4.4 of 92 Ratings
Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC.
A 30-year-old manual laborer is forced to jump from a collapsing building. He lands on his feet but experiences severe right foot pain. He presents with intact skin, moderate swelling and ecchymosis about the right heel, and global tenderness of the hindfoot. He is otherwise neurovascularly intact. Radiographs of his right foot are shown in Figures A-C. When considering surgery, which of the following is the only undisputed difference when comparing nonoperative management of this injury to open reduction and internal fixation?
Decreased risk of development of clinically significant subtalar arthritis
Decreased risk of wound complications
Decreased long-term subjective and functional outcomes
Greater difficulty with shoe wear but increased likelihood of returning to work post-operatively
Worse radiographic indices at long-term follow-up
Select Answer to see Preferred Response
Which of the following is not commonly seen following malunion of a conservatively-managed calcaneus fracture?
Decreased hindfoot height and increased calcaneal width
Hindfoot valgus with subfibular impingement
Lateral wall exostosis with peroneal tendon irritation
A 36-year-old male sustains the closed injury shown in Figure A after falling from a ladder. He is treated nonoperatively. Two years following the injury he presents to the clinic complaining of laterally based hindfoot pain which is worsened when walking on uneven surfaces. His tibiotalar motion remains pain-free. He obtains good pain relief with a steroid injection into the sinus tarsi. What additional treatment modality is appropriate at this time?
ASO/Lace-up ankle brace
Arizona/Gauntlet ankle brace
Custom orthotic with arch support and medial wedging
UCBL ankle brace
Distraction bone block arthrodesis
Which of the following arteries supplies the surgical flap in the extensile open treatment of the injury shown in Figure A?
Lateral calcaneal branch of the anterior tibial artery
Lateral calcaneal branch of the peroneal artery
Lateral malleolar branch of the peroneal artery
Lateral malleolar branch of the dorsalis pedis artery
Lateral malleolar branch of the anterior tibial artery
A 25-year-old woman began training for a marathon and she reports a 2-week history of heel pain. She has pain throughout the day that worsens with prolonged weight-bearing. On exam, the location of maximal tenderness is indicated by the white arrow in Figure A. The patient denies point tenderness at the location of the yellow arrow in Figure A. Which of the following MRI images (Figures B to F) would you expect to find in this patient?
Figure A is a radiograph of a healthy, independent 51-year-old male. He is treated with immediate open reduction internal fixation to prevent which of the following complications?
Plantar flexion weakness
A 25-year-old, training for a marathon, presents with persistent heel pain over the past several weeks. He has difficulty with ambulation and has an antalgic gait. A squeeze test of the heel is positive. A lateral foot radiograph is shown Figure A. Of the options listed below, what is the most appropriate next step in management?
Heel pad cortisone injection
Physical therapy with Graston techniques to plantar fascia
MRI of the foot
Non-weight bearing cast for 4-6 months
A 19-year-old military recruit complains of 7 weeks of right heel pain. He notes the pain is worse with jumping and long distance running. He has completed a course of plantar fascia and Achilles tendon stretching with no significant improvement in his symptoms. He denies constitutional symptoms. On examination, his body mass index is 22, he has a normal foot posture and can perform a single leg heel rise without difficulty. There is no pain with palpation of the lateral border of the foot or with external rotation stress to the midfoot. There is tenderness with medial and lateral compression of the hindfoot and there is a negative syndesmosis squeeze test. There is a negative Tinel's sign at the tibial nerve. Axial and lateral radiographs are shown in Figures A and B. What is the most appropriate next step in management?
Heel pad cortisone injection
Platelet rich plasma injection and 6 weeks of physical therapy
Restricted weight bearing and magnetic resonance imaging of the foot
Release of the first branch of the lateral plantar nerve
ASTYM or Graston physical therapy techniques to the achilles and plantar fascia
A 47-year-old male presents with a one month history of heel pain after starting marathon training. The heel is tender when squeezed. A foot radiograph is shown in Figure A, and an MRI is obtained which is shown in Figures B and C. What is the most likely diagnosis?
A 26-year-old male sustains a comminuted, intra-articular calcaneus fracture and subsequently undergoes operative intervention as shown in Figure A. Postoperatively in the recovery room, he presents with an isolated, fixed flexed great toe. What is the most likely etiology of this finding?
Use of a lateral extensile approach to the calcaneus
Calcaneal tuberosity varus malalignment
Use of screws in the constant fragment that are too long
Missed foot compartment syndrome
Plantar nerve palsy
A 47-year-old male sustained a comminuted calcaneus fracture in a motorcyle accident. He subsequently develops the post-traumatic condition shown in Figure A. All of the following would be indications for a subtalar distraction arthrodesis using a bone graft instead of an in-situ subtalar arthrodesis EXCEPT:
Decreased calcaneus height
Decreased talocalcaneal angle
Decreased talar declination angle
Presence of a collapsed subtalar joint from AVN
Presence of full ankle dorsiflexion with no tibiotalar impingement
A 42-year-old male sustains the injury seen in figure A. What negative sequelae would occur with displacement of this fracture in the characteristic fashion?
