ABFAS PEDIATRIC HIGH YIELD EXAM | QUESTIONS & ANSWERS (VERIFIED) | LATEST UPDATE | GRADED A+

1 ABFAS PEDIATRIC HIGH YIELD EXAM | QUESTIONS & ANSWERS (VERIFIED) | LATEST UPDATE | GRADED A+ Which XRAY view is the most accurate judge of a clubfoot correction Correct Answer: Lateral stress dorsiflexion view Club foot posterior release, which structures are released Correct Answer: - inferior/posterior achilles - FHL sheath - ankle and STJ capsule - calcaneao-fibular ligament - posterior talofibular ligaments - *superficial part of the deltoid ligament (talotibial)* - Lengthen FDL to precent claw toe Surgical treatment of club roof after 3 months of failed conservative care Correct Answer: posterior release posterior medial release plantar release subtalar release 2 met adductus procedure tendon transfer Failure of the calcaneus to ________ is evidence of incomplete subtalar correction Correct Answer: dorsiflex If met adductus present in club foot deformity, what is the treatment choice Correct Answer: HHS: Release of all soft tissue structures at Lisfranc joint except lateral and plantar lateral ligaments Club foot posterior MEDIAL STJ release, which structures are released Correct Answer: - isolate posterior tibial muscle, FHL, FDL , medial achilles band, neurovacualr structures - Loosen abductor hallucinations from medial calcaneal tuberosity - release the master knot of Henry Club foot medial foot release, which structures are released Correct Answer: - posterior tibial muscle sectioned - resect spring ligament - resect superficial part of deltoid ligament 3 Club foot plantar release, which structures are released Correct Answer: - incise plantar fascia - incise first layer of intrinsics - incise long plantar ligament Club foot STJ release, which structures are released Correct Answer: interosseous TC ligament bifurcate ligament All resected tendons should be repaired in CLUB foot correction EXCEPT Correct Answer: Posterior tibial tendon Complication in club foot serial casting when the equines is corrected before the virus component Correct Answer: rocker bottom foot Surgical treatment for club foot after the child is 4 years old Correct Answer: - lateral closing wedge of cuboid/CC - dwyer calcanceal osteotomy - triple arthrodesis XR view for calcaneal-navicular coalitions 4 Correct Answer: Medial oblique XR view for talo-calcaneal coalitions Correct Answer: Lateral, Harris-Beath, and Isherwood views What is the most common cause of peroneal spastic flatfoot. Correct Answer: tarsal coalitions Most common complication following PRE-axial polydactyly repair Correct Answer: Hallux varus What is the most common hyper/poly/dactyly variant and denotes lateral digital duplication Correct Answer: Postaxial polydactyly Preaxial polydactyly is applied to _______ digital duplication Correct Answer: MEDIAL digital duplication What is the least common polydactyly and involves duplication of the inner most digits, most often the second toe Correct Answer: Central polydactyly common complication following CENTRAL-axial polydactyly repair 5 Correct Answer: forefoot splaying Most common tarsal coalitions Correct Answer: Talocalcaneal, middle facet Calcaneal-navicular Two extra-articular tarsal coalitions Correct Answer: Calcanealnavicular Cuboid-navicular In the older patient with a calcaneonavicular coalition and minimal secondary changes (adult IA coalition); treatment choice? Correct Answer: extensor digitorum brevis arthroplasty. Immature patient with an incomplete CN coalition, treatment choice? Correct Answer: extensor digitorum brevis arthroplasty. When resection of the calcaneonavicular bar has failed, or when significant arthritic changes are present (i.e., juvenile IB, adult IB), what is the next best treatment option? Correct Answer: triple arthrodesis intra-articular coalitions are traditionally considered an indication for __________ Correct Answer: arthrodesis 6 In treating middle facet talocalcaneal coalitions, what is the most popular surgical approach in the literature? Correct Answer: medial resection of the coalition with subsequent interposition of autogenous fat into the defect." In the older patient with a talocalcaneal coalition and minimal secondary arthritic changes (adult IIA), _______ is usually the preferred approach Correct Answer: arthrodesis (triple) Pathognomonic XR features of talocalcaneal coalition Correct Answer: - talar beak sign - halo "C" sign What has been been shown to be the most sensitive and specific radiographic sign of a STJ coalition? Correct Answer: halo "C" sign C-shaped line formed by the medial outline of the talar dome and the inferior outline of the sustentaculum tali Talocalcaneal coalition fuse _____-_____ Correct Answer: 12-16 yo 7 CN coalition fuse ____ - ____ Correct Answer: 8-12 yo Best diagnostic image study for tarsal coalition? Correct Answer: CT Calcaneonavicular bar resection