ABFAS Clinical Procedures and Protocols 3 — Questions and Answers
Question 1: When performing a subtalar joint arthroereisis for pediatric flatfoot, where is the implant placed?
- Talonavicular joint
- Sinus tarsi (Correct answer)
- Calcaneocuboid joint
- Spring ligament
Correct answer: Sinus tarsi
The arthroereisis implant is inserted into the sinus tarsi to mechanically block excessive pronation and subtalar joint eversion.
Question 2: Which principle governs the appropriate level of Kirschner wire placement when treating an unstable fifth metatarsal base fracture (Jones fracture) with intramedullary screw fixation?
- The screw should cross the fracture site by at least 2 cortices
- The screw tip must engage the fourth metatarsal
- The screw should be placed along the long axis of the metatarsal shaft (Correct answer)
- The screw head must be countersunk below the cortex
Correct answer: The screw should be placed along the long axis of the metatarsal shaft
Intramedullary screw fixation of Jones fractures requires placement along the medullary canal axis of the fifth metatarsal for optimal purchase.
Question 3: A patient presents with a recurrent ingrown toenail. Which procedure provides the most definitive long-term resolution?
- Partial nail avulsion with phenol matrixectomy (Correct answer)
- Total nail avulsion alone
- Winograd procedure
- Zadek procedure
Correct answer: Partial nail avulsion with phenol matrixectomy
Partial nail avulsion followed by phenol matrixectomy destroys the germinal matrix of the offending nail border, providing the highest success rate for permanent correction.
Question 4: During calcaneal osteotomy for cavovarus foot correction, which direction is the calcaneus translated to reduce lateral column overload?
- Medially
- Laterally (Correct answer)
- Anteriorly
- Posteriorly
Correct answer: Laterally
In cavovarus correction, the calcaneus is shifted laterally to reduce varus heel alignment and redistribute plantar pressure.
Question 5: What is the recommended tourniquet inflation pressure for an ankle tourniquet in an adult patient with a systolic blood pressure of 120 mmHg?
- 100 mmHg
- 150 mmHg
- 250 mmHg (Correct answer)
- 350 mmHg
Correct answer: 250 mmHg
Ankle tourniquet pressure is typically set at 250 mmHg or approximately twice the systolic blood pressure to achieve hemostasis.
Question 6: Which classification system is most commonly used to stage osteochondral defects of the talus?
- Sanders classification
- Berndt and Harty classification (Correct answer)
- Essex-Lopresti classification
- Hawkins classification
Correct answer: Berndt and Harty classification
The Berndt and Harty classification stages talar osteochondral lesions from I (compression) through IV (displaced fragment) based on radiographic appearance.
Question 7: In first metatarsophalangeal joint arthrodesis, what is the recommended position for fusion in the sagittal plane?
- 0 degrees (neutral)
- 5–10 degrees of dorsiflexion
- 15–20 degrees of dorsiflexion (Correct answer)
- 30 degrees of dorsiflexion
Correct answer: 15–20 degrees of dorsiflexion
The first MTP joint is fused at 15–20 degrees of dorsiflexion relative to the ground to permit normal toe-off during gait.
ABFAS Clinical Procedures and Protocols 3
When performing a subtalar joint arthroereisis for pediatric flatfoot, where is the implant placed?