Three weeks after a supracondylar humerus fracture treated in a cast, a child develops a firm swelling in front of the elbow with progressive restriction of flexion. Radiographs show fluffy calcification in the antecubital soft tissues. ESR is mildly raised. The single most important step to prevent worsening is:

• A Aggressive passive stretching of the elbow several times daily
• B Gentle active-assisted range of motion exercises within pain limits ✓
• C Immediate excision of the ossified mass
• D High-dose systemic corticosteroids

Explanation

This is myositis ossificans traumatica, heterotopic bone formation in muscle after trauma, commonest around the elbow. Passive forcible stretching causes further haemorrhage and new bone formation, so it is strictly avoided. Management is rest followed by gentle active movements once acute inflammation settles. Excision, if needed for functional block, is deferred until the lesion matures, typically 6 to 12 months, when it stops enlarging.

Reference: Maheshwari's Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.