8. Foot and Ankle MCQs

A 22-year-old male develops severe foot pain out of proportion to injury following a high-energy calcaneus fracture. Compartment syndrome of the foot is suspected but treated non-operatively due to delayed diagnosis. What is the classic long-term clinical deformity expected from untreated foot compartment syndrome?

According to the Lauge-Hansen classification, what is the initial anatomical structure to fail in a Pronation-External Rotation (PER) ankle injury?

A 55-year-old male presents with severe pain and functional limitation two years after an open reduction and internal fixation of a Sanders type IV calcaneus fracture. Radiographs and CT demonstrate end-stage subtalar arthritis, loss of calcaneal height, and decreased talocalcaneal angle. What is the most appropriate surgical intervention?

A 30-year-old athlete undergoes ORIF for a syndesmotic injury associated with an ankle fracture. Postoperatively, what is the most sensitive and specific imaging modality to assess the accuracy of the syndesmotic reduction?

A 45-year-old female sustains an ankle fracture. Radiographs demonstrate a transverse fracture of the medial malleolus and a comminuted fracture of the fibula at the level of the syndesmosis. According to the Lauge-Hansen classification, what is the mechanism of injury?

A surgeon uses a posterolateral approach to the ankle for fixation of a large posterior malleolus fragment. The surgical interval to access the posterior tibia is developed between which two muscle groups?

A 28-year-old patient had two cortical screws placed across the syndesmosis for a Maisonneuve fracture. At 10 weeks postoperatively, the patient is asymptomatic but asks about routine removal of the screws before initiating full weight-bearing. Based on current orthopedic literature, what is the recommended management regarding syndesmotic screw removal?

On a normal lateral radiograph of the calcaneus, Bohler's angle typically ranges from 20 to 40 degrees. Which specific pathoanatomical feature of a calcaneus fracture is primarily responsible for the reduction or flattening of this angle?

During ankle fracture surgery, after rigid fixation of the fibula and medial malleolus, the surgeon suspects a syndesmotic injury. An intra-operative 'hook test' (Cotton test) is performed. What is the primary purpose of this test?

A 65-year-old diabetic female presents with acute posterior heel pain after a low-energy fall. Radiographs demonstrate a displaced avulsion fracture of the calcaneal tuberosity with proximal retraction. The skin overlying the posterior heel is visibly blanched and tense. What is the most appropriate next step in management?

During an extensile lateral approach for open reduction and internal fixation of a calcaneus fracture, the vertical limb of the incision is placed anterior to the Achilles tendon. Which nerve is at greatest risk of iatrogenic injury if this vertical limb is carried too proximally or carelessly dissected?

A 24-year-old athlete sustains a severe external rotation ankle injury. Intraoperatively, after rigid fixation of the fibula, a Cotton test demonstrates 4 mm of lateral displacement of the fibula relative to the tibia. What is the most appropriate next step in management?

A 40-year-old construction worker falls from a ladder and sustains an intra-articular calcaneus fracture. On the lateral radiograph, Bohler's angle is measured at 5 degrees. What does a decreased Bohler's angle primarily indicate in the setting of a calcaneal fracture?

A 35-year-old woman requires fixation of a large, displaced posterior malleolus fracture via a standard posterolateral approach. The surgeon develops the primary intermuscular plane. What are the key tendinous/muscular boundaries of this surgical interval?

Which of the following is considered a primary advantage of early functional rehabilitation (early active range of motion) following rigid internal fixation of a bimalleolar ankle fracture in a healthy, compliant patient?

In a high-energy intra-articular calcaneus fracture, which fragment classically remains anatomically aligned with the talus due to strong ligamentous attachments, serving as the 'constant' fragment during surgical reconstruction?

A 42-year-old male presents with persistent lateral hindfoot pain one year after non-operative management of a displaced intra-articular calcaneus fracture. Physical examination reveals focal tenderness just inferior to the lateral malleolus and limited subtalar motion. Radiographs demonstrate a widened calcaneus. Which of the following conditions is the most likely primary source of his focal lateral pain?

According to the Lauge-Hansen classification, what is the expected sequence of structural failure in a Supination-External Rotation (SER) type IV ankle injury?

A 55-year-old patient with poorly controlled diabetes mellitus and peripheral neuropathy sustains an unstable bimalleolar ankle fracture. When planning operative fixation, what modification in surgical technique is most critical to minimize catastrophic postoperative complications?

Following uncomplicated open reduction and internal fixation of an intra-articular calcaneus fracture, what is the most appropriate initial rehabilitation protocol for the patient, assuming a stable fixation construct and healthy soft tissues?