ABOS Part I Comprehensive Review - Batch 57

Question 1

A 32-year-old male presents to the emergency department after a fall from a ladder, landing on his foot. He complains of severe midfoot pain and inability to bear weight. Initial non-weight-bearing radiographs are interpreted as normal. However, due

Accepted Answer

Order a CT scan of the foot to further evaluate for subtle bony displacement and articular involvement.

Question 2

A 40-year-old male sustains a high-energy twisting injury to his foot. Clinical examination reveals significant midfoot swelling, ecchymosis, and tenderness over the tarsometatarsal joints. Radiographs show a subtle avulsion fracture from the plantar

Accepted Answer

The avulsion fracture from the second metatarsal base signifies a disruption of the interosseous Lisfranc ligament, which is the most crucial stabilizer of the midfoot.

Question 3

A 28-year-old professional athlete presents with acute midfoot pain after a direct crush injury. Initial radiographs show a fracture of the base of the second metatarsal with 1.5mm widening between the medial cuneiform and the second metatarsal. Stre

Accepted Answer

Open reduction and internal fixation (ORIF) with transarticular screw fixation of the first, second, and third tarsometatarsal joints.

Question 4

During surgical planning for a Lisfranc injury, the surgeon reviews the patient's CT scan, which confirms a fracture-dislocation involving the second and third tarsometatarsal joints. The surgical approach will involve two dorsal incisions. The dorsa

Accepted Answer

Between the extensor hallucis longus and extensor digitorum longus tendons; the deep peroneal nerve.

Question 5

A 55-year-old male undergoes open reduction and internal fixation for a Lisfranc fracture-dislocation. Intraoperatively, after initial debridement, the surgeon begins the reduction sequence. The image below shows an intraoperative fluoroscopic view d

Accepted Answer

Meticulously reducing the second metatarsal base into its recess within the cuneiforms and restoring its alignment with the medial cuneiform.

Question 6

Following successful anatomical reduction of a Lisfranc injury, the surgeon proceeds with definitive internal fixation. The image below shows a post-operative radiograph.Regarding the critical fixation of the second ray, which of the following statem

Accepted Answer

A 3.5mm or 4.0mm cortical screw is placed from the dorsal aspect of the medial cuneiform into the base of the second metatarsal, and this hardware is typically removed 3-6 months post-operatively to allow for restoration of normal midfoot motion.

Question 7

A 48-year-old construction worker undergoes ORIF for a severe Lisfranc fracture-dislocation. Despite meticulous surgical technique and anatomical reduction, he develops persistent midfoot pain, swelling, and stiffness 18 months post-operatively. Radi

Accepted Answer

Post-traumatic arthritis; arthrodesis of the symptomatic tarsometatarsal joints.

Question 8

A 35-year-old female undergoes ORIF for a Lisfranc injury. Post-operatively, she is placed in a well-padded splint. According to the typical rehabilitation protocol described in the case, which of the following statements accurately reflects the init

Accepted Answer

Strict non-weight-bearing is maintained for 6-8 weeks, with early toe and ankle range of motion exercises, avoiding midfoot stress.

Question 9

A 60-year-old patient with a history of diabetes and pre-existing midfoot osteoarthritis presents with a severely comminuted Lisfranc fracture-dislocation that is irreducible with closed manipulation. Given the patient's comorbidities and the nature

Accepted Answer

Primary arthrodesis is a recognized option for severe comminuted injuries, chronic unreduced injuries, or in patients with pre-existing midfoot arthritis, often fusing the first, second, and third TMT joints.

Question 10

A 22-year-old collegiate football player sustains a Lisfranc injury. Despite undergoing meticulous anatomical reduction and stable internal fixation, he develops chronic pain and functional limitations. According to the key literature and guidelines,

Accepted Answer

Residual displacement greater than 1-2mm after surgical reduction.

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Key Takeaway