Surgical Discussion

Patient positioning:  The patient was positioned supine on the operating table, with the affected limb elevated and supported to allow for optimal access to the tibiotalar joint.

Anatomical surgical approach:  A longitudinal incision was made over the anterior aspect of the ankle joint. Subcutaneous tissues were dissected to expose the tibiotalar joint. Careful debridement of osteoarthritic and necrotic bone was performed. The joint surfaces were prepared for arthrodesis, ensuring adequate bone contact for fusion. An external fixator was applied to maintain alignment and compression across the arthrodesis site.

The surgeon noted that the previous osteomyelitis had resulted in some bone loss, which required meticulous debridement and preparation of the joint surfaces to ensure successful fusion. Dynamic compression was applied through the external fixator to promote bone healing. Conversion from external to internal fixation with cannulated screws was planned once initial stability and early healing were confirmed.

Postoperative protocol:   Postoperatively, the patient was allowed full weight-bearing as tolerated with the external fixator in place. On-the-go training was encouraged to maintain mobility and muscle strength. Transition to internal fixation was planned once sufficient healing was observed.

Follow up:   Not specified.

Orthopaedic implants used:   External fixator, cannulated screws (for planned conversion).