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

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Feb 13, 2023 166 likes •225 views

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

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5/8/2014 1

Inman-Abbott UNIVERSITY OF CALIFORNIA, SAN FRANCISCO

May 8, 2014

Case Presentations

50 yo M with DM II, peripheral neuropathy, twisted his left

ankle in July 2011

He presented to OSH 2 weeks after injury. He had continued

“instability” in his left ankle but had minimal pain

External Fixation + ORIF fibula and syndemosis

(3 wks after injury)

Intraoperative Findings

Healing callus present Rotation deformity and

shortening of fibula

Treatment Approaches?

External fixation + limited

ORIF

ORIF of fibula and tibia Nonoperative

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5/8/2014 2

Perioperative Considerations

Complicated DM and healing Bone quality and fixation Delayed presentation with

deformity and bone loss

Postoperative Protocol

Timing for ROH ± ORIF tibia? Duration of NWB?

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5/8/2014 3

Clinic Visit

Lateral wound cellulitis and

purulent drainage

Hardware failure and loss of

reduction

Treatment Goals

Eradication of infection Stable, plantigrade foot

Treatment Options

Limb salvage Revision ORIF Ring fixation Amputation

Operative Procedure

Fibular osteotomy Ilizarov circular

external fixator

Open reduction of

distal tibia

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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

Plantigrade foot Tibiotalar ROM: 7° DF, 15° PF Subtalar ROM: 10° inversion and eversion