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Re: Застарелое повреждение голеностопа
Evgueny Tchekashkine 16 Август 2008, 16:33
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Hello Arcady,
How long do you keep the joint in distraction? Is there any risk of chondrolysis correlated with duration of distraction?
Do you think it's going to work in this case as the talus remains subluxated?
Probably the patient should be given an options to choose: ankle fusion restoring painfree??? (metatarsalgia) weight bearing function or ankle
anatomy reconstruction combined with joint distraction as there is 60% functional improvement after 5 yrs.
Kind Regards,
Evgueny Tchekashkine
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Re: Застарелое повреждение голеностопа
Отправитель: A.Liberson 16 Август 2008, 20:45
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Dear Evgueny,
I did it with a circular frame, distracted it on a table with an arthroscopy and coninued the distraction for 3 month. The same did a Dutch group, If I recall well from Amsterdam also on small group of patients. There is also an
American one.
I do not think there is a lot cartilage ther to be afraid of a lysis.
I would appreciate a weight bearing AP film in order to answer on your second question-talar subluxation did not look very prominant-its about 1 nn if I SEE WELL. I beleive in a thick pseudocartilage -I distract 3-4 MM and
do not imagine a reposition without an open intervention.
I would be very cautious to plan an osteotomy with reposition in this destroyed joint-I might be wrong looking on radiographs provided. I did some late repositions, though in an earlier phase. I would consult and explain the p-nt every one of those-agree.
yours
Aharon
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