Ankle Arthroscopy — MCQs
Deltoid ligament is attached to all, except which structure?
After a brawl, a young male presented with inability to extend his distal interphalangeal joint. An X-ray was taken and was shown to be normal. What should be the next step in managing the patient?
A ballet dancer presents with chronic anterolateral ankle pain. Most likely diagnosis?
What is the most appropriate management option for an intra-articular fracture?
A policeman found a person lying unconscious in the lateral position on the road with superficial injury to the face, bruises on the right arm, and injury to the lateral aspect of the right knee. Given the mechanism of injury and positioning, which nerve is most probably injured?
All of the following are described surgical procedures for CTE V except -
Sudden dorsiflexion of the foot may lead to which of the following injuries?
A 36-year-old man presents with an ankle injury sustained during a soccer match. What urgent intervention is required?
Keinbock's disease is osteochondritis of ?
Which one of the following statements about Compartment Syndrome is NOT correct?
Ankle Arthroscopy Indian Medical PG Practice Questions and MCQs
Question 1: Deltoid ligament is attached to all, except which structure?
- A. Sustentaculum tali
- B. Medial cuneiform (Correct Answer)
- C. Navicular bone
- D. Medial malleolus
Explanation: ***Medial cuneiform*** - The **deltoid ligament** is located on the **medial side of the ankle** and primarily connects the **tibia** to several tarsal bones. It does not attach to the medial cuneiform. - The **medial cuneiform** is a midfoot bone primarily involved in the **tarsometatarsal joint** and is not a direct attachment site for the deltoid ligament. *Medial malleolus* - The **medial malleolus**, the distal end of the **tibia**, serves as the **proximal attachment point** for all four parts of the deltoid ligament. - This strong connection is crucial for **stabilizing the ankle joint** medially. *Navicular bone* - The **tibionavicular part** of the deltoid ligament attaches to the **tuberosity of the navicular bone**. - This attachment helps **limit excessive abduction** and **eversion** of the foot. *Sustentaculum tali* - The **tibiocalcaneal part** of the deltoid ligament attaches to the **sustentaculum tali** on the calcaneus. - This attachment provides significant stability to the **subtalar joint**.
Question 2: After a brawl, a young male presented with inability to extend his distal interphalangeal joint. An X-ray was taken and was shown to be normal. What should be the next step in managing the patient?
- A. Splint (Correct Answer)
- B. Wax bath
- C. Ignore
- D. Surgery
Explanation: ***Splint*** - The patient presents with **inability to extend the distal interphalangeal joint** after an injury, with a **normal X-ray**. This clinical picture is highly suggestive of a **mallet finger**. - **Splinting** the distal interphalangeal joint in **extension** for 6-8 weeks is the primary non-surgical treatment for mallet finger, aiming to allow the ruptured extensor tendon to heal. *Wax bath* - A **wax bath** is a form of thermotherapy used to relieve pain and stiffness in joints by applying heat. - While it can be helpful for chronic conditions like **arthritis**, it is not an appropriate initial treatment for an acute **tendon injury** like mallet finger, as it does not promote healing of the extensor mechanism. *Ignore* - **Ignoring** the symptoms would lead to a failure to treat the injury, potentially resulting in a **chronic extensor lag deformity** (mallet finger deformity). - Untreated, this condition can cause persistent functional impairment and cosmetic deformity of the affected finger. *Surgery* - **Surgery** is typically reserved for specific cases of mallet finger, such as those with a **large avulsion fracture** of the dorsal base of the distal phalanx (where the fragment involves more than 30-50% of the articular surface), or if non-surgical treatment fails. - Since the **X-ray was normal** in this case, indicating no significant bony avulsion, and it's an acute presentation, surgery is not the appropriate first-line management.
Question 3: A ballet dancer presents with chronic anterolateral ankle pain. Most likely diagnosis?
- A. Lateral Ankle Sprain (Correct Answer)
- B. Calcaneal Stress Fracture
- C. Tibialis Posterior Tendinitis
- D. Anterior Ankle Impingement Syndrome
Explanation: **Lateral Ankle Sprain** - **Chronic anterolateral ankle pain** in a ballet dancer is highly suggestive of a **lateral ankle sprain**, often due to repetitive strain and instability. - Sprains commonly involve the **anterior talofibular ligament (ATFL)** and **calcaneofibular ligament (CFL)**, leading to persistent discomfort and potential functional deficits. *Calcaneal Stress Fracture* - A **calcaneal stress fracture** typically presents with **heel pain** that is worse with weight-bearing activities, rather than primarily anterolateral pain. - While common in athletes, the pain location is less consistent with the description in the question. *Tibialis Posterior Tendinitis* - **Tibialis posterior tendinitis** causes pain and tenderness along the **medial arch** and posterior aspect of the ankle, often associated with a **flatfoot deformity**. - The pain location described (anterolateral) does not align with the typical presentation of this condition. *Anterior Ankle Impingement Syndrome* - **Anterior ankle impingement syndrome** results from compression of soft tissues or bony spurs at the **anterior ankle joint**, typically causing pain with **dorsiflexion**. - While possible in a dancer, the presentation as chronic anterolateral pain without specific mention of dorsiflexion-related pain makes a lateral ankle sprain a more probable initial diagnosis.
