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Sorry, this question is for (SBQ18FA.21) Figures A-C are the radiographs of a 26-year-old male who presents to the emergency department following a motocross accident. Two attempts at a closed reduction by the on-call orthopedic resident were unsuccessful. Figures D and E are the pre-operative axial CT-images that were obtained. The patient undergoes surgical fixation seen in Figure F. Limitations in post-operative dorsiflexion is likely influenced by which of the following? QID: 211330 Fracture extension to the posteromedial rim Initial displacement of the fibula fracture Posterior fixation of the fibula and posterior malleolus Initial talar subluxation Inability to reduce the ankle L 5 B Select Answer to see Preferred Response (SBQ18FA.20) A 35-year-old morbidly obese female presents with global right ankle pain and significant swelling after a misstep over one of her cats on the stairs. She is unable to bear weight, but the skin is intact. Injury films are shown in Figures A through D. What is the internervous plane through which direct anatomic reduction and fixation of both fractures could best be achieved? QID: 211319 Deep peroneal nerve, sural nerve Deep peroneal nerve, tibial nerve Superficial and deep peroneal nerves Superficial peroneal nerve, tibial nerve There is no true internervous plane L 3 A Select Answer to see Preferred Response (SBQ18FA.13) A 32-year-old soccer player presents with severe right ankle pain and inability to bear weight after sustaining a slide-tackle injury during a game. Radiographs are shown in Figures A and B. Given the nature of his injury, he is taken for surgical reduction and fixation. Following medial malleolar fixation, the syndesmosis is addressed. All of the following are true regarding the most appropriate intra-operative technique for anatomic syndesmotic reduction EXCEPT: QID: 211242 The axis of the reduction clamp should parallel the anatomic trans-syndesmotic angle The lateral tine of the clamp should be seated just posterior to the lateral malleolar ridge The medial tine should be placed on the anterior third of the tibia on a true lateral fluoroscopic view of the ankle The reduction clamp should be placed 1-2cm proximal to the tibial plafond The surgeon should apply judicious compression under fluoroscopic visualization to avoid over-compression of the syndesmosis L 5 A Select Answer to see Preferred Response (SBQ18FA.19) A 42-year-old male who works as a professional clown presents with severe ankle pain and gross deformity after tripping and falling over his props at a children’s birthday party. His radiograph is shown in Figure A. Following fixation of the medial and lateral malleolar fractures, the syndesmosis is assessed and is found to be persistently unstable. All of the following are true regarding posterior malleolar fixation EXCEPT: QID: 211308 Fixation of the posterior malleolus obviates the need for syndesmotic fixation in most cases Fixation of the posterior malleolus remains biomechanically inferior to trans-articular syndesmotic fixation Functional and radiographic outcomes following posterior malleolar fixation are at least equivalent if not superior to those following syndesmotic fixation Non-anatomic fixation of the posterior malleolus will compromise syndesmotic fixation The syndesmosis is often incompletely injured in the setting of a posterior malleolar fracture L 3 A Select Answer to see Preferred Response (OBQ18.94) A 26-year-old male recreational basketball player sustained an ankle injury 6 months prior. He continues to complain of ankle pain and instability. Current imaging is shown in Figures A & B. Imaging of the proximal fibula is unremarkable and there is little concern for syndesmotic injury. What is the next best step in treatment? QID: 212990 Open reduction and internal fixation (ORIF) with autograft Obtain stress radiographs Physical therapy and management of symptoms Percutaneous skeletal fixation L 2 A Select Answer to see Preferred Response (OBQ18.29) A 63-year-old patient presents with right ankle pain after a fall down four stairs. Figures A and B are the radiographs of the injury. The patient reports a history of diabetes mellitus type 2 and peripheral neuropathy with a most recent hemoglobin A1c of 9.8. The injury is reduced and placed in a well-padded bivalved cast. The patient is then discharged with outpatient follow-up without DVT prophylaxis. Twelve weeks later, the patient presents to the clinic for the first time in the same bivalved cast. The has remained non-weight bearing and the bottom of the cast confirms this. What is the expected outcome at this point? QID: 212925 L 3 A Select Answer to see Preferred Response Sorry, this question is for Sorry, this question is for Sorry, this question is for (SBQ18FA.18) A 