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 tibial and ankle regions.

Anatomical surgical approach:  A percutaneous approach was employed for the tibiotalar arthrodesis, facilitated by ankle arthroscopy. This minimally invasive technique allowed for direct visualization and preparation of the joint surfaces. Cannulated screws were inserted to achieve compression across the tibiotalar joint, with BMP applied to promote osseous integration and fusion.

The surgeon noted that despite previous interventions, including transport lengthening and conversion to a nail, the patient continued to experience significant ankle pain upon walking. The decision to proceed with tibiotalar arthrodesis was made to address this issue. Intraoperatively, cultures were taken to ensure resolution of infection prior to definitive fusion. The use of BMP was intended to enhance the likelihood of successful arthrodesis.

Postoperative protocol:   Postoperatively, the patient was advised to remain non-weight bearing on the affected limb for a period of 6 weeks, followed by gradual progression to partial weight bearing as tolerated. Physical therapy focused on maintaining range of motion in adjacent joints and strengthening exercises.

Follow up:   Not specified.

Orthopaedic implants used:   Ilizarov external fixator, reverse tibial nail, cannulated screws, bone morphogenetic protein (BMP).