Case
One
This is the case of severe post-traumatic arthritis of the ankle. This
gentleman was a retiring warrant officer with progressive deterioration in
his activities due to increasing ankle pain. He exhibited a painful limp. He
was distressed by the loss of his former active lifestyle. Conservative
management had not led to a satisfactory result. Several previous surgeries
on his ankle had left substantial pre-existing scars. This compromises the
skin and soft tissue envelope around the ankle, and it is felt to be a
significant risk factor for infection and poor healing. Dr. Lurate performed
an ankle fusion in 1994 using arthroscopic technique and four tiny
incisions. This gentleman healed quickly with an outstanding result. At last
follow up, he was reportedly jogging 3 miles at a time on a treadmill.
  
Case Two
This is a similar case of a 64-year-old retired military gentleman with severe degenerative arthritis of his ankle. He hobbled into the clinic on a walker, wearing orthopaedic shoes with metal bars extending up to the knee for support. Despite these supports, he found it difficult to bear even partial weight on his ankle. He underwent minimally invasive arthoscopic ankle fusion. Postoperatively he regained the ability to walk normally with regular shoes and without a walker or cane. Pain relief was dramatic. After surgery, he is shown doing a one-legged stand on his fused side. He was thrilled with the result. Clinical studies have demonstrated substantially shorter time required for fusion, excellent fusion rates, and substantially lower rates of infection when compared to traditional open techniques. As with similar techniques, Dr. Lurate predicts this will be the standard of care for similar select patients within the next 10 -15 years.
  
Case Three
This is the case of a hard-charging athlete and marathon runner. While rock climbing near El Paso, Texas, he fell 30 feet. He sustained a broken wrist and a rather devastating broken heel bone. He was given a very poor prognosis by his treating orthopaedic surgeons and was given the choice of a foot fusion. Having worked with Dr. Lurate at the Navy Hospital he requested transfer to Dr. Lurate's care. His preoperative studies showed rather severe fragmentation of his calcaneus (heel bone) as well as a fragmentation of his wrist joint. He underwent external fixation of his wrist. This is a percutaneous procedure in which pins are placed through very small incisions in the skin. These pins are connected to an external frame. This device holds the bones in proper alignment until adequate healing has occurred. On the other hand, his calcaneus required a forma incision whereby the multiple fragments were meticulously repaired. This gentleman went on to place 30th out of 600 in a marathon 6 months later. Less than a year after the surgery he and his team took first place in the Blue Angel Marathon.
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This preoperative CT scan gives a good indication of the degree of fragmentation. |
This is a special oblique
(Broden type view) postoperative x-ray showing virtually perfect restoration of the joint surface. |
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