Case 56: Gradual Correction of Malunited Ankle Arthrodesis with the Taylor Spatial Frame

Abstract

A 64 year old woman presented with pain and swelling in her right ankle. She had a closed ankle fracture that was corrected with open reduction and internal fixation 4 years prior to presentation. She underwent ankle fusion for post-traumatic arthritis, but her talus collapsed and a hindfoot fusion was then performed with a hindfoot fusion rod. After hindfoot fusion, the ankle developed a chronic infected nonunion. Ankle range of motion was within normal limits even though the ankle was supposed to be fused. She had a 5-cm limb length discrepancy (LLD) on her right side. Treatment included removal of the radiographically loose hindfoot fusion rod (locked only distally) and application of the Taylor Spatial Frame (TSF) (Smith & Nephew, Memphis, TN) for approximately 6 months to distract the nonunion. Two casts were applied sequentially, and then the patient transitioned to a custom ankle foot orthosis (AFO) with weight-bearing as tolerated. After treatment, she was given a 1-in. shoe lift to address the 3-cm LLD. Radiographs obtained 1 year after removal showed progressive bony healing at the fusion site. She did not have any appreciable range of motion at the ankle joint. Minimal dorsiflexion and plantarflexion were possible through the midtarsal joint, but this motion did not cause pain. She had limited inversion and eversion of the right subtalar joint (approximately 15 degrees of inversion and 15 degrees of eversion), but this motion was not painful. 1 Brief Clinical History A 64 year old woman presented with pain and swelling in her right ankle, which had been problematic for the previous 4 years. Both lower extremities had palpable pulses and diminished sensation. She had a closed ankle fracture that was initially treated with open reduction and internal fixation. The internal fixation was removed 1 year after it was inserted. She developed posttraumatic arthritis and then underwent ankle fusion. Her talus went on to collapse, and subsequently, a hindfoot fusion was performed. After these procedures, the ankle developed a chronic infection and a nonunion. She observed intermittent drainage, but this drainage had stopped a few weeks prior to presenting at our clinic. The patient stated that she did not have any systemic symptoms of infection. At initial presentation, she wore a CAMWalker boot on the right ankle. The patient had a pressure ulcer on the plantar aspect of the first metatarsal head. The right heel was valgus, and the right lower extremity was erythematous and mildly swollen when compared with the left lower extremity. Sensation in both lower extremities was diminished. Ankle range of motion was within normal limits even though the ankle was supposed to be fused. Muscle strength of the right lower *Email: jconway@lifebridgehealth.org Limb Lengthening and Reconstruction Surgery Case Atlas DOI 10.1007/978-3-319-02767-8_137-1 # Springer International Publishing Switzerland 2014