1. 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

2. 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

3. Typical deformity

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

5. 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 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 Apr;468(4):958–968.

6. Corrective arthrodesis

7. 4.5-year follow-up

8. 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 Apr;468(4):958–968.
Zwipp et al. Clin Orthop Relat Res. 2010;468:958–968