Open fractures: 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 · Open fractures

Sample item

A farmer's tibia is fractured by a tractor wheel. A 14 cm wound is contaminated with soil, with extensive periosteal stripping and exposed bone that cannot be covered without a flap. Which classification fits, and what is the correct initial management?

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

The answer and the reasoning

C. Gustilo type IIIB, with early intravenous antibiotics including gram-negative cover, tetanus prophylaxis, thorough debridement and fixation with soft-tissue cover

Gustilo-Anderson type III injuries have wounds typically more than 10 cm with extensive soft-tissue damage, and type IIIB has periosteal stripping needing flap cover. Management is early antibiotics (a cephalosporin with an aminoglycoside for type III), tetanus prophylaxis, serial radical debridement, skeletal stabilisation and early soft-tissue coverage.

Option by option

  • A. Gustilo type I, with wound closure in the emergency room and a cast

    Type I is a clean wound under 1 cm and does not apply to such extensive injury.

  • B. Gustilo type IIIA, with primary closure and no antibiotics

    Type IIIA has adequate soft-tissue cover of the bone, and no antibiotics and primary closure of a contaminated wound would be dangerous.

  • C. Gustilo type IIIB, with early intravenous antibiotics including gram-negative cover, tetanus prophylaxis, thorough debridement and fixation with soft-tissue cover (correct)

    Correct. Bone exposure needing flap cover defines IIIB, and the plan is antibiotics, debridement, stabilisation and cover.

  • D. Gustilo type II, with oral antibiotics and delayed wound closure after a week

    Type II involves a wound of 1 to 10 cm without extensive soft-tissue damage, and a week's delay is unsafe.

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 C, Gustilo type IIIB, with early intravenous antibiotics including gram-negative cover, tetanus prophylaxis, thorough debridement and fixation with soft-tissue cover. Gustilo-Anderson type III injuries have wounds typically more than 10 cm with extensive soft-tissue damage, and type IIIB has periosteal stripping needing flap cover.

Why is "Gustilo type I, with wound closure in the emergency room and a cast" not the answer?

Type I is a clean wound under 1 cm and does not apply to such extensive injury.

Why is "Gustilo type IIIA, with primary closure and no antibiotics" not the answer?

Type IIIA has adequate soft-tissue cover of the bone, and no antibiotics and primary closure of a contaminated wound would be dangerous.

Why is "Gustilo type II, with oral antibiotics and delayed wound closure afte…" not the answer?

Type II involves a wound of 1 to 10 cm without extensive soft-tissue damage, and a week's delay is unsafe.

What concept does this question test?

It tests Open fractures in Orthopaedics. Management is early antibiotics (a cephalosporin with an aminoglycoside for type III), tetanus prophylaxis, serial radical debridement, skeletal stabilisation and early soft-tissue coverage.

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 Open fractures?

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.