Ankle injuries: practice question

A Orthopaedics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Orthopaedics · Ankle injuries

Sample item

A man twists his ankle and the radiograph shows a fibular fracture proximal to the syndesmosis with widening of the medial clear space and a positive stress view. What is the likely treatment, and why?

AOperative fixation, since the syndesmosis and the ankle mortise are unstableBCompression bandage onlyCExcision of the distal fibulaDBelow-knee cast and early weight bearing, since all fibular fractures are stable

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Operative fixation, since the syndesmosis and the ankle mortise are unstable

A Weber type C fracture lies above the syndesmosis, with disruption of the tibiofibular ligaments and often the deltoid ligament, so the mortise is unstable. It is usually treated by fixation of the fibula with syndesmotic stabilisation, as anatomical congruence prevents post-traumatic arthritis.

Option by option

A. Operative fixation, since the syndesmosis and the ankle mortise are unstable (correct)
Correct. Instability of the mortise calls for surgical stabilisation.
B. Compression bandage only
A bandage cannot control an unstable mortise.
C. Excision of the distal fibula
Excising the fibula would destabilise the ankle.
D. Below-knee cast and early weight bearing, since all fibular fractures are stable
A cast is acceptable only for stable injuries with an intact syndesmosis and mortise.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is A, Operative fixation, since the syndesmosis and the ankle mortise are unstable. A Weber type C fracture lies above the syndesmosis, with disruption of the tibiofibular ligaments and often the deltoid ligament, so the mortise is unstable.

Why is "Compression bandage only" not the answer?

A bandage cannot control an unstable mortise.

Why is "Excision of the distal fibula" not the answer?

Excising the fibula would destabilise the ankle.

Why is "Below-knee cast and early weight bearing, since all fibular fractures…" not the answer?

A cast is acceptable only for stable injuries with an intact syndesmosis and mortise.

What concept does this question test?

It tests Ankle injuries in Orthopaedics. It is usually treated by fixation of the fibula with syndesmotic stabilisation, as anatomical congruence prevents post-traumatic arthritis.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Ankle injuries?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.