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8. Foot and Ankle MCQs

Practice Set 36 of 353

This practice set contains high-yield board review questions covering key concepts in 8. Foot and Ankle. Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.

Question 701

Topic: 8. Foot and Ankle

A 55-year-old patient presents with a displaced bimalleolar ankle fracture following a high-energy supination-external rotation injury. After initial closed reduction attempts in the emergency department fail to achieve anatomical alignment, the patient is scheduled for ORIF. Intraoperatively, despite a standard lateral approach and direct manipulation of the fibula, the lateral malleolus remains irreducible to the fibular incisura. Based on the provided case, which of the following is the most appropriate next step in management?

. Proceed with syndesmotic screw fixation to pull the fibula into reduction.
. Perform a medial malleolus osteotomy to facilitate reduction.
. Thoroughly inspect the fracture site between the fibula and talus/tibia for soft tissue interposition.
. Apply increased traction and external rotation force to the foot.
. Convert to a posterior approach to address potential posterior malleolus block.

Correct Answer & Explanation

. Thoroughly inspect the fracture site between the fibula and talus/tibia for soft tissue interposition.

Explanation

Correct Answer: CThe case highlights that a significant challenge arises when anatomical reduction is blocked or incomplete despite appropriate manipulative techniques. Such a scenario mandates careful evaluation for mechanical impediments. The inability to achieve anatomical reduction of the lateral malleolus to the fibular incisura, even with direct manipulation, is a strong indication for soft tissue interposition. The Extensor Digitorum Brevis (EDB) muscle or its tendinous components are specifically mentioned as a less frequently recognized, yet critical, cause of blocked reduction, particularly in specific patterns of lateral malleolar fractures or posteromedial ankle dislocations. Therefore, the most appropriate next step is to visually inspect the fracture site for any interposed soft tissue.Option A is incorrect because attempting syndesmotic fixation without achieving anatomical reduction of the fibula first will lead to malreduction and poor outcomes. Option B is incorrect as a medial malleolus osteotomy is not indicated for a blocked lateral malleolus reduction. Option D is incorrect; applying increased force against a mechanical block can cause further soft tissue damage and is unlikely to achieve reduction. Option E is incorrect; while a posterior malleolus block can occur, the primary issue described is the irreducibility of the lateral malleolus, which points to a local block on the lateral side, not necessarily a posterior one, unless the posterior malleolus fragment is large and displaced, which is not the primary concern in this specific scenario of lateral malleolus irreducibility.

Question 702

Topic: 8. Foot and Ankle

A 42-year-old patient undergoes ORIF for a displaced bimalleolar ankle fracture. Post-operatively, radiographs reveal persistent widening of the ankle mortise and subtle talar subluxation, despite what was believed to be adequate fixation. The surgeon suspects a missed soft tissue interposition. If the Extensor Digitorum Brevis (EDB) was the missed interposing structure, what is the most likely long-term consequence for this patient?

. Increased risk of deep vein thrombosis due to prolonged immobilization.
. Development of Complex Regional Pain Syndrome (CRPS) in the affected limb.
. Early onset of post-traumatic arthritis and chronic pain due to incomplete reduction.
. Hardware failure requiring immediate revision surgery.
. Superficial peroneal nerve neuropathy requiring surgical decompression.

Correct Answer & Explanation

. Early onset of post-traumatic arthritis and chronic pain due to incomplete reduction.

Explanation

Correct Answer: CThe case specifically addresses 'Incomplete Reduction' under 'Blocked Reduction and EDB Interposition Complications,' stating: 'If EDB interposition is missed or inadequately addressed, the ankle joint will remain subluxed or malreduced, leading to early onset of post-traumatic arthritis, chronic pain, and functional limitations. This is a critical intraoperative error.'Option A is a general complication of surgery and immobilization but not the most direct or likely long-term consequence of a missed anatomical malreduction. Option B, CRPS, is a potential complication of any trauma or surgery but is not directly caused by missed EDB interposition. Option D, hardware failure, can occur but is often a consequence of persistent instability or malreduction rather than the primary long-term consequence itself. Option E, superficial peroneal nerve neuropathy, is a risk during the lateral approach but not a direct consequence of missed EDB interposition causing malreduction.

