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A 56 year-old male underwent a tibiotalar joint fusion six months ago. He presents for a second opinion due to chronic pain and difficulty walking. His current radiographs are shown in Figure A. The patient has a history of alcoholic induced neuropathy, type 2 diabetes, and had a previous nonunion of his left femur from an unrelated injury. His tibiotalar arthrodesis was completed for treatment of post-traumatic arthritis and his infection workup is currently negative. Which of the following places the patient at greatest risk for persistent nonunion with revision surgical fixation?
Prior femoral nonunion
Initial fixation method
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A 59-year-old male present with left ankle pain and drainage 3 years after surgery for a traumatic injury to the left ankle. He notes worsening pain over the past year. On examination ankle range of motion is limited to a 10-degree arc of motion with erythema and serous drainage from an anterior ankle incision. Figures A and B are his current radiographs. The patient requests a discussion of limb salvage surgery. Of the following, which is the best surgical plan for his condition?
Maintenance of prior hardware and simultaneous arthrodesis
Maintenance of prior hardware and staged arthrodesis
Removal of hardware, I&D, and simultaneous arthrodesis
Removal of hardware, I&D, and staged arthrodesis
Removal of hardware, I&D, and simultaneous ankle arthroplasty
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
A 42-year-old female sustains the injury exhibited in Figure A. Fluoroscopic images are exhibited in Figure B following open reduction and internal fixation. Should she go on to develop tibiotalar arthritis and fail conservative management for this, which of the following treatment modalities has the highest success rate?
Isolated osteochondral allograft transplantation
Interpositional soft tissue replacement
Arthroscopic debridement and microfracture
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
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?
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