Case Presentations 50 yo M with DM II, peripheral neuropathy, - PowerPoint PPT Presentation

5/8/2014 Case Presentations � 50 yo M with DM II, peripheral neuropathy, twisted his left ankle in July 2011 Inman-Abbott � He presented to OSH 2 weeks after injury. He had continued UNIVERSITY OF CALIFORNIA, SAN FRANCISCO “instability” in his left ankle but had minimal pain May 8, 2014 External Fixation + ORIF Treatment Approaches? fibula and syndemosis � External fixation + limited (3 wks after injury) ORIF � ORIF of fibula and tibia Intraoperative Findings � Healing callus present � Nonoperative � Rotation deformity and shortening of fibula 1

5/8/2014 � Timing for ROH ± ORIF tibia? Perioperative Considerations Postoperative Protocol � Complicated DM and healing � Bone quality and fixation � Duration of NWB? � Delayed presentation with deformity and bone loss 2

5/8/2014 Clinic Visit � Lateral wound cellulitis and purulent drainage � Hardware failure and loss of reduction Treatment Goals Operative Procedure � Eradication of infection � Fibular osteotomy � Stable, plantigrade foot � Ilizarov circular external fixator Treatment Options � Open reduction of distal tibia � Limb salvage � Revision ORIF � Ring fixation � Amputation 3

5/8/2014 He is quite happy with his function. � Currently walks 1 mile/day, plans to increase to 2 miles/day, return to golf � No instability � Occasional soreness and swelling Physical Exam � Tibiotalar ROM: 7 ° DF, 15 ° PF � Plantigrade foot � Subtalar ROM: 10 ° inversion and eversion 4

5/8/2014 Complications related to DM � Loss of protective sensation and Charcot arthropathy � Impaired healing � Infection Treatment Principles � Control of infection � Stable plantigrade foot 5