PMC7608849_01
Clinical photograph of the lateral ankle wound with gross ankle deformity.
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Clinical examination revealed an open wound over the lateral aspect of his ankle with gross ankle deformity noted (Fig. 1).
Anteroposterior and lateral ankle radiographs showing dislocations of the subtalar, calcaneocuboid and naviculocuneiform joints.
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Post-reduction radiographs revealed dislocations of the calcaneocuboid, naviculocuneiform and subtalar joints (Fig. 2).
Intraoperative fluoroscopic images showing pre (A) and post (B) reduction of the naviculocuneiform joints. Dorsiflexion and eversion of the foot provided maximum stability.
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The foot was maintained in dorsiflexion and eversion, a position of maximum stability (Fig. 3).
Computed tomography scan showing the unstable calcaneocuboid and naviculocuneiform joints, with a partially extruded navicular bone. Fractures of the cuboid and anterior calcaneal process were also defined.
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The calcaneocuboid, naviculocuneiform and subtalar joints were still identified to be unstable, with partial extrusion of the navicular (Fig. 4).
1.6 mm K wires were inserted to reduce the navicular bone and to hold the talonavicular, naviculocuneiform and calcaneocuboid joints in position (A). The navicular bone was then held with a buttress plate spanning the talonaviculocuneiform joints (B).
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The talonaviculocuneiform joint was reduced and held with a dorsal medial buttress plate, and the calcaneocuboid joint was held with 1.6 mm Kirschner wires (Figs. 5 and 6).
Immediate post-operative radiographs showing good reduction of the calcaneocuboid and naviculocuneiform joints. The external fixator was left in-situ for additional stability.
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The talonaviculocuneiform joint was reduced and held with a dorsal medial buttress plate, and the calcaneocuboid joint was held with 1.6 mm Kirschner wires (Figs. 5 and 6).
Radiographs at 6 weeks (A, B) and 3 months (C, D) post-operatively showing cell-reduced calcaneocuboid and naviculocuneiform joints. The external fixator was removed after 6 weeks and the patient was allowed to bear weight at 10 weeks.
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Serial radiographs revealed no implant loosening with the naviculocuneiform, calcaneocuboid and subtalar joints well-reduced (Fig. 7).
Clinical photograph at 4 months showing well-healed wounds.
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At 4 months, his wounds were completely healed (Fig. 8).