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Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC.
A patient with subtalar and tibiotalar arthritis underwent the surgery shown in Figure A. The patient now complains of numbness on the plantar/lateral aspect of his foot including the 4th and 5th toes. Which nerve was most likely injured?
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A 45-year-old laborer sustained the injury shown in Figure A. Closed reduction is performed and post-reduction films are shown in Figure B. He elects to proceed with nonoperative treatment. Two years later he now presents with persistent ankle pain and difficulty walking long distances. On physical exam, he is found to have an antalgic gait with limited ankle motion secondary to pain. Crepitus is felt with passive range of motion of the ankle. The most recent radiographs are shown in Figure C. An MRI report indicates the presence of degenerative changes in the ankle. What would be the most appropriate option for definitive management?
Steroid injection into the ankle
Total ankle arthroplasty.
Tibiotalocalcaneal (TTC) arthrodesis with femoral head allograft
A 36-year-old construction worker sustained an ankle fracture 4 years ago after falling off a roof. Postoperative radiographs are seen in Figure A. The hardware is removed 2 years later. He now returns with ankle pain and intermittent swelling but has no difficulty with uneven surfaces. Examination reveals 5 degrees of gastrocnemius equinus contracture, pain with passive plantar and dorsiflexion, but no pain with hindfoot inversion and eversion. Recent radiographs are seen in Figure B. CT scan shows no degenerative changes in the hindfoot. What is the best treatment option?
Arthroscopic debridement of the tibiotalar joint and corticosteroid injection
Tibiotalar arthrodesis with screws
Total ankle arthroplasty
Tibiotalocalcaneal arthrodesis with an intramedullary device
Tibiotalocalcaneal arthrodesis with an extramedullary device
When performing an ankle fusion, the foot should be in:
0 degrees dorsiflexion/plantarflexion, 0-5 degree hindfoot valgus, 5-10 degree external rotation
0 degrees dorsiflexion/plantarflexion, 0-5 degrees hindfoot valgus, 0 degrees external rotation
10 degrees dorsiflexion, 0-5 degrees hindfoot valgus, 5-10 degrees external rotation
0 degrees dorsiflexion/plantarflexion, 20 degrees hindfoot valgus, 5-10 degrees external rotation
10 degrees plantarflexion, 0-5 degrees hindfoot valgus, 5-10 degrees external rotation
A 40-year-old male presents with long-standing right heel pain. He reports pain and swelling and points to the region of the sinus tarsi as the maximal area of pain, particularly when walking on uneven surfaces. He also reports a history of recurrent ankle sprains when he was younger. A clinical image of his foot posture is shown in Figure A. Inversion and eversion of the hindfoot reproduce pain. He has no discomfort with passive ankle dorsiflexion and plantarflexion. Coleman block testing reveals a rigid hindfoot. Sensation is fully intact throughout the extremity and he has full strength with ankle dorsiflexion, ankle plantarflexion and he can perform a single-leg heel rise without difficulty. A radiograph is shown in Figure B. What is the most appropriate step in management if conservative measures fail?
Brostrom anatomic reconstruction with Gould modification
Hindfoot arthroscopy with synovial debridement and Os trigonum resection
Chrisman-Snook nonanatomic reconstruction using tendon transfer