[Ortho] Re: Застарелое повреждение голеностопа

[Dr. A. Liberson]

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

----- Original Message ----- 
From: "Evgueny" <evgueny на iway.na>
To: "Orthoforum" <ortho на weborto.net>
Sent: Saturday, August 16, 2008 11:09 AM
Subject: Re: [Ortho] Застарелое повреждение голеностопа


> 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
>
> ----- Original Message ----- 
> From: "Dr. A. Liberson" <cishaifa на netvision.net.il>
> To: "Orthoforum" <ortho на weborto.net>
> Sent: Friday, August 15, 2008 7:02 PM
> Subject: [Ortho] Re: Застарелое повреждение голеностопа
>
>
>> As I already wrote, a Distraction arthroplasty would fit taking into
>> account
>> the young age-I did some of them and at least 60% feel well after 5 
>> years.
>> An endoprosthesis in 30 y old is only in case he understands that we do
>> the
>> endoprosthesis for last 20 years and he might need a reop at age of 
>> 45-50.
>> We do not speak of endoprosthesis of hip.
>> My youngest endoprosthesis of the ankle was 37 when I did it, He is a
>> large
>> man of 43 by now and he understands that he might be a "test case".
>> AL
>> ----- Original Message ----- 
>> From: "Иван" <orthoforum на weborto.net>
>> To: <ortho на weborto.net>
>> Sent: Friday, August 15, 2008 5:34 PM
>> Subject: Re: [Ortho] Застарелое повреждение голеностопа
>>
>>
>>> Здравствуйте Михаил на действительно сустава та нет. на учитывая молодой
>>> возраст рекомендовать артродез как то не хотелось бы. скорее
>>> эндопротезирование. если по финансовым (парамедицинским) вопросам нет то
>>> артродез избавит от боли. а функция за счет предплюсны будет хотя и
>>> скудная. удачи.
>>> Иван
>>>
>>>
>>>
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>>
>>
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