Compartment syndrome: 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 · Compartment syndrome

Sample item

A 25-year-old with a tibial shaft fracture in a below-knee cast has increasing pain 10 hours later that is unrelieved by analgesics. The calf is tense, passive toe extension is very painful, and pedal pulses are palpable. What is the most appropriate immediate step?

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

The answer and the reasoning

C. Split the cast and all underlying padding, then proceed to fasciotomy if there is no prompt relief

Pain out of proportion and pain on passive stretch suggest acute compartment syndrome, a clinical diagnosis. Constricting casts and dressings must be released immediately, and urgent fasciotomy follows if symptoms persist. Pulses are usually preserved until very late, so waiting for their loss means irreversible damage.

Option by option

  • A. Arrange a vascular duplex study before any intervention

    Delaying for imaging wastes time when the diagnosis is clinical.

  • B. Wait for the pulses to disappear before acting

    Loss of pulses is a late sign, so waiting for it allows muscle necrosis.

  • C. Split the cast and all underlying padding, then proceed to fasciotomy if there is no prompt relief (correct)

    Correct. Releasing external constriction is the first step, followed by fasciotomy if needed.

  • D. Raise the limb well above heart level and give stronger analgesia

    Excessive elevation lowers arterial perfusion pressure in the limb and can worsen ischaemia.

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, Split the cast and all underlying padding, then proceed to fasciotomy if there is no prompt relief. Pain out of proportion and pain on passive stretch suggest acute compartment syndrome, a clinical diagnosis.

Why is "Arrange a vascular duplex study before any intervention" not the answer?

Delaying for imaging wastes time when the diagnosis is clinical.

Why is "Wait for the pulses to disappear before acting" not the answer?

Loss of pulses is a late sign, so waiting for it allows muscle necrosis.

Why is "Raise the limb well above heart level and give stronger analgesia" not the answer?

Excessive elevation lowers arterial perfusion pressure in the limb and can worsen ischaemia.

What concept does this question test?

It tests Compartment syndrome in Orthopaedics. Constricting casts and dressings must be released immediately, and urgent fasciotomy follows if symptoms persist. Pulses are usually preserved until very late, so waiting for their loss means irreversible damage.

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 Compartment syndrome?

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.