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Nonunion and Bone Defects
Posted: Jan 27 2021 #(C101706)
A

Ankle Deformity s/p Infection in 16F

HPI

A 16-year-old female with a history of prior ankle ORIF complicated by infected hardware presents for evaluation of lower limb deformity. She complains of deformity, leg length discrepancy, and pain with weight bearing.

PMH

PE

Healed medial distal tibia incision without erythema or drainage. Overall poor skin quality. Valgus and recurvatum deformity of the left ankle.

Poll
1 of 12
1. If this patient presented to your clinic, would you attempt to manage it yourself or refer to a tertiary care center?
Manage it myself
38%
290/752
Refer to orthopedic partner at your institution
21%
159/752
Refer out to a tertiary care center
35%
266/752
Outside my area of expertise - best if I don't vote
4%
37/752
2. Assuming workup for infection was negative, and the skin envelop was intact, how would you manage the patient at this time?
Nonoperative
1%
11/754
Operative
96%
727/754
Outside my area of expertise - best if I don't vote
2%
16/754
3. If you choose Operative management, what type of treatment would you choose?
I would not choose Operative management
0%
0/745
Ankle joint salvage procedure with Supramalleolar Osteotomy (SMO)
88%
656/745
Ankle arthrodesis
8%
66/745
Outside my area of expertise - best if I don't vote
3%
23/745
4. If you choose Ankle joint salvage procedure with Supramalleolar Osteotomy (SMO), would how would you correct the deformity?
I would not choose Ankle joint salvage procedure with Supramalleolar Osteotomy (SMO)
2%
20/732
Acute correction & fixation (single OR procedure)
47%
346/732
Gradual correction with ex-fix (correction program)
46%
341/732
Outside my area of expertise - best if I don't voteWide excision
3%
25/732
5. If you choose Ankle joint salvage procedure with Supramalleolar Osteotomy (SMO) and Acute correction, what fixation technique would you use?
I would not choose Ankle joint salvage procedure with SMO and Acute correction
8%
61/703
Intramedulary nail (IMN) (i.e. Antegrade tibial nail)
3%
24/703
Open reduction internal fixation (ORIF) (plate and screws)
53%
377/703
External Fixation (ExFix) (includes monoplanar, ringed circular fixation, etc.)
30%
216/703
Outside my area of expertise - best if I don't vote
3%
25/703
6. If you choose Ankle joint salvage procedure with Supramalleolar Osteotomy (SMO) and Gradual correction with External Fixation (ExFix), what type of construct would you apply?
I would not choose Gradual correction with ExFix
10%
75/689
Monolateral/monoplanar fixator
1%
13/689
Ringed circular fixation - Ilizarov technique
33%
232/689
Ringed circular fixation - Taylor Spatial frame (or equivalent)
47%
327/689
Outside my area of expertise - best if I don't vote
6%
42/689
7. If you choose Ankle joint salvage procedure with Supramalleolar Osteotomy (SMO) and Gradual correction with Ringed Circular Fixation, how would you fix the construct to the bone?
I would not choose Gradual correction with Ringed Circular Fixation
8%
55/639
Thin wires only
9%
63/639
Half pins only
2%
19/639
Both Thin wires + Half pins
71%
460/639
Outside my area of expertise - best if I don't voteWide excision
6%
42/639
8. If you choose Ankle joint salvage procedure with Supramalleolar Osteotomy (SMO) and Gradual correction with Ringed Circular Fixation, would you span the ankle with the construct?
I would not choose Gradual correction with Ringed Circular Fixation
7%
45/624
No
13%
85/624
Yes - with an articulation/hinge at the ankle
46%
292/624
Yes - rigidly (allowing no motion of the ankle)
26%
165/624
Outside my area of expertise - best if I don't voteWide excision
5%
37/624
9. If you choose Ankle joint salvage procedure with Supramalleolar Osteotomy (SMO) and Gradual correction with Ringed Circular Fixation, would you apply bone graft to the osteotomy site?
I would not choose Gradual correction with Ringed Circular Fixation
4%
30/607
No - I would not apply bone graft
38%
234/607
Yes - Allograft only (e.g. DBX/DBM)
11%
68/607
Yes - Autograft (+/- allograft)
41%
253/607
Outside my area of expertise - best if I don't vote
3%
22/607
10. If you choose to use Autograft, what type would you select?
I would not choose to use Autograft
13%
83/611
Iliac crest
64%
393/611
Reamer-irrigator-aspirator (RIA)
15%
94/611
Other
3%
22/611
Outside my area of expertise - best if I don't vote
3%
19/611
11. If you choose Ankle joint salvage procedure with Supramalleolar Osteotomy (SMO) and Gradual correction with Ringed Circular Fixation, would you supplement the osteotomy site with biologics?
I would not choose Gradual correction with Ringed Circular Fixation
4%
24/593
No
55%
328/593
Yes - rhBMP
22%
134/593
Yes - PRP
9%
56/593
Yes - Other
2%
14/593
Outside my area of expertise - best if I don't vote
6%
37/593
12. If you choose Ankle joint salvage procedure with Supramalleolar Osteotomy (SMO) and Gradual correction with Ringed Circular Fixation, would what type of weight bearing would you allow during correction?
I would not choose Gradual correction with Ringed Circular Fixation
4%
28/601
Non-weight-bearing
24%
150/601
Toe-touch/Foot-flat weight-bearing (TTWB/FFWB)
24%
149/601
Partial/protected (25-50%) weight-bearing (PWB)
28%
173/601
Full Weight Bearing (+/- Crutches)
12%
78/601
Outside my area of expertise - best if I don't vote
3%
23/601
PROCEDURE #1

Circular External Fixation Gradual Correction

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OUTCOMES
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