Free Test MCQs/SBAs Foot &Ankle

Best answer: C
The photographs show a planovalgus posture of the foot. The foot deformity and decreased inversion strength are secondary to laceration of the posterior tibial tendon 18 months ago. If the injury had been recognized acutely, optimal treatment would have consisted of repair of the tendon; however, contracture now precludes that possibility. Therefore, transfer of the flexor digitorum longus or flexor hallucis longus is the preferred treatment. In adults with posterior tibial dysfunction, the entire tendon is typically degenerated and the transfer must be anchored through a drill hole in the navicular. In this patient, the distal end of the posterior tibial tendon is a satisfactory insertion site. Lengthening osteotomy of the calcaneus could be combined with the tendon transfer if the patient had a fixed deformity of the foot. UCBL orthoses and an ankle-foot orthosis are not considered good long-term solutions for a 12-year-old patient.

Best Answer: C
Immediate open reduction and internal fixation of this fracture is required to prevent necrosis of the overlying soft tissue. Because of the power and proximal pull of the triceps surae, nonsurgical management is not indicated with avulsion fractures of the calcaneus. It leaves a large void that will not fill in with bone, leaves the Achilles tendon weak, and has a high complication rate, especially skin breakdown. The Achilles tendon is securely attached to the fractured tuberosity. Bone-to-bone healing is more reliable than detaching the Achilles tendon from the tuberosity and reattaching it to the remainder of the calcaneus. Because of the size of the avulsed fragment, it will be difficult to correctly tension the tendon if the fractured piece is excised. Percutaneous Kirschner wire fixation is not strong enough to provide a stable fixation of the tuberosity, especially in view of the power of the Achilles tendon contracture.

Best Answer E
The radiographs show a displaced Lisfranc injury. The outcome of treatment is dependent on achieving an anatomic reduction and stabilization, which is only possible with primary ORIF. Some studies indicate primary fusion may provide superior short-term results compared with ORIF. Closed treatment (reduction with casting or splinting) will not achieve or maintain the reduction, whereas delayed treatment by secondary fusion after arthritis occurs yields inferior outcomes to primary ORIF.

Best answer : A .
Figure demonstrates a talar neck fracture. A subchondral talar lucency at approximately 6 weeks postoperatively indicates revascularization of the talus and is good prognostic factor for this injury .

Best answer: B .
The MRI demonstrates a stress fracture of the second metatarsal. Appropriate initial management includes a period of non-weight bearing, as well as assessment of risk factors for additional stress fractures such as poor nutrition and amenorrhea.

Best answer: B .
Ankle arthrodesis must be used as a salvage procedure for failed management of the osteochondral lesion of the talus. Although osteoarticular autograft is a popular procedure, the results are variable and unpredictable, particularly in posteromedial lesions. Ankle arthroscopy with transarticular drilling is the most predictable procedure with expected satisfactory results in approximately 80% of patients.

Best Answer : B .
While the 1st-3rd tarsometatarsal joints are relatively immobile the 4th and 5th are mobile allowing accomodation to rough ground. As such arthrodesis of these joint is generally not well tolerated. However in a foot with either painful malunion or degeneration arthrodesing the 1st - 3rd joints may provide sustained pain relief and return to activity. Post-operative management usually requires a period of non-weight-bearing and the conventional approach is dorsally.