60-year-old woman with a history of well-controlled diabetes and hypertension sustained a fall into a ditch yesterday and presents with persistent left ankle pain and deformity. The injury is closed, and the patient is neurovascularly intact. Injury films are shown in Figures A and B. An unsuccessful attempt at reduction in the emergency department with sedation was made. What is the cause of failure of closed reduction? QID: 211297 Subacute nature of fracture Incarceration of the deltoid ligament Incarceration of the fibula behind the posterolateral ridge of tibia Entrapment of the flexor hallucis longus (FHL) tendon Entrapment of the extensor digitorum brevis (EDB) L 4 A Select Answer to see Preferred Response Sorry, this question is for (OBQ16.105) Radiographs of a 32-year-old male show a lateral malleolus fracture as well as a spur sign on the mortise view. Figure A is an axial CT scan of the plafond. What is the most appropriate treatment of this patient's fracture? QID: 8867
ORIF fibula and anterior to posterior screw placement for posterior malleolus via lateral approach to fibula ORIF fibula, stress ankle and syndesmotic fixation if widening via lateral approach to fibula ORIF fibula with buttress plating of posterior malleolus via posterolateral approach ORIF fibula with buttress plating of posterior malleolus via posteromedial approach ORIF fibula, stress ankle and syndesmotic fixation if widening via posterolateral approach L 2 A Select Answer to see Preferred Response Sorry, this question is for Sorry, this question is for
Sorry, this question is for Sorry, this question is for Sorry, this question is for (OBQ16.260) A 40-year-old man fell off of a ladder at work sustaining the injury shown in Figures A and B. On examination, his skin is intact, but the pulses in his foot are absent. Following closed reduction and splinting, what would be the next best step? QID: 9022 Vascular surgery consultation Surgical exploration and stabilization L 1 A Select Answer to see Preferred Response Sorry, this question
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Sorry, this question is for Sorry, this question is for (OBQ14.216) A 33-year-old female sustains the injury shown in Figure A as the result of a fall off a chair, and subsequently undergoes operative stabilization of her injury. Which of the following is most correlated with positive outcomes when treating this injury? QID: 5626 Subchondral debridement of any osteochondral defect Repair of medial ligamentous structures Casting or splinting in a neutral position postoperatively
Anatomic reduction of the syndesmosis L 1 B Select Answer to see Preferred Response Sorry, this question is for Sorry, this question is for (OBQ13.137) Which of the following ankle fractures seen in Figures A-E most likely occurred as a result of abduction of the foot relative to the tibia? QID: 4772 L 3 A Select Answer to see Preferred Response (OBQ13.87) A 40-year-old male patient sustains a bimalleolar ankle fracture and undergoes open reduction and internal fixation. Four months later, he returns for follow-up with mild ankle discomfort, and a radiograph is shown in Figure A. What is the most appropriate next step in treatment? QID: 4722 Syndesmosis sagittal plane reduction and fixation Syndesmosis coronal plane reduction and fixation Osteotomy and revision of the fibula and syndesmosis Retrieval of osteochondral fragment Revision plating of the fibula and syndesmosis reduction and fixation. L 4 A Select Answer to see Preferred Response (OBQ13.54) Figure A shows an isolated left ankle injury in an active 48-year-old recreational hockey player. Past medical history includes insulin dependent diabetes mellitus for 35 years. On physical examination the patient is unable to feel a 5.07 gm monofilament on the plantar aspect of his foot. His pedal pulses are palpable. Of the following options, what would be the recommended treatment? QID: 4689 Closed reduction and casting for 6 weeks Closed reduction and casting for 12 weeks Open reduction and internal fixation with restricted weight bearing for 2 weeks Open reduction and internal fixation with restricted weight bearing for 6 weeks Open reduction and internal fixation with restricted weight bearing for 12 weeks L 2 B Select Answer to see Preferred Response (OBQ13.261) A 27-year-old man presents to the emergency department with an ankle fracture. CT scans note anteromedial marginal impaction. Which radiograph (Figures A-E) would best correlate with this finding? QID: 4896 L 1 A Select Answer to see Preferred Response Sorry, this question is for (SBQ12TR.104) Surgical fixation with absolute stability would be most appropriate for which of the following fracture patterns? QID: 4019 L 2 B Select Answer to see Preferred Response (SBQ12FA.77) An otherwise healthy 45-year-old