NEET-PG 2025 — Orthopaedics

Q: A Patients presents with ankle pain and swelling after a forceful eversion injury. Based on the mechanism of injury, which ligament is most likely to be damaged?

Deltoid ligament. ***Deltoid ligament***- This strong ligament complex is located on the medial side of the ankle and is the primary stabilizer resisting excessive **valgus** or **eversion forces**.- A forceful eversion mechanism subjects the medial side to tension, leading potentially to rupture of the Deltoid ligament or an associated avulsion fracture of the **medial malleolus**. *Anterior talofibular ligament*- This is the **most commonly injured** ligament in the ankle, typically resulting from an **inversion injury** combined with plantar flexion.- It connects the fibula to the talus and is the weakest of the lateral ligaments, making it the primary target of **lateral ankle sprains**. *Calcaneofibular ligament*- This ligament also acts as a restraint against **inversion** and is located laterally, deep to the peroneal tendons.- Injury to the CFL often occurs when the foot is **dorsiflexed** and inverted, usually damaged secondarily after the **ATFL** tears. *Posterior talofibular ligament*- Located on the posterior-lateral aspect, this ligament is the **strongest** of the lateral stabilizers.- It is rarely injured in isolated ligamentous sprains, typically requiring severe **dislocations** or extensive high-grade **inversion injuries**. [Practice more Orthopaedics PYQs on OnCourse]

Q: A 25-year-old man presents to the emergency department following a motorbike accident and is found to have a closed midshaft fracture of the left tibia. Six hours later, he develops severe leg pain that is disproportionate to the injury and worsens with passive dorsiflexion of the foot. The pain is not relieved by analgesics. On examination, dorsalis pedis and posterior tibial pulses are present, but there is no sensation over the first dorsal webspace. What is the most appropriate next step in management?

Immediate fasciotomy. ***Immediate fasciotomy*** - The clinical presentation of severe, disproportionate pain, pain on passive stretching, and altered sensation (**paresthesia**) in the setting of a major fracture is highly indicative of **acute compartment syndrome**. - **Fasciotomy** is the definitive, urgent treatment to decompress the muscle compartments and prevent irreversible tissue necrosis and nerve damage. *Elevate the limb and observe* - Elevating the limb may further decrease the **arterial-venous pressure gradient**, potentially worsening an already compromised perfusion. - Observation is inappropriate because **acute compartment syndrome** requires immediate surgical intervention to prevent serious, permanent deficits or loss of function. *Administer opioid analgesics and continue observation* - Analgesics, even strong opioids, will only mask the classic symptom (**disproportionate pain**) but will not address the underlying pathology (increased intracompartmental pressure). - Continued observation will lead to progression of **ischemia**, resulting in irreversible muscle and nerve damage after approximately 6-8 hours. *Apply cast and follow up* - Applying a cast in the setting of suspected **compartment syndrome** is contraindicated, as the rigid cast can contribute to or exacerbate the compartment pressure. - Following up later is dangerous and negligent, as this condition is a surgical emergency requiring intervention within the **golden hour(s)** to salvage limb function. [Practice more Orthopaedics PYQs on OnCourse]

2 Previous Year Questions with Answers & Explanations

Questions

A Patients presents with ankle pain and swelling after a forceful eversion injury. Based on the mechanism of injury, which ligament is most likely to be damaged?

A 25-year-old man presents to the emergency department following a motorbike accident and is found to have a closed midshaft fracture of the left tibia. Six hours later, he develops severe leg pain that is disproportionate to the injury and worsens with passive dorsiflexion of the foot. The pain is not relieved by analgesics. On examination, dorsalis pedis and posterior tibial pulses are present, but there is no sensation over the first dorsal webspace. What is the most appropriate next step in management?

NEET-PG 2025 - Orthopaedics NEET-PG Practice Questions and MCQs

Question 1: A Patients presents with ankle pain and swelling after a forceful eversion injury. Based on the mechanism of injury, which ligament is most likely to be damaged?

A. Posterior talofibular ligament
B. Anterior talofibular ligament
C. Deltoid ligament (Correct Answer)
D. Calcaneofibular ligament

Explanation: ***Deltoid ligament***- This strong ligament complex is located on the medial side of the ankle and is the primary stabilizer resisting excessive **valgus** or **eversion forces**.- A forceful eversion mechanism subjects the medial side to tension, leading potentially to rupture of the Deltoid ligament or an associated avulsion fracture of the **medial malleolus**. *Anterior talofibular ligament*- This is the **most commonly injured** ligament in the ankle, typically resulting from an **inversion injury** combined with plantar flexion.- It connects the fibula to the talus and is the weakest of the lateral ligaments, making it the primary target of **lateral ankle sprains**. *Calcaneofibular ligament*- This ligament also acts as a restraint against **inversion** and is located laterally, deep to the peroneal tendons.- Injury to the CFL often occurs when the foot is **dorsiflexed** and inverted, usually damaged secondarily after the **ATFL** tears. *Posterior talofibular ligament*- Located on the posterior-lateral aspect, this ligament is the **strongest** of the lateral stabilizers.- It is rarely injured in isolated ligamentous sprains, typically requiring severe **dislocations** or extensive high-grade **inversion injuries**.

Question 2: A 25-year-old man presents to the emergency department following a motorbike accident and is found to have a closed midshaft fracture of the left tibia. Six hours later, he develops severe leg pain that is disproportionate to the injury and worsens with passive dorsiflexion of the foot. The pain is not relieved by analgesics. On examination, dorsalis pedis and posterior tibial pulses are present, but there is no sensation over the first dorsal webspace. What is the most appropriate next step in management?

A. Administer opioid analgesics and continue observation
B. Immediate fasciotomy (Correct Answer)
C. Apply cast and follow up
D. Elevate the limb and observe

Explanation: ***Immediate fasciotomy*** - The clinical presentation of severe, disproportionate pain, pain on passive stretching, and altered sensation (**paresthesia**) in the setting of a major fracture is highly indicative of **acute compartment syndrome**. - **Fasciotomy** is the definitive, urgent treatment to decompress the muscle compartments and prevent irreversible tissue necrosis and nerve damage. *Elevate the limb and observe* - Elevating the limb may further decrease the **arterial-venous pressure gradient**, potentially worsening an already compromised perfusion. - Observation is inappropriate because **acute compartment syndrome** requires immediate surgical intervention to prevent serious, permanent deficits or loss of function. *Administer opioid analgesics and continue observation* - Analgesics, even strong opioids, will only mask the classic symptom (**disproportionate pain**) but will not address the underlying pathology (increased intracompartmental pressure). - Continued observation will lead to progression of **ischemia**, resulting in irreversible muscle and nerve damage after approximately 6-8 hours. *Apply cast and follow up* - Applying a cast in the setting of suspected **compartment syndrome** is contraindicated, as the rigid cast can contribute to or exacerbate the compartment pressure. - Following up later is dangerous and negligent, as this condition is a surgical emergency requiring intervention within the **golden hour(s)** to salvage limb function.