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Ankle Arthritis
Posted: Sep 21 2015 #(C2372)
A

Ankle Arthritis s/p Ankle Fx ORIF in 52M

HPI

Ankle fracture fixed 4 years prior. Global ankle pain and profound stiffness. Bone scan and CT scan rule out osteomyelitis.

PMH

No history of diabetes, PVD

PE

LLE - gross deformity, antalgic gait, intact skin w/o changes, TTP globally about ankle, NVID w/ SILT and W/WP foot

Poll
1 of 8
1. In addition to plain film radiographs, would you obtain any other imaging to guide management?
No - current radiographs are sufficient
27%
234/866
Yes - additional radiographic views (XR)
2%
22/866
Yes - CT scan of the leg/ankle (CT)
53%
465/866
Yes - MRI scan of the leg/ankle (MRI)
5%
44/866
Yes - CR + XR
2%
18/866
Yes - MRI + XR
0%
6/866
Yes - MRI + CT
4%
43/866
Yes - MRI + CT + XR
2%
18/866
Outside my area of expertise - best if I don't vote
1%
16/866
2. Would you obtain any additional infection work-up?
No - this would not affect my management
12%
132/1033
Serum labs (CBC, ESR, CRP) only
42%
443/1033
Aspirate (gram stain, cell count, etc.) only
6%
68/1033
Open biopsy (gram stain, cultures) only
5%
58/1033
Serum labs + Aspirate
17%
184/1033
Serum labs + Open biopsy
4%
51/1033
Aspirate + Open biopsy
0%
10/1033
Serum labs + Aspirate + Open biopsy
7%
79/1033
Outside my area of expertise - best if I don't vote
0%
8/1033
3. How would you manage this patient?
Nonoperative (injections, physical therapy, activity modification, NSAIDs, etc.)
2%
21/820
Operative
95%
782/820
Outside my area of expertise - best if I don't vote
2%
17/820
4. If you choose Operative management, in addition to possible hardware removal (HWR) what surgery would you perform?
I would not choose Operative management
0%
1/824
I would perform HWR only
3%
27/824
Revision ORIF
3%
31/824
Arthrodesis
84%
699/824
Arthroplasty
5%
45/824
Amputation
0%
4/824
Outside my area of expertise - best if I don't vote
2%
17/824
5. If you choose Arthrodesis, what type would you perform?
I would not choose Arthrodesis
1%
10/794
Tibiotalar (TT)
39%
310/794
Tibiotalocalcaneal (TTC)
55%
444/794
Other
0%
6/794
Outside my area of expertise - best if I don't vote
3%
24/794
6. If you choose Tibiotalocalcaneal (TTC) Arthrodesis, what implant(s) would you use?
I would not choose TTC Arthrodesis
8%
68/756
External fixation only (includes monoplanar, ringed circular fixation, etc.) (Includes limited internal fixation)
5%
45/756
Percutaneous fixation (screws) only
3%
27/756
Plate and screws
12%
94/756
Intramedullary nail (IMN)
65%
493/756
Outside my area of expertise - best if I don't vote
3%
29/756
7. If you choose Tibiotalocalcaneal (TTC) Arthrodesis, would you prepare the tibiotalar and/or subtalar joints?
I would not choose TTC Arthrodesis
5%
42/733
No - I would not prepare either joint
3%
26/733
Yes - Subtalar joint only
2%
19/733
Yes - Tibiotalar joint only
11%
81/733
Yes - Tibiotalar + Subtalar joints
73%
537/733
Outside my area of expertise - best if I don't vote
3%
28/733
8. If you choose Operative Management and attained the construct shown, what would your immediate post-operative weight-bearing status be?
I would not choose Operative management
0%
3/712
Non-weight-bearing (NWB)
41%
293/712
Toe-touch/Foot-flat weight-bearing (TTWB/FFWB)
19%
136/712
Partial/protected (25-50%) weight-bearing (PWB)
20%
148/712
Weight-bearing as tolerated (WBAT)
17%
122/712
Outside my area of expertise - best if I don't vote
1%
10/712
PROCEDURE #1 DOP: 9/22/2015

1 time surgery: Removal of broken anterior plate. Medial malleolus screws and removal of distal third of fibula with its plate. Tibio talo calcaneous fusion with a retrograde nailing.

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OUTCOMES
Post-procedure P1
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