Complex Foot and Ankle Trauma

Aug 26, 2022 | Foot + Ankle

The team at Grosvenor Orthopaedics are highly experienced in managing extremely challenging trauma. The case described below is done so with patients explicit consent and contains some intra-operative images.

Mr Tim Sinnett accepted the following challenging injury as a tertiary referral. The patient had fallen down half a flight of stairs and sustained a complex fracture to the distal tibia and body of talus. These injuries carry a high risk of complication including infection, mal-union, non-union, stiffness and post traumatic arthritis.

The case is explained below in chronological order.

Image 1 demonstrates initial X-rays performed at the local hospital. We can see an intra-articular fracture with severe comminution and displacement of both the tibial plafond and talar body.

Image1

Images 2 and 3 show the detailed imaging obtained through CT scanning. They highlight the severity of the injury.

Image 2. Coronal CT image showing significant displacement and comminution of Tibial and Talar fractures

Image 3. Saggital CT image of the injury

An external fixator was applied at the admitting hospital and the patient was discharged home to elevate the leg to allow swelling and blistering to settle.

Definitve fixation was undertaken by Mr Sinnett once the skin condition was appropriate after 16 days. After detailed surgical planning, Mr Sinnett utilised the vertical medial malleolar fracture to gain access to the talus fracture. The intra-operative image below shows the comminuted talus fracture with some bone loss. The medial malleolus is retracted inferiorly to allow fixation of the talar body.

Image 4. Intra-operative photo.

Fixation was performed following reduction and stabilisation with K-wires. Joint surfces were elevated and restored. Image 5 shows a post-operative X-ray at 6 weeks.

Image 6. Post-operative lateral X-ray 6 weeks after surgery

Image 7 shows that the single surgical wound has healed well.

Image 7. Single wound 6 weeks post op

These injuries carry a high complication rate and risk of morbidity. The post-operative X-rays and video of range of movement below are very encouraging.

[evp_embed_video url="https://gop.health/wp-content/uploads/2022/08/IMG_5020.mov"]

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