Master every high-yield orthopedics topic for NEET PG 2026: fracture classification (Salter-Harris, Garden, Neer), upper and lower limb fractures, bone tumors, joint disorders, spine pathology, congenital conditions, and soft tissue injuries.
Version 1.0 — Published March 2026
Orthopedics contributes 12-15 questions to NEET PG and rewards candidates who master classification systems and anatomical correlations. Focus on these 8 high-yield areas:
Orthopedics is the surgical specialty where classification systems directly determine the answer. Unlike general surgery where anatomical relationships are the substrate, orthopedics questions live and die on whether you know the correct classification type, the associated nerve injury, or the age-location-X-ray pattern of a bone tumor. The specificity is both the challenge and the opportunity — master the classifications, and you convert 10+ marks into reliable territory.
This guide covers the eight areas that generate the highest NEET PG question density. Each section gives you the classification systems NBE tests, the clinical associations that distinguish correct from close-but-wrong options, and the management principles that flow from accurate classification. Pair it with the surgery high-yield guide for overlapping trauma topics, and the brachial plexus anatomy guide for nerve injury correlations.
Fracture classification systems are the single most tested topic in NEET PG orthopedics. Each classification determines management and prognosis — NBE uses them to test clinical decision-making, not just recall.
Salter-Harris classification applies to fractures involving the growth plate (physis) in children. It is the most tested orthopedic classification in NEET PG.
This content is for educational purposes for NEET PG exam preparation. It is not a substitute for professional medical advice, diagnosis, or treatment. Clinical information has been reviewed by qualified medical professionals.
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Join on Telegram →| Type | Fracture pattern | Mnemonic | Prognosis | Management |
|---|---|---|---|---|
| I | Through the physis only | Slipped / Straight | Excellent | Closed reduction, cast |
| II | Through physis + metaphysis | Above | Excellent (most common type, ~75%) | Closed reduction, cast |
| III | Through physis + epiphysis | Lower / beLow | Good if anatomically reduced | ORIF (intra-articular) |
| IV | Through metaphysis + physis + epiphysis | Through / Together | Poor without ORIF | ORIF mandatory |
| V | Crush injury to physis | Rammed / cRushed | Worst (growth arrest) | Diagnosed retrospectively |
Type II is the most common (approximately 75% of Salter-Harris fractures). Type V has the worst prognosis because the crushed physis leads to premature growth plate closure and limb length discrepancy. Type V is often diagnosed only in retrospect when growth arrest becomes evident — a classic NBE trap where the initial X-ray appears "normal."
Garden classification is the standard for intracapsular femoral neck fractures and directly determines surgical management:
| Garden type | Description | Blood supply | Management |
|---|---|---|---|
| I | Incomplete (impacted/valgus) | Preserved | Cancellous screws |
| II | Complete, undisplaced | Mostly preserved | Cancellous screws |
| III | Complete, partially displaced | Compromised | Hemiarthroplasty (>60 years) or ORIF (<60 years) |
| IV | Complete, fully displaced | Destroyed | Hemiarthroplasty (>60 years) or total hip replacement (active elderly) |
The critical decision point: Garden I-II (undisplaced) are treated with internal fixation (3 cancellous screws in an inverted triangle pattern). Garden III-IV (displaced) in patients above 60 years old are treated with hemiarthroplasty because the disrupted blood supply makes AVN of the femoral head almost inevitable after fixation (Maheshwari's Essential Orthopaedics, 6th Edition).
Neer classifies proximal humerus fractures based on the number of displaced fragments (greater tuberosity, lesser tuberosity, anatomical neck, surgical neck). A fragment is considered "displaced" if separated by >1 cm or angulated >45 degrees.
Axillary nerve injury is the most commonly associated nerve injury with proximal humerus fractures — test for loss of sensation over the "regimental badge area" (lateral aspect of the deltoid) and deltoid weakness.
Upper limb fractures are a perennial NEET PG topic. NBE tests the mechanism, deformity pattern, associated nerve injuries, and management for each fracture type.
Colles fracture is a fracture of the distal radius with dorsal displacement and dorsal angulation of the distal fragment, occurring from a fall on an outstretched hand (FOOSH) in an osteoporotic patient (typically postmenopausal women over 50).
Deformity: "Dinner fork" deformity (lateral view) and "bayonet" deformity (AP view — radial deviation of the hand with loss of radial inclination).