Question 703

Topic: 8. Foot and Ankle

Following successful reduction and fixation of the malleolar fractures in a 28-year-old athlete with a pronation-external rotation injury, the surgeon assesses syndesmotic stability. Intraoperative stress tests confirm syndesmotic disruption. The image below shows a common method of syndesmotic fixation.

Which of the following statements regarding syndesmotic fixation is most accurate?

. Syndesmotic screws should always be placed with the foot in maximal plantarflexion to ensure optimal fibular reduction.
. A quadricortical syndesmotic screw provides less stiffness than a tricortical screw and is preferred for dynamic fixation.
. The most common pitfall in syndesmotic screw fixation is over-compression of the syndesmosis.
. Suture button devices are contraindicated in athletes due to their limited ability to withstand high-impact forces.
. Syndesmotic screws are typically placed 5-6 cm proximal to the tibial plafond to avoid articular penetration.

Correct Answer & Explanation

. The most common pitfall in syndesmotic screw fixation is over-compression of the syndesmosis.

Explanation

Correct Answer: CThe case states under 'Syndesmotic Fixation' that 'The most common pitfall is over-compression.' Over-compression of the syndesmosis can lead to loss of the normal tibiofibular clear space, altered ankle biomechanics, and potentially pain or early arthritis.Option A is incorrect; the foot should be placed in neutral dorsiflexion during syndesmotic reduction and fixation to prevent over-compression or malreduction. Option B is incorrect; a quadricortical screw provides increased stiffness compared to a tricortical screw, and neither is designed for dynamic fixation in the way suture button devices are. Option D is incorrect; suture button devices (e.g., TightRope) are increasingly popular and provide dynamic fixation, allowing for micro-motion, and are often used in athletes. Option E is incorrect; syndesmotic screws are typically placed 2-3 cm proximal to the tibial plafond, not 5-6 cm, to ensure adequate purchase while avoiding the articular surface.

Question 704

Topic: 8. Foot and Ankle

A 70-year-old patient with a displaced bimalleolar ankle fracture undergoes ORIF. The primary goal of achieving anatomical reduction and stable internal fixation is to restore the integrity of the ankle mortise. Failure to achieve this anatomical reduction, potentially due to soft tissue interposition like the EDB, directly compromises which of the following biomechanical principles?

. Maximizing the range of motion of the subtalar joint.
. Ensuring even load distribution across the talar dome and tibial plafond.
. Preventing excessive tension on the Achilles tendon.
. Enhancing the blood supply to the talus.
. Facilitating early weight-bearing on the calcaneus.

Correct Answer & Explanation

. Ensuring even load distribution across the talar dome and tibial plafond.

Explanation

Correct Answer: BThe case emphasizes under 'Ankle Stability Biomechanics' that 'Anatomical reduction restores the talar dome's contact with the tibial plafond, ensuring even load distribution and preventing abnormal stresses that can lead to post-traumatic arthrosis. Failure to achieve anatomical reduction, often due to soft tissue interposition like the EDB, directly compromises these biomechanical principles.'Option A is incorrect; while ankle fractures can affect subtalar motion, the primary biomechanical principle compromised by mortise incongruity is related to the talocrural joint. Option C is incorrect; Achilles tendon tension is not directly related to ankle mortise congruence. Option D is incorrect; blood supply to the talus is critical but not directly compromised by mortise incongruity in this context. Option E is incorrect; early weight-bearing on the calcaneus is a rehabilitation goal, not a biomechanical principle compromised by mortise incongruity.

Question 705

Topic: 8. Foot and Ankle

A 35-year-old male presents with a displaced ankle fracture-dislocation. During closed reduction attempts, the talus remains persistently subluxed despite appropriate manipulative techniques. The orthopedic resident correctly identifies that a mechanical impediment is likely blocking the reduction. Besides the Extensor Digitorum Brevis (EDB), which of the following structures is also a commonly reported cause of blocked ankle fracture reduction?

. Plantaris tendon.
. Peroneus longus tendon.
. Flexor hallucis longus tendon.
. Extensor hallucis longus tendon.
. Tibialis anterior tendon.

Correct Answer & Explanation

. Flexor hallucis longus tendon.

