Orthopedic Medicine and Surgery
(858) 300-0487
Case 1: Infected Non-unions
A 52 year old woman from Georgia who sustained an open fracture/dislocation of her right ankle in 2008, failing her initial treatment with plates, screws and bone grafts. One year later, she presented to our Musculoskeletal Sepsis Center http://www.osteomyelitis.com/about in San Diego with persistent sepsis, mal-alignment and a soft tissue deficit. Here, definitive treatment included 1) a radical bone and soft tissue debridement /external fixation /shortening to achieve coverage; 2) an ankle fusion; 3) tibio-fibular limb lengthening via the Ilizarov method of distraction osteogenesis. She is now out to length, back to work, fully functional and infection-free.
Distal Tibia: shaft + ankle
Fixation: external fixator
Fusion: yes
Lengthening: Yes
Stage IVA osteomyelitis, distal leg with infected non-union distal tibia and chronic sepsis of the ankle joint
close-up details of the disrupted joint surfaces, residual non-viable bone fragments and holes from previous fixation
Patient's external frame with site for ankle fusion marked with parallel lines and site for lengthening, an "x"
the corresponding x-ray to figure 3, with the arrow indicating the ankel fusion and the arrowhead, the corticotomy (bone cut) for lengthening.
lengthening begins(arrowhead);
lengthening complete;
new, "regenerate" bone has consolidated.
the reconstruction: the regenerate and fusion have healed and the mechanical axis has been restored.
a clinical photograph of the patient's right and left legs with matching contours and a plantigrade foot