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Re: ankle deformity
T. I. George 13 Январь 2009, 21:44
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Dr Emal,
Are you sure it is a post traumatic problem or are there any clinical signs of any neurologic problems? Any evidence to say that it could be a neuropathic problem?
In any case this young person has walked on it during the growing stage which has brought in changes. What are the clinical problems? Pain, instability, shortening, cosmetic problems etc? We have to be sure that we are not going to restore normalcy but are going to do a salvage procedure which may address his clinical problems. So it is important to know the clinical problems and patient's expectations to plan salvage procedure so that the treatment can address patient's demands and not radiological and clinical pictures.
Dr. T. I. George,
(Dr George T Ittoop),
Sr Specialist, Orthopaedics,
Ibra Regional Hospital,
PO Box no: 3,
Postal code 413.
North Sharquia Region,
Sultanate of Oman.
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Re: ankle deformity
Emal Wardak 14 Январь 2009, 23:23
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Dear Dr. George.
yes its 100% post traumatic, there is no neurologic deficit, or any sign of weakness, or infection, the history as father tells, the guy
had felt from horse and then he was taken to local bone setter at that time, and the ankle was fixed for onemonth, after they opened they saw the foot was facing out side, and the guy started to walk on it, without any pain, they have come from village for two reasons, one cosmetic second he is having slight limping due to around 2cm of true shortening but no pain.
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Re: ankle deformity
Отправитель: T.I.George 14 Январь 2009, 23:25
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Dr Emal,
Thanks for the info.
My impression is that whatever procedure we undertake will be of salvage nature. Options according to me are:
1) Acute correction with further shortening and arthrodesis of the affected joints, (You can consider a lengthening at some stage)
2) Gradual correction with a frame and lengthening along with arthrodesis.
The questions are, will these address patient's problems?
1) Cosmetic appearence - yes but it may not look absolutely normal.
2) Limping - may not address fully.
3) Shortening - can be addressed but some shortening may be desirable in view of the requirement for arthrodesis.
Now you have to face the big question. Do the patient and his relative understand all these and are they prepared for the expected result at the end of treatment? ( From what you say they come from a village background and may not comprehend the full problems).
Do keep us informed on what is done and the follow up. Good case for academic discussion but difficult one to tackle.
Best of luck.
Dr. T. I. George,
(Dr George T Ittoop)
Sr Specialist, Orthopaedics,
Ibra Regional Hospital,
PO Box no: 3,
Postal code 413.
North Sharquia Region,
Sultanate of Oman.
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