This practice set contains high-yield board review questions covering key concepts in Ankle Trauma & Sports. Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.
Question 161
Topic: Ankle Trauma & Sports
A patient presents with a chronic high ankle sprain, affecting the syndesmosis. Which ligament is the primary static stabilizer of the distal tibiofibular syndesmosis?
Correct Answer & Explanation
. Anterior inferior tibiofibular ligament (AITFL)
Explanation
The anterior inferior tibiofibular ligament (AITFL) is the primary static stabilizer of the distal tibiofibular syndesmosis, along with the posterior inferior tibiofibular ligament (PITFL) and the interosseous membrane. The ATFL, CFL, and PTFL are components of the lateral ankle complex, not the syndesmosis. The deltoid ligament is on the medial side of the ankle.
Question 162
Topic: Ankle Trauma & Sports
A patient undergoes a modified Brostrom-Gould repair. What is the typical initial rehabilitation phase (0-2 weeks post-op) focused on?
Correct Answer & Explanation
. Immobilization in a boot or cast, non-weight-bearing, and pain/swelling control.
Explanation
The initial rehabilitation phase (typically 0-2 weeks) after a modified Brostrom-Gould repair focuses on protecting the surgical repair. This involves immobilization in a boot or cast (or combination of both), non-weight-bearing to protect the suture lines, and controlling pain and swelling. Aggressive motion, strengthening, or plyometrics are deferred to later phases to allow for initial soft tissue healing.
Question 163
Topic: Ankle Trauma & Sports
A 30-year-old male sustains a twisting injury to his ankle while playing basketball. He has significant pain and swelling over the lateral malleolus. X-rays show a spiral fracture of the distal fibula extending proximally, with widening of the medial clear space and an intact deltoid ligament on stress views. What is the most appropriate classification for this injury?
Correct Answer & Explanation
. Maisonneuve fracture
Explanation
This describes a classic Maisonneuve fracture. It is an external rotation injury characterized by a spiral fracture of the proximal fibula (often extending into the shaft, as described by 'distal fibula extending proximally'), associated with disruption of the syndesmotic ligaments, and medial ankle injury (either a deltoid ligament rupture or medial malleolus fracture). The widening of the medial clear space indicates medial ankle instability. While the description mentions an 'intact deltoid ligament on stress views,' significant medial clear space widening implies functional compromise of the medial stabilizers, even if the main deltoid fibers are not overtly torn or it's a subtle injury combined with syndesmotic failure. The high fibula fracture is the key distinguishing feature differentiating it from Weber type ankle fractures which are limited to the distal fibula.
Question 164
Topic: Ankle Trauma & Sports
You are presenting a case of recurrent instability of the distal tibiofibular syndesmosis after initial operative fixation. The examiner asks, 'What are the two most common reasons for recurrent instability after syndesmotic fixation?'
Correct Answer & Explanation
. Malreduction of the syndesmosis during the initial surgery and/or hardware failure/loosening.
Explanation
The two most common reasons for recurrent instability of the distal tibiofibular syndesmosis after initial operative fixation are malreduction of the syndesmosis during the primary surgery (often leading to persistent diastasis or impingement) and/or hardware failure or loosening (e.g., screw breakage, loosening of suture button). Correct anatomical reduction is paramount for long-term stability. While inadequate rehab (A) and non-compliance (B) can contribute, technical errors in reduction or hardware problems are often the primary culprits. DVT (D) is a complication, not a cause of instability. Over-tightening (E) can cause stiffness and pain but typically doesn't lead torecurrent instabilityas the primary issue.
Question 165
Topic: Ankle Trauma & Sports
During open reduction and internal fixation of a pronation-external rotation (Weber C) ankle fracture, what is a critical technical prerequisite before utilizing a clamp to anatomically reduce the syndesmosis?
Correct Answer & Explanation
. Fibular length must be anatomically restored prior to syndesmosis reduction.
Explanation
Restoring anatomical fibular length and rotation is an absolute prerequisite before clamping and fixing the syndesmosis. Failure to restore fibular length will result in proximal migration of the fibula and a malreduced syndesmosis.
Question 166
Topic: Ankle Trauma & Sports
A 28-year-old female skier presents with acute ankle pain after forced dorsiflexion and eversion. Radiographs reveal a small bony avulsion flake arising from the lateral ridge of the distal fibula. What pathology does this 'fleck sign' typically represent?
Correct Answer & Explanation
. Avulsion of the superior peroneal retinaculum (SPR)
Explanation
A fleck of bone off the lateral ridge of the distal fibula represents an avulsion of the superior peroneal retinaculum (SPR), which is pathognomonic for acute peroneal tendon subluxation or dislocation.