Question 4: What is the most appropriate management option for an intra-articular fracture?
- A. External Fixation
- B. Arthrodesis
- C. Plaster of Paris
- D. Plating (Correct Answer)
Explanation: ***Plating*** - Plating offers **stable fixation** for intra-articular fractures, allowing for early mobilization and preserving joint function. - It provides **anatomic reduction**, which is crucial for restoring the smooth articular surface and preventing post-traumatic arthritis. *Arthrodesis* - Arthrodesis, or joint fusion, is typically reserved for **severe joint destruction** or failed previous treatments, as it sacrifices joint motion. - It is not the primary approach for acute intra-articular fractures where the goal is to **restore joint function**. *Plaster of Paris* - Plaster of Paris casts often provide **insufficient stability** for complex intra-articular fractures, risking malunion or nonunion. - While it offers immobilization, it can lead to **joint stiffness** and does not allow for early range of motion, which is vital for articular cartilage healing. *External Fixation* - External fixation is usually preferred for **open fractures** with significant soft tissue injury or as a temporary measure in polytrauma patients. - It carries a risk of **pin site infections** and can be cumbersome for the patient, generally not being the definitive treatment for closed intra-articular fractures.
Question 5: A policeman found a person lying unconscious in the lateral position on the road with superficial injury to the face, bruises on the right arm, and injury to the lateral aspect of the right knee. Given the mechanism of injury and positioning, which nerve is most probably injured?
- A. Femoral nerve
- B. Common peroneal nerve (Correct Answer)
- C. Radial nerve
- D. Trigeminal nerve
Explanation: **Correct: Common peroneal nerve** - The **lateral aspect of the right knee** is particularly vulnerable to direct trauma to the **common peroneal nerve** due to its superficial course around the neck of the fibula. - The unconscious state and lateral position suggest a prolonged compression or direct impact mechanism, making this nerve highly susceptible to injury. - The common peroneal nerve is the **most commonly injured nerve in the lower limb** due to its superficial location. *Incorrect: Femoral nerve* - The **femoral nerve** runs deep within the groin region and anterior thigh, making direct injury at the knee unlikely from an isolated lateral knee trauma. - Injuries to the femoral nerve typically result from pelvic fractures, abdominal surgery, or deep penetrating wounds to the groin. *Incorrect: Radial nerve* - The **radial nerve** is located in the upper limb and primarily affects the extensor muscles of the arm, forearm, and hand. - While bruises on the right arm are noted, an injury to the radial nerve would not explain the specific trauma to the lateral aspect of the knee. *Incorrect: Trigeminal nerve* - The **trigeminal nerve** is a cranial nerve responsible for sensation in the face and motor functions such as biting and chewing. - Superficial injury to the face might affect sensory branches, but it is entirely unrelated to an injury to the lateral aspect of the knee.
Question 6: All of the following are described surgical procedures for CTE V except -
- A. Dwyer's osteotomy
- B. Salter's osteotomy (Correct Answer)
- C. Posteromedial soft tissue release
- D. Triple Arthrodesis
Explanation: ***Salter's osteotomy*** - **Salter's osteotomy** is a procedure primarily used for treating **developmental dysplasia of the hip (DDH)**, aiming to redirect the acetabulum. - It is not a described surgical procedure for the correction of **congenital talipes equinovarus (CTEV)**. *Dwyer's osteotomy* - **Dwyer's osteotomy** is a surgical procedure performed on the **calcaneus** to correct **hindfoot varus**, typically seen in CTEV. - It involves removing a wedge of bone from the lateral aspect of the calcaneus. *Posteromedial soft tissue release* - This is a common and traditional surgical procedure for correcting severe **CTEV** by addressing the contracted soft tissues on the medial and posterior aspects of the foot. - It involves releasing structures such as the **tibial tendon**, **flexor digitorum longus**, **flexor hallucis longus**, and the **posterior ankle joint capsule**. *Triple Arthrodesis* - **Triple arthrodesis** is a salvage procedure that involves fusing three joints in the foot: the **talonavicular**, **calcaneocuboid**, and **subtalar** joints. - It is used in older children or adolescents with severe, rigid, or recurrent CTEV, often after failed conservative or primary surgical treatments.
Question 7: Sudden dorsiflexion of the foot may lead to which of the following injuries?
