Fractures and post-operative rehabilitation

60 Gulf Prometric Physiotherapist (DHA, DOH, MOH, SCFHS, QCHP) practice questions on Fractures and post-operative rehabilitation, part of Musculoskeletal Rehabilitation. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

1. Question 1 · Easy

   What does 'weight bearing as tolerated' (WBAT) mean?

   1. AOnly a fixed percentage of body weight is allowed through it
   2. BOnly light toe contact is allowed for balance
   3. CNo weight is allowed through the limb at all until it has healed
   4. DThe patient may put as much weight on the limb as pain allows

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   Answer: D · The patient may put as much weight on the limb as pain allows

   In WBAT the patient decides the load in line with comfort, usually with an aid, and often progresses to full weight bearing as healing allows.

   • A: A fixed percentage is partial weight bearing.
   • B: Toe contact is TTWB.
   • C: No weight is non-weight-bearing.

   Remember this

   WBAT lets pain guide the amount of loading.

2. Question 2 · Medium

   What usually allows progression from partial to full weight bearing after a fracture?

   1. AClinical and radiographic signs of union, with surgeon approval
   2. BDisappearance of the swelling, which proves union
   3. CThe elapsed time alone, whatever the clinical findings
   4. DThe patient says that he feels ready to put weight on it again

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   Answer: A · Clinical and radiographic signs of union, with surgeon approval

   Progression depends on fracture type, fixation stability, and signs of healing: no tenderness at the site and bridging callus on films. The surgeon's approval is required before the physiotherapist advances loading.

   • B: Swelling alone does not show union.
   • C: Healing varies, so time alone is unsafe.
   • D: Feeling ready is unreliable.

   Remember this

   Advance loading on clinical and radiographic healing with surgeon approval.

3. Question 3 · Medium

   How should axillary crutches be fitted?

   1. AAt hip height, with the elbows bent to about 90 degrees
   2. BTop 5 cm below the axilla, with the elbows flexed 20-30 degrees on the grips
   3. CPressed firmly into the axilla, with the elbows fully straight
   4. DAt shoulder height, with the shoulders hitched up

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   Answer: B · Top 5 cm below the axilla, with the elbows flexed 20-30 degrees on the grips

   The pads sit below the axilla so weight goes through the hands, avoiding pressure on the brachial plexus and radial nerve. Slightly bent elbows allow triceps to push the body forward.

   • A: Too low a fit forces a stooped posture.
   • C: Axillary pressure risks crutch palsy.
   • D: Too high a fit elevates the shoulders and strains nerves.

   Remember this

   Crutch pads sit two to three fingers below the axilla; elbows 20-30 degrees flexed.

4. Question 4 · Medium

   In the early phase after ACL reconstruction, which open-chain knee extension range produces the least strain on the graft?

   1. A45 to 0 degrees of flexion
   2. B30 to 0 degrees with heavy load
   3. CFull range with maximum resistance
   4. D90 to 45 degrees of flexion

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   Answer: D · 90 to 45 degrees of flexion

   ACL strain from quadriceps pull is highest near extension (about 0-45 degrees) and low between 90 and 45 degrees. Closed-chain exercises are favoured early, and open-chain work is limited to the safer arc.

   • A: The terminal range produces the highest strain.
   • B: Heavy loading near extension strains the graft.
   • C: Full range with maximum resistance is unsafe early.

   Remember this

   Early open-chain extension is limited to 90 to 45 degrees to protect the graft.

5. Question 5 · Easy

   Which crutch gait suits a patient who must keep one leg non-weight-bearing?

   1. ATwo-point gait
   2. BSwing-through with both feet
   3. CThree-point gait
   4. DFour-point gait

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   Answer: C · Three-point gait

   In three-point gait both crutches and the affected leg move together, and the unaffected leg bears all the weight. It is used for unilateral non-weight-bearing or restricted loading.

   • A: Two-point gait also needs both legs to bear weight.
   • B: Swing-through loads both feet.
   • D: Four-point gait needs both legs to bear weight.

   Remember this

   Three-point gait is used for unilateral non-weight-bearing.

6. Question 6 · Easy

   What does 'toe-touch weight bearing' (TTWB) mean?

   1. AFull body weight is allowed through the limb
   2. BThe toes or ball of the foot touch the ground for balance only
   3. CNo contact with the ground at all is allowed
   4. DHalf of body weight is allowed through the limb during every step

   Answer and explanation in LearnFree account

7. Question 7 · Medium

   After an ACL reconstruction using a hamstring autograft, which exercise is delayed in the early weeks?

   1. AResisted open-chain hamstring curls
   2. BAnkle pumps
   3. CQuadriceps setting
   4. DStationary cycling with low resistance

   Answer and explanation in LearnFree account

8. Question 8 · Hard

   Nine months after ACL reconstruction, a footballer has quadriceps and hop limb symmetry above 95%, but scores low on psychological readiness (ACL-RSI). What is best?

   1. APlan a revision operation to restore his confidence
   2. BAddress confidence with graded return-to-sport exposure before full clearance
   3. CAdvise him to stop all sport permanently to avoid reinjury
   4. DClear him for full match play immediately as the tests are good

   Answer and explanation in LearnFree account

9. Question 9 · Medium

   A child has a supracondylar humerus fracture and later develops a fixed flexed wrist and fingers with a clawed hand. Which condition has occurred?

   1. AComplex regional pain syndrome
   2. BVolkmann's ischaemic contracture
   3. CMyositis ossificans of the forearm flexors
   4. DCubital tunnel syndrome

   Answer and explanation in LearnFree account

10. Question 10 · Medium

    Which preventive programme component reduces ACL injury risk in female athletes?

