DPM Surgical Interventions & Procedures 3 — Questions and Answers
Question 1: Which structure is at greatest risk of injury during a fibular osteotomy for ankle fracture fixation?
- Anterior talofibular ligament
- Sural nerve and peroneal tendons (Correct answer)
- Posterior tibial artery
- Saphenous nerve
Correct answer: Sural nerve and peroneal tendons
The sural nerve and peroneal tendons are in close proximity to the fibula along its posterior and lateral borders, placing them at risk during fibular osteotomies.
Question 2: A Cotton osteotomy is used primarily to correct which deformity in flatfoot reconstruction?
- Hindfoot valgus
- Forefoot supination (dorsal opening wedge of medial cuneiform) (Correct answer)
- First ray hypermobility
- Calcaneal pitch reduction
Correct answer: Forefoot supination (dorsal opening wedge of medial cuneiform)
The Cotton osteotomy is a dorsal opening wedge osteotomy of the medial cuneiform that corrects forefoot supination in adult acquired flatfoot deformity.
Question 3: What is the most common complication of digital arthroplasty (Keller procedure) for hallux rigidus?
- Avascular necrosis of the first metatarsal head
- Transfer metatarsalgia and floppy hallux (Correct answer)
- Recurrence of hallux valgus
- Sural nerve entrapment
Correct answer: Transfer metatarsalgia and floppy hallux
Resection of the proximal phalanx base in the Keller procedure disrupts the windlass mechanism and intrinsic muscle attachments, commonly causing transfer metatarsalgia and a floppy, unstable hallux.
Question 4: During a tarsal tunnel release, which structure forms the roof of the tarsal tunnel?
- Plantar fascia
- Flexor retinaculum (laciniate ligament) (Correct answer)
- Spring ligament
- Inferior extensor retinaculum
Correct answer: Flexor retinaculum (laciniate ligament)
The flexor retinaculum, also called the laciniate ligament, forms the fibrous roof of the tarsal tunnel that is released to decompress the posterior tibial nerve.
Question 5: Which osteotomy is indicated to correct isolated hallux valgus interphalangeus (HVI) deformity?
- Austin/chevron osteotomy
- Akin osteotomy (medial closing wedge proximal phalangeal osteotomy) (Correct answer)
- Lapidus arthrodesis
- Scarf osteotomy
Correct answer: Akin osteotomy (medial closing wedge proximal phalangeal osteotomy)
The Akin osteotomy removes a medial closing wedge from the proximal phalanx to correct valgus deformity that occurs at the interphalangeal joint of the hallux.
Question 6: In the Evans calcaneal osteotomy for flatfoot correction, the osteotomy is placed approximately how far from the posterior calcaneal facet?
- 5 mm
- 1.5 cm (Correct answer)
- 3 cm
- 4.5 cm
Correct answer: 1.5 cm
The Evans osteotomy is placed approximately 1.5 cm anterior to the posterior facet of the subtalar joint to allow lateral column lengthening without violating the joint.
Question 7: Which tendon transfer is most commonly used to correct a flexible dropfoot deformity in podiatric surgery?
- Peroneus longus to dorsum
- Posterior tibialis tendon transfer through the interosseous membrane (Correct answer)
- Extensor hallucis longus to calcaneus
- Flexor digitorum longus to dorsum
Correct answer: Posterior tibialis tendon transfer through the interosseous membrane
Transfer of the posterior tibialis tendon through the interosseous membrane to the dorsum of the foot restores active dorsiflexion in flexible dropfoot.
DPM Surgical Interventions & Procedures 3
Which structure is at greatest risk of injury during a fibular osteotomy for ankle fracture fixation?