- A. Anterior talofibular ligament injury
- B. Tendo Achilles avulsion injury (Correct Answer)
- C. Rupture of deltoid ligament
- D. Tarsal tunnel syndrome
Explanation: ***Tendo Achilles avulsion injury*** - **Sudden dorsiflexion** of the foot, especially if forced or excessive, can cause extreme stretch on the **Achilles tendon**, potentially leading to its avulsion or rupture. - This mechanism often occurs during activities requiring a forceful push-off or landing with the foot in dorsiflexion, placing significant tensile stress on the tendon. *Anterior talofibular ligament injury* - This injury typically results from an **inversion sprain** of the ankle, where the foot is forcefully turned inward, causing damage to the lateral ankle ligaments. - **Dorsiflexion** alone is not the primary mechanism for injury to the **anterior talofibular ligament**. *Rupture of deltoid ligament* - The **deltoid ligament** is located on the medial side of the ankle and is most commonly injured with an **eversion sprain**, where the foot rolls outward. - While extreme dorsiflexion can put some strain on anterior fibers, it is not the primary mechanism, and a concomitant eversion force would likely be required for rupture. *Tarsal tunnel syndrome* - This condition involves **compression of the tibial nerve** as it passes through the tarsal tunnel, typically causing pain, numbness, and tingling in the sole of the foot. - It is often caused by chronic factors such as swelling, repetitive stress, or structural abnormalities, rather than an acute traumatic event like sudden dorsiflexion.
Question 8: A 36-year-old man presents with an ankle injury sustained during a soccer match. What urgent intervention is required?
- A. Performing a CT scan to assess the injury
- B. Manipulation to restore alignment
- C. Immediate reduction of the dislocation
- D. Applying a splint to stabilize the injury (Correct Answer)
Explanation: ***Applying a splint to stabilize the injury*** - **Splinting** is a crucial urgent intervention for an ankle injury to **immobilize** the affected joint, reducing pain and preventing further damage to soft tissues or bone fragments. - It provides temporary stability until a definitive diagnosis and treatment plan can be established. *Performing a CT scan to assess the injury* - A **CT scan** is a diagnostic tool used to visualize complex fractures or soft tissue injuries in detail, but it is not an urgent intervention for initial management. - While important for diagnosis, it should typically follow initial stabilization and clinical assessment. *Immediate reduction of the dislocation* - **Reduction** is an urgent intervention for **dislocations**, but the question describes an "ankle injury," which could be a sprain, fracture, or dislocation. **Reduction** is only appropriate if a **dislocation** is confirmed. - Attempting to reduce a potential fracture without imaging can cause further trauma or pain. *Manipulation to restore alignment* - **Manipulation to restore alignment** is typically reserved for **dislocations** or certain types of **fractures** after proper imaging has been performed to understand the extent and type of injury. - Similar to reduction, it is not the universal first urgent intervention for an undiagnosed ankle injury.
Question 9: Keinbock's disease is osteochondritis of ?
- A. Scaphoid
- B. Lunate (Correct Answer)
- C. Calcaneum
- D. Tibial tuberosity
Explanation: ***Lunate*** - **Keinbock's disease** is characterized by avascular necrosis of the **lunate bone** in the wrist. - This condition leads to pain, stiffness, and eventual collapse of the lunate, affecting wrist function. *Scaphoid* - Avascular necrosis of the scaphoid is referred to as **Preiser's disease**, not Keinbock's disease. - The scaphoid is more commonly associated with **fractures** due to its precarious blood supply. *Calcaneum* - The calcaneum (heel bone) is affected by **Sever's disease**, which is osteochondrosis of the calcaneal apophysis, typically seen in children. - This condition is not related to osteonecrosis of a carpal bone. *Tibial tuberosity* - The tibial tuberosity is associated with **Osgood-Schlatter disease**, which is an inflammation of the patellar ligament at its insertion point on the tibia, common in adolescents. - This is an apophysitis, not an osteochondrosis affecting a carpal bone.
Question 10: Which one of the following statements about Compartment Syndrome is NOT correct?
- A. Pain is on active movement but not on passive movement of muscles (Correct Answer)
- B. Fasciotomy is the treatment of choice
- C. It is commonest in a closed fracture
- D. Volkmann's Ischaemic contracture is a late complication
Explanation: ***Pain is on active movement but not on passive movement of muscles*** - This statement is incorrect because pain in compartment syndrome is characteristically **out of proportion to the injury** and is **exacerbated by passive stretching of the muscles** within the affected compartment. - While active movement can cause pain, the hallmark sign related to pain is its intensification with passive stretching due to increased pressure. *Fasciotomy is the treatment of choice* - **Fasciotomy** is indeed the definitive surgical treatment for compartment syndrome to relieve pressure and prevent irreversible tissue damage. - It involves incising the fascia to decompress the affected muscle compartment. *It is commonest in a closed fracture* - Compartment syndrome most frequently occurs after a **closed fracture**, particularly in the tibia and forearm, because the intact fascial compartments restrict expansion, leading to increased pressure. - The swelling and hemorrhage associated with the fracture are contained, causing pressure to rise rapidly. *Volkmann's Ischaemic contracture is a late complication* - **Volkmann's ischemic contracture** is a severe and debilitating late complication of unresolved or undertreated compartment syndrome, primarily affecting the forearm muscles. - It results from prolonged ischemia, causing muscle necrosis, fibrosis, and subsequent shortening and contracture.
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