Am J Orthop (Belle Mead NJ). 2016 Nov/Dec;45(7):E472-E477.
Which test for acute syndesmotic injury of the ankle has the fewest false-positive results and smallest inter-observer variance when used intraoperatively?
External rotation stress test
Dr. Almurabet -there's quite a bit of info on syndesmotic injuries in the literature, and the one versus two screws is generally surgeon dependant, just as is screw size (3.5 vs 4.5) or even use of other fixation constructs like suture buttons or anatomic ligament reconstruction/avulsion repair.An Update on Management of Syndesmosis Injury: A National US Database Study.Carr JC 2nd, Werner BC, Yarboro SRAm J Orthop (Belle Mead NJ). 2016 Nov/Dec. 45. (7). :E472-E477PMID: 28005114 (Link to Abstract)Management of syndesmotic injuries: What is the evidence?Schnetzke M, Vetter SY, Beisemann N, Swartman B, Grützner PA, Franke JWorld J Orthop. 2016 Nov 18. doi: 10.5312/wjo.v7.i11.718. 7. (11). :718-725PMID: 27900268 (Link to Abstract)
Halux valgus interphalangealis
Hello,what type of surgical procedure would you suggest for this young women (19 y)? The deformation is flexible. Distal phalanx osteotomy? Thank you for your answers and comments.
Lateral release at the ip joint and a Akin
A 41-year-old female feels a pop in her ankle while playing tennis. She is diagnosed with an acute Achilles tendon rupture and elects to undergo nonoperative management. Which of the following is a difference seen with nonoperative management with early functional rehabilitation compared with operative treatment?
decreased incidence of deep venous thrombosis
no significant differences
increased rate of re-rupture
earlier return to sport
increased complication rate
Thank you for this, very useful.
Arch Orthop Trauma Surg. 2017 Mar;137(3):333-340. Epub 2017 Jan 17.
Dr. Mifsud - that's a great question. There are a whole bunch of functional rehab protocols that are in use, with little to no comparisons of them head to head. In fact, this paper below found 243 different protocols in Germany alone, and reviewed the similarities and differences of them:Rehabilitation of Achilles tendon ruptures: is early functional rehabilitation daily routine?Frankewycz B, Krutsch W, Weber J, Ernstberger A, Nerlich M, Pfeifer CGArch Orthop Trauma Surg. 2017 Mar. doi: 10.1007/s00402-017-2627-9. pii: 10.1007/s00402-017-2627-9. 137. (3). :333-340PMID: 28097423 (Link to Abstract)
Here's an attempt at some evidence-based protocol design, with some decent recommendations:Accelerated rehabilitation following Achilles tendon repair after acute rupture - Development of an evidence-based treatment protocol.Brumann M, Baumbach SF, Mutschler W, Polzer HInjury. 2014 Nov. pii: S0020-1383(14)00315-5. doi: 10.1016/j.injury.2014.06.022. 45. (11). :1782-90PMID: 25059505 (Link to Abstract)
What are people's preferences for a non-operative management regime as I've come across several different ones?
A 24-year-old female who is training for her first marathon presents with six weeks of increasing foot pain. An AP radiograph and representative axial cut of her CT scan of her injury are seen in figures A and B. Management should consist of which of the following?
Weight bearing as tolerated in a hard soled shoe
Non weight bearing cast immobilization
Fragment excision and posterior tibial tendon advancement
Percutaneous screw fixation
Open reduction with autologous bone graft
this is a non healing fracture with sclerosis at the fracture site, should be derided and ORIF
Tarsal Tunnel Release - Dr. Susan E. Mackinnon
I couldn't watch the video for somehow. Why do I have to register in this vimeo to gain an access?
When we can use 2 screws for syndesmotic injry?
A 70-year-old sedentary female underwent a silastic arthroplasty of the right 1st metatarsophalangeal joint 15 years ago. She now presents with pain, swelling and erythema of the MTPJ. She is afebrile, bloodwork reveals normal ESR, CRP and WBC, and her erythema resolves with elevation. NSAIDs and activity modification have failed to provide relief. What is the best option to treat her painful toe?
Steroid joint injection
Custom molded orthosis with recessed 1st metatarsal molding
Irrigation and debridement and IV antibiotics
Revision of silastic implant and synovectomy
Removal of implant and synovectomy
I would remove & fuse. Who wants a floppy toe?
in the trauma section anteroposterior fibular stress is preffered
please correct the HVA >
A 54-year-old female has a painful flatfoot that has not improved with over 8 months of conservative management with orthotics. Preoperatively, she was unable to perform a single-heel rise and her hindfoot was passively correctable. Figures A and B are radiographs of the affected left foot. She undergoes FDL tendon transfer to the navicular, medial slide calcaneal osteotomy, and tendoachilles lengthening procedures. Following these procedures, the appearance of the foot is demonstrated in Figure C. What is the next most appropriate intraoperative procedure to be performed during her foot reconstruction?
Dorsiflexion closing wedge medial cuneiform osteotomy
In-situ 1st-3rd tarsometatarsal joint arthrodesis
Plantarflexion opening wedge medial cuneiform osteotomy
Lateral column closing wedge shortening osteotomy
The lateral column lengthening is used to correct forefoot abduction, not varus. You would do this in stage 2B PTTI. Stage 2C is defined by the varus as seen above, and may or may not also include abduction.
A 57-year-old man taking metformin for diabetes and gabapentin for peripheral neuropathy has a superficial plantar midfoot ulcer with a clean, noninfected appearance. Total contact casting is implemented for mechanical relief. Which of the following radiographs most likely corresponds to the clinical situation described?
surprised by the negative rating here. Well written question clearly trying to lead towards charcot foot. Much better than the foot/ankle SAE questions!
A 44-year-old recreational runner began training for a half marathon 6 weeks ago. Over the last week he has developed heel pain that is worse in the morning upon awakening and when he arises from his desk at the end of the workday. Physical exam is notable for tenderness with direct palpation of the anteromedial heel. Which of the following is the best initial management?
Stretching of the achilles tendon and plantar fascia along with a prefabricated shoe insert
Immobilization in a short leg cast
Steroid injection of the plantar fascia
Custom made orthotic with arch support
Surgical release of the medial third of the plantar fascia origin
In this question the answer is stretching, in a previous question the answer to "best initial management" was immobilization in cast. Please advise.
A 19-year-old cross country runner complains of 3 months of foot pain with running. Based on the radiographs shown in Figure A, what is the most appropriate next step in treatment?
open reduction, internal fixation
continue running with a molded orthotic
protected weightbearing with crutches, with slow return to running
percutaneous Kirschner wire fixation
Would disagree. Taking this patient to a level where they are without symptoms is all that is needed. This could be no running and WB in a boot.