Review Question - QID 215426

Figure A is the radiograph of a 55-year-old female who is a poorly-controlled diabetic with neuropathy and peripheral vascular disease (PVD) that underwent ankle open reduction internal fixation (ORIF) two years ago at an outside facility. She was noncompliant with her immediate postoperative weight-bearing instructions and went on to fixation failure. She subsequently underwent revision ORIF with bone grafting soon after as seen in Figure B. One year ago, she underwent hardware removal secondary to irritation. Current radiographs are seen in Figure C. She complains of continued pain in the ankle which is not manageable with non-surgical treatments and would like to proceed with surgical treatment. She asks if limb salvage is an option for her. Which surgery is most indicated at this time?