in fractures of the olecranon or lateral condyle one point is displaced, so the triangle is disturbed. This clinical test helps when swelling makes deformity hard to judge.
- A: A displaced olecranon fracture moves the olecranon tip and disturbs the triangle.
- B: Dislocation moves the olecranon back relative to the epicondyles and disturbs the triangle.
- D: A displaced lateral condyle fragment carries the lateral epicondyle with it.
Question 5 · Medium
A 66-year-old woman from Indore has a Colles fracture after a fall at home. The intern lists four statements for the teaching round: 1. The fracture lies at the corticocancellous junction of the distal radius. 2. The distal fragment is displaced and tilted dorsally. 3. The nerve most often compressed after this fracture is the ulnar nerve. 4. Rupture of the extensor pollicis longus tendon can occur weeks later. Which statements are correct?
1. A1, 2 and 3 only
2. B2 and 4 only
3. C1 and 2 only
4. D1, 2 and 4 only
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Answer: D · 1, 2 and 4 only
Statements 1, 2 and 4 are correct. A Colles fracture is a fracture of the distal radius at its corticocancellous junction, with dorsal displacement and dorsal tilt of the distal fragment, radial displacement and impaction. Rupture of the extensor pollicis longus tendon near Lister's tubercle is a recognised late complication. Statement 3 is false: the nerve compressed after distal radius fractures is the median nerve in the carpal tunnel, not the ulnar nerve.
- A: Includes the ulnar nerve; the median nerve is the one compressed.
- B: Omits statement 1; the fracture does lie at the corticocancellous junction.
- C: Omits extensor pollicis longus rupture, a true late complication.
Question 6 · Hard
A 26-year-old man has a closed fracture of both bones of the leg. A postgraduate student notes four statements about compartment syndrome in this patient: 1. A palpable dorsalis pedis pulse excludes compartment syndrome. 2. A difference of less than 30 mmHg between diastolic blood pressure and compartment pressure supports fasciotomy. 3. Fasciotomy in the leg should release all four compartments, usually through two incisions. 4. An open tibial fracture cannot develop compartment syndrome. Which statements are correct?
1. A1, 2 and 3 only
2. B2 and 3 only
3. C1 and 4 only
4. D2, 3 and 4 only
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Question 7 · Hard
A 5-year-old boy is brought to a district hospital two hours after falling off a swing. He has a grossly swollen elbow and a completely displaced extension-type supracondylar fracture on X-ray. The hand is pale and cool, the radial pulse cannot be felt, and capillary refill in the fingers is 5 seconds. He can move his fingers and there is no pain on passive finger extension. The orthopaedic team is available and a theatre is free. What is the next best step?
1. ACT angiography of the arm before any reduction
2. BElevation, observation and repeat checks every hour
3. CExploration of the brachial artery before reduction
4. DUrgent closed reduction and pinning in theatre
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Question 8 · Medium
A 40-year-old man has intramedullary nailing of a closed tibial fracture. For post-operative pain he receives a continuous lumbar epidural infusion of bupivacaine with fentanyl. The next morning he reports little pain, but the anterior leg is tense and he cannot move his toes; compartment pressure is markedly raised. What most likely delayed the diagnosis?
1. AIntramedullary nailing prevents compartment syndrome
2. BBupivacaine lowers the compartment pressure
3. CThe epidural block masked the ischaemic pain
4. DFentanyl causes direct necrosis of muscle
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Question 9 · Medium
A 6-year-old boy from Nashik fell from a mango tree onto his outstretched right hand. The elbow is swollen with an S-shaped deformity. X-ray shows an extension-type supracondylar fracture of the humerus with the distal fragment completely displaced backwards and no cortical contact. The hand is warm and pink, the radial pulse is palpable and nerve function is intact. What is the most appropriate treatment?
1. AClosed reduction and percutaneous K-wire fixation
2. BCollar and cuff sling with early movement
3. COpen reduction and fixation with a plate
4. DAbove-elbow slab in 90 degrees of flexion
Answer and explanation in LearnFree account
Question 10 · Medium
A 24-year-old fast bowler for a Ranji Trophy team falls on his outstretched hand during a match. He has tenderness in the anatomical snuffbox and pain on axial compression of the thumb, but four scaphoid views on X-ray show no fracture. His team wants to know within days whether he can play. Which investigation is most appropriate to confirm or exclude a fracture now?
1. ARepeat X-ray after two weeks
2. BMRI of the wrist
3. CUltrasound of the wrist
4. DTechnetium bone scan today
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Question 11 · Medium
A 7-year-old girl is seen in casualty with a displaced extension-type supracondylar fracture after a fall at school. The distal fragment is displaced backwards and laterally. She can feel touch normally over the whole hand, but when asked to make an 'O' with her thumb and index finger, the tips stay straight and she forms a flat pinch instead. Which nerve is injured?
1. APosterior interosseous nerve
2. BAnterior interosseous nerve
3. CSuperficial branch of the radial nerve
4. DUlnar nerve at the medial epicondyle
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Question 12 · Medium
An 80-year-old man in a village near Mysuru has an intertrochanteric fracture of the right femur after a fall. His family refuses surgery, and he is treated with traction and bed rest for ten weeks. The fracture unites. Which deformity is he most likely to be left with?
1. ACoxa valga with internal rotation and lengthening
2. BAvascular necrosis with collapse of the femoral head
3. CCoxa vara with external rotation and shortening
4. DNonunion of the fracture with a mobile false joint
Answer and explanation in LearnFree account
Question 13 · Medium
An 83-year-old woman from Jaipur with moderate dementia, who walks only inside her home with a walker, trips and has a completely displaced subcapital fracture of the right femoral neck. She has no hip arthritis and is medically fit for anaesthesia. What is the most appropriate treatment?
