ABFAS - Trauma Section|Complete with A+
Graded Answers
Achilles tendon rupture is likely to occur in this position
Sprinters
Gastroc-soleal complex is enervated by:
Tibial nerve (S1 - S2)
Runs between the gastrocnemius and soleus. Assists in plantarfexion of the foot and flexion of the
knee
Plantaris
Nerve enervation of the plantaris
L4, L5, S1
The narrowest part of the achilles tendon
4cm proximal to its insertion
An Achilles tendon rupture is likely to occur at what anatomical location?
2-6cm proximal to attachment (watershed area) of the left lower extremity (due to handedness: Right
handed individuals more commonly push off with the left foot).
Name the Test: squeezing of the calf muscle does not result in plantar flexion of the foot
Thompson Test
Name the Test: A 25 gauge needle is inserted at a right angle to the leg through the skin of the calf
muscle just medial to midline. This should be performed 10 cm proximal to the calcaneal insertion of
the Achilles tendon. Motion of the hub of the needle in a direction opposite that of the tendon during
passive dorsiflexion and plantarflexion of the foot confirms an intact tendon distal to the level of
needle insertion.
O'Brien Test
The parameters of Kager's triangle are. . .
Anterior border: FHL, Posterior border: Achilles Tendon, Inferior Border: Superior cortex of the
calcaneus
What classification is used for achilles tendon ruptures?
Kuwada (1: partial tear 2: complete tear up to 3, 3: 3-6cm tear, 4: greater than 6cm tear
Case: 34 year old male presents with left 2cm Achilles tendon rupture confirmed on MRI. No other
comorbidities. What is the best treatment of choice?
End-to-end anastomosis
, Case: 36 year old female presents with 7cm Achilles tendon rupture occurring just yesterday while
skiing. She states that she had been on levofloxacin for 2 weeks for abscess in her left thigh. She has
no other significant past medical history. What is the best treatment of choice?
1. Gastroc recession, 2. Turn down with tendon graft and or synthetic graft.
Case: a 42 year old male presents with an Achilles tendon rupture to the left lower extremity
occurring while running a marathon the previous day. He denies taking any medications and has no
significant / contributory past medical history. MRI reveals a 4cm complete rupture of the left Achilles
tendon. Which of the following is the most appropriate treatment of choice.
Following surgical debridement of the tendon ends to healthy tissue. Recommended treatment:
Tendon graft flap, +/- a synthetic graft augment. Additionally a V-Y advancement, a Bosworth
turndown, tendon transfer, or a combination of these may also be used for type 3 injuries.
Which component of the deltoid ligament blends with the spring ligament?
Tibiocalcaneal
Which component of the deltoid ligament is deep to the others?
Anterior tibiotalar
What two tendons pass over the Deltoid ligament?
FDL and Tibialis posterior
What is the strongest of the lateral collateral ligaments of the ankle?
Posterior talofibular ligament
Which of the lateral collateral ligaments of the ankle are extrasynovial but intracapsular?
Posterior talofibular ligament
Which of the extracapsular lateral collateral ligaments of the ankle are just deep to the peroneal
tendons?
CFL
Which is the shortest lateral collateral ligament of the ankle?
ATFL
A surgeon is inverting the foot with the ankle in a dorsiflexed position. The surgeon is preparing to do
a modified brostrum. Which ligament are they specifically assessing?
CFL
The proximal tibiofibular joint is best described as what type of joint?
plain synovial joint
A patient presents to the office complaining that they "rolled their ankle". X-rays reveal soft tissue
inflammation. If the patient were to have, hypothetically, inverted their foot while the foot was in
neutral position (neither dorsiflexed nor plantarflexed) on the sidewalk, which ligament would be at
stake?
Graded Answers
Achilles tendon rupture is likely to occur in this position
Sprinters
Gastroc-soleal complex is enervated by:
Tibial nerve (S1 - S2)
Runs between the gastrocnemius and soleus. Assists in plantarfexion of the foot and flexion of the
knee
Plantaris
Nerve enervation of the plantaris
L4, L5, S1
The narrowest part of the achilles tendon
4cm proximal to its insertion
An Achilles tendon rupture is likely to occur at what anatomical location?
2-6cm proximal to attachment (watershed area) of the left lower extremity (due to handedness: Right
handed individuals more commonly push off with the left foot).
Name the Test: squeezing of the calf muscle does not result in plantar flexion of the foot
Thompson Test
Name the Test: A 25 gauge needle is inserted at a right angle to the leg through the skin of the calf
muscle just medial to midline. This should be performed 10 cm proximal to the calcaneal insertion of
the Achilles tendon. Motion of the hub of the needle in a direction opposite that of the tendon during
passive dorsiflexion and plantarflexion of the foot confirms an intact tendon distal to the level of
needle insertion.
O'Brien Test
The parameters of Kager's triangle are. . .
Anterior border: FHL, Posterior border: Achilles Tendon, Inferior Border: Superior cortex of the
calcaneus
What classification is used for achilles tendon ruptures?
Kuwada (1: partial tear 2: complete tear up to 3, 3: 3-6cm tear, 4: greater than 6cm tear
Case: 34 year old male presents with left 2cm Achilles tendon rupture confirmed on MRI. No other
comorbidities. What is the best treatment of choice?
End-to-end anastomosis
, Case: 36 year old female presents with 7cm Achilles tendon rupture occurring just yesterday while
skiing. She states that she had been on levofloxacin for 2 weeks for abscess in her left thigh. She has
no other significant past medical history. What is the best treatment of choice?
1. Gastroc recession, 2. Turn down with tendon graft and or synthetic graft.
Case: a 42 year old male presents with an Achilles tendon rupture to the left lower extremity
occurring while running a marathon the previous day. He denies taking any medications and has no
significant / contributory past medical history. MRI reveals a 4cm complete rupture of the left Achilles
tendon. Which of the following is the most appropriate treatment of choice.
Following surgical debridement of the tendon ends to healthy tissue. Recommended treatment:
Tendon graft flap, +/- a synthetic graft augment. Additionally a V-Y advancement, a Bosworth
turndown, tendon transfer, or a combination of these may also be used for type 3 injuries.
Which component of the deltoid ligament blends with the spring ligament?
Tibiocalcaneal
Which component of the deltoid ligament is deep to the others?
Anterior tibiotalar
What two tendons pass over the Deltoid ligament?
FDL and Tibialis posterior
What is the strongest of the lateral collateral ligaments of the ankle?
Posterior talofibular ligament
Which of the lateral collateral ligaments of the ankle are extrasynovial but intracapsular?
Posterior talofibular ligament
Which of the extracapsular lateral collateral ligaments of the ankle are just deep to the peroneal
tendons?
CFL
Which is the shortest lateral collateral ligament of the ankle?
ATFL
A surgeon is inverting the foot with the ankle in a dorsiflexed position. The surgeon is preparing to do
a modified brostrum. Which ligament are they specifically assessing?
CFL
The proximal tibiofibular joint is best described as what type of joint?
plain synovial joint
A patient presents to the office complaining that they "rolled their ankle". X-rays reveal soft tissue
inflammation. If the patient were to have, hypothetically, inverted their foot while the foot was in
neutral position (neither dorsiflexed nor plantarflexed) on the sidewalk, which ligament would be at
stake?
