Ortho Rosh Review exam 3 UPDATED ACTUAL Questions and
CORRECT Answers
BDebridement
1. A young woman
presents with an-
kle pain and ede-
ma. While wearing
high-heel shoes,
she twisted her
ankle upon step-
ping off a curb.
She is tender about
the lateral malleo-
lus. Skin and neu-
rovascular exami-
nation are nor-
mal. She has no
medial tenderness.
Ligament testing
is negative. Ra-
diographic exami-
nation reveals a
non-displaced lat-
eral malleolar frac-
ture below the an-
kle joint. The tibia is
unaffected. Which
of the following is
the most appropri-
ate definitive treat-
ment for this pa-
tient?
AClosed reduction
, :
C
Fracture of the ankle may include injury to the medial malleolus (tibia), the
o
lateral malleolus (fibula), the posterior malleolus (tibia), the talus and the
r
collateral ligaments. Stability of the fracture depends on how many sides are
r
injured. Stable fractures involve only one side of the joint, whereas unstable
e
fractures include both sides of the joint. Stable fractures are treated with 4-6
c
weeks of a weight-bearing cast or brace
t
A
n
s
w
e
r
(
D
)
E
x
p
l
a
n
a
t
i
o
n
, CNon-weight-bear-
ing orthosis
DWeight-bearing
cast
2. Rapid Review Ankle Fractures
Ankle Fractures
Single malleolar: either distal fibula or tibia
Bimalleolar: distal fibula + tibia
Trimalleolar: bimalleolar fracture + posterior tibial involvement
Rx: possible ORIF if unstable
3. One Step Further Answer: The fibular head. External rotation forces at the ankle can cause a
Question: Examina- Maisonneuve fracture, a compilation of fibular head fracture, tear of the ankle's
tion of which struc- medial collateral ligament and disruption of the tibiofibular syndesmosis.
ture is important in
any suspected an-
kle fracture or in-
jury?
4. Which of the fol- Correct Answer ( C )
lowing maneuvers Explanation:
tests the meniscus Meniscal injuries occur frequently in patients with sudden rotary or exten-
of the knee? sion-flexion motions. The menisci have no sensory nerve fibers, and the pain
that results after these injuries is from irritation of the ligaments near the joint
Anterior drawer line. Several symptoms suggest the presence of a meniscal tear including: joint
test line pain, joint effusion, locking, and giving way of the knee. The McMurray test
Lachman test is performed with the patient supine and the hip and knee flexed. To check the
McMurray test medial meniscus, the examiner palpates the posteromedial joint line with one
Posterior drawer hand while the other hand grasps the foot. The leg is externally rotated to trap
test the medial meniscus, and the knee is slowly extended. Conversely, the lateral
meniscus is examined with the clinician palpating the posterolateral joint line
while internally rotating the leg. A painful click, popping, or thud felt in early
, extension is considered abnormal. It is 53% sensitive for a meniscal injury.
The Anterior Drawer (A) and Lachman tests (B) are used to assess anterior
cruciate ligament (ACL) instability.
5. Rapid Review Meniscus Injuries
Meniscus Injuries
Knee rotary stress
Rapidly changing directions, squatting
Medial > lateral
Clicking, locking
McMurray test
Medial joint line pain: medial meniscus injury
Lateral joint line pain: lateral meniscus injury
Ege test: pain/click on knee rotation with patient in squatting position
External rotation pain: medial meniscus injury
Internal rotation pain: lateral meniscus injury
Dx: MRI
6. One Step Further Answer: Anterior cruciate ligament (ACL) rupture.
Question: What is
the most com-
mon injury associ-
ated with traumatic
hemarthrosis of the
knee joint?
7. A 14-year-old girl Correct Answer ( B )
sprained her ankle. Explanation:
She rates her pain Ankle sprains are caused by partial or complete tearing of one or more liga-
5/10. On examina- ments that support the ankle joint. Injuries are most often due to an inversion
tion, she has mod- mechanism, causing injury to the lateral ligaments. The anterior talofibular
erate tenderness ligament (ATFL) is the first ligament to be injured, followed by the calcane-
CORRECT Answers
BDebridement
1. A young woman
presents with an-
kle pain and ede-
ma. While wearing
high-heel shoes,
she twisted her
ankle upon step-
ping off a curb.
