Fracture complications: Volkmann contracture pathology: 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: Volkmann contracture pathology

Sample item

A 6-year-old is treated in a tight cast for a displaced supracondylar fracture. He had severe forearm pain worsened by passive finger extension, but the cast was not loosened. Six weeks later the fingers are fixed in a claw-like flexed position. What is the underlying pathology?

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

The answer and the reasoning

D. Ischaemic necrosis and fibrosis of the deep forearm flexor muscles

Brachial artery injury or a tight cast raises forearm compartment pressure and the deep flexors, particularly flexor digitorum profundus and flexor pollicis longus, are the first to die. They are replaced by fibrous tissue that shortens, so the fingers flex and passive extension is resisted. Pain on passive stretch is the earliest warning sign.

Option by option

  • A. Contracture of the palmar fascia

    Palmar fascial contracture describes Dupuytren disease, which does not follow a cast.

  • B. Fibrosis of the extensor compartment muscles of the forearm

    The flexor compartment, not the extensor compartment, is mainly affected.

  • C. Primary ulnar nerve palsy with intrinsic muscle wasting

    Nerve damage may coexist, but the fixed flexion is caused by shortened fibrotic muscle.

  • D. Ischaemic necrosis and fibrosis of the deep forearm flexor muscles (correct)

    Correct. Ischaemic fibrosis of the deep flexor muscles produces Volkmann contracture.

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 D, Ischaemic necrosis and fibrosis of the deep forearm flexor muscles. Brachial artery injury or a tight cast raises forearm compartment pressure and the deep flexors, particularly flexor digitorum profundus and flexor pollicis longus, are the first to die.

Why is "Contracture of the palmar fascia" not the answer?

Palmar fascial contracture describes Dupuytren disease, which does not follow a cast.

Why is "Fibrosis of the extensor compartment muscles of the forearm" not the answer?

The flexor compartment, not the extensor compartment, is mainly affected.

Why is "Primary ulnar nerve palsy with intrinsic muscle wasting" not the answer?

Nerve damage may coexist, but the fixed flexion is caused by shortened fibrotic muscle.

What concept does this question test?

It tests Fracture complications: Volkmann contracture pathology in Orthopaedics. They are replaced by fibrous tissue that shortens, so the fingers flex and passive extension is resisted. Pain on passive stretch is the earliest warning sign.

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: Volkmann contracture pathology?

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.