In a patient with a left forearm fracture, which sign indicates impaired venous return?

• A. Bounding Distal Pulse
• B. Acute Pain
• C. Ecchymosis of Surrounding Skin
• D. Increasing Edema

Answer: (D)

Impaired venous return causes blood to pool in the distal limb, raising venous pressure and pushing fluid into the interstitial spaces, which presents as increasing edema in the forearm and hand. This swelling directly reflects a failure of venous drainage from the area.

In contrast, a bounding distal pulse mainly indicates that arterial inflow is present and strong, not that venous outflow is compromised. Acute pain is a general symptom of injury and isn’t specific to venous return status. Ecchymosis shows bleeding into tissues, not the status of venous drainage. So the sign that most specifically points to impaired venous return is the progressive edema.