Fractures: subtrochanteric femur: 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: subtrochanteric femur

Sample item

In a displaced subtrochanteric fracture, the proximal fragment lies flexed, abducted and externally rotated. Which muscle forces explain this deformity?

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

The answer and the reasoning

A. Iliopsoas flexing, gluteus medius and minimus abducting, and short external rotators rotating the fragment

The iliopsoas flexes the proximal fragment, the gluteal abductors abduct it and the short external rotators rotate it outward. The distal fragment is pulled into adduction and shortening by the adductors. A cephalomedullary nail is usually used to control these forces.

Option by option

  • A. Iliopsoas flexing, gluteus medius and minimus abducting, and short external rotators rotating the fragment (correct)

    Correct. Iliopsoas, abductors and short external rotators deform the proximal fragment.

  • B. Adductors pulling the proximal fragment into adduction

    The adductors act on the distal fragment, not the proximal one.

  • C. Hamstrings extending the proximal fragment

    Hamstrings act on the distal fragment and do not extend the proximal segment.

  • D. Quadriceps rotating the proximal fragment internally

    Quadriceps does not internally rotate the proximal fragment.

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, Iliopsoas flexing, gluteus medius and minimus abducting, and short external rotators rotating the fragment. The iliopsoas flexes the proximal fragment, the gluteal abductors abduct it and the short external rotators rotate it outward.

Why is "Adductors pulling the proximal fragment into adduction" not the answer?

The adductors act on the distal fragment, not the proximal one.

Why is "Hamstrings extending the proximal fragment" not the answer?

Hamstrings act on the distal fragment and do not extend the proximal segment.

Why is "Quadriceps rotating the proximal fragment internally" not the answer?

Quadriceps does not internally rotate the proximal fragment.

What concept does this question test?

It tests Fractures: subtrochanteric femur in Orthopaedics. The distal fragment is pulled into adduction and shortening by the adductors. A cephalomedullary nail is usually used to control these forces.

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: subtrochanteric femur?

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.