Rosh Emergency Medicine Practice Test

What late finding might be expected in a patient with significant pain and a history of distal tibial shaft fracture?

1. Pain out of proportion

2. Pain with passive stretch

3. Paralysis

4. Paresthesias

The correct answer is: Paralysis

In a patient with significant pain and a history of a distal tibial shaft fracture, the presence of paralysis as a late finding can indicate serious complications such as acute compartment syndrome. This condition occurs when there is increased pressure within a fascial compartment, leading to compromised circulation and function of the tissues within that compartment. Acute compartment syndrome can develop after fractures due to swelling and bleeding within the muscle compartments, especially in the lower leg where the compartments are more rigid. Early symptoms typically include severe pain that is disproportionate to the injury and pain with passive stretch. As the condition worsens and nerve and muscle tissue become ischemic, paralysis may occur as nerves lose their function due to lack of blood supply. This is a critical late finding that indicates a surgical emergency, as prolonged ischemia can lead to permanent muscle and nerve damage. Recognizing paralysis as a late finding is crucial for timely intervention. Other symptoms, such as paresthesias or pain out of proportion, are generally considered earlier indicators of potential compartment syndrome and would not be classified as late findings.