Six features of Colles fracture: Dorsal displacement, dorsal angulation (apex volar), radial shift, radial shortening, supination of distal fragment, impaction.
Associated injuries: Median nerve compression (acute carpal tunnel), ulnar styloid fracture, DRUJ (distal radioulnar joint) disruption.
Smith fracture is the "reverse Colles" — volar (palmar) displacement of the distal fragment. Caused by a fall on the dorsum of the hand or a direct blow to the back of the wrist. Produces a "garden spade" deformity.
The most common elbow fracture in children (5-8 years). Extension type (97-98%) results from FOOSH with the elbow in extension.
Nerve injuries by fracture displacement:
Brachial artery injury is the most important vascular complication. Absent radial pulse does NOT necessarily indicate arterial transection — it may be arterial spasm. Assess perfusion of the hand (color, warmth, capillary refill). Volkmann ischemic contracture (forearm compartment syndrome leading to flexion contracture of wrist and fingers) is the most devastating complication — the 5 P's of compartment syndrome (Pain out of proportion, Pain with passive stretch, Paresthesia, Pallor, Pulselessness) must be recognized early.
Treatment: Undisplaced — above-elbow POP slab. Displaced — closed reduction and percutaneous K-wire fixation. Avoid hyperflexion during splinting (worsens vascular compromise).
The most common fracture in childhood and the most commonly fractured bone at birth.
Location: Middle third (80% — thinnest part, junction of two curvatures), lateral third (15%), medial third (5%).
Mechanism: FOOSH (transmitted force) or direct blow.
Complication of middle third fracture: Subclavian vessel injury is rare but tested. More commonly tested: malunion with cosmetic deformity and brachial plexus irritation.
Treatment: Most clavicle fractures are managed conservatively with a figure-of-eight bandage or arm sling. Surgical fixation (plate and screw) is indicated for: open fractures, tenting of skin, neurovascular compromise, significant displacement (>2 cm shortening), floating shoulder (ipsilateral clavicle + scapular neck fracture), and nonunion (Apley's System of Orthopaedics, 10th Edition).
Lower limb fractures test classification-based management decisions. The Garden classification for femoral neck fractures is covered above; this section covers the remaining high-yield lower limb fractures.
The critical distinction is whether the fracture is inside or outside the hip joint capsule:
| Feature | Intracapsular (femoral neck) | Extracapsular (intertrochanteric/subtrochanteric) |
|---|---|---|
| Blood supply | Disrupted (retinacular vessels from medial circumflex femoral artery) | Preserved (good blood supply to trochanteric region) |
| AVN risk | High (especially Garden III-IV) | Low |
| Nonunion risk | High (shearing forces, poor blood supply) | Low (compressive forces, good vascularity) |
| Treatment (elderly) | Hemiarthroplasty or THR (displaced) | Dynamic hip screw (DHS) |
| Treatment (young) | Anatomic reduction + cancellous screws (attempt to preserve head) | DHS or intramedullary nail |
The medial circumflex femoral artery supplies the femoral head via retinacular vessels running along the femoral neck. Intracapsular fracture disrupts these vessels — this is why displaced intracapsular fractures have high AVN rates and why elderly patients get replacement rather than fixation (Campbell's Operative Orthopaedics reference).
| Type | Pattern | Treatment |
|---|---|---|
| I | Lateral split (wedge) | If depressed <3 mm: conservative. If >3 mm: ORIF |
| II | Lateral split-depression | ORIF with bone grafting for depression |
| III | Lateral pure depression | ORIF with bone grafting |
| IV | Medial condyle | ORIF (high energy, associated ligament injuries) |
| V | Bicondylar | ORIF with dual plates or external fixation |
| VI | Dissociation of metaphysis from diaphysis | External fixation, staged ORIF |
Type II (split-depression of the lateral tibial plateau) is the most common type in adults. It occurs from a valgus force with axial loading — the classic "bumper fracture" from a car hitting a pedestrian's lateral knee.