Explanation

Correct Answer: CThe case lists several common causes of blocked reduction: 'Common causes of blocked reduction include interposed osteochondral fragments, incarcerated deltoid ligament, tibialis posterior tendon, flexor hallucis longus tendon, or even the posterior talofibular ligament.' It further states, 'Other soft tissue blocks like the tibialis posterior and flexor hallucis longus tendons have been reported, primarily in posteromedial dislocations of the talus.'Options A, B, D, and E (Plantaris, Peroneus longus, Extensor hallucis longus, and Tibialis anterior tendons) are not explicitly mentioned in the case as commonly reported causes of blocked ankle fracture reduction, although theoretically, any soft tissue could become entrapped in rare circumstances. The Flexor Hallucis Longus (FHL) tendon is specifically highlighted in the provided text.

Question 706

Topic: 8. Foot and Ankle

A 50-year-old patient has undergone ORIF for a stable bimalleolar ankle fracture with syndesmotic repair using a suture button device. The surgeon emphasizes a structured post-operative rehabilitation protocol. In the immediate post-operative period (first 2 weeks), which of the following is the most appropriate weight-bearing and range of motion instruction?

. Full weight-bearing as tolerated in a walking boot.
. Protected weight-bearing (25-50% body weight) in a short leg cast.
. Non-weight bearing on the operative extremity with active range of motion of the toes, knee, and hip.
. Non-weight bearing with aggressive active and passive ankle dorsiflexion and plantarflexion.
. Full weight-bearing in a posterior splint with isometric ankle strengthening.

Correct Answer & Explanation

. Non-weight bearing on the operative extremity with active range of motion of the toes, knee, and hip.

Explanation

Correct Answer: CThe case outlines the 'Immediate Post-Operative Period' for rehabilitation: 'Weight-Bearing: Non-weight bearing (NWB) on the operative extremity. Crutches, walker, or knee scooter for ambulation.' And for 'Range of Motion (ROM): Active ROM of the toes, knee, and hip of the operative leg to prevent stiffness and promote circulation. Isometric quadriceps and gluteal strengthening exercises.'Option A and E are incorrect as full weight-bearing is not typically allowed in the immediate post-operative period for ankle fractures requiring ORIF. Option B is incorrect as protected weight-bearing usually begins later (3-4 weeks) for stable fixations, and the initial immobilization is often a splint transitioning to a cast/boot. Option D is incorrect because aggressive active and passive ankle ROM is generally avoided in the immediate post-operative period to protect the healing fracture and soft tissues, especially with syndesmotic repair.

Question 707

Topic: Ankle Trauma & Sports

A 35-year-old female sustains a twisting injury to her ankle. Radiographs demonstrate a short oblique fracture of the lateral malleolus at the level of the syndesmosis and a transverse fracture of the medial malleolus. According to the Lauge-Hansen classification, what is the initial structure injured in this sequence?

. Deltoid ligament
. Posterior inferior tibiofibular ligament
. Anterior inferior tibiofibular ligament
. Calcaneofibular ligament
. Interosseous membrane

Correct Answer & Explanation

. Anterior inferior tibiofibular ligament

Explanation

This is a Supination-External Rotation (SER) stage IV injury. The predictable sequence of SER injuries begins with rupture of the anterior inferior tibiofibular ligament (AITFL) in Stage I.

Question 708

Topic: 8. Foot and Ankle

A 25-year-old athlete sustains an external rotation injury to his right ankle. Radiographs show no fracture, but the medial clear space measures 5.5 mm on a gravity stress view. Which ligament is primarily responsible for preventing lateral displacement of the talus?

. Anterior talofibular ligament
. Superficial deltoid ligament
. Deep deltoid ligament
. Calcaneofibular ligament
. Anterior inferior tibiofibular ligament

Correct Answer & Explanation

. Deep deltoid ligament

Explanation

The deep deltoid ligament is the primary medial stabilizer of the ankle, preventing lateral excursion of the talus. Rupture of the deep deltoid, often indicated by a widened medial clear space (>4 mm), is necessary for lateral talar shift to occur.

Question 709

Topic: Ankle Trauma & Sports

A 30-year-old male undergoes open reduction and internal fixation for a Weber C ankle fracture with syndesmotic disruption. Postoperative CT evaluation is ordered to assess the syndesmosis. Which of the following technical errors during surgery most commonly leads to a malreduced syndesmosis?

