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A 
B 
Figure 1. (A) Radiograph and (B) computed tomography scans of the left ankle of the patient described in questions 1 and 2.
Questions 1 and 2 refer to the following case.
A 13-year-old boy presents to the emergency department with left ankle pain after a fall that occurred while he was playing football. After the injury, he was unable to bear weight and ambulate on the left ankle. Physical examination reveals significant edema around the ankle and tenderness to palpation medially and laterally. Motor and sensory function is intact distally, and there are no abrasions or wounds to the skin. Plain radiographs and a computed tomography (CT) scan of the left ankle are obtained (Figure 1).
1. What is this patient’s diagnosis?
- Maisonneuve fracture
- Salter-Harris type V fracture of the distal tibia
- Thurston-Holland fracture
- Tillaux fracture
- Triplane fracture
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2. How should this patient be treated?
- Closed reduction and long leg cast
- Closed reduction and short leg cast
- Open reduction and internal fixation with a distal tibial locking plate
- Open reduction and screw fixation
- Placement of an external fixator
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Figure 2. (A) Anteroposterior and (B) lateral radiographs of the left wrist of the patient described in question 3.
3. A 7-year-old girl presents with a left wrist injury after a fall onto an outstretched hand. She undergoes closed reduction and splinting in the emergency department. At follow-up 2 weeks later, radiographs are obtained (Figure 2). Based on results of radiography, definitive management should now include which of the following?
- Accept the current reduction and convert to a long arm cast
- Assess distal-radial-ulnar joint stability and resplint in supination
- Closed reduction and intramedullary fixation
- Open reduction and internal fixation using a distal radius locking plate
- Repeat closed reduction and splinting
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Figure 3. (A) Anteroposterior and (B) lateral radiographs of the right elbow of the patient described in questions 4 and 5
Questions 4 and 5 refer to the following case.
A 6-year-old boy complains of right elbow pain after a fall from a trampoline onto his outstretched upper extremity. The patient has a gross deformity of the right elbow but is able to move his fingers without difficulty or limitation. Capillary refill to the fingers is less than 2 seconds, and the right hand is warm and supple. The radial artery pulse is difficult to palpate, and there are no open wounds associated with the injury. Anteroposterior and lateral radiographs are obtained (Figure 3).
4. How should this patient’s fracture be treated?
- Closed reduction and casting
- Closed reduction and lateral percutaneous pinning of the olecranon
- Closed reduction and lateral pinning of the
distal humerus
- Closed reduction and screw fixation of the distal humerus
- Open reduction and plating of the distal humerus
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5. What is the most common complication associated with this type of fracture?
- Chronic pain
- Cubitus varus
- Elbow stiffness
- Posttraumatic arthritis
- Radial nerve palsy
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6. A 7-year-old boy sustains a transverse mid-shaft femur fracture after a high-speed motor vehicle collision and undergoes operative management using flexible intramedullary nails without complication. Compared with casting with or without traction, which of the following is associated with the use of flexible nails?
- Higher rate of fracture malunion
- Higher rate of fracture nonunion
- Increased risk of leg length discrepancy
- Increased risk of osteonecrosis of the femoral head
- Lower rate of fracture malunion
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7. A 10-year-old boy is brought to the ED after a skateboarding injury and diagnosed with a closed mid-shaft tibia fracture. The patient receives conscious sedation and closed reduction and casting are performed. What is the acceptable alignment for this patient’s fracture?
- 0 degrees of varus, 3 degrees of sagittal deformity, and 2 cm of shortening
- 0 degrees of varus, 10 degrees of sagittal deformity, and 1 cm of shortening
- 5 degrees of valgus, 3 degrees of sagittal deformity, and 1 cm of shortening
- 5 degrees of valgus, 10 degrees of sagittal deformity and 0 cm of shortening
- 10 degrees of varus, 3 degrees sagittal deformity, and 2 cm of shortening
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