Andrew Haskell, MD Approved by PAMF IRB Palo Alto Medical - PowerPoint PPT Presentation

5/10/2013 Novel Ankle Fusion Technique Novel Ankle Fusion Technique Through Medial Malleolar Through Medial Malleolar Nonunion Nonunion I have no conflicts for this presentation Andrew Haskell, MD Approved by PAMF IRB Palo Alto Medical Foundation / UCSF Palo Alto Medical Foundation / UCSF Peninsula Orthopaedic Ankle Surgeons Peninsula Orthopaedic Ankle Surgeons Ankle DJD & Surgical Goals for Ankle Surgery Medial Malleolar Nonunion • Must have a ... Post-traumatic Charcot Arthropathy – STABLE PAINLESS – PLANTIGRADE FOOT – • but we would ALSO like to... – MAINTAIN MOTION – NORMALIZE GAIT – PROTECT SURROUNDING JOINTS 1

5/10/2013 Why Are Medial Malleolar Why Are Medial Malleolar Non-unions a Problem? Non-unions a Problem? • Standard screw techniques rely on intact • Retrocalcaneal nail sacrifices the subtalar joint medial buttress for stability • Total ankle replacement needs intact medial malleolus Bad Good Methods Why a Medial Based Approach? • Retrospective chart review • 42 sequential ankle/hindfoot fusion cases • Approach via the nonunion • January 2006 - December 2008 • Does not rely on medial • Inclusion buttress • intention to fuse ankle through a medial approach • Preserves the subtalar joint • Data collection Demographics • • Can use bone for graft Success of fusion • Subjective improvement & motion • Need for further surgery • 2

5/10/2013 Technique Results • Medial approach • Joint preparation • 4 fusions using a medial approach identified • 4 male • Wire in center of talus • Average age 61 • wire parallel to plantigrade foot • use plate as guide • Etiology • 3 Charcot • Impact blade into talus • 1 post-traumatic • Compress if possible • Secure plate to tibia Results Results • 4 (100%) of 4 fused using medial approach • Average time to ambulation 3.3 months • 2 ICBG • Charcot braced 6+ months • 1 required conversion to tib-talo-calcaneal fusion after • No additional procedures required intraoperative talus fracture Case 2: Charcot ankle fracture Case 1: Post-traumatic nonunion 3

5/10/2013 Results Literature - Ankle Fusion • 4 of 4 report improvement in pain & stability Study Method # Pts F/U Fusion Outcome • 2 of 4 require walking aid Rate • Subtalar joint motion rated fair to normal Mann Open 81 1-6 yr 88% AOFAS 1996 41 -> 74 Myerson Mini-open 15 1 yr 100% AOFAS 1996 43-> 82 Winson Scope 118 5 yr 92% 79% 2005 good/exc Ferkel Scope 35 6 yr 97% 74% 2005 good/exc Case 3: Charcot ankle nonunion Literature - Medial Approach Future Directions • Medial malleolar osteotomy • Locked Plates • Union 12 (92%) of 13 Schuberth, J Foot Ankle Surg, 2005 Anterior Medial 4

5/10/2013 Future Directions Thank You • Primary Fusion? Palo Alto Medical Foundation / UCSF Peninsula Orthopaedic Ankle Surgeons 5