She is tender about
the lateral malleo-
lus. Skin and neu-
rovascular exami-
nation are nor-
mal. She has no
medial tenderness.
Ligament testing
is negative. Ra-
diographic exami-
nation reveals a
non-displaced lat-
eral malleolar frac-
ture below the an-
kle joint. The tibia is
unaffected. Which
of the following is
the most appropri-
ate definitive treat-
ment for this pa-
tient?
AClosed reduction
, :
C
Fracture of the ankle may include injury to the medial malleolus (tibia), the
o
lateral malleolus (fibula), the posterior malleolus (tibia), the talus and the
r
collateral ligaments. Stability of the fracture depends on how many sides are
r
injured. Stable fractures involve only one side of the joint, whereas unstable
e
fractures include both sides of the joint. Stable fractures are treated with 4-6
c
weeks of a weight-bearing cast or brace
t
A
n
s
w
e
r
(
D
)
E
x
p
l
a
n
a
t
i
o
n
, CNon-weight-bear-
ing orthosis
DWeight-bearing
cast
2. Rapid Review Ankle Fractures
Ankle Fractures
Single malleolar: either distal fibula or tibia
Bimalleolar: distal fibula + tibia
Trimalleolar: bimalleolar fracture + posterior tibial involvement
Rx: possible ORIF if unstable
3. One Step Further Answer: The fibular head. External rotation forces at the ankle can cause a
Question: Examina- Maisonneuve fracture, a compilation of fibular head fracture, tear of the ankle's
tion of which struc- medial collateral ligament and disruption of the tibiofibular syndesmosis.
ture is important in
any suspected an-
kle fracture or in-
jury?
4. Which of the fol- Correct Answer ( C )
lowing maneuvers Explanation:
tests the meniscus Meniscal injuries occur frequently in patients with sudden rotary or exten-
of the knee? sion-flexion motions. The menisci have no sensory nerve fibers, and the pain
that results after these injuries is from irritation of the ligaments near the joint
Anterior drawer line. Several symptoms suggest the presence of a meniscal tear including: joint
test line pain, joint effusion, locking, and giving way of the knee. The McMurray test
Lachman test is performed with the patient supine and the hip and knee flexed. To check the
McMurray test medial meniscus, the examiner palpates the posteromedial joint line with one
Posterior drawer hand while the other hand grasps the foot. The leg is externally rotated to trap
test the medial meniscus, and the knee is slowly extended. Conversely, the lateral
meniscus is examined with the clinician palpating the posterolateral joint line
while internally rotating the leg. A painful click, popping, or thud felt in early
, extension is considered abnormal. It is 53% sensitive for a meniscal injury.
The Anterior Drawer (A) and Lachman tests (B) are used to assess anterior
cruciate ligament (ACL) instability.
5. Rapid Review Meniscus Injuries
Meniscus Injuries
Knee rotary stress
Rapidly changing directions, squatting
Medial > lateral
Clicking, locking
McMurray test
Medial joint line pain: medial meniscus injury
Lateral joint line pain: lateral meniscus injury
Ege test: pain/click on knee rotation with patient in squatting position
External rotation pain: medial meniscus injury
Internal rotation pain: lateral meniscus injury
Dx: MRI
6. One Step Further Answer: Anterior cruciate ligament (ACL) rupture.
Question: What is
the most com-
mon injury associ-
ated with traumatic
hemarthrosis of the
knee joint?
7. A 14-year-old girl Correct Answer ( B )
sprained her ankle. Explanation:
She rates her pain Ankle sprains are caused by partial or complete tearing of one or more liga-
5/10. On examina- ments that support the ankle joint. Injuries are most often due to an inversion
tion, she has mod- mechanism, causing injury to the lateral ligaments. The anterior talofibular
erate tenderness ligament (ATFL) is the first ligament to be injured, followed by the calcane-