. Over-tightening of the medial malleolar screw
. Placing the reduction clamp too anteriorly on the fibula
. Using a fully threaded instead of partially threaded syndesmotic screw
. Tying the tightrope device in plantarflexion
. Inadequate debridement of the deltoid ligament

Correct Answer & Explanation

. Placing the reduction clamp too anteriorly on the fibula

Explanation

Malreduction of the syndesmosis most frequently occurs due to improper reduction clamp placement. Placing the clamp too anteriorly on the fibula and too posteriorly on the tibia can cause the fibula to internally rotate and translate anteriorly.

Question 710

Topic: 8. Foot and Ankle

A 22-year-old soccer player sustains a twisting injury to the ankle. Examination reveals tenderness over the medial malleolus and the proximal lateral leg. Radiographs of the ankle show a widened medial clear space but no distal fibula fracture. Which additional radiographic view is imperative?

. Contralateral ankle series
. Full-length tibia/fibula series
. Knee MRI
. Foot series
. Pelvis AP

Correct Answer & Explanation

. Full-length tibia/fibula series

Explanation

A Maisonneuve fracture involves a proximal third fibula fracture associated with a syndesmotic disruption and medial ankle injury. A full-length tibia/fibula x-ray is essential to identify the proximal fibular fracture when ankle films show isolated syndesmotic widening.

Question 711

Topic: 8. Foot and Ankle

A 22-year-old male presents to the emergency department with a knee dislocation after a motorcycle accident. Initial assessment reveals a grossly deformed knee, absent dorsalis pedis and posterior tibial pulses, and a cold, pale foot. After immediate closed reduction, pulses remain absent. Which of the following is an absolute indication for immediate surgical intervention in this patient?

. Gross instability after reduction.
. Concomitant fibular head fracture.
. Suspected multi-ligamentous injury on MRI.
. Persistent vascular compromise after reduction.
. Open dislocation with minimal contamination.

Correct Answer & Explanation

. Persistent vascular compromise after reduction.

Explanation

Correct Answer: DThe case clearly identifies 'Vascular Compromise' as the most urgent indication for operative management. It states: 'Any signs of vascular injury (absent pulses, diminished Ankle-Brachial Index (ABI < 0.9), expanding hematoma, cold limb, pulsatile bleeding) necessitate immediate surgical exploration and repair by a vascular surgeon.' In this patient, absent pulses and a cold, pale foot indicate acute limb ischemia due to popliteal artery injury, which persists even after reduction. This is a limb-threatening emergency requiring immediate surgical exploration and repair to prevent amputation.Option A (Gross instability after reduction) is an indication for surgical stabilization, but not necessarily immediate, limb-salvaging surgery like vascular compromise. The timing for ligamentous reconstruction can be debated (acute vs. staged).Option B (Concomitant fibular head fracture) may require surgical fixation if it contributes to instability or joint incongruity, but it is not an immediate limb-threatening indication.Option C (Suspected multi-ligamentous injury on MRI) is an indication for definitive surgical reconstruction, but MRI is typically performed after acute limb-threatening issues are addressed, and the timing of reconstruction can be acute or staged.Option E (Open dislocation with minimal contamination) is an indication for immediate surgical debridement and stabilization to prevent infection, but persistent vascular compromise takes precedence as it directly threatens limb viability.

Question 712

Topic: 8. Foot and Ankle

A 25-year-old male undergoes multi-ligament knee reconstruction following a high-energy knee dislocation. Post-operatively, he develops a foot drop and numbness in the first web space of his foot. Clinical examination confirms a common peroneal nerve palsy. What is the MOST appropriate initial management strategy for this complication?

. Immediate surgical exploration and nerve repair.
. Application of an ankle-foot orthosis (AFO) and observation.
. High-dose corticosteroid administration.
. Referral for immediate nerve conduction studies (NCS) and electromyography (EMG).
. Manipulation under anesthesia (MUA) to decompress the nerve.

Correct Answer & Explanation

. Application of an ankle-foot orthosis (AFO) and observation.

