Fractures and dislocations: distal tibial fracture union: 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: distal tibial fracture union

Sample item

A tibial shaft fracture in the distal third often heals more slowly than one in the proximal third. Which feature of the anatomy mainly explains this?

AA thicker periosteum that blocks callus formationBAn absence of cancellous bone at the siteCHigher muscle bulk that distracts the fragmentsDPoor soft tissue cover and a reduced blood supply in the distal tibia

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

The answer and the reasoning

D. Poor soft tissue cover and a reduced blood supply in the distal tibia

The nutrient artery enters the tibia in the proximal posterior part, and the distal third has little muscle cover and a limited blood supply. Fractures here have higher rates of delayed union and non-union, particularly with open injuries.

Option by option

A. A thicker periosteum that blocks callus formation
Periosteum promotes callus formation and does not block it.
B. An absence of cancellous bone at the site
The distal tibial metaphysis contains abundant cancellous bone.
C. Higher muscle bulk that distracts the fragments
Muscle bulk is less in the distal leg and the tendons there have little distracting force.
D. Poor soft tissue cover and a reduced blood supply in the distal tibia (correct)
Correct. Little muscle cover and weaker perfusion slow healing in the distal third.

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 D, Poor soft tissue cover and a reduced blood supply in the distal tibia. The nutrient artery enters the tibia in the proximal posterior part, and the distal third has little muscle cover and a limited blood supply.

Why is "A thicker periosteum that blocks callus formation" not the answer?

Periosteum promotes callus formation and does not block it.

Why is "An absence of cancellous bone at the site" not the answer?

The distal tibial metaphysis contains abundant cancellous bone.

Why is "Higher muscle bulk that distracts the fragments" not the answer?

Muscle bulk is less in the distal leg and the tendons there have little distracting force.

What concept does this question test?

It tests Fractures and dislocations: distal tibial fracture union in Orthopaedics. Fractures here have higher rates of delayed union and non-union, particularly with open injuries.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. 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: distal tibial fracture union?

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.