Case for small group discussion Ankle arthritis Case for small group discussion AOTrauma—Foot & Ankle Module 7: Ankle arthritis Stefan Rammelt and Hans Zwipp, DE

Patient presentation 57-year-old man Gradually increasing pain and malalignment for last 2 years No known trauma except recurrent ankle sprains Apparent varus deformity of the heel Reduced ankle ROM

Typical deformity

Anterior talar subluxation Typical deformity Anterior talar subluxation 30° of varus .

Stable fixation with 4 (–5) screws References: Zwipp H, Tscherne H, Thermann H, Weber T. Osteosynthesis of displaced intraarticular fractures of the calcaneus. Results in 123 cases. Clin Orthop Relat Res. 1993 May;(290):76–86. Zwipp H, Rammelt S, Endres T, et al. High union rates and function scores at midterm followup with ankle arthrodesis using a four screw technique. Clin Orthop Relat Res. 2010 Apr;468(4):958–968.

Corrective arthrodesis

4.5-year follow-up

Take-home message Most important—realignment Stable internal fixation with screws Good long-term results Lower incidence of adjacent joint arthrosis with correct technique References: Zwipp H, Rammelt S, Endres T, et al. High union rates and function scores at midterm followup with ankle arthrodesis using a four screw technique. Clin Orthop Relat Res. 2010 Apr;468(4):958–968. Zwipp et al. Clin Orthop Relat Res. 2010;468:958–968