female slips and falls with immediate right ankle pain. Stress examination of the right ankle is shown in Figure A. Which of the following is the most important for achieving a satisfactory outcome following open reduction internal fixation for this injury? QID: 3884 Weight-bearing before 3 weeks. Talocrural angle of 83 degrees Tibiofibular clear space of >6mm L 2 B Select Answer to see Preferred Response (SBQ12FA.12) A 45-year-old male with long-standing diabetes sustains the injury shown in Figure A. He has a BMI of 38, established peripheral neuropathy, and his most recent HbA1c is 8.8. What is the most appropriate definitive management option of Figures B through F? QID: 3819 L 2 B Select Answer to see Preferred Response (SBQ12FA.3) A 28-year-old male sustained an ankle injury 3 months ago, and was treated with closed management and splinting; a current x-ray is shown in Figure A. Which of the following is the most important factor in deciding between a joint sacrificing and a joint preserving operation for this patient at this time? QID: 3810 Workers' Compensation involvement Degree of tibiotalar arthritis L 3 B Select Answer to see Preferred Response Sorry, this question is for Sorry, this question is for Sorry, this question is for Sorry, this question is for (OBQ12.127) A 34-year-old female requests a second opinion following open reduction internal fixation (ORIF) of her left ankle three weeks ago. Which of the following is most appropriate step based on Figures A and B? QID: 4487 Progressive weightbearing in 3-4 weeks based on radiographs Deltoid ligament repair vs reconstruction Revision ORIF of fibula with lengthening Revision ORIF of fibula and syndesmosis Removal of syndesmotic screws in 3-6 months L 3 B Select Answer to see Preferred Response Sorry, this question is for Sorry, this question is for Sorry, this question is for Sorry, this question is for Sorry, this question is for Sorry, this question is for (OBQ11.17) A 25-year-old male sustains an ankle fracture dislocation and undergoes open reduction and internal fixation. He returns to clinic five months following surgery complaining of continued ankle pain and instability with weight bearing. His immediate post-operative AP radiograph is seen in Figure A. Which of the following could have prevented this patient from developing persistent pain? QID: 3440 Deep deltoid ligament repair Quadricortical syndesmotic screw fixation Restoration of fibular length and rotation Lateral collateral ligament complex repair Use of two syndesmotic screws L 1 B Select Answer to see Preferred Response (OBQ10.40) In an isolated ankle syndesmotic injury, the fibula is unstable in the incisura fibularis of the tibia. In what direction is the fibula most unstable? QID: 3128 Equivalent instability in all axes L 1 C Select Answer to see Preferred Response (OBQ10.121) A 34-year-old man sustains a twisting injury to his left ankle playing soccer. Radiographs from the ER are provided in figures A and B. Four hours later, he undergoes open reduction internal fixation. An intraoperative fluoroscopy image is provided in figure C. Which of the following is the best method to assess the integrity of the syndesmosis? QID: 3215 Measurement of medial clear space widening Measurement of the tibiofibular overlap Anterior drawer test with comparison to the contralateral ankle External rotation stress radiograph Evaluation of the syndesmosis on preoperative CT scan L 1 B Select Answer to see Preferred Response (OBQ10.5) A 32-year-old female sustains the injury shown in Figure A. What is the most reliable method to evaluate the competence of the deltoid ligament? QID: 3093 Stress radiography of the ankle L 1 B Select Answer to see Preferred Response (OBQ09.52) In which of the following radiographs of different types of ankle fractures should the medial malleolus be treated with screw fixation directed parallel to the ankle joint? QID: 2865 L 1 B Select Answer to see Preferred Response (SAE09FA.55) A 32-year-old laborer reports left ankle pain and deformity. History reveals that he sustained a left ankle fracture 2 years ago and was treated with closed reduction and casting. Radiographs are shown in Figures 25a through 25c. What is the most appropriate management? QID: 6743 Bracing and physical therapy Intra-articular injection of steroids into the ankle joint, bracing, and physical therapy Intra-articular injection of hyaluronic acid product into the ankle joint, bracing, and physical therapy Corrective osteotomy of the fibula and medial malleolus with reconstruction of the syndesmosis if unstable L 2 D Select Answer to see Preferred Response Sorry, this question is for Sorry, this question is for (OBQ09.173) In the Lauge-Hansen classification system, a pronation-abduction ankle fracture has what characteristic fibular fracture