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Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC.
A 45-year-old male construction worker presents with right ankle pain after falling from a two-story building and landing on his right leg. He noticed immediate pain and inability to bear weight on the affected limb. Physical examination reveals diffuse soft tissue swelling around the ankle joint without any open injuries. The patient reveals he never completed a high school degree, smokes 1/2 a pack of cigarettes per day, and occasionally uses marijuana recreationally. Injury radiographs are shown in figures A and B. The patient undergoes an ankle-spanning external fixator placement for soft tissue stabilization and then undergoes definitive fixation shown in figures C and D. Which factor suggests a poor clinical outcome and failure to return to work?
Use of a temporizing external fixator
Varus collapse of the distal tibia at the time of injury
Recreational marijuana use
Lower level of education
Use of more than one plate for definitive fixation of the tibia
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A 37-year-old construction worker falls off a rock and lands on his right leg. He reports severe pain and inability to bear weight on the right leg. Current imaging is shown in figures A-C. On examination, the injury is closed, but there is substantial soft tissue swelling. An ankle spanning external fixator is placed on the right leg to allow for soft tissue stabilization. The treating surgeon decides to perform an open reduction internal fixation (ORIF) through combined anterolateral and medial approaches. What is true regarding the anterolateral approach for this injury?
The entire articular surface cannot be visualized through the anterolateral approach
Anterior compartment tendons are retracted laterally to protect the neurovascular structures
Anterolateral approach is contraindicated with central dome comminution
Dorsal foot numbness is the most common associated neurologic complication
Fibular fixation is usally performed through the same incision
A 34-old-male was involved in a high speed MVC. He sustained an injury to his right leg as seen in Figures A and B. He was treated initially with external fixation for 11 days before his soft-tissues would permit definitive open internal fixation. After removing the external fixator and plating the fibula, what would be next step in the operative plan for reduction and fixation of this injury?
Application of an anterolateral pre-contoured plate with distal locking screws to the tibia
Anatomical reduction and stabilization of the tibial articular surface
Application of a medial pre-contoured plate with distal non-locking screws to the tibia
Anatomical reduction and stabilization of the tibial metaphyseal segment
Proximal screw insertion with non-locking screws to distract the metaphyseal fracture comminution
A 46-year-old male falls 15 feet from a ladder while working. He presents with the radiographs shown in Figures A and B. The injury is closed, and soft tissues are intact upon arrival. Which of the following treatment regimens has been shown to decrease wound complications in the definitive management of these injuries?
Immediate definitive fixation of the tibia, and nonoperative treatment of the fibula
Immediate ankle-spanning external fixation device with consideration of immediate fixation of the fibula, followed by delayed reconstruction of the tibia
Placement of a temporary splint, elevation, and definitive fixation 1 week from injury
Immediate definitive fixation of the tibia and fibula
Immediate placement of a spanning Ilizarov fixator with limited internal fixation of the distal tibia and fibula
A 55-year-old female presents to the emergency room after falling off her balcony. She sustained the isolated, closed injury shown in Figures A and B. She is otherwise healthy, but routinely smokes 30 cigarettes per day. What would be the most appropriate sequence of treatment steps for definitive management of this injury?
Closed reduction and splinting followed by delayed casting
Immediate open reduction internal fixation
Closed reduction and splinting, CT scan, and immediate open reduction internal fixation
Closed reduction and splinting, CT scan, external fixation, delayed open reduction internal fixation
Closed reduction and splinting, external fixation, CT scan, delayed open reduction internal fixation
A 52-year-old carpenter falls off of a balcony while at work and sustains the injury shown in Figure A. The patient's BMI is 52 and he smokes 2 packs of cigarettes per day; a clinical photograph of the limb is shown in Figure B. What is the most appropriate next step in management?
Short leg splint placement and transition to short leg cast at 2 weeks
Closed reduction and spanning external fixation of the ankle
Open reduction and internal fixation of the fibula and tibia
Open reduction and internal fixation of the fibula with Blair arthrodesis of the ankle
Open reduction and internal fixation of the tibia and articulating external fixation of the ankle
Which of the following statements is true regarding brake travel time after surgical treatment of complex lower extremity trauma?
Brake travel time is significantly increased until 6 weeks after patient begins weight bearing
Return of normal brake travel time takes longer after long bone fracture compared to articular fractures
Normal brake travel time correlates with improved short musculoskeletal functional assessment scores
Brake travel time is significantly reduced until 8 weeks after patient begins weight bearing
Brake travel time returns to normal when weight bearing begins
A 34-year-old male sustains the closed injury seen in Figure A as a result of a high-speed motor vehicle collision. What is the most appropriate next step in treatment?
Open reduction and internal fixation
Spanning external fixation
Percutaneous internal fixation
Closed reduction and cast placement
A 33-year-old male sustains the injury shown in Figure A. He is initially treated with a spanning external fixator followed by definitive open reduction internal fixation of the tibia and fibula. His wounds healed without infection or other complications. Two years following surgery, which of the following parameters will most likely predict a poor clinical outcome and inability to return to work?
Joint line restoration
Degree of fracture displacement
Time before definitive ORIF
In a pilon fracture, the Chaput fragment typically maintains soft tissue attachment via which of the following structures?
Anterior inferior tibiofibular ligament
Posterior inferior tibiofibular ligament
A 32-year-old man sustains a pilon fracture which is treated initially with a spanning external fixator, as shown in figure A. He is now 3 weeks from injury and skin swelling has subsided significantly. What is the most appropriate definitive treatment?
open reduction internal fixation of the fibula only
open reduction internal fixation of the tibia and fibula
removal of external fixator and conversion to a walking cast
dynamization of the external fixator
A 35-year-old male laborer falls off a ladder and sustains the injury shown in Figures A and B. He has a 2 cm laceration over the medial ankle with exposed bone and a normal neurovascular exam. What is the recommended initial treatment?
Immediate open reduction and internal fixation
Closed reduction and casting
Irrigation and debridement and external fixation
Irrigation and debridement and splinting
A 45-year-old male laborer falls off a 15 foot retaining wall 6 hours ago and sustains an open fracture shown in Figures A through C. He has a normal neurovascular exam. Coronal and sagittal CT scan images are shown in Figures D and E. What is the MOST appropriate next step in management in addition to operative irrigation and debridement?
ORIF with standard plating of the tibia and fibula
ORIF with locked plating of the tibia and fibula
ORIF with standard plating of the tibia and fibula and immediate bone grafting of tibia defect
External fixation of the tibia, ORIF of the fibula with standard plating, and immediate bone grafting of tibia defect
External fixation of the tibia