8. Foot and Ankle MCQs

A 24-year-old motorcyclist sustains a traumatic knee dislocation (KD-IV). Upon closed reduction in the emergency department, the ipsilateral foot remains cool and pulseless. What is the immediate next step in management?

A 30-year-old male sustains a knee dislocation during a fall from a height. After closed reduction, his Ankle-Brachial Index (ABI) is calculated to be 0.7. He has palpable distal pulses and no active bleeding. What is the most appropriate next step in management?

Compared to surgical repair, traditional nonoperative management with prolonged cast immobilization for an acute Achilles tendon rupture is historically associated with which of the following?

A 21-year-old athlete sustains an external rotation injury to his ankle. Radiographs show a widened medial clear space and tibiofibular clear space. He is tender along the proximal fibula. What is the standard operative management?

A 40-year-old marathon runner complains of chronic, localized pain and thickening of the Achilles tendon 4 cm proximal to its calcaneal insertion. What is the most widely supported initial treatment?

A 28-year-old professional soccer player sustains an external rotation injury to the right ankle. Radiographs show a widening of the medial clear space to 6 mm and a tibiofibular clear space of 8 mm on the AP view. Stress radiographs demonstrate further dynamic widening. Which of the following is the most appropriate surgical management?

A 13-year-old boy sustains an intra-articular fracture of the distal tibia. Radiographs show a fracture line traversing the lateral epiphysis and extending superiorly through the lateral physis. What is the classic mechanism of this specific injury pattern?

Figure 28 shows the radiograph of a 6-year-old girl who has a right thoracic scoliosis that measures 60 degrees. Examination shows multiple cafe-au-lait spots, and family history reveals that the child's mother has the same disorder. The gene responsible for this disorder codes for

A 28-year-old unrestrained driver is involved in a high-speed motor vehicle collision and sustains a posterior hip dislocation with an associated posterior wall acetabular fracture. Following reduction, the patient has a foot drop. Which of the following sensory deficits is most likely to be found on examination?

Following a primary total hip arthroplasty via a posterior approach, a patient exhibits a foot drop and inability to extend the great toe. Sensation is diminished over the dorsum of the foot. Which division of the sciatic nerve is injured, and what is its primary sensory distribution?

In a highly comminuted pilon fracture, the posterior articular fragment (Volkmann fragment) is typically displaced due to the pull of which attached structure?

Despite achieving anatomic articular reduction and stable fixation of a high-energy pilon fracture, the patient has a high risk of developing post-traumatic ankle arthrosis. What is the primary pathophysiologic reason for this outcome?

A 30-year-old male sustains an anterior knee dislocation during a sporting event. The joint is reduced in the emergency department. Palpation reveals symmetric pedal pulses, but the measured Ankle-Brachial Index (ABI) is 0.85. What is the most appropriate next step in the management of this patient?

A 22-year-old athlete sustains a midfoot injury with severe midfoot pain and plantar ecchymosis. Radiographs reveal widening of the interval between the first and second metatarsal bases. The primary stabilizing ligament disrupted in this classic Lisfranc injury connects which two osseous structures?

A 28-year-old driver is involved in a motor vehicle collision and sustains a posterior hip dislocation. He presents with a foot drop and decreased sensation over the dorsum of the foot. Following emergent, uneventful closed reduction within 2 hours of injury, the neurologic deficit persists. What is the most appropriate management of this persistent deficit?

A 40-year-old female sustains a high-energy knee dislocation. Following closed reduction, her foot is warm, but the Ankle-Brachial Index (ABI) is calculated to be 0.8. What is the most appropriate next step in management?

A 24-year-old warehouse worker drops a heavy crate on his midfoot. AP and oblique radiographs are obtained to evaluate for a Lisfranc injury. On a normal anteroposterior (AP) radiograph of the foot, what is the key radiographic parameter that confirms structural integrity of the Lisfranc complex?

A 55-year-old poorly controlled diabetic presents with a swollen, erythematous, warm, and painless right foot. Pulses are palpable and bounding. Radiographs are unremarkable. MRI demonstrates diffuse marrow edema in the midfoot without focal fluid collections. What is the most appropriate initial management?

According to the classic biomechanical study by Ramsey and Hamilton, a 1-mm lateral displacement of the talus within the ankle mortise following an ankle fracture reduces the tibiotalar contact area by approximately what percentage?

A 45-year-old man sustains a pronation-external rotation (PER) ankle fracture. Intraoperatively, after rigid internal fixation of the medial and lateral malleoli, an intraoperative Hook test demonstrates 3 mm of lateral syndesmotic widening. Which of the following represents the most appropriate next step?