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Review Question - QID 8054

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QID 8054 (Type "8054" in App Search)
Figures 32a and 32b are the radiographs of a 34-year-old woman who has a painful ankle following an attempted fusion of her ankle 6 months ago. Infection work-up was negative. The subtalar joint is pain free with manipulation. What is the most appropriate treatment?
  • A
  • B

Removal of hardware and an intramedullary rod tibiocalcaneal fusion

6%

53/873

Bone grafting of the nonunion

2%

19/873

Use of an external bone stimulator

2%

16/873

Removal of the plate and screws and the addition of an internal bone stimulator

1%

9/873

Revision fusion with stable compression fixation and bone graft

87%

761/873

  • A
  • B

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Because the subtalar joint looks normal, and there is enough talus to work with, the subtalar joint should be spared and only an ankle fusion performed, especially in view of the patient's young age. There is clearly a distraction at the fusion site and the distal fixation is loose. The patient needs a formal revision with a transfibular approach with compression screws. A simple bone grafting, removal of hardware, and/or a bone stimulator will not be sufficient.

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