• Partial injury, divergent dislocation
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A 35-year-old motorcyclist is involved in a motor vehicle accident. He complains of pain and swelling in his right foot. Examination demonstrates dorso-medial midfoot tenderness. A clinical photograph is seen in Figure A. Supine and standing radiographs are seen in Figures B and C respectively. What is the most appropriate definitive treatment step?
Non-weightbearing in a CAM walker boot for 6-10 weeks
Weightbearing as tolerated in a CAM walker boot for 6-10 weeks
Closed reduction and K-wire fixation of the first and second tarsometatarsal joints
Open reduction and rigid internal fixation of the first and second tarsometatarsal joints
Open reduction and rigid internal fixation of the first to third tarsometatarsal joints and K-wire fixation of the fourth and fifth tarsometatarsal joints
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A 22-year-old soccer player complains of foot pain after sustaining a twisting injury. A clinical photo is shown in Figure A. On the physical examination, he is focally tender in the midfoot region. Weight bearing radiographs are shown in Figure B. What is the optimal definitive treatment for this patient?
Weight bearing in a walking boot
Immobilization in a cast for 8 weeks
Open reduction and internal fixation of the injury
Open reduction and internal fixation of the injury along with lateral column stabilization
A 25-year-old male sustains a left foot injury while playing soccer. His radiographs are shown in figures A and B. Which of the following techniques would lead to the best outcome when addressing his injury?
Rigid cast immobilization
Spanning medial column external fixation
Percutaneous screw fixation of medial column of foot
K-wire fixation of medial column of foot
Open reduction and internal fixation of medial column of foot
A 40-year-old male sustains a right foot injury after a head-on motor vehicle collision. He is unable to place weight on the foot to ambulate due to pain along the medial aspect of the foot. The pain is exacerbated with abduction of the midfoot. The patient denies pain along the lateral border of the midfoot. He is neurovascularly intact in the foot. An injury radiograph is shown in Figure A, while a clinical image of the foot is shown in Figure B. What is the most appropriate next step in management?
Open reduction and arthrodesis of the medial two tarsometatarsal joints
External fixation of the foot followed with staged open reduction and screw fixation across the medial two tarsometatarsal joints
Open reduction and screw fixation across the medial three tarsometatarsal joints and percutaneous pinning of the 4th and 5th tarsometatarsal joints
Debridement of Morel-Lavallee lesion and external fixation of the foot followed with staged open reduction and screw fixation across the medial two tarsometatarsal joints
Open reduction and screw fixation across the medial two tarsometatarsal joints with anatomic ligamentous reconstruction
A 24-year-old man sustains an injury to his left foot. Stress radiographs are seen in Figure A. Injury to which ligament or ligaments are needed to produce the transverse instability seen here?
Spring ligament and bifurcate ligament
Interosseous first cuneiform-second metatarsal ligament
Interosseous first cuneiform-second metatarsal ligament and plantar ligament between the first cuneiform and the second and third metatarsals
Bifurcate ligament and Interosseous first cuneiform-second metatarsal ligament
Long plantar ligament and plantar ligament between the first cuneiform and the second and third metatarsals
As an alternative to open reduction and internal fixation for the injury pattern seen in Figure A, what alternative treatment has been shown to be more effective?
open reduction and arthrodesis of the medial and middle column, reduction and stabilization of the lateral column
open reduction and primary arthrodesis of the medial, middle, and lateral columns
closed percutanous pinning of the medial, middle, and lateral columns
closed reduction of the midfoot and casting
partial weight bearing in removable boot
Which ligament connects the medial cuneiform to the base of the second metatarsal?
A 37-year-old man was involved in a high velocity motor vehicle accident 6 months ago. He spent 4 months in the ICU recovering from a severe head injury. He has now transitioned to a rehabilitation hospital and complains of left foot pain that becomes severe with weightbearing and attempted ambulation. Radiographs are provided in figures A-C. Which of the following is the best management?
Custom orthotics and physical therapy
Closed reduction and percutaneous screw fixation of 1st through 3rd tarsometatarsal joints
Open reduction internal fixation of 1st through 3rd tarsometatarsal joints
Arthrodesis of 1st through 3rd tarsometatarsal joints
Tarsometatarsal arthrodesis and triple arthrodesis
A 30-year-old equestrian caught her foot in a stirrup 1 week ago and now complains of midfoot pain with difficulty bearing weight. Radiographs are shown in figure A. What treatment is most appropriate?
Non-weight bearing in an aircast
Weight bearing as tolerated in a walking cast
Delayed corrective osteotomy and arthrodesis of the medial column
Arthrodesis of the medial tarsometatarsal joints
A 54-year-old male sustained a right foot injury two years ago in a motor vehicle collision. The patient reports he was treated for a ligament injury in his foot with a non-weightbearing short leg cast for 2 months. Physical examination reveals no signs of infection and full sensation and motor strength in the foot. During gait examination he has pain during push-off of the right foot and loss of medial longitudinal arch height in the stance phase. A radiograph obtained at the time of initial injury is shown in Figure A. What is the most appropriate next step in management?
Lateral column lengthening procedure (Evans)
Tarsometatarsal joint arthrodesis
Talonavicular joint arthrodesis
Lateral wedge closing calcaneal osteotomy (Dwyer)
Subtalar, talonavicular, and calcaneocuboid joint arthrodesis (Triple)
A 54-year-old woman sustains a twisting injury to her foot. A radiograph is provided in Figure A. Which of the following is the most appropriate treatment?
closed reduction and pinning
closed reduction and casting
open reduction and internal fixation
CAM walker and weight bearing as tolerated
weight bearing as tolerated