PMC6925794_01
Clinical picture. (a) The patient is limping, but not using any assistive device. Marked varus instability of the left ankle is observed during the stance phase of walking. (b) There is marked swelling but no instability of the left knee joint. (c) The left ankle joint has marked swelling, and the foot is medially dislocated. A skin ulcer has formed at the lateral malleolus.
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fig1
Marked varus instability of the left ankle was observed during the stance phase of walking (Figure 1). There was marked swelling, but no instability (Figure 1). A skin ulcer had formed at the lateral malleolus (Figure 1).
Preoperative radiographs of the knee and ankle. (a, b) Marked narrowing at the joint space, depression and an osseous defect of the medial tibial articular surface, and marked proliferative changes of the femoral condyle in the left knee. (c, d) Medial dislocation of the talus bone, accompanied by an old fracture of the medial malleolus, an osseous defect of the distal medial tibial articular surface, and an osseous defect of the proximal talus articular surface in the left ankle joint. (e) Lower extremity full-length standing X-ray shows a femorotibial angle (FTA) of 202 .
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fig2
Plain X-ray of the left knee revealed marked narrowing at the joint space, depression and an osseous defect of the medial tibial articular surface, and marked proliferative changes of the femoral condyle (Figure 2). Plain X-ray of the left ankle joint showed medial dislocation of the talus bone, accompanied by an old fracture of the medial malleolus, an osseous defect of the distal medial tibial articular surface, and an osseous defect of the proximal talus articular surface (Figure 2). A lower extremity full-length standing X-ray showed a femorotibial angle (FTA) of 202  (Figure 2).
Intraoperative picture. (a) Giant loose bodies surrounding the femur. (b) The large mass of local bone is saved for ankle arthrodesis.
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fig3
A marked intra-articular osteophyte and formation of giant loose bodies surrounding the femur were observed (Figure 3). The large mass of local bone was saved for ankle arthrodesis (Figure 3).
Postoperative radiographs of the knee and ankle. (a, b) A 5 mm defect is observed at the medial tibia. After drilling, cement is used as filling. The posterior-stabilized (PS) type is fixed with cement. (c-e) Ilizarov external fixation is performed on the ankle joint. The bone is repositioned to a neutral position without shortening.
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fig4
The posterior-stabilized (PS) type was fixed with cement (Figure 4), and the wound was closed. The distal tibial articular surface and proximal talus articular surface were rasped, drilling was performed, and the bone was repositioned to a neutral position without shortening (Figure 4). In addition, six straight wires were inserted into the distal tibia for strong fixation (Figure 4).