pattern? QID: 2986 Transverse fracture below the level of the syndesmosis Short oblique fracture running from anteroinferior to posteriosuperior Short oblique fracture running from posteroinferior to anteriosuperior Comminuted fracture at or above the level of the syndesmosis L 1 A Select Answer to see Preferred Response (OBQ09.204) An 18-year-old football player presents to the emergency department after sustaining an ankle injury. His radiograph is shown in figure A. What is the most appropriate definitive treatment? QID: 3017 Open reduction and internal fixation of the medial malleolus with syndesmosis reduction and suture-button repair Repair of the anterior talo-fibular ligament Open reduction internal fixation of the fibula with syndesmosis reduction and suture-button repair Open reduction internal fixation of the medial malleolus and fibula Open reduction internal fixation of the fibula and medial malleolus with syndesmosis reduction and suture-button repair L 1 C Select Answer to see Preferred Response
(OBQ09.259) Presence of diabetes-induced peripheral neuropathy has been shown to be an independent risk factor for postoperative complications of which of the following injuries? QID: 3072 L 1 C Select Answer to see Preferred Response (OBQ09.17) A 34-year-old male falls off of a ladder and sustains the ankle injury shown in Figure. Which of the following is unique with this particular ankle fracture pattern and must be recognized by the operating surgeon to optimize outcomes? QID: 2830 Marginal impaction of the anteromedial tibial plafond Posterolateral osteochondral lesion of the talus L 2 B Select Answer to see Preferred Response (OBQ09.121) A 31-year-old male sustains an irreducible ankle fracture-dislocation with the foot maintained in an externally rotated position. An AP and lateral radiograph are shown in figures A and B respectively. The attempted post reduction AP and lateral are shown in C and D. What structure is most likely preventing reduction? QID: 2934 Anterior-inferior tibiofibular ligament Posterior-inferior tibiofibular ligament Posterolateral ridge of the tibia Flexor hallucis longus tendon L 1 B Select Answer to see Preferred Response (OBQ09.70) Following operative repair of lower extremity long bone and periarticular fractures, what is the time frame for patients to return to normal automobile braking time? QID: 2883 6 weeks after initiation of weight bearing 8 weeks from the date of injury Once full range of motion of the ankle and knee exist At the time of bony union L 2 B Select Answer to see Preferred Response Sorry, this question is for Sorry, this question is for
Sorry, this question is for Sorry, this question is for (OBQ08.103) A 25-year-old man sustains a twisting injury to his ankle. His radiograph is shown in Figure A. Which of the following is the most appropriate method to assess the competency of his deltoid ligament? QID: 489 External rotation stress radiograph Internal rotation stress radiograph Palpation of the medial ankle in the region of the deltoid Inversion stress radiograph L 2 C Select Answer to see Preferred Response Sorry, this question is for (OBQ08.210) A 68-year-old female sustains a closed ankle fracture and is treated with open reduction and internal fixation. Her postoperative radiographs are shown in Figure A. Widening of the tibia-fibular clear space with external rotation stress would be a result of injury of which structure? QID: 596 Anterior ankle joint capsule Anterior talofibular ligament L 1 B Select Answer to see Preferred Response (OBQ08.93) A 35-year-old male with a pronation abduction ankle injury would have which of the following radiographs? QID: 479 L 3 A Select Answer to see Preferred Response (OBQ08.81) A 19-year-old male sustains the injury shown in Figure A while skiing. Injury to what structure should be evaluated intraoperatively during fixation of the fibula? QID: 467 L 1 C Select Answer to see Preferred Response (OBQ07.223) Appropriate treatment of the bimalleolar ankle fracture shown in Figure A includes which of the following? QID: 884 Bridge plating of the fibula with oblique medial malleolar screws Antiglide plating of the fibula with oblique medial malleolar screws Intramedullary fibular screw with medial malleolar tension banding Fibular plating with open correction of plafond impaction with medial malleolar antiglide plate Fibular plating with open correction of syndesmosis and oblique medial malleolar screws L 2 B Select Answer to see Preferred Response (OBQ07.39) The Cotton test evaluates which of the following structures? QID: 700 Lateral ulnar collateral ligament of the elbow Anterior talofibular ligament L 1 C Select Answer to see Preferred Response (OBQ07.88) After undergoing the treatment seen in Figure A, when should a patient be expected to safely operate the