Weber classification is based on the level of the fibular fracture relative to the ankle syndesmosis:
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Start Free Practice →Bone tumor questions follow a predictable pattern: NBE gives you age, location, and X-ray appearance, then asks for the diagnosis or next step. Knowing the "signature" of each tumor is the key to reliable marks.
| Tumor | Age group | Location | X-ray | Histology | Key fact |
|---|---|---|---|---|---|
| Osteosarcoma | 10-25 years | Metaphysis of long bones (distal femur most common) | Sunburst pattern, Codman triangle | Osteoid production by malignant cells | Most common primary malignant bone tumor; bimodal peak (adolescents + Paget disease in elderly) |
| Ewing sarcoma | 5-15 years | Diaphysis of long bones (femur, tibia, pelvis) | Onion-peel (lamellated) periosteal reaction | Small round blue cells | t(11;22) translocation; EWS-FLI1 fusion; PAS positive |
| Chondrosarcoma | 40-70 years | Pelvis, proximal femur, proximal humerus | Punctate/popcorn calcification, endosteal scalloping | Malignant cartilage | Resistant to chemo and radiation; surgery is the only effective treatment |
| Multiple myeloma | >40 years | Axial skeleton, skull, vertebrae | Punched-out lytic lesions (skull "rain drop" pattern) | Malignant plasma cells | Most common primary malignant bone tumor overall (if you count it as bone tumor); Bence-Jones proteinuria |
Codman triangle is a triangular elevation of periosteum at the margin of a bone tumor — it is NOT pathognomonic for osteosarcoma (any aggressive bone lesion can cause it), but NBE associates it strongly with osteosarcoma.
| Tumor | Age group | Location | X-ray | Key fact |
|---|---|---|---|---|
| Osteochondroma | 10-30 years | Metaphysis of long bones (distal femur, proximal tibia) | Sessile or pedunculated bony outgrowth with cartilage cap | Most common benign bone tumor; <1% malignant transformation (higher in hereditary multiple exostoses) |
| Giant cell tumor (GCT) | 20-40 years | Epiphysis of long bones (distal femur, proximal tibia) | Eccentric, expansile, lytic "soap bubble" lesion, extends to subchondral bone | Locally aggressive; Campanacci grading; curettage + bone cement is standard |
| Osteoid osteoma | 10-30 years | Cortex of long bones (proximal femur, tibia) | <2 cm nidus with surrounding sclerosis | Night pain relieved by aspirin/NSAIDs (pathognomonic); nidus produces prostaglandins |
Giant cell tumor is the classic epiphyseal bone tumor — it crosses the closed physis to involve the epiphysis and extends to subchondral bone. This location distinguishes it from other tumors (most malignant tumors are metaphyseal). Age 20-40 + epiphyseal + soap bubble = GCT until proven otherwise (Turek's Orthopaedics, 7th Edition).
Joint disorders are tested through clinical vignettes, X-ray interpretation, and lab findings. The differentiating features between inflammatory and degenerative arthropathy are a perennial NBE favorite.
| Feature | Rheumatoid arthritis | Osteoarthritis |
|---|---|---|
| Age | 30-50 years (any age) | >50 years |
| Joints | MCP, PIP, wrist, knee (symmetric) | DIP, knee, hip, spine (may be asymmetric) |
| DIP involvement | Rarely (consider psoriatic arthritis) | Heberden nodes (pathognomonic for OA) |
| Morning stiffness | >30 minutes (often >1 hour) | <30 minutes |
| X-ray | Periarticular osteoporosis, erosions, uniform joint space narrowing | Subchondral sclerosis, osteophytes, asymmetric JSN, subchondral cysts |
| Lab | RF positive (70%), Anti-CCP (more specific), raised ESR/CRP | Normal inflammatory markers |
| Deformities | Boutonniere, swan neck, ulnar deviation, Z-thumb | Heberden nodes (DIP), Bouchard nodes (PIP) |
Gout — monosodium urate crystals. Needle-shaped, negatively birefringent under polarized microscopy (yellow when parallel to compensator). First MTP joint (podagra) is the classic site. Tophi in chronic gout. Serum uric acid >7 mg/dL but can be normal during an acute attack. Acute treatment: NSAIDs or colchicine. Chronic: allopurinol (start after 2 weeks of acute attack resolution, with colchicine cover).
Pseudogout (CPPD) — calcium pyrophosphate dihydrate crystals. Rhomboid-shaped, positively birefringent (blue when parallel). Knee is the most common joint. X-ray: chondrocalcinosis (linear calcification in cartilage, especially meniscal and triangular fibrocartilage of wrist).
The polarized microscopy distinction is the most tested crystal arthropathy question: negative birefringence = gout, positive birefringence = pseudogout.
Septic arthritis is a surgical emergency. The most common organism is Staphylococcus aureus in all age groups except neonates (Group B Streptococcus) and sexually active young adults (Neisseria gonorrhoeae).
