A 28-year-old woman presents 6 weeks after a displaced intra-articular fracture of the distal femur. She has persistent joint stiffness and swelling. Regarding the complications and sequelae of fractures, all of the following are true EXCEPT:

Explanation

## Fracture Complications: Union Disorders and Sequelae ### Classification of Healing Disorders **Key Point:** Fracture healing complications are classified into three categories: delayed union, nonunion, and malunion. Each has distinct pathophysiology and reversibility. ### Detailed Analysis | Complication | Definition | Reversibility | Pathophysiology | |---|---|---|---| | **Delayed Union** | Fracture healing slower than expected but progressing | **Reversible** — healing continues with time/intervention | Inadequate immobilization, poor blood supply, infection, soft tissue interposition | | **Nonunion** | Complete cessation of healing; no bridging callus | Irreversible without intervention | Severe soft tissue damage, infection, vascular compromise, excessive motion | | **Malunion** | Fracture heals in abnormal position/alignment | Partially reversible (surgical correction) | Inadequate reduction, loss of reduction, poor immobilization | **High-Yield:** Delayed union is **NOT irreversible**. It is a temporary arrest of healing that responds to: - Prolonged immobilization - Electrical stimulation - Bone grafting - Improved nutrition and infection control Once union occurs (even if delayed), the fracture is healed. Nonunion is the irreversible condition. ### Why Each Correct Option Is True **Option 1: Post-traumatic arthritis after intra-articular fractures** - Intra-articular fractures disrupt the articular cartilage surface. - Even with anatomic reduction, residual cartilage damage and incongruity lead to early osteoarthritis. - Extra-articular fractures do not directly damage the joint surface. - **This is TRUE.** **Option 3: Malunion and limb length discrepancy** - Malunion occurs when fracture heals in an abnormal position (angulation, rotation, shortening). - Results in functional impairment, altered gait, and cosmetic deformity. - **This is TRUE.** **Option 4: Joint stiffness as a complication** - Immobilization of adjacent joints during fracture treatment causes loss of range of motion. - Periarticular soft tissue contracture and muscle atrophy contribute. - Requires aggressive physiotherapy to restore function. - **This is TRUE.** **Warning:** The phrase "irreversible" in Option 2 is the trap. Delayed union is a temporary setback in the healing timeline, not a permanent failure. It is reversible with appropriate intervention and time.