Post-traumatic subtalar arthrosis
Stress fracture of the fibula
Reflex sympathetic dystrophy
Achilles tendon rupture
Posterior skin necrosis
A 28 year-old-male presents with the injury pattern seen in Figure A. Which of the following is a risk factor for wound complications following operative treatment?
Workers' Compensation involvement
Adjunct use of allograft
Contralateral calcaneus fracture
A patient sustains a comminuted calcaneus fracture. Three months after the injury the patient complains of shoewear problems secondary to clawing of the lesser toes. What is the most likely explanation for this deformity?
Sural nerve injury
Tethering of the flexor hallucis longus by fracture fragments
Medial plantar nerve neuropathy
Weakness of the tibialis posterior
Unrecognized foot compartment syndrome
Which of the following patients who sustained a calcaneal fracture will most likely undergo an eventual subtalar fusion?
Male worker's compensation patient who participates in heavy labor work with an initial Böhler angle less than 0 degrees
Female worker's compensation patient who participates in heavy labor work with an initial Böhler angle >15 degrees
Male non-worker's compensation patient who participates in heavy labor work with an initial Böhler angle less than 0 degrees
Male worker's compensation patient who participates in heavy labor work with an initial Böhler angle >15 degrees
Female non-worker's compensation patient who participates in heavy labor work with an initial Böhler less than 0 degrees
A 55-year-old male sustained a Sanders IV intra-articular calcaneus fracture two years ago that was treated nonoperatively. He presents to your office with a mechanical block preventing his ankle from dorsiflexing to neutral, continued severe pain and a widened heel. Radiographs show significant loss of calcaneal height and an incongruous subtalar joint. What is the most appropriate surgical treatment at this time?
Arthroscopic debridement of the subtalar joint and subfibular recess with in situ subtalar joint arthrodesis
Distraction bone block subtalar arthrodesis
Corrective intra-articular osteotomy of the calcaneus
Arthroscopic debridement of the subtalar joint and subfibular recess with lateral distraction opening wedge calcaneal osteotomy
In the treatment of intra-articular calcaneal fractures, surgical reduction and fixation has been shown to have improved outcomes over nonoperative treatment in all of the following patient groups EXCEPT:
Sanders IIb fractures
Younger age (<29 years old)
Previous calcaneus fracture
The flexor hallucis longus tendon is at greatest risk of injury with a lateral-to-medial drill or screw during fixation of what structure?
Navicular body fracture
Intra-articular calcaneus fracture
Nutcracker cuboid fracture
Talar neck fracture
A 42-year-old female undergoes a subtalar bone block distraction arthrodesis as sequelae of a nonoperatively treated calcaneus fracture ten years prior. This procedure improves which of the following issues?
Subtalar joint stiffness
Sinus tarsi impingement
Anterior ankle impingement
A 27-year-old male sustains closed injuries to his right foot in a motor vehicle collision. He is a nonsmoker. A radiograph and computed tomography scan are provided in Figures A and B. All of the following are prognostic of a superior outcome with operative treatment EXCEPT:
Works as an attorney
Twenty-seven years old
He was injured while off his job
A 48-year-old female sustains the injury seen in Figure A. Which of the following preoperative variables has been shown to be associated with improved outcomes following surgical treatment of this injury pattern?
Patients with a heavier workload
Patients receiving Worker's Compensation
Gissane angle of 140°
Böhler angle of > 15°
Comminuted posterior facet
A 42-year-old male sustains the closed injury shown in Figure A. Which of the following factors is associated with improved outcomes with open reduction and internal fixation?
Age > 40
No worker's compensation involvement
Career as construction worker
A 35-year-old patient sustains a left calcaneus fracture. Which of the following fractures has the highest risk of post-traumatic arthritis?
Male patient, Sanders Type III fracture, treated with ORIF
Male patient, Sanders Type II fracture, treated with ORIF and bone graft
Female patient, workers compensation, Sanders Type I fracture, treated non-operatively
Female patient, Sanders Type II fracture, treated non-operatively
Female patient, workers compensation, Sanders Type II fracture, treated with ORIF
Which of the following statements is true regarding the superomedial fragment of an intra-articular calcaneus fracture?
Fragment typically does not move due to its attachment to the Achilles tendon
Fragment has the flexor hallucis longus wrap inferiorly around it
Fragment typically does not move due to its attachment to the navicular
Fragment typically displaces superior and laterally
Fragment has the tibialis posterior wrap inferiorly around it