First ray surgery

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QUESTION 1 OF 7

A 46-year-old man presents with pain in the right 1st metatarsal phalangeal joint (MTPJ). He recalls a rugby injury to the joint 20 years ago. On examination he has moderate pain on end range of motion, reduced range of motion (10o dorsiflexion, 50o plantar flexion) and pain on axial loading of the 1st MTPJ. Radiographs demonstrate around 40% joint space narrowing with dorsal osteophyte on the metatarsal and phalanx.  He has failed conservative treatment and still wishes to play rugby. What is the most appropriate treatment?

QUESTION ID: 49

1. A. Dorsal cheilectomy
2. B. Keller’s procedure
3. C. MTPJ arthrodesis
4. D. MTPJ arthroplasty
5. E. Synovectomy
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QUESTION 2 OF 7

In an otherwise normally aligned foot when performing a scarf osteotomy, to avoid shortening or lengthening the first metatarsal what landmark or reference point should be used for your distal transverse cut?

QUESTION ID: 50

1. A. Parallel to proximal phalanx base joint surface
2. B. Parallel with the 5th metatarsal phalangeal (MTP) joint
3. C. Perpendicular to 1st metatarsal
4. D. Perpendicular to 2nd metatarsal
5. E. Perpendicular to cut surface after removing medial eminence
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QUESTION 3 OF 7

This 56 year old fit an healthy builder presents to clinic with painful lesser MTPJ, distal plantar metatarsal callosities and a painful hallux rigidus.
What is the most appropriate surgical option?

Foot ankle LR .png

QUESTION ID: 1236

1. 1st metatarsalphalangeal arthrodesis of 1st metatarsal and distal metatarsal osteotomies to lesser metatarsals
2. Distraction arthrodesis of 1st metatarsal and distal metatarsal osteotomies to lesser metatarsals
3. Interposition arthroplasty of 1st metatarsal and proximal oblique elevating osteotomy (BRT) to lesser metatarsals
4. Keller’s excision arthroplasty and lesser metatarsal head resections
5. Lengthening osteotomy of 1st metatarsal +/- distal metatarsal osteotomies to lesser metatarsals
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QUESTION 4 OF 7

A 52 year old male attend your clinic with end stage osteoarthritis of the 1st metatarsophalangeal joint. He still works as a labourer.
What would be your preferred surgical treatment?

QUESTION ID: 1324

1. Arthrodesis
2. Ceramic replacement
3. Cheilectomy
4. Moberg osteotomy
5. Silastic replacement
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QUESTION 5 OF 7

What force on the proximal phalanx is created by the abductor hallucis in a hallux valgus deformity?

QUESTION ID: 1325

1. Adduction
2. Adduction and supination
3. Dorsiflexion and pronation
4. Plantar flexion
5. Pronation and plantar flexion
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QUESTION 6 OF 7

93.A patient presents to you with a Hallux Valgus deformity with HVA of 35 degrees and IMA of 12 degrees. Operative treatment is undertaken. During the surgical approach, an osteotomy is performed. On follow up, it is noted that the metatarsal head has undergone avascular necrosis.
What factor is most likely to cause iatrogenic avascular necrosis?

QUESTION ID: 3291

1. Akin osteotomy
2. Distal short Chevron osteotomy
3. Proximal dome osteotomy
4. Scarf osteotomy
5. Single medial incision
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QUESTION 7 OF 7

94.What is true of posterior malleolar fractures of the ankle?

QUESTION ID: 3292

1. All posterior malleolar fractures should be fixed through a posterolateral approach.
2. Morphology of fracture determines functional outcome in fixed posterior malleolar fractures.
3. Percentage of joint involved should dictate surgical treatment.
4. Plain radiographs are accurate at estimation of the size of the posterior malleolar fracture fragment.
5. Posterior malleolar fracture fixation negates the need for syndesmosis fixation.
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