contraindications: Correct Answer: - presence of degenerative changes in the talonavicular joint with accompanying talar beaking - complete ossification of the bar - second coalition between the talus and calcaneus. Associated conditions: Tarsal coalitions have been reported to be associated with: Correct Answer: Phocomelia Hemimelia Nievergelt-Pearlman syndrome Arthrogryposis multiplex congenita Which flat foot recon procedure can unmask a previously unappreciated metatarsus adductus 8 Correct Answer: EVANS lateral column lengthening A 14-year-old male child presents with the increasing CAVUS foot deformity. On physical exam, it is noted that he is unable to walk on his heels and has decreased Achilles reflexes bilaterally. Coleman block testing reveals *correctable hindfoot deformity*. Which procedure is associated with improved clinical outcomes in patients with the above described condition? Correct Answer: posterior tibial tendon retains its strength in CMT and can aid in decreasing hindfoot varus while providing ankle dorsiflexion when transferred to the dorsum of the foot. Best image view to distinguish between oblique vs vertical talus Correct Answer: forced LATERAL (stressed) plantarflexion radiograph Progressive bilateral cavovarus are the most common foot deformity in patients with Correct Answer: Hereditary sensory motor neuropathy (CMT) Ped ankle fracture, ipsilateral fibular epiphysiodesis inidcation Correct Answer: physeal bar of >50% physeal involvement in a patient with at least 2 years of growth, prevents various deformity The corrective foot orthosis for CAVUS deformity (if flexible on examination) would include 9 Correct Answer: *lateral heel posting (ie, wedge)* to shift the heel into a more neutral position and *lateral forefoot posting* to elevate the lateral border of the foot and accommodate and neutralize the varus-producing effects of the fixed plantar flexion of the first ray. What structural biomolecular compound is defective in osteogenesis imperfecta Correct Answer: type 1 (ONE) collagen 23-year-old woman with a history of bilateral recurrent ankle sprains, progressive cavovarus feet, and a family history of high arches and foot deformities is seen for evaluation. Management consisting of bracing and physical therapy has been poorly tolerated. *Heel varus is partially corrected with a Coleman block*. There are thick *calluses under the first metatarsal heads.* Correct Answer: Peroneus longus to brevis transfer first metatarsal cuneiform dorsal closing wedge osteotomy lateralizing calcaneal osteotomy with proximal translation Congenital calcaneovalgus foot is associated with ___________ bowing of the tibia. Correct Answer: posteromedial 10 What is the preferred treatment for newly diagnosed irreducible congenital vertical talus in a toddler? Correct Answer: Casting followed by open reduction and Achillies lengthening Tarsal coalitions are the result of an embryological failure of mesenchymal ____________ between tarsal bones. Correct Answer: segmentation In patients with vertical talus, which ligament is CONTRACTED? Correct Answer: tibionavicular ligament is contracted In patients with vertical talus, which ligament is ELONGATED? Correct Answer: Calcaneonavicular (spring) ligament is elongated Ball-and-socket ankle, which can be associated with Correct Answer: fibular hemimelia. What happens when treating equinus is corrected before heel varus and forefoot pronation (ponseti for clubfoot) Correct Answer: rocker-bottom deformity The three most common errors when performing ponsetti technique Correct Answer: pronation of the foot 11 external rotation of the foot with the calcaneus in varus, abducting the forefoot through the midtarsal joints. Key features of Ponseti casting include Correct Answer: forefoot supinated, applying lateral pressure to the talar neck only, weekly long leg casts, percutaneous achilles tenotomy before final cast application to address any residual equinus deformity. What has been associated with the greatest risk of premature physeal closure (ped ankle fracture)? Correct Answer: Residual gap after closed reduction Which ped ankle fractures have the highest rate of growth disturbance? Correct Answer: medial malleolus SH IV Distal fibular arrest results in ankle ______ deformity (PED ankle fx) Correct Answer: valgus Medial distal tibia arrest results in ________ deformity (Ped ankle fx) Correct Answer: varus 12 Fibular epiphysiodesis helps prevent _______ deformity Correct Answer: varus Physeal fractures of the distal tibia are fairly common injuries. Interposition of periosteum and other soft tissues is occasionally responsible for creating a block to reduction in these injuries. The periosteum becomes entrapped at the ________ side of the injury. Correct Answer: TENSION Which structure is the primary restraint to lateral displacement of talus? Correct Answer: deltoid ligament