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A 35-year-old roofer sustains a fall from height onto his feet. He notes immediate pain and swelling upon his hindfoot, and is unable to bear weight. He is brought to the emergency department by his coworkers, where radiographs are obtained (Figure A). The patient is placed into a well-padded Bulky Jones splint and placed on the surgery schedule for the next day for open reduction and internal fixation. Which of the following is true regarding acute definitive fixation of his injury?
Higher rates of infection
Higher rates of varus malunion
Lower rates of osteonecrosis
Lower rates of subsequent subtalar osteoarthritis
Lower rates of wound dehiscence
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A 35-year-old male sustains an isolated injury depicted in Figure A after a motor vehicle accident. On examination, there is significant soft tissue swelling without open wounds. A decision is made to delay surgery until soft tissues are stabilized. Which of the following statements are true regarding this injury?
Avascular necrosis is more common following this injury than post-traumatic arthritis
Delayed internal fixation of displaced fractures does not increase the risk of avascular necrosis
Fracture comminution is associated with a decreased avascular necrosis rate
Delayed internal fixation increased the risk of secondary surgical procedures
Fracture displacement is not associated with avascular necrosis
A 27-year-old male is involved in a motor vehicle collision and presents to the ER with the right lower extremity injury shown in Figures A and B. He undergoes immediate closed reduction and the post-reduction CT is shown in Figures C and D. The patient undergoes percutaneous surgical screw fixation of the injury. At 2 years follow-up, he presents with a supination deformity with decreased eversion of the foot at rest. Radiographs reveal no evidence of talus subchondral sclerosis or collapse. Which of the following is the most likely cause of the finding in this patient?
A 35-year-old male fell and sustained an open talar neck fracture. He underwent operative fixation of his fracture. He presents at 2 months after surgery. He denies any constitutional symptoms and his pain is well controlled. On exam, his wounds are well healed with no erythema. Imaging is shown in Figure A. What can the patient be told about his condition?
Hawkins sign is positive. The likelihood of developing osteonecrosis is high
Hawkins sign is positive. The likelihood of developing osteonecrosis is low
Hawkins sign is negative. The likelihood of developing osteonecrosis is high
Hawkins sign is negative. The likelihood of developing osteonecrosis is low
He has developed chondrolysis
A 25-year-old male sustained an isolated injury to his right foot after a fall from height. On examination, he has moderate swelling and pain over the dorsum of the foot. The overlying skin is intact. Radiographs of the foot are seen in Figures A and B. A CT scan image is seen Figures C. When consenting the patient for open reduction and internal fixation of this injury, what would you document as the most common complication?
A 35-year old male is involved in a fall from height and present with the isolated injury shown in Figures A and B. The body of the talus is extruded medially through a large linear open wound. Along with irrigation and debridement, what is the most appropriate definitive management of this injury?
Reimplantation of the talar body followed by cast immobilization
Reduction of talar body, fracture fixation with smooth Steinman pins, and spanning fixator placement
Talar body allograft with internal fixation to native talar head
Fragment removal, antibiotic spacer placement and external fixation
Reduction of native talar body and ORIF of talar neck fracture
A 25-year-old man presents one year after undergoing open reduction and internal fixation of the fracture seen in Figure A. Current radiographs demonstrate a united fracture with no evidence of ostenecrosis, subtalar or tibiotalar arthritis. Physical exam is notable for ambulation on the lateral border of the right foot with hindfoot varus, midfoot supination and diminished subtalar motion compared with the contralateral side. Which of the following is an option for reconstruction of this patient's deformity?
Total ankle arthroplasty
Lateral calcaneus closing wedge osteotomy
Calcaneal neck opening wedge osteotomy
Talar neck opening medial wedge osteotomy
Varus malalignment after a talar neck fracture with medial comminution causes a decrease in what motion?
A 30-year-old patient underwent open reduction internal fixation of a talar neck fracture 8 weeks ago. His current radiographs demonstrate a subchondral radiolucency of the dome of the talus. What is the next most appropriate course of action?
Injection of bone cement into the talus to prevent further avascular necrosis
Ankle arthroscopy to address this osteochondral lesion
Continued observation as the vascularity to the talus is intact
A 29-year-old male sustains the isolated lower extremity injury shown in Figure A. During open reduction, what structure must be kept intact in order to protect the remaining blood supply to the talar body?
Anterior talofibular ligament
A 47-year-old male sustains the closed injury seen in Figures A and B after failing to land a motorcycle jump. A post-reduction radiograph is seen in Figure C. Which of the following is the most appropriate treatment at this time?
Definitive closed treatment
Addition of percutaneous pins
Open reduction and internal fixation
Primary subtalar arthrodesis
A 30-year-old male undergoes successful surgical fixation of a displaced talar neck fracture. Which of the following is the most likely long-term complication even after anatomic reduction and stable fixation is achieved?
Tibiotalar and/or subtalar arthritis
Loss of forefoot supination
A 30-year-old male sustains the injury shown in figure A and undergoes successful open reduction and internal fixation. Which of the following radiographic features is a good prognostic factor for this injury?
Talar dome subchondral lucency
Talar dome subchondral sclerosis
Associated medial malleolus fracture
Talar lateral process fracture
A 34-year-old female is involved in a motorcycle crash. She sustains a talus fracture with associated dislocation of the subtalar joint and maintained congruence of the tibiotalar and talonavicular joints as shown in Figure A. The fracture has healed and she now has symptomatic impingement of the dorsal surface of the talus on the distal tibia and restriction of ankle dorsiflexion. What is the most likely deformity causing these symptoms?
Combined varus and plantar malunion
Isolated varus malunion
Isolated valgus malunion
Isolated dorsal malunion
Isolated plantar malunion