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21/01/2022

Patient had previous foot charcot which was improving but then charcot attacked the ankle.

Used an anterior plate, beams and a low beginning syndesmotic ladder. This should decrease rotation/ Axial forces on the fusion site

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11/01/2022

2nd collage patient had a standard calc slide. Admitted walking on it and presented with a return to pre op position with calc shortening and loss of height. This is in the 1st collage of on the table for the revisional case. We milled graft to get height returned and bent a plate to contour the re-correction.

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04/01/2022

Patient referred to us for chronic pain with peroneals s/p ORIF of Tri Mal by another provider. The reduction was anatomic but we suspected the hardware was creating a level of tissue drag. You can see the hardware adhesions present on this post anti glide plating style. We removed it and applied stem cell around the peroneals and repaired small distal sheath tear from the hardware.

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23/12/2021

DM with charcot. We used a medial and lateral approach to create a superconstruct. The plantar hook should decrease torsional stresses.

Will post recent post op films soon.

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09/11/2021

DM patient with a distal tuft wound. A simple release using a 18 gauge needle was performed. It was enough to align the toe so he was applying pressure to the fat pad, rather than the tip.

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$DM patient with an ankle fracture. She was advised to ambulate on it in a boot by another provider. She presented for a ...$

08/11/2021

DM patient with an ankle fracture. She was advised to ambulate on it in a boot by another provider. She presented for a second opinion several weeks later. We noted shorting and +3mm displacement on MRI. We ordered the MRI over CT to evaluate the soft tissue. We fixated the the lateral mal first. Then, we used the plate and a towel clamp to distract. We were still short, so we eccentrically distal loaded the BB Tak on the fibula, which gave us anatomic length. We grafted the remaining space. Dr Micheal Brage has a great lecture on what to do when these are healed and short. We also presented a healed, shorten case here approx 6 months ago.
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$Diabetic patient with previous fusion was hit with a grocery cart, calc thrown into valgus as fractured off previous fus...$

04/11/2021

Diabetic patient with previous fusion was hit with a grocery cart, calc thrown into valgus as fractured off previous fusion, remaining screw crushed through Talar head and most of navicular was gone medially. We did a Calc osteotomy angulated medial plantar with beams to create length and a midfoot fusion with graft. Ex fix to help stabilize. We found the tip of screw, used a tamp and malleted posterior and the head poked through (was previously covered by bone).

The bit we used as a tamp showing the screw trajectory pushing the foot into valgus.

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03/11/2021

DM who developed a wound and, per the spouse, spit out a screw previously fixated to the nail through that nail. They had multiple hospital admits and we were consulted. The nail was assumed to be infected and noted non union/ charcot of STJ on CT. We pulled the nail and obtained biopsies of the surrounding bone. We used two innovative techniques. One, we made an abx nail from a skinny wire and then bent it as it can out of the foot and attached to the frame. This avoids it falling out, while also making it easy to find. He also had a broken screw at the run out. We pulled the headed end after putting a wire through it, used a cannulated guide and malleted that to push the threaded portion out.

We should also note the foot was locked into the position shown in pre/post op pics. They will need a proper fusion in the future but we were able to quite improve Post op alignment with the Ex Fix.

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02/11/2021

Newly DX DM patient who had exposed fibula with noted fx. She had been working and walking on it for weeks. Concern for OM versus charcot or both. We sectioned out the fibula and remaining fragments of talus. Biopsies and cultures taken. Ex fix applied and used the olives to walk the foot back under the tibia. Will monitor for need for proper fusion versus septic fusion.

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28/10/2021

Large Bunion with noted previous failure and now midfoot OA. Of note is the non functional STJ implant pre op, as the fault is in the midfoot. Note once the midfoot was addressed, you can see the “bullet hole” in the STJ implant.

Also, we used graft at the Lapidus to avoid shorting of the first met as well as in the pipjs of 2 and 3 to angular correct and get some length back to them. All the pinning in the first is to overcome soft tissue contractures.

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27/10/2021

An update on one of our salvage patients. Unfortunately, home health had not seen him for 5 days and he developed maggots. They are efficient at tissue debridement, though. We cleaned up the maggots and you can see them in the Tenex collection bin. The wound actually looked really good after. The picture with tendon and bone exposure is a reminder of how we began. We will continue wound care, grafting and using the frame for stabilization until we can safely beam in the future. Of note, they have a BKA on the contralateral limb.

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26/10/2021

DM pt with concern for OM on MRI and long-standing lateral 5th ulcer from absent PB post partial 5th ray amp. We excised the remaining 5th that lit up on MR. We found a larger tertius and remains of the the PL. advanced the tertius and anchored through the cuboid and used prolene and a JP trimmed drain as surgical buttons (nothing left behind). This took him out of varus.

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Address

92691–92692, 92694

Website

https://www.artisanfootandankle.com/

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