1. ASkin traction for six to eight weeks
2. BClosed reduction and cannulated screw fixation
3. CHemiarthroplasty of the hip
4. DTotal hip replacement
Answer and explanation in LearnFree account
Question 14 · Medium
A 10-year-old boy from rural Bihar is brought to the orthopaedic OPD. Eight months ago a traditional bonesetter tied tight splints for a 'broken elbow'. His forearm is now thin and woody, the fingers are held flexed, and they can be straightened fully only when the wrist is flexed. Which muscle is most commonly and most severely affected in this condition?
1. AFlexor digitorum profundus
2. BPronator teres
3. CFlexor carpi ulnaris
4. DFlexor digitorum superficialis
Answer and explanation in LearnFree account
Question 15 · Medium
A 34-year-old man had screw fixation of a displaced femoral neck fracture 18 months ago, and the fracture united. He now has increasing groin pain and a limp. X-ray shows a subchondral lucent line (crescent sign) in the superolateral femoral head. Damage to branches of which artery explains this complication?
1. ANutrient artery of the femur
2. BArtery of ligamentum teres
3. CLateral circumflex femoral artery
4. DMedial circumflex femoral artery
Answer and explanation in LearnFree account
Question 16 · Medium
A 76-year-old woman in Chennai had a hemiarthroplasty for a femoral neck fracture after a fall from standing height. DEXA shows a femoral neck T-score of -3.1. Her eGFR is 62 mL/min/1.73 m², serum calcium and vitamin D have been corrected, and she has no dental problems. Which drug, given after hip fracture repair, has been shown to reduce both new fractures and mortality?
1. ANasal salmon calcitonin daily
2. BCalcium and vitamin D alone
3. CIntravenous zoledronic acid once yearly
4. DOral raloxifene daily
Answer and explanation in LearnFree account
Question 17 · Medium
Consider these statements about why intracapsular fractures of the femoral neck often fail to unite: 1. The intracapsular neck has a thin periosteum with no cambium layer to form callus. 2. Synovial fluid lyses the fracture haematoma. 3. The blood supply to the femoral head is easily disrupted by displacement. 4. Shear forces across the fracture line are minimal. Which statements are correct?
1. A3 and 4 only
2. B1, 2, 3 and 4
3. C1, 2 and 3 only
4. D1 and 2 only
Answer and explanation in LearnFree account
Question 18 · Medium
A 26-year-old software engineer in Bengaluru had a fracture through the waist of the scaphoid nine months ago, treated in a cast for six weeks. He still has wrist pain. X-ray now shows that the proximal fragment is uniformly dense and sclerotic while the distal fragment looks normal. What explains why only the proximal fragment is affected?
1. AIts blood supply enters distally and flows backwards
2. BIt is covered with cartilage and has no periosteum
3. CIt is the fragment that bears most of the axial load
4. DIts synovial fluid washes away the fracture haematoma
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Question 19 · Hard
A 67-year-old man from Kanpur sustains a fracture of the right femoral neck while turning in bed. For four months he has had back pain and tiredness. Hb is 8.9 g/dL, ESR 112 mm/h, serum calcium 11.9 mg/dL (reference 8.5-10.5), creatinine 2.1 mg/dL, total protein 9.4 g/dL and albumin 3.1 g/dL. The alkaline phosphatase is normal, and X-ray of the femur shows punched-out lytic areas. Which investigation will best establish the cause of the fracture?
1. ATechnetium-99m whole-body bone scan
2. BDEXA scan of the hip and the spine
3. CSerum protein electrophoresis
4. DSerum parathyroid hormone level
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Question 20 · Medium
Consider these statements about fractures of the scaphoid: 1. It is the most commonly fractured carpal bone. 2. Fractures of the proximal pole carry the highest risk of avascular necrosis. 3. Tenderness in the anatomical snuffbox after a fall is a sign of a possible fracture. 4. Fractures of the distal pole have the highest rate of nonunion. Which statements are correct?
1. A1 and 3 only
2. B1 and 4 only
3. C1, 2 and 3 only
4. D2, 3 and 4 only
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Question 21 · Easy
A 19-year-old college student falls on his outstretched hand while playing volleyball and has a scaphoid fracture on X-ray. Which part of the scaphoid is most commonly fractured?
1. ATubercle
2. BWaist
3. CDistal pole
4. DProximal pole
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Question 22 · Easy
A 30-year-old man has a closed fracture of the tibial shaft after a road accident and is admitted to the orthopaedic ward of a district hospital. Which finding is the earliest and most reliable sign of developing compartment syndrome?
1. APain on passive stretching of the muscles
2. BParalysis of the toe extensors
3. CPallor and coldness of the foot
4. DLoss of the dorsalis pedis pulse
Answer and explanation in LearnFree account
Question 23 · Easy
A 30-year-old motorcyclist falls and lands on the back of his flexed right wrist. The wrist shows a 'garden spade' deformity. X-ray shows an extra-articular fracture of the distal radius with the distal fragment displaced and tilted towards the palm. What is this fracture called?
1. AColles fracture
2. BGaleazzi fracture
3. CChauffeur's fracture
4. DSmith fracture
Answer and explanation in LearnFree account
Question 24 · Easy
A 71-year-old woman slips in her bathroom and cannot bear weight on the left leg. X-ray shows an intracapsular fracture of the femoral neck that is complete and fully displaced, with no contact between the fragments. Which classification is used to grade displacement in this fracture?
1. AGarden classification
2. BGustilo-Anderson classification
3. CGartland classification
4. DSalter-Harris classification
Answer and explanation in LearnFree account
Question 25 · Medium
A 58-year-old woman had an undisplaced fracture of the distal radius treated in a below-elbow cast. Seven weeks after the injury, while lifting a vessel, she felt a click on the back of the wrist. She now cannot lift her thumb off the table with the palm flat, and the interphalangeal joint of the thumb cannot be actively straightened. Which structure has failed?
1. APosterior interosseous nerve trunk
2. BTendon of abductor pollicis longus
3. CTendon of extensor pollicis longus
4. DTendon of flexor pollicis longus
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Fractures and their classifications and complications

