4.5 of 66 Ratings
A 19-year-old male injured his ankle while playing soccer. A CT scan is shown in Figure A. What structure attaches to the site marked with the arrow, and what is the next best step in treatment?
Anterior inferior tibiofibular ligament (AITFL); Open reduction and internal fixation (ORIF) of the fibula with subsequent syndesmotic assessment
Anterior talofibular ligament (ATFL); ORIF of the fibula with subsequent syndesmotic assessment
Interosseous membrane; ORIF of the fibula with fixation of syndesmosis
Interosseous ligament; ORIF of the fibula with subsequent syndesmotic assessment
Inferior transverse ligament; ORIF of the fibula with fixation of syndesmosis
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A football player develops a synostosis between the distal tibia and fibula 8 months following treatment for a high ankle sprain. What is the most appropriate indication and timing for surgical excision?
Chronic lateral ankle instability at any time
Progressive loss of plantar-flexion at any time
Progressive loss of plantar-flexion and increased uptake on bone scan
Persistent pain despite non-operative treatment and no uptake on bone scan
Persistent pain despite non-operative treatment and "hot" on bone scan
A 21-year-old male collegiate basketball player presents with 1 year of left lower leg pain. The pain is worse with activity and the leg is tender to palpation. He denies constitutional symptoms, and conservative treatment has failed to provide relief. He denies recent trauma, but did sustain a severe ankle sprain 7 years ago. Radiograph, bone scan, and CT scans are shown in Figures A-D. What is the next most appropriate step in management?
External beam irradiation with 60Gray to lesion
Neoadjuvant multiagent chemotherapy followed by surgical resection of lesion followed by adjuvant multiagent chemotherapy
Observation and repeat bone scans to plan external beam irradiation of 700cGray to lesion
Indomethacin 25 mg PO tid for 6 weeks
Observation and repeat bone scan followed by surgical resection if no increased uptake
Which test for acute syndesmotic injury of the ankle has the fewest false-positive results and smallest inter-observer variance when used intraoperatively?
External rotation stress test