1. Foot and Ankle Symposium: Post-traumatic Reconstruction S. Robert Rozbruch, MD Director, Institute for Limb Lengthening and Reconstruction www.LimbLengthening.com

2. Fibula lengthening

3. Short fibula

4. End Distraction, 2weeks

6. Preop 4 weeks

7. 4 months

8. Ankle Fusion with Ilizarov Frame Septic arthritis and osteomyelitis after ankle fracture and initial treatment

9. Richard, injury  ORIF

10. After ORIF, osteomyelitis, septic arthritis

11. 2 months

12. 4 months

14. Bone Transport ankle fusion Septic arthritis andosteomyelitis with bone loss after trauma

15. preop Needs 8 cm lengthening and tibio-talar fusion

16. Infected Use beads

18. 15 months 8 cm lengthening Tibia Diaphysis To talus fusion

19. Repair of distal tibia nonunion and simultaneous ankle fusion Septic arthritis and osteomyeltis and nonunion after trauma

20. One year Infected nonunion pilon Metaphyseal nonunion and joint arthrosis Osteopenia, NWB for 1 year

23. Ankle arthrodesis with gradual positioning of the foot Post-traumatic arthritis with severe rigid equinovarus deformity associated with head injury

24. Cavovarus Head injury Post-trauma

27. Tibia to Calcaneous ankle fusion with simultaneous lengthening For failed ankle fusion with necrosis of the talus

28. Dead talus

29. Talus excision IV antibiotics LLD 3.5 cm Proximal tibia lengthening

31. TC fusion 1” lengthening

33. Distal tibia and fibula osteotomy for lengthening and deformity correction Malunion of tibia with valgus, shortening, and pain/early arthritis of ankle

34. 25 y/o M, open tibia fx Boating accident

35. PREOP Tibial malunion 15 deg VALGUS 1.5 cm short Lateral ankle OA and pain BIG FLAP

36. 4 months

37. 5 months at Frame Removal

38. 5.5 months LLD = 0 LDTA 90 deg ADTA 80 0

39. Osteotomy and gradual correction of a malpositioned ankle fusion and simultaneous lengthening at the proximal tibia

40. Malposition of ankle fusion Anterior translation Calcaneus Dorsiflexion def LLD- too short

41. 1 inch lengthening 6 months

42. Gradual correction of an equinus ankle contracture

43. Ankle contracture

45. 25 degrees

46. ankle contracture we choose the center of the talus as the rotation point ankle is also inclined 10 degrees off the neutral coronal plane –mount ring 10 degrees off neutral

47. Ankle distraction for ankle arthritis and AVN of the talus

48. preop

51. 3 months 1 year

52. Ankle distraction and re-alignment osteotomy for deformity and ankle arthritis

53. Ankle distraction with realignment Medial plafond defect Increases varus Osteophyte Limits DF

56. 2 years

57. Repair of ankle nonunion with gradual correction of deformity

58. Altered malleolar relationship

59. postop 6 weeks

61. 5 months

62. Thank You