4.4 of 79 Ratings
A patient presents to your office with lateral midfoot pain after an inversion injury. In which of the following scenarios would early surgical intervention be indicated?
Collegiate soccer player with an acute nondisplaced zone 2 proximal 5th metatarsal fracture
High school varsity lacrosse player with a subacute zone 2 proximal 5th metatarsal fracture and no evidence of bony healing after 1 month of conservative management
Elite dancer with an acute zone 1 proximal 5th metatarsal fracture
Recreational football player with an acute zone 2 proximal 5th metatarsal fracture
All of the above
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A 23-year-old professional skier presents to the orthopedic clinic with foot pain after a mechanical fall at home. He is diagnosed with a Zone II base of 5th metatarsal fracture and is recommended for internal fixation. Which of the following is the primary advantage of operative intervention for these fractures compared to non-operative treatment?
Improved union rate
Decreased heterotopic ossification
Improved range of motion
Reduced long-term cost
An 19-year-old elite dancer falls and sustains the injury seen in Figure A. Which of the following interventions is most appropriate at this time?
Weight-bearing as tolerated and immediate return to competitive dancing
Resection of the proximal fifth metatarsal base with advancement of the peroneus brevis tendon
Non-weight-bearing in a short-leg cast
Intramedullary screw fixation with return to play after signs of radiographic healing
Protected weight-bearing in a stiff soled shoe with gradual return to activity
A 23-year-old professional lacrosse player injures her left foot while walking down a flight of stairs. She has pain and inability to bear weight on her injured foot. She has no plantar ecchymosis but does have tenderness over her lateral foot. A radiograph of her foot is found in Figure A. What is the best form of management?
Modified Brostrom procedure
Intramedullary screw fixation
Operative repair of the Lisfranc fracture
A 19-year-old college soccer player has been experiencing pain along the lateral border of her foot since the beginning of the season 6 weeks ago. A current radiograph is seen in Figure A. Which of the following would be a risk factor for failure after operative fixation?
Age less than 20-years-old
Return to sport prior to radiographic union
Use of a solid screw as opposed to a cannulated screw
Use of a 4.5mm screw
a 19-year old collegiate football lineman sustains a twisting injury to his right foot 1 week ago and radiographs are shown in Figure A. He was initially treated with a short leg splint, non-weight bearing and elevation. What treatment offers the fastest time to bony union and return to sport?
short leg cast and non weight bearing
long leg cast and non weight bearing
intramedullary screw fixation
plate and screw fixation
A 20-year-old male collegiate basketball player presents with a 1 day history of left foot pain. He developed severe pain on the lateral border of his left foot after landing from a jump. The pain is worsened with weightbearing and walking. The patient reports that 12 weeks ago he sustained a similar injury and underwent surgery on his foot by a different surgeon. He reports that his physician released him to full activity 8 weeks ago because he had no pain. He is currently tender to palpation on the lateral border of the foot. Radiographs and CT scan are shown in Figures A-D. What is the most likely etiology for the new injury?
Use of a partially threaded screw
Use of cannulated screw
Absence of adjunctive ultrasound stimulator use
Return to play prior to radiographic union
Use of a 5.0mm diameter screw
A 25-year-old professional basketball player sustains a twisting injury to his foot. He complains of immediate pain and is unable to finish the game. Two days following the injury, he has continued tenderness with palpation of the base of the 5th metatarsal. A radiograph is provided in Figure A. Which of the following would most likely lead to the quickest return to play?
Protected weightbearing in a short leg cast with gradual return to sport
Intramedullary screw fixation
Foot and ankle taping with immediate return to sport
Open reduction internal fixation with a precontoured plate