Explanation

Correct Answer: BThe case describes the management of common peroneal nerve palsy: 'Management: Usually a stretch injury (neurapraxia or axonotmesis). Often managed non-operatively with observation, physical therapy, and ankle-foot orthosis (AFO) to prevent foot drop. If nerve laceration is suspected (e.g., open injury), surgical exploration and repair/grafting may be indicated.' Given that this is a post-operative complication following a closed injury (implied by reconstruction), a stretch injury is most likely. An AFO provides functional support for the foot drop, and observation allows for potential spontaneous recovery.Option A (Immediate surgical exploration and nerve repair) is generally reserved for suspected nerve laceration (e.g., in open injuries) or if there is no recovery after several months (typically 3-6 months), not as an immediate first step for a post-operative palsy.Option C (High-dose corticosteroid administration) is not a standard treatment for peripheral nerve palsies.Option D (Referral for immediate NCS and EMG) is useful for confirming the extent of nerve injury and prognosis, but it is typically performed at 3-6 weeks post-injury, not immediately, as nerve degeneration needs time to occur for these studies to be diagnostic. The immediate priority is functional support and observation.Option E (MUA) is used for arthrofibrosis/stiffness, not for nerve compression or palsy.

Question 713

Topic: 8. Foot and Ankle

A 22-year-old male presents with a grossly deformed knee following a rugby tackle. Closed reduction of an anterior knee dislocation is performed. The Ankle-Brachial Index (ABI) is calculated to be 0.8. Distal pulses are palpable but slightly asymmetric compared to the contralateral limb. What is the most appropriate next step in management?

. Discharge with close outpatient follow-up in 1 week
. Immediate popliteal artery exploration in the operating room
. Perform a CT angiogram of the lower extremity
. Apply a long leg cast in 15 degrees of flexion
. Obtain a routine MRI of the knee

Correct Answer & Explanation

. Perform a CT angiogram of the lower extremity

Explanation

In knee dislocations, an ABI < 0.90 or asymmetric pulses requires advanced vascular imaging, most commonly a CT angiogram, to rule out an intimal tear or other popliteal artery injuries. Hard signs of ischemia (e.g., absent pulses, expanding hematoma) would mandate immediate surgical exploration without delaying for a CT.

Question 714

Topic: 8. Foot and Ankle

A 32-year-old semi-professional soccer player presents to the emergency department after a high-energy rotational injury to the left ankle. He reports being tackled from behind while his foot was planted and externally rotated, resulting in immediate severe pain and inability to bear weight. Based on the described mechanism, which of the following Lauge-Hansen classifications is most consistent with this injury?

. Supination-Adduction
. Supination-External Rotation
. Pronation-Abduction
. Pronation-External Rotation
. Dorsiflexion-Compression

Correct Answer & Explanation

. Pronation-External Rotation

Explanation

Correct Answer: DThe case explicitly states, 'The mechanism describedโ€”a pronation-external rotation forceโ€”is highly suggestive of a syndesmotic injury, often accompanied by associated fractures, aligning with the Lauge-Hansen classification system.' The patient's description of the foot being 'planted and externally rotated' directly corresponds to the external rotation component of this mechanism. Pronation is often the initial force that destabilizes the medial structures, allowing for subsequent external rotation of the talus and fibula, leading to syndesmotic disruption.Incorrect Options:A) Supination-Adduction:This mechanism typically results in transverse fibular fractures below the level of the syndesmosis (Weber A) or avulsion fractures of the lateral malleolus, often with medial malleolus fractures, but not primary syndesmotic disruption.B) Supination-External Rotation:While involving external rotation, the initial supination phase typically leads to spiral fibular fractures at or above the level of the syndesmosis (Weber B) and medial injury, but the case specifically points to pronation-external rotation as highly suggestive of syndesmotic injury.C) Pronation-Abduction:This mechanism typically causes a transverse fibular fracture above the syndesmosis (Weber C) or a comminuted fibular fracture, often with medial injury, but the primary force described is external rotation, not pure abduction.E) Dorsiflexion-Compression:This is a less common mechanism for ankle fractures and typically involves axial loading, often leading to pilon fractures or talar dome injuries, not primarily syndesmotic disruption.

