National Physical Therapy Examination (NPTE) Practice Exam

Which clinical finding is indicative of an unstable fracture site in the context of a femoral fracture?

1. Intact range of motion

2. Severe swelling

3. Increased pain with weight-bearing

4. A visible deformity

The correct answer is: Increased pain with weight-bearing

In the context of a femoral fracture, increased pain with weight-bearing is a strong indicator of an unstable fracture site. When a fracture site is unstable, applying weight or elevating the mechanical load to the affected area often results in heightened pain. This occurs because unstable fractures typically involve significant disruption of bone integrity and the surrounding soft tissues, leading to instability that is exacerbated by movement or bearing weight. The increased stress on the injury from weight-bearing can further irritate the fracture site and the surrounding structures, causing the patient's pain to worsen. Other clinical findings, such as severe swelling, may be present in various injury types, including stable fractures or soft tissue injuries, making them less specific. Intact range of motion could sometimes be observed even with a fractured bone, particularly if there is no associated soft tissue damage or if the fracture is stable. A visible deformity can also signal a fracture, but not all fractures, especially stable ones, will present with noticeable deformities. Therefore, the presence of increased pain specifically correlates to the instability of the fracture site, making it the most indicative clinical finding in this scenario.