A 7-year-old girl had a supracondylar fracture of the left humerus treated in plaster a year ago. Her parents now notice that when she straightens the left elbow, the forearm angles towards the midline instead of slightly outwards. Which deformity has developed?

An 11-year-old girl falls from a cycle onto her outstretched hand. The wrist X-ray shows separation through the distal radial growth plate, with a small triangular fragment of metaphysis attached to the displaced epiphysis. What type of injury is this?

A 9-year-old boy is brought to the casualty of a Kolkata hospital after a fall on his outstretched hand. The elbow is swollen and painful. On examination, the tip of the olecranon and the two humeral epicondyles still form an isosceles triangle with the elbow flexed. Which injury is most likely?

An 80-year-old man in a village near Mysuru has an intertrochanteric fracture of the right femur after a fall. His family refuses surgery, and he is treated with traction and bed rest for ten weeks. The fracture unites. Which deformity is he most likely to be left with?

An 83-year-old woman from Jaipur with moderate dementia, who walks only inside her home with a walker, trips and has a completely displaced subcapital fracture of the right femoral neck. She has no hip arthritis and is medically fit for anaesthesia. What is the most appropriate treatment?

A 19-year-old college student falls on his outstretched hand while playing volleyball and has a scaphoid fracture on X-ray. Which part of the scaphoid is most commonly fractured?

A 30-year-old man has a closed fracture of the tibial shaft after a road accident and is admitted to the orthopaedic ward of a district hospital. Which finding is the earliest and most reliable sign of developing compartment syndrome?

A 30-year-old motorcyclist falls and lands on the back of his flexed right wrist. The wrist shows a 'garden spade' deformity. X-ray shows an extra-articular fracture of the distal radius with the distal fragment displaced and tilted towards the palm. What is this fracture called?

A 71-year-old woman slips in her bathroom and cannot bear weight on the left leg. X-ray shows an intracapsular fracture of the femoral neck that is complete and fully displaced, with no contact between the fragments. Which classification is used to grade displacement in this fracture?