Question 715

Topic: 8. Foot and Ankle

The case emphasizes the critical importance of anatomical reduction of the syndesmosis. Biomechanical studies have demonstrated that even a 1-millimeter lateral shift of the talus secondary to syndesmotic diastasis has a profound effect on tibiotalar contact mechanics. What is the approximate percentage decrease in tibiotalar contact area associated with this 1-millimeter lateral shift?

. 10%
. 25%
. 42%
. 58%
. 75%

Correct Answer & Explanation

. 42%

Explanation

Correct Answer: CUnder 'Biomechanical Principles,' the case explicitly states: 'Biomechanical studies have demonstrated that even a 1-millimeter lateral shift of the talus secondary to syndesmotic diastasis decreases the tibiotalar contact area by 42%, exponentially increasing peak contact stresses and predisposing the joint to rapid cartilaginous degeneration.' This highlights the severe consequences of even subtle malreduction.Incorrect Options:A, B, D, E) 10%, 25%, 58%, 75%:These percentages are incorrect based on the specific biomechanical data provided in the case. The 42% reduction is a critical figure often cited in orthopedic literature regarding syndesmotic injuries.

Question 716

Topic: 8. Foot and Ankle

During the initial assessment of the 32-year-old athlete with a suspected high-energy syndesmotic injury, the emergency physician performs several clinical tests. Which of the following tests, performed by compressing the tibia and fibula at the mid-calf, would elicit sharp pain distally at the syndesmosis, indicating interosseous membrane disruption?

. Anterior Drawer Test
. Talar Tilt Test
. Squeeze Test
. External Rotation Stress Test
. Cotton Test

Correct Answer & Explanation

. Squeeze Test

Explanation

Correct Answer: CUnder 'Clinical Presentation and Initial Assessment,' the case describes the Squeeze Test: 'The Squeeze Test, involving compression of the tibia and fibula at the mid-calf, elicits sharp pain distally at the syndesmosis, indicating interosseous membrane disruption.' This test is a classic indicator of syndesmotic injury.Incorrect Options:A) Anterior Drawer Test:This test assesses the integrity of the anterior talofibular ligament (ATFL) and is primarily for lateral ankle sprains, not syndesmotic injury.B) Talar Tilt Test:This test assesses the integrity of the calcaneofibular ligament (CFL) and deltoid ligament, primarily for lateral or medial ankle instability, not syndesmotic injury.D) External Rotation Stress Test:While a key test for syndesmotic instability, it involves externally rotating the foot, not compressing the mid-calf.E) Cotton Test:This test assesses lateral translation of the talus/fibula by applying lateral traction to the fibula, often performed intraoperatively or under anesthesia, not by mid-calf compression.

Question 717

Topic: Ankle Trauma & Sports

Following fibular and medial malleolar fixation in the 32-year-old athlete, the surgeon proceeds to reduce the syndesmosis. A large Weber clamp is used to hold the reduction. According to current guidelines, at what approximate distance proximal to the joint line and at what angle relative to the coronal plane should the reduction clamp be applied to achieve optimal anatomical reduction?

. 1 cm proximal, 0 degrees (parallel to coronal)
. 2-3 cm proximal, 20-30 degrees anterior
. 4-5 cm proximal, 10 degrees posterior
. At the joint line, 45 degrees anterior
. 2-3 cm proximal, 0 degrees (parallel to coronal)

Correct Answer & Explanation

. 2-3 cm proximal, 20-30 degrees anterior

Explanation

Correct Answer: BUnder 'Placement of the Reduction Clamp,' the case specifies: 'The clamp should be applied at the level of the planned fixation, typically 2 to 3 centimeters proximal to the joint line... The vector of compression must be parallel to the joint line and directed slightly anteriorly (approximately 20 to 30 degrees relative to the coronal plane) to match the anatomical axis of the syndesmosis.'Incorrect Options:A) 1 cm proximal, 0 degrees (parallel to coronal):This is too close to the joint line and lacks the correct anterior angulation.C) 4-5 cm proximal, 10 degrees posterior:This is too proximal and the posterior angulation is incorrect.D) At the joint line, 45 degrees anterior:Applying the clamp directly at the joint line is generally avoided to prevent articular damage, and 45 degrees anterior may be excessive.E) 2-3 cm proximal, 0 degrees (parallel to coronal):While the proximal distance is correct, the lack of anterior angulation (0 degrees) would not match the anatomical axis of the syndesmosis, potentially leading to malreduction.