Diagnosis: Joint aspiration showing turbid fluid with WBC >50,000/mm3 (predominantly neutrophils), positive Gram stain/culture, and elevated synovial fluid lactate. Blood cultures are positive in 50% of cases.
Management: Urgent joint aspiration/washout (arthroscopic or open) + IV antibiotics. In children, hip joint septic arthritis is particularly dangerous because raised intra-articular pressure can compromise the femoral head blood supply (same retinacular vessels at risk as in femoral neck fractures).
Spine questions test clinical correlation — which nerve root is affected, what is the deformity classification, and when is surgery indicated.
Scoliosis is a lateral curvature of the spine with a Cobb angle >10 degrees. Idiopathic scoliosis is the most common type (80%), classified by age of onset: infantile (<3 years), juvenile (3-10 years), and adolescent (>10 years — most common subtype, F:M ratio 7:1).
Cobb angle measurement determines management:
Adam forward bend test is the screening test — a rib hump on forward flexion indicates structural scoliosis (rotational component). A scoliometer reading >7 degrees warrants X-ray evaluation.
PIVD questions test nerve root correlation. The posterolateral disc prolapse (most common direction) compresses the nerve root of the level below:
| Disc level | Nerve root compressed | Motor deficit | Sensory loss | Reflex affected |
|---|---|---|---|---|
| L3-L4 | L4 | Quadriceps weakness, knee extension | Medial leg | Knee jerk (diminished) |
| L4-L5 | L5 | EHL weakness, foot dorsiflexion (foot drop) | First web space, dorsum of foot | None (no specific reflex) |
| L5-S1 | S1 | Plantarflexion weakness, unable to stand on toes | Lateral foot, sole | Ankle jerk (absent) |
Cauda equina syndrome is the surgical emergency: bilateral leg weakness, urinary retention (overflow incontinence), fecal incontinence, and saddle anesthesia (perianal numbness). It results from massive central disc prolapse compressing the cauda equina. Urgent surgical decompression within 48 hours is mandatory — delay worsens neurological outcome (Apley's System of Orthopaedics).
Spondylolisthesis is the anterior slippage of one vertebra over another, most commonly at L5-S1.
Meyerding grading (percentage of slippage):
Types: Isthmic (pars interarticularis defect — spondylolysis, common in young athletes, gymnasts, fast bowlers) and degenerative (facet joint arthropathy in elderly).
Scottie dog sign on oblique lumbar X-ray: the "collar" around the Scottie dog's neck represents a pars interarticularis defect (spondylolysis). This is a classic NEET PG image question.
Congenital orthopedic conditions generate 1-2 questions per NEET PG paper. The questions test diagnostic maneuvers (especially for DDH) and first-line management.
CTEV is a complex foot deformity with four components (remember CAVE):
Ponseti method is the gold standard treatment: serial casting (weekly cast changes correcting components in the order CAVE — cavus first, adductus, varus, equinus last), followed by percutaneous Achilles tenotomy for residual equinus (needed in ~80% of cases), then Denis Browne boots-and-bar for maintenance. The success rate of Ponseti casting exceeds 95% when started early.
Pirani score (0-6) assesses severity: 0 = normal, 6 = most severe. Used to monitor progress during Ponseti casting.
DDH is a spectrum from acetabular dysplasia to frank dislocation of the femoral head. More common in firstborn females, breech presentation, and oligohydramnios.
Neonatal screening tests:
Treatment by age:
Imaging: Ultrasound (Graf classification) is used until age 4-6 months (femoral head is cartilaginous and not visible on X-ray). After 6 months, X-ray becomes useful — look for Shenton line disruption, Perkin line and Hilgenreiner line quadrant analysis, and acetabular index measurement.
Torticollis is a postural deformity where the head is tilted toward and the chin is rotated away from the affected sternocleidomastoid (SCM). It is caused by fibrosis of the SCM, presenting as a palpable "SCM tumor" in the first 2-4 weeks of life.
Treatment: Physiotherapy (gentle stretching) resolves 90% of cases by 1 year. Surgical release of the SCM is indicated if torticollis persists beyond 1 year of age or if facial asymmetry develops.
Soft tissue injuries are increasingly tested in NEET PG, especially knee ligament and rotator cuff pathology. The questions test clinical examination findings and MRI correlations.
ACL tear is the most common ligamentous knee injury. Mechanism: non-contact pivoting injury (sudden deceleration + change of direction — classic in football, basketball).