Question 167
Topic: Ankle Trauma & Sports
A 14-year-old boy presents with an ankle injury after an external rotation force. Radiographs show a Salter-Harris III fracture of the anterolateral aspect of the distal tibia. Which ligament is responsible for the avulsion of this bony fragment?
Correct Answer & Explanation
. Anterior inferior tibiofibular ligament (AITFL)
Explanation
A juvenile Tillaux fracture is an SH III fracture of the anterolateral distal tibia. The fragment is avulsed by the intact anterior inferior tibiofibular ligament (AITFL) during an external rotation injury.
Question 168
Topic: Ankle Trauma & Sports
Which ligament is critical for maintaining the stability of the distal tibiofibular syndesmosis?
Correct Answer & Explanation
. Anterior inferior tibiofibular ligament (AITFL)
Explanation
The anterior inferior tibiofibular ligament (AITFL) is a primary stabilizer of the distal tibiofibular syndesmosis, along with the posterior inferior tibiofibular ligament (PITFL) and the interosseous ligament. Injuries to these ligaments result in syndesmotic (high ankle) sprains. The ATFL, PTFL, and CFL are components of the lateral ankle collateral ligaments, stabilizing the talocrural joint. The deltoid ligament is the medial collateral ligament of the ankle.
Question 169
Topic: Ankle Trauma & Sports
A 29-year-old professional athlete undergoes MRI evaluation for chronic anterolateral ankle pain following a rotational injury. The imaging reveals a chronic tear of the primary anterior stabilizer of the distal tibiofibular syndesmosis. Which of the following ligaments is most likely injured?
Correct Answer & Explanation
. Anterior inferior tibiofibular ligament
Explanation
Correct Answer: B. Anterior inferior tibiofibular ligamentThe tibiofibular syndesmosis is a complex ligamentous structure that maintains the integrity of the distal tibiofibular articulation. It is composed of four main ligaments: the anterior inferior tibiofibular ligament (AITFL), the posterior inferior tibiofibular ligament (PITFL), the interosseous ligament, and the transverse ligament. The AITFL is the most commonly injured component in rotational ankle injuries (specifically external rotation) and serves as the primary anterior stabilizer of the syndesmosis. The ATFL and CFL are part of the lateral collateral ligament complex of the ankle, not the syndesmosis.
Question 170
Topic: Ankle Trauma & Sports
A 13-year-old girl twists her ankle and sustains a juvenile Tillaux fracture. Which of the following ligaments is responsible for avulsing the anterolateral distal tibial epiphysis in this fracture pattern?
Correct Answer & Explanation
. Anterior inferior tibiofibular ligament (AITFL)
Explanation
A juvenile Tillaux fracture is a Salter-Harris III fracture of the anterolateral distal tibia. It is caused by an external rotation force, resulting in the AITFL avulsing the epiphyseal fragment as the physis closes from central to anterolateral.
Question 171
Topic: Ankle Trauma & Sports
A 24-year-old athlete sustains an inversion injury to the ankle. Which ligament of the lateral collateral complex is most frequently injured in this scenario?
Correct Answer & Explanation
. Anterior talofibular ligament (ATFL)
Explanation
Correct Answer: Anterior talofibular ligament (ATFL)The lateral collateral ligament complex of the ankle includes the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and posterior talofibular ligament (PTFL). The ATFL is the weakest of these ligaments and is the most commonly injured structure during a classic inversion and plantarflexion ankle sprain.
Question 172
Topic: Ankle Trauma & Sports
A 13-year-old boy sustains an external rotation injury to his ankle. Radiographs show a Salter-Harris III fracture of the anterolateral distal tibial epiphysis. This avulsion fracture is caused by the pull of which ligament?
Correct Answer & Explanation
. Anterior inferior tibiofibular ligament (AITFL)
Explanation
A juvenile Tillaux fracture is avulsed by the AITFL. It occurs in adolescents because the distal tibial physis closes from central to medial, leaving the anterolateral physis open and vulnerable last.
Question 173
Topic: Ankle Trauma & Sports
A 28-year-old sustains a Maisonneuve fracture. During syndesmotic fixation, at what distance proximal to the tibial plafond should the syndesmotic screws ideally be placed to maximize biomechanical stability without entering the joint?
Correct Answer & Explanation
. 2.0 to 3.0 cm
Explanation
Biomechanical studies have demonstrated that syndesmotic screws placed 2 to 3 cm proximal to the tibiotalar joint line provide optimal stability. Placement too distal risks intra-articular penetration, while placing them too high provides inadequate stabilization.
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