Rearfoot

1.Patient has a history of ankle sprains and has a flexible flat foot?  Evans osteotomy with Brostrom Gold procedure
2.Patient has an isolated ATFL chronic rupture, what procedure do you do?  Brostrom for isolated. Lee, Christman snook, and Evans are for double ligament repairs
 3.Patient has a lateral ankle sprain with the foot dorsiflexed, what ligament is most likely affected?  ATFL
 4.Patient has pain after plantarflexion and abducting his foot, what ligament is affected?  Bifurcate ligament
5.You suspect your patient has a cyst in his calcaneus, what radio-graphic views will you certainly order?  Calcaneal axial and lateral view
6. Patient has decreased Achilles tendon reflex, what nerves are affected? S1,S2
Spiral oblique fracture, with two screws under plate, what kind of plate to use?  Neutralization plate
Angles/position for ankle fusion?
  • sagittal plane neutral 90 degrees
  • valgus 0-5 degrees
  • externally rotated 5-10 degrees
What is a Dwyer? lateral closing base wedge of calcaneus to correct frontal plane deformity (varus)
Described a gastroc-soleal equinus, what surgery is best?  TAL
Ankle fracture, what do you address first?  get back fibular length
What ligament holds in place a non-displaced calcaneal anterior process fracture? bifurcate ligament
What is the treatment for a non-displaced calcaneal anterior process fracture? WB cast
A patient with decreased Achilles Tendon Reflex is affected at what spinal level? S1/S2
In a popliteal block, what nerved is missed? Saphenous nerve
Describe Gastroc-soleus equinus Patient has limited ankle dorsiflexion at knee extended and flexed
 Person with calcaneal fx but before surgery notice parasthesia in both legs, what do you do first?  check for possible vertebral spine fracture (L5)
 Topaz (instrument) Radiofrequency Coblation, microscopic damage increase BS via microtears, angiogenesis/healing. Used in plantar fasciitis surgical treatment.

Ankle

At what angle should syndesmotic screws be placed?  They should be directed obliquely from back to front at an angle of 25-30 degrees starting posterolaterally and aiming anteromedially
What position do you want the foot when throwing syndesmotic screws? You want the foot in slight dorsiflexion because the syndesmosis is narrower in plantarflexion and throwing it while in plantarflexion could lead to overtightening
Aside from metallic screws, what are some other ways that syndesmotic injuries can be repaired? K wires, bioabsorbable implants, knotless suture with button fixation device
 Triple Arthodesis  Fusion of subtalar, calcaneocuboid, and talonavicular joints
 Triple Arthrodesis: Positioning  1. RF parallel to leg
2. 3-5 degrees STJ valgus
3. RF parallel to FF (Meary’s)
4. MT1 same level as MT5 head loaded – slight MTJ valgus, Foot abducted 10-15 degrees (MTJ pronated)
5. Foot 90 degrees to leg
 Triple Arthrodesis: Postop course Cast – 10 weeks, about 6 weeks into CAM walker, serial XR until fusion noted
 Ankle scope, which nerve is most likely in danger of getting hurt?   superficial peroneal (int. dorsal cutaneous is most common injury)
Conti Classification Stage Ia Tenosynovitis
1 or 2 fine longitudinal splits
 Conti Stage Ib
 Conti Stage II  Narrower tendon signal with intramural degeneration
A bulbous tendon in the diseased segment
 Conti Stage IIIa  Diffuse synovial swelling and prominent, uniform degeneration
Uniform degeneration with some intact tendon
 Conti Stage IIIb  Completely ruptured
Replaced with scar tissue in the gapped sections
1.A patient feels numbness on his medial arch after surgery, what nerve is most likely damaged?  Saphenous nerve
4.Describe clubfoot deformity
5.When do you start serial casting for clubfoot? 1 week
6.Clubfoot in a kid, describe radiographic findings?
  •  1st-talus angle > 15
  • Kites <15
  • Metatarsal stacking (indicates forefoot supination)
18 yo with IM 20 degrees, hypermobility, what procedure?  Lapidus
Flexible pes planus, which 3 procedures would be best?  Cotton,
What ligament prevents excessive STJ supination?  cervical ligament
 Which imaging is the mainstay of diagnostic accuracy in regards to Lisfranc injury?CT scan
When do you see an increase in Engel’s angle?
How do you calculate true metatarsal adductus angle?
In a 9-month post-op Lapidus procedure, radiographs show evidence of non-union, what do you do?  immobilize and use bone stimulator?