Clinical tests:
MRI findings: Discontinuity or abnormal signal in the ACL (normally a taut, dark band on T2). Associated injuries: "unhappy triad" (O'Donoghue triad) = ACL tear + MCL tear + medial meniscus tear (originally described) or lateral meniscus tear (more common per recent data).
Management: Young, active patients with ACL tear and functional instability — ACL reconstruction (hamstring tendon or bone-patellar tendon-bone autograft). Conservative management for low-demand patients.
Medial meniscus tears are more common than lateral (medial is attached to the MCL and less mobile).
McMurray test — the examiner flexes the knee fully, then externally rotates the tibia while extending the knee (tests medial meniscus) or internally rotates while extending (tests lateral meniscus). A positive test is a palpable/audible click with pain.
Apley grind test — patient prone, knee flexed 90 degrees. Compression + rotation produces pain in meniscal tear. Distraction + rotation produces pain in ligament injury.
Bucket-handle tear — longitudinal vertical tear where the inner fragment flips into the intercondylar notch, causing mechanical locking of the knee. MRI shows the "double PCL sign" (displaced meniscal fragment lies parallel to the PCL).
The rotator cuff comprises four muscles (SITS): Supraspinatus, Infraspinatus, Teres minor, Subscapularis.
Supraspinatus is the most commonly torn tendon (initiates abduction 0-15 degrees). Testing: Jobe (empty can) test — arm abducted 90 degrees in the scapular plane, internally rotated (thumb pointing down), resist downward force. Positive = pain or weakness.
Neer impingement test — passive forward flexion of the arm with the scapula stabilized. Pain between 60-120 degrees suggests subacromial impingement (supraspinatus tendon compressed under the acromion).
Drop arm test — patient abducts the arm fully, then slowly lowers it. Inability to lower smoothly (arm drops suddenly) suggests a large rotator cuff tear.
Orthopedics contributes 12-15 questions in NEET PG (2021-2024 analysis), making it one of the highest-weighted surgical subspecialties. Fracture classification and management account for 4-6 questions, bone tumors for 2-3, joint disorders for 2-3, and congenital conditions for 1-2. Soft tissue injuries appear with increasing frequency.
Salter-Harris classification of epiphyseal plate injuries is the most tested. The SALTR mnemonic covers all five types. Garden classification of femoral neck fractures is the second most tested, followed by Neer classification of proximal humerus fractures.
SALTR mnemonic: Type I = Slipped (straight across physis), Type II = Above (metaphysis involved, most common, best prognosis), Type III = Lower (epiphysis involved), Type IV = Through (all three layers, needs ORIF), Type V = Rammed (crush injury, worst prognosis).
Femoral head (after femoral neck fracture), scaphoid (after waist fracture), talus (after neck fracture), and lunate (Kienbock disease). The common mechanism is disruption of retrograde blood supply.
Osteosarcoma (sunburst pattern, Codman triangle, age 10-25), Ewing sarcoma (onion-peel, t(11;22), age 5-15), giant cell tumor (soap bubble, epiphyseal, age 20-40), and osteochondroma (most common benign bone tumor).
RA shows periarticular osteoporosis, erosions, and uniform joint space narrowing. OA shows subchondral sclerosis, osteophytes, and asymmetric joint space narrowing. RA involves MCP/PIP/wrist; OA involves DIP/knee/hip.
PIVD questions test nerve root correlation. L4-L5 disc compresses L5 (foot drop, first web space numbness). L5-S1 compresses S1 (absent ankle jerk, plantarflexion weakness). Cauda equina syndrome (urinary retention, saddle anesthesia) is a surgical emergency.
CTEV (clubfoot — Ponseti casting), DDH (Barlow = dislocate, Ortolani = reduce, Pavlik harness under 6 months), and congenital torticollis (SCM tumor, physiotherapy resolves 90% by 1 year). These appear in 1-2 questions per paper.
Start your orthopedics preparation today. Open the Orthopedics subject page and solve your first 15 MCQs — the classifications you drill now will be the marks you collect on exam day. Want unlimited AI-powered orthopedics MCQs with detailed explanations? Explore NEETPGAI Pro.
Written by: NEETPGAI Editorial Team Reviewed by: Pending SME Review Last reviewed: March 2026
This article is reviewed by qualified medical professionals for clinical accuracy and exam relevance. For corrections or updates, contact the editorial team.