When a woman in her 20s sustained an open pilon fracture in a motor vehicle accident, she received high-quality surgical treatment. After recovery, however, she developed post-traumatic arthritis in the injured ankle, leaving her unable to walk or participate in daily activities without pain. Conservative management failed to give her relief.
“When we evaluate patients with post-traumatic arthritis, we consider both joint-sparing and joint-sacrificing options for treatment,” says Duke Health foot and ankle surgeon Christopher D. Murawski, MD. “In this young woman, the joint-sacrificing option of ankle arthrodesis was the best option.”
Fellow Duke foot and ankle surgeon Andrew Hanselman, MD, agrees that the patient faced a difficult situation: “It’s very rare to get arthritis in the ankle at such a young age. With the deformity and bone loss in the area, her pain was severe.”
How did the Duke Orthopaedics team restore the patient’s pain-free mobility?
In consultation with the patient, Murawski determined the best course of action was to fuse the ankle in a two-stage surgery alongside Hanselman. Repeat ankle surgery is often difficult, Hanselman explains: “There’s very little room around the ankle. We have to plan each approach individually based on what previous surgeons did. Many cases are referred here because of this difficulty.”
Hanselman and Murawski’s collaboration reduced surgical time. In the first operation, they removed the hardware from the initial repair. In the second procedure, they removed the remaining cartilage and fused the tibia to the talus. After friction between the bones was eliminated, the patient was able to walk without pain. “Three months after surgery, she admitted that she was still a bit surprised to take that first step in the morning and not have it hurt — she’d become so accustomed to living with pain,” says Murawski.
Despite the name’s connotation, ankle fusion preserves a patient’s mobility. “The foot and ankle’s ability to adapt to one segment being stiff is remarkable,” Murawski says. “There is certainly some reduction in range of motion, but the other joints adapt to facilitate gait and help achieve our goal of relieving pain”
Duke Orthopaedics is adept at treating cases from the simple to complex. “In the foot and ankle division, we are fortunate to manage everything from straightforward ankle fractures to Achilles tendon ruptures to bunions to total ankle replacements,” says Murawski. “We take pride in helping people return to the activities that they enjoy.”
Hanselman similarly encourages providers to consider referral. “We make referral as seamless as possible. If you feel your patient needs more help or if you’re not sure whether they need surgery, send them to us. We’ll take it from there.”