|
Year |
2005 |
|---|---|
|
Question Number |
205. |
|
Category |
Foot and Ankle |
Question
A previously healthy 58-year-old woman sustained a twisting injury to the ankle 3 months ago. She was diagnosed with an ankle sprain, and crutches were provided for initial care. She now reports increasing ankle pain. Examination reveals a smooth arc of ankle motion, chronic swelling around the ankle, and pain with palpation. Current radiographs are shown in Figures 73a and 73b. Management should consist of
1- ankle arthroplasty.
2- ankle fusion.
3- ankle cheilectomy.
4- open reduction and internal fixation of the malunited fracture.
5- valgus tibial osteotomy.
Figures
Answer (click for answer)
PREFERRED RESPONSE: 4
This question concerns management of a late complication of a missed fibular fracture. Some of the answers are relatively aggressive, and can be disregarded. These incuded ankle arthroplasty, and ankle fusion, both of which would be salvage procedures and are overly aggressive at this point, given that it has only been 3 month and the ankle joint does not show advanced arthritis. Ankle cheilectomy also makes little sense and would do little to correct this problem. That leaves ORIF vs. valgus tibial osteotomy. Given the fact that the patient still has pain over the fracture site and that late revision ORIF have been attempted in the past with success, this option makes the most sense and is the least aggressive option which has the potential to solve the problem. A valgus tibial osteotomy would potentially fix the deformity at the ankle, but would not address the malunion of the fibular and therefore not remove the causative agent of this process.
Reference: RECOMMENDED READINGS: Chao KH, Wu CC, Lee CH, et al: Corrective-elongation osteotomy without bone graft for old ankle fracture with residual diastasis. Foot Ankle Int 2004;25:123-127.
Weber D, Friederich NF, Muller W: Lengthening osteotomy of the fibula for post-traumatic malunion: Indications, technique and results. Int Orthop 1998;22:149-152.
Weber BG, Simpson LA: Corrective lengthening osteotomy of the fibula. Clin Orthop 1985;199:61-67.
Offierski CM, Graham JD, Hall JH, et al: Late revision of fibular malunion in ankle fractures. Clin Orthop 1982;171:145-149.