brakes of an automobile? QID: 749 L 2 C Select Answer to see Preferred Response (OBQ06.140) The Lauge-Hansen classification of ankle fractures identifies characteristic fracture patterns based on mechanism of injury. What is the mechanism for the fracture pattern shown in Figure A? QID: 326 Supination-External Rotation Pronation-External Rotation L 1 A Select Answer to see Preferred Response (OBQ06.250) What is the most appropriate plating technique utilized for the medial malleolus fracture typically seen in a displaced supination-adduction ankle fracture? QID: 261 L 1 B Select Answer to see Preferred Response (OBQ06.85) The talocrural angle of an ankle mortise x-ray is formed between a line perpendicular to the tibial plafond and a line drawn: QID: 196 perpendicular to the medial clear space parallel to the talar body between the tips of the malleoli perpendicular to the shaft of the fibular parallel to the subtalar joint L 2 C Select Answer to see Preferred Response (OBQ06.28) A 34-year-old woman twists her right ankle stepping off the city bus. An AP ankle radiograph is provided in Figure A. Which of the following statements accurately describe this radiograph? QID: 139 The tibiofibular overlap is less than 3 mm The fibula demonstrates a Weber C fracture pattern The tibiofibular clear space is less than 4 mm The fracture is consistent with a Lauge-Hansen pronation-external rotation injury pattern The medial clear space is greater than 5 mm L 3 D Select Answer to see Preferred Response (OBQ05.89) When comparing the fibular plating techniques shown in Figures A and B, the plate position shown in Figure B is associated with which of the following? QID: 975 Decreased rate of hardware prominence Increased risk of intra-articular screw penetration Increased peroneal tendinitis L 2 C Select Answer to see Preferred Response (OBQ05.205) Coupled with reduction of the syndesmosis, which of the following interventions is most important when surgically addressing the ankle malunion shown in Figure A? QID: 1091 Placement of an osteochondral allograft Fibular lengthening osteotomy Calcaneofibular ligament release Medial malleolar shortening osteotomy Deltoid ligament imbrication L 3 B Select Answer to see Preferred Response (OBQ04.23) A 32-year-old taxi driver sustains a displaced supination external rotation ankle injury after slipping off of a curb. He subsequently undergoes surgical fixation, and a post-operative radiograph is shown in Figure A. At the eight-week postoperative visit, you are asked to fill out a return to work form. How long from today’s visit will his braking time be expected to return to normal? QID: 134 L 4 C Select Answer to see Preferred Response (OBQ04.49) A 33-year-old male is involved in a motor vehicle accident and suffers a right pilon fracture. Which of the bone fragments labeled on the distal tibia in the axial CT scan shown in Figure A is attached to the posterior inferior tibiofibular ligament? QID: 110 L 1 D Select Answer to see Preferred Response (OBQ04.243) A 32-year-old female sustained a bimalleolar ankle fracture and was treated with open reduction and internal fixation four months ago. A radiograph of her ankle is shown in Figure A. Recommended management should consist of? QID: 1348 Physical therapy for ambulation assistance and proprioception training Revision open reduction and internal fixation with open syndesmosis reduction Addition of syndesmosis screw from fibula to tibia Open medial ankle ligament reconstruction L 2 C Select Answer to see Preferred Response What is a nondisplaced fracture of lateral malleolus?A lateral malleolus fracture is a fracture of the lower end of the fibula. Nonsurgical Treatment. Similar to a nondisplaced medial malleolus fracture, a nondisplaced lateral malleolus fracture can often be treated with a short leg cast or walking boot.
How long does it take for a lateral malleolus fracture to heal?Lateral Malleolus Fracture Recovery Timeline
It takes approximately 6 weeks for bones to heal, and associated ligaments and other soft tissue even longer. A pain management protocol is given to the patient, typically in hopes that opioid medications will not be needed.
How serious is a lateral malleolus fracture?Lateral malleolus fractures can cause severe pain, swelling, and bruising in the injured ankle. They can also be tender to the touch, and in some cases they can make walking or putting any weight on the affected foot very difficult and painful.
How long does a non displaced ankle fracture take to heal?Most of the time, this will be at least 6 to 10 weeks. Putting weight on your ankle too soon may mean the bones do not heal properly.
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Nondisplaced fracture of lateral malleolus of right fibula
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