    1. ALong static stretching of the lower limb muscles only
    2. BNeuromuscular training including landing technique and hip and knee control
    3. CReducing all jumping activity during training and play
    4. DIsolated quadriceps strengthening on a leg extension machine

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11. Question 11 · Medium

    A footballer has a deep quadriceps contusion and, after two weeks of massage and aggressive stretching, develops a hard painful mass and reduced knee flexion. Which complication is suspected?

    1. AMyositis ossificans
    2. BStress fracture of the femur
    3. CDeep vein thrombosis
    4. DNerve palsy

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12. Question 12 · Medium

    A boy with a forearm fracture has increasing deep pain despite analgesia, pain on passive finger stretch, and a tense swollen forearm. What is the correct action?

    1. AIncrease active gripping exercises to improve circulation
    2. BApply a tighter cast to control the swelling
    3. CUrgently alert the medical team for suspected compartment syndrome
    4. DElevate the arm and review the child again next week

    Answer and explanation in LearnFree account

13. Question 13 · Medium

    A man has tenderness in the anatomical snuffbox after falling on an outstretched hand, with normal initial radiographs. What should be done?

    1. AReassure him and allow full activity as the films are normal
    2. BStart wrist strengthening because the radiographs are clear
    3. CApply a compression bandage and discharge him with advice
    4. DImmobilise as a suspected scaphoid fracture and arrange repeat imaging

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14. Question 14 · Medium

    Which muscles waste fastest during prolonged immobilisation?

    1. AThe diaphragm, as breathing is passive during rest
    2. BFacial muscles, because they are rarely moved
    3. CAntigravity muscles, with mostly slow-twitch fibres
    4. DSmall intrinsic muscles of the hand and the fingers

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15. Question 15 · Hard

    A man who must remain non-weight-bearing on his right leg descends stairs holding a handrail on his left with one crutch in his right hand. What is the correct sequence?

    1. ALower both legs together while holding the handrail
    2. BLower the crutch and right leg first, then bring the left leg down
    3. CHop down on the left foot, then bring the crutch along
    4. DStep down with the left leg first, then bring the crutch down after it

    Answer and explanation in LearnFree account

16. Question 16 · Medium

    A patient has a stable fracture in the soft callus stage, at about three weeks. Which exercise approach is appropriate?

    1. AForceful passive stretching of the tissues around the fracture
    2. BComplete rest of the whole limb until radiographic union
    3. CHeavy resistance applied directly across the fracture site
    4. DProtect the site, while moving adjacent joints and training isometrics

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17. Question 17 · Hard

    A woman weighing 72 kg is allowed 25% weight bearing at week 4 and 50% at week 6. By how much, in kg, should the scale reading increase between those two stages?

    1. A9 kg
    2. B18 kg
    3. C25 kg
    4. D36 kg

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18. Question 18 · Hard

    A female distance runner has groin pain that increases with running and hopping, with painful limited hip internal rotation. Plain films are normal. What is the best action?

    1. AAdvise a gradual return to running over the next two weeks
    2. BTreat as a groin muscle strain with stretching and massage
    3. CStart hip adductor strengthening with resistance bands
    4. DStop loading and arrange urgent imaging for a femoral neck stress fracture

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19. Question 19 · Easy

    A footballer attends with an acutely swollen knee after a pivoting injury. Which examination finding is the most sensitive for ACL rupture?

    1. AMedial opening on the valgus stress test
    2. BIncreased posterior sag on the posterior drawer test
    3. CA click on the McMurray test
    4. DIncreased anterior tibial translation on the Lachman test

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20. Question 20 · Medium

    A woman days after a posterior THR stands from a low chair and feels a sudden pop, with a shortened, adducted and internally rotated leg. What does this suggest?

    1. AAnterior dislocation of the prosthesis with an externally rotated limb
    2. BPosterior dislocation of the prosthesis
    3. CNormal post-operative pain
    4. DFemoral nerve palsy

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21. Question 21 · Medium

    Which movements are restricted after total hip replacement through an anterior approach?

    1. AHip flexion beyond 90 degrees combined with internal rotation
    2. BHip extension and external rotation
    3. CAnkle dorsiflexion
    4. DHip adduction only

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22. Question 22 · Medium

    A patient has calf swelling, tenderness and warmth two days after a knee replacement. What should the physiotherapist do?

    1. AMassage the calf firmly to disperse the swelling
    2. BStop mobilising and alert the medical team for suspected DVT
    3. CContinue walking and ignore the swelling for now
    4. DApply deep heat to the calf to improve circulation

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23. Question 23 · Hard

    A frail 82-year-old woman has poor balance and must be partial weight bearing on her left leg after femoral fracture fixation. Which walking aid is best?

    1. AA single stick, as it is the lightest option
    2. BA walker, which gives the widest base of support
    3. CAxillary crutches, since all patients are taught to use them
    4. DNo aid, relying on her own balance

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24. Question 24 · Medium

    A man using axillary crutches develops weak wrist extension and numbness on the back of his hand. Which nerve is most likely affected?

    1. AUlnar nerve, compressed at the elbow
    2. BRadial nerve, from pressure in the axilla
    3. CMedian nerve, compressed under the flexor retinaculum
    4. DMusculocutaneous nerve in the upper arm

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25. Question 25 · Hard

    At six weeks after TKA with supervised therapy, a patient's knee flexion has plateaued at 70 degrees, and extension is full. The goal is over 110 degrees. What is the next step?

    1. AReduce exercise for some weeks to let the knee settle down completely
    2. BConsult the surgeon about possible manipulation under anaesthesia
    3. CDischarge from therapy with no further review planned
    4. DForce flexion with heavy overpressure during treatment

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