FRACTURAS DE TOBILLO

NOMBRE: _____________________________________________________________ GRADO: ________ FECHA: ___________

1.- Figure 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?

A) Closed reduction and casting for 6 weeks

B) Closed reduction and casting for 12 weeks
C) Open reduction and internal fixation with restricted weight bearing for 2 weeks
D) Open reduction and internal fixation with restricted weight bearing for 6 weeks
E) -Open reduction and internal fixation with restricted weight bearing for 12 weeks

2.- 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) Progressive weightbearing in 3-4 weeks based on radiographs

B) eltoid ligament repair vs reconstruction
C) Revision ORIF of fibula with lengthening
D) -Revision ORIF of fibula and syndesmosis
E) Removal of syndesmotic screws in 3-6 months

3.- 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. Which of the following could have prevented this patient from developing persistent pain?

A) Deep deltoid ligament repair

B) Quadricortical syndesmotic screw fixation
C) -Restoration of fibular length and rotation
D) Lateral collateral ligament complex repair
E) Use of two syndesmotic screws

4.-A 32-year-old female sustains the injury shown in Figure. What is the most reliable method to evaluate the competence of the deltoid ligament?
A) Medial ankle tenderness
B) Medial ankle ecchymosis
C) Squeeze test
D) -Stress radiography of the ankle
E) Canale view radiograph

5.- 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?
A) -Anterior-posterior
B) Medial-lateral
C) Proximal-distal
 D) Rotational
E) Equivalent instability in all axes

6.- A 34-year-old man sustains a twisting injury to his left ankle playing soccer. Radiographs from the ER are provided in figures. 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? 
A) Measurement of medial clear space widening
B) Measurement of the tibiofibular overlap
C) Anterior drawer test with comparison to the contralateral ankle
D) -External rotation stress radiograph
E) Evaluation of the syndesmosis on preoperative CT scan

7.- 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?
A) -Marginal impaction of the anteromedial tibial plafond
B) Syndesmosis diastasis
C) Deltoid ligament tear
D) Posterolateral osteochondral lesion of the talus
E) Fibular overlengthening

8.- 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?

A) -6 weeks after initiation of weight bearing

B) 4 weeks postoperatively
C) 8 weeks from the date of injury
D) Once full range of motion of the ankle and knee exist
E) At the time of bony union

9.-  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?

A) Anterior-inferior tibiofibular ligament

B) Posterior-inferior tibiofibular ligament
C) Peroneus brevis tendón
D) -Posterolateral ridge of the tibia
E) Flexor hallucis longus tendon

10.- MENCIONA LA CLASIFICACIÓN ORIGINAL DE WEBER PARA FRACTURAS DE LA ARTICULACIÓN TIBIOPERONEO

ASTRAGALINA.