Question 718

Topic: Ankle Trauma & Sports

In the context of the 32-year-old semi-professional soccer player, the surgeon is considering fixation options for the syndesmosis. Current literature and guidelines, as summarized in the case, suggest which of the following regarding suture button constructs compared to trans-syndesmotic screws?

. Suture button constructs are associated with a higher incidence of syndesmotic malreduction.
. Suture button constructs require routine removal at 8-12 weeks postoperatively.
. Suture button constructs permit physiological micromotion, potentially accelerating rehabilitation.
. Trans-syndesmotic screws consistently yield superior functional outcome scores.
. Suture button constructs are contraindicated in high-demand athletic populations due to lower stability.

Correct Answer & Explanation

. Suture button constructs permit physiological micromotion, potentially accelerating rehabilitation.

Explanation

Correct Answer: CUnder 'Syndesmotic Fixation Options' and 'Summary of Key Literature and Guidelines,' the case states: 'Suture Button Constructs: Increasingly preferred for high-energy athletic injuries. These dynamic devices... permit physiological micromotion, potentially accelerating rehabilitation and eliminating the need for routine hardware removal.' It further notes that 'dynamic fixation is associated with a lower incidence of syndesmotic malreduction' and 'yield equivalent or superior functional outcome scores.'Incorrect Options:A) Suture button constructs are associated with a higher incidence of syndesmotic malreduction:This is incorrect. The case states, 'dynamic fixation is associated with a lower incidence of syndesmotic malreduction.'B) Suture button constructs require routine removal at 8-12 weeks postoperatively:This is incorrect. The case states they 'eliminat[e] the need for routine hardware removal.'D) Trans-syndesmotic screws consistently yield superior functional outcome scores:This is incorrect. The case states, 'Studies consistently demonstrate that suture button constructs yield equivalent or superior functional outcome scores... compared to screw fixation.'E) Suture button constructs are contraindicated in high-demand athletic populations due to lower stability:This is incorrect. The case states they are 'increasingly preferred for high-energy athletic injuries' due to their dynamic nature and ability to accommodate physiological loading.

Question 719

Topic: 8. Foot and Ankle

A 32-year-old male presents with a high-energy ankle injury, and the provided radiograph shows a distal fibular fracture. Given the high-energy mechanism and the potential for syndesmotic disruption, what additional radiographic view is imperative to obtain if a Maisonneuve fracture is suspected?

. Contralateral ankle AP view
. Stress views of the injured ankle
. Full-length tibia-fibula radiographs
. Oblique view of the foot
. Calcaneal axial view

Correct Answer & Explanation

. Full-length tibia-fibula radiographs

Explanation

Correct Answer: CUnder 'Radiographic Evaluation,' the case states: 'Full-length tibia-fibula radiographs are imperative if a Maisonneuve fracture is suspected.' A Maisonneuve fracture involves a proximal fibula fracture with associated syndesmotic disruption and medial injury, and it would not be visible on standard ankle radiographs.Incorrect Options:A) Contralateral ankle AP view:While sometimes useful for comparison, it is not imperative for diagnosing a Maisonneuve fracture on the injured side.B) Stress views of the injured ankle:These are used to unmask latent syndesmotic instability but would not visualize a proximal fibular fracture.D) Oblique view of the foot:This view focuses on the midfoot and forefoot and would not show a proximal fibular fracture.E) Calcaneal axial view:This view is used to assess the calcaneus and subtalar joint, not the proximal fibula.

Question 720

Topic: Ankle Trauma & Sports

Biomechanical studies of the distal tibiofibular syndesmosis demonstrate that varying ligaments contribute to its stability. Which structure provides the greatest resistance to lateral displacement of the fibula?

. Anterior inferior tibiofibular ligament
. Posterior inferior tibiofibular ligament
. Interosseous ligament
. Transverse tibiofibular ligament
. Deltoid ligament

Correct Answer & Explanation

. Posterior inferior tibiofibular ligament

Explanation

The posterior inferior tibiofibular ligament (PITFL) contributes approximately 42% of the resistance to lateral displacement, making it the strongest syndesmotic stabilizer. The AITFL contributes roughly 35%.

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