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Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC.
A 35-year-old morbidly obese female presents with global right ankle pain and significant swelling after a misstep over one of her cats on the stairs. She is unable to bear weight, but the skin is intact. Injury films are shown in Figures A through D. What is the internervous plane through which direct anatomic reduction and fixation of both fractures could best be achieved?
Deep peroneal nerve, sural nerve
Deep peroneal nerve, tibial nerve
Superficial and deep peroneal nerves
Superficial peroneal nerve, tibial nerve
There is no true internervous plane
Select Answer to see Preferred Response
A 32-year-old soccer player presents with severe right ankle pain and inability to bear weight after sustaining a slide-tackle injury during a game. Radiographs are shown in Figures A and B. Given the nature of his injury, he is taken for surgical reduction and fixation. Following medial malleolar fixation, the syndesmosis is addressed. All of the following are true regarding the most appropriate intra-operative technique for anatomic syndesmotic reduction EXCEPT:
The axis of the reduction clamp should parallel the anatomic trans-syndesmotic angle
The lateral tine of the clamp should be seated just posterior to the lateral malleolar ridge
The medial tine should be placed on the anterior third of the tibia on a true lateral fluoroscopic view of the ankle
The reduction clamp should be placed 1-2cm proximal to the tibial plafond
The surgeon should apply judicious compression under fluoroscopic visualization to avoid over-compression of the syndesmosis
A 42-year-old male who works as a professional clown presents with severe ankle pain and gross deformity after tripping and falling over his props at a children’s birthday party. His radiograph is shown in Figure A. Following fixation of the medial and lateral malleolar fractures, the syndesmosis is assessed and is found to be persistently unstable. All of the following are true regarding posterior malleolar fixation EXCEPT:
Fixation of the posterior malleolus obviates the need for syndesmotic fixation in most cases
Fixation of the posterior malleolus remains biomechanically inferior to trans-articular syndesmotic fixation
Functional and radiographic outcomes following posterior malleolar fixation are at least equivalent if not superior to those following syndesmotic fixation
Non-anatomic fixation of the posterior malleolus will compromise syndesmotic fixation
The syndesmosis is often incompletely injured in the setting of a posterior malleolar fracture
A 26-year-old male recreational basketball player sustained an ankle injury 6 months prior. He continues to complain of ankle pain and instability. Current imaging is shown in Figures A & B. Imaging of the proximal fibula is unremarkable and there is little concern for syndesmotic injury. What is the next best step in treatment?
Open reduction and internal fixation (ORIF) with autograft
Obtain stress radiographs
Physical therapy and management of symptoms
Percutaneous skeletal fixation
A 63-year-old patient presents with right ankle pain after a fall down four stairs. Figures A and B are the radiographs of the injury. The patient reports a history of diabetes mellitus type 2 and peripheral neuropathy with a most recent hemoglobin A1c of 9.8. The injury is reduced and placed in a well-padded bivalved cast. The patient is then discharged with outpatient follow-up without DVT prophylaxis. Twelve weeks later, the patient presents to the clinic for the first time in the same bivalved cast. The has remained non-weight bearing and the bottom of the cast confirms this. What is the expected outcome at this point?
Diabetic foot ulcer
Deep vein thrombosis
Elevation of A1c
A 60-year-old woman with a history of well-controlled diabetes and hypertension sustained a fall into a ditch yesterday and presents with persistent left ankle pain and deformity. The injury is closed, and the patient is neurovascularly intact. Injury films are shown in Figures A and B. An unsuccessful attempt at reduction in the emergency department with sedation was made. What is the cause of failure of closed reduction?
Subacute nature of fracture
Incarceration of the deltoid ligament
Incarceration of the fibula behind the posterolateral ridge of tibia
Entrapment of the flexor hallucis longus (FHL) tendon
Entrapment of the extensor digitorum brevis (EDB)
A 40-year-old man fell off of a ladder at work sustaining the injury shown in Figures A and B. On examination, his skin is intact, but the pulses in his foot are absent. Following closed reduction and splinting, what would be the next best step?
Vascular surgery consultation
Surgical exploration and stabilization
A 33-year-old female sustains the injury shown in Figure A as the result of a fall off a chair, and subsequently undergoes operative stabilization of her injury. Which of the following is most correlated with positive outcomes when treating this injury?
Subchondral debridement of any osteochondral defect
Repair of medial ligamentous structures
Casting or splinting in a neutral position postoperatively
Anatomic reduction of the syndesmosis
Which of the following ankle fractures seen in Figures A-E most likely occurred as a result of abduction of the foot relative to the tibia?
A 40-year-old male patient sustains a bimalleolar ankle fracture and undergoes open reduction and internal fixation. Four months later, he returns for follow-up with mild ankle discomfort, and a radiograph is shown in Figure A. What is the most appropriate next step in treatment?
Syndesmosis sagittal plane reduction and fixation
Syndesmosis coronal plane reduction and fixation
Osteotomy and revision of the fibula and syndesmosis
Retrieval of osteochondral fragment
Revision plating of the fibula and syndesmosis reduction and fixation.
Figure A shows an isolated left ankle injury in an active 48-year-old recreational hockey player. Past medical history includes insulin dependent diabetes mellitus for 35 years. On physical examination the patient is unable to feel a 5.07 gm monofilament on the plantar aspect of his foot. His pedal pulses are palpable. Of the following options, what would be the recommended treatment?
Closed reduction and casting for 6 weeks
Closed reduction and casting for 12 weeks
Open reduction and internal fixation with restricted weight bearing for 2 weeks
Open reduction and internal fixation with restricted weight bearing for 6 weeks
Open reduction and internal fixation with restricted weight bearing for 12 weeks
A 27-year-old man presents to the emergency department with an ankle fracture. CT scans note anteromedial marginal impaction. Which radiograph (Figures A-E) would best correlate with this finding?
Surgical fixation with absolute stability would be most appropriate for which of the following fracture patterns?
An otherwise healthy 45-year-old female slips and falls with immediate right ankle pain. Stress examination of the right ankle is shown in Figure A. Which of the following is the most important for achieving a satisfactory outcome following open reduction internal fixation for this injury?
Weight-bearing before 3 weeks.
Medial clear space >5mm
Talocrural angle of 83 degrees
Tibiofibular clear space of >6mm
Talar tilt of >5 degrees