50: Ankle Distraction for Arthrosis Using the SBI RingFIX(TM) RAD Frame

Fig. 1

(a, b) X-rays showing post-traumatic arthrosis of the left ankle. Note ankle joint space narrowing especially in the anterior third of the joint

Fig. 2

(a–c) Side and back views showing equinus contracture. (a, c) Patient is unable to get heel to floor; (b) with left foot forward, heel touches the floor

3 Preoperative Problem List

Post-traumatic ankle arthrosis

Equinus contracture of ankle

4 Treatment Strategy

Joint preservation approach. Avoid ankle fusion or ankle replacement in this young patient with ankle mobility.

Anterior ankle arthrotomy, anterior debridement of scar tissue and osteophyte, and microfracture of areas of joint with full-thickness cartilage loss.

Bone marrow aspiration from the ipsilateral iliac crest.

Gastroc-soleus recession.

Ankle distraction with circular hinged external fixator.

5 Basic Principles

Ankle distraction leads to formation of reparative tissue in the ankle that increases the joint space on X-ray.

Microfracture and addition of mesenchymal stem cells lead to formation of reparative tissue.

Bone marrow aspirate concentrate (BMAC) contains mesenchymal stem cells.

The ankle axis of rotation is oblique in both the coronal and axial planes. It is a line from posterolateral to anteromedial.

6 Images During Treatment

See Figs. 3, 4, and 5.

Fig. 3

(a–f) Schematic images of the SBi RingFIX RAD^TM frame showing surgical technique. (a) The tibial ring is applied orthogonal to the tibial axis. The location is 10 cm proximal to the ankle. (b) Stabilization of the tibial ring is with two 6 mm half-pins. (c) The axis of rotation of the ankle is located by inserting a trans-malleolar wire through the talus. (d

Only gold members can continue reading. Log In or Register to continue