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 Отправлено Emal Wardak 13 Январь 2009, 21:36
hello there
i have a patient 17 years of age, with post traumatic ankle joint dislocation,
he has walked with dislocation for 6 years now and has this deformity,, can some body suggest what would be the appropriate name to describe it, and treatment options
May Almighty bless us all
Dr Emal Wardak
Orthopaedic Surgeon
Kabul
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Re: ankle deformity
T. I. George 13 Январь 2009, 21:44
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Dr Emal,
Are you sure it is a post traumatic problem or are there any clinical signs of any neurologic problems? Any evidence to say that it could be a neuropathic problem?
In any case this young person has walked on it during the growing stage which has brought in changes. What are the clinical problems? Pain, instability, shortening, cosmetic problems etc? We have to be sure that we are not going to restore normalcy but are going to do a salvage procedure which may address his clinical problems. So it is important to know the clinical problems and patient's expectations to plan salvage procedure so that the treatment can address patient's demands and not radiological and clinical pictures.
Dr. T. I. George,
(Dr George T Ittoop),
Sr Specialist, Orthopaedics,
Ibra Regional Hospital,
PO Box no: 3,
Postal code 413.
North Sharquia Region,
Sultanate of Oman.
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Re: ankle deformity
Отправитель: Emal Wardak 14 Январь 2009, 23:23
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Dear Dr. George.
yes its 100% post traumatic, there is no neurologic deficit, or any sign of weakness, or infection, the history as father tells, the guy
had felt from horse and then he was taken to local bone setter at that time, and the ankle was fixed for onemonth, after they opened they saw the foot was facing out side, and the guy started to walk on it, without any pain, they have come from village for two reasons, one cosmetic second he is having slight limping due to around 2cm of true shortening but no pain.
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Re: ankle deformity
Отправитель: T.I.George 14 Январь 2009, 23:25
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Dr Emal,
Thanks for the info.
My impression is that whatever procedure we undertake will be of salvage nature. Options according to me are:
1) Acute correction with further shortening and arthrodesis of the affected joints, (You can consider a lengthening at some stage)
2) Gradual correction with a frame and lengthening along with arthrodesis.
The questions are, will these address patient's problems?
1) Cosmetic appearence - yes but it may not look absolutely normal.
2) Limping - may not address fully.
3) Shortening - can be addressed but some shortening may be desirable in view of the requirement for arthrodesis.
Now you have to face the big question. Do the patient and his relative understand all these and are they prepared for the expected result at the end of treatment? ( From what you say they come from a village background and may not comprehend the full problems).
Do keep us informed on what is done and the follow up. Good case for academic discussion but difficult one to tackle.
Best of luck.
Dr. T. I. George,
(Dr George T Ittoop)
Sr Specialist, Orthopaedics,
Ibra Regional Hospital,
PO Box no: 3,
Postal code 413.
North Sharquia Region,
Sultanate of Oman.
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Re: ankle deformity
Bruce Sangeorzan 13 Январь 2009, 21:46
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Do you have xrays of the ankle? a CT?
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Re: ankle deformity
Alexander Chelnokov 13 Январь 2009, 21:47
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Dear Emal
Looks like neglected subtalar foot dislocation. AP view of the ankle will help.
Good case for the tibia-foot frame and gradual reduction.
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Re: ankle deformity
Lev Lapidus 14 Январь 2009, 21:20
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Dear Dr Wardak
According to clinical picture and x-rays, I think that your patient has next problems- severe calcaneo-valgus deformity of the foot,
shortening of his leg, subtalar or ankle dislocation(?) and severe deformity of the distal end of tibia and fibula. In such case the reasonable solution will be - pantalar arthrodesis and lengthening of the leg.
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Re: ankle deformity
A. Liberson 15 Январь 2009, 21:47
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I would not rely on fathers story completely.
This may be an old dislocation, but I would also concider other possibilities. A gradual correction following good neurological and CTexamination or one step are the possibilities.
I agree that we have to get p-nts and his family understanding of the problems and understanding of each of the processess befor starting the
tretment.
I myself feel comfortable with gradual Ilizarov in such a case-every other technique would be appropriate.
An arthrodesis with later elongation will also do.
Good luck!
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