Hey everyone.
Occasionally there are times we have these patients that really capture your
heart and imagination with their case
because they have really nowhere else to go with their diagnosis
and sometimes they've been to multiple specialists and multiple surgeries already,
this is one of those patients, I mean he's only two years older than I
and he was only given the choice of a below knee amputation.
Now being about 42 years old you can only imagine what that can do to a person.
So this is a quick review of this case, basically he has osteomyelitis of the talus,
chronic osteomyelitis and basically they're keeping him in on crutches,
feeding him antibiotics, that went on for about a year or so until finally he found me,
somebody referred him to our office for care.
Surprising that took that long but bear with me, we'll go through this case.
After six to eight weeks this cadaveric talus
was placed in along with internal fixation and
an IM rod, this was done with an addition of
external fixation on top of this
in order to salvage the limb.
Remember the guy was facing amputation.
This is the mortise view of the same guy,
we're talking about a year now out really no pain,
he's able to walk with the AFO,
again this is the talus, as you can see, the talus
and calcaneus are coming into view better
and we're talking -- the iron rod is still in place,
the talus is not as dark as it used to be,
gives a good sign of revascularization of the talus,
between the talus and the calcaneus,
there is some hope, this patient does not have any pain, now let's go on to the patient interview.
You'll be surprised.
A little bit further along,
this guy weight bears as you can see again,
luckily the calcaneus is holding up, the talus is
still holding up, no crush deformity
and IM rod is still in place. Everything is good,
patient has been able to weight bear with the use of
a cam boot without other assistive device.
Here's the final fixation with the external fixator taken off, this is the IM rod
with the fixation in the talus navicular joint,
the remainder of the talus was taken out,
remember this is a cadaveric talus,
at this point we're seeing the darkness of the talus,
hopefully getting revascularized
but rigid internal fixation was achieved utilizing
plate screws and IM rod.
Here you see the first surgery by me
which is number four for the patient himself,
took out the body of the talus, those are antibiotic
beads that you see in there and a nice Ilizarov
circular fixation to maintain the length or else
we're gonna have problems with the length later on.
This was placed in for about six to eight weeks.
This is a case of a forty year old guy with
osteomyelitis of the talus, this is how he presents
to me completely collapsed, talus,
confirmed osteomyelitis, went through HBO therapy,
intravenous antibiotics, multiple surgeries
to try to salvage his ankle,
unfortunately none were effective.
This is him on another view, again, chronic pain
unable to bear weight on this ankle,
the only solution was a below knee amputation.
Man right here had osteomyelitis of the talus.
"Yeah." It was after an auto accident, am I correct?
"Yeah." And then you came to me
for a second opinion because you had a big hole
here that was draining... "Yes, it was horrible.
Yes there was three surgeries that I had prior to you
but nobody did what you did with fusing the talus,
the bone... You said you could do it
and you said hang in there...you said do it my way
or not anyway [laughs]
it's gonna be a year and a half process."
You're doing really good,
this actually looks like a foot, you can't tell that you
had a previous infection and this hole has not
opened up, am I correct?
"No it's actually coming up like,
there was a really big indent,
I have a picture of how big the hole was originally. Awesome, awesome.
This is the wire site for the Ilizarov frame,
the big frame we have in, and then you have a rod
that was put up through the bottom to stabilize
everything, you actually had yeah cadaver talus,
drilled it, put some stem cells on there, put some of
your own stem cell, took it out of your tibia
and put it in to actually mix it in
so it looks like it's incorporating very well,
that bone is not collapsed whatsoever, looks like
that talus almost look like yours
actually on the x-ray. And your pain before
the surgery was how much, would you say?
Twelve [laughter] it was like an 8, 9...
Like an 8, 9, okay. How is it now?
You went into AFO,
Yeah, I'm still doing physical therapy
which has worked out great. Awesome.
Two months in. Good. Yeah.
Well, you're able to use that leg again.
I'm walking. I'm very proud of you. Yeah, this thing is
helping me because again I can walk without like a
limp or anything, I'm working on that.
That's awesome, I'm very proud of you,
I think you've done very well, you've been to
three surgeries before me, this is the fourth surgery,
which was mine so I'm very glad.
We did put antibiotic beads in there.
I remember that talus was very -- it was not
very good smelling, when we took it out,
the talus was really infected so I'm very glad
you had the result that you had,
I think you'll continue to do better.
Yeah, it kept getting infected, six months,
a year after surgery I mean,
yeah that was the kicker, it was like I was starting to
look into amputation and then...
How did you find us anyway?
I was in Phoenix, I came here, sent by...
okay, a good friend of your.. yes, yes
and he came to you a couple of times,
hit the jackpot. No I'm very happy you know there's
plenty of patients like yourself out there that
has a hard time finding us or whatever so
we're trying to figure out a way how to prevent some
amputations and hopefully have more
success stories like yourself, you're a young guy,
we need to get yourself out of amputation,
looks very good. I know, I know. Got to you in time.
Well I'm glad you did, I'm glad you did.
I'm very glad we had this.
I'm glad I found you. I'll rave about you.
Well thank you.
Dr. Patel... Dr. Patel works for me, yeah
so, he trained with us and we took him on
so it's awesome.
He's doing awesome, he is at our North office
seeing our patients up there,
he's learned our tricks now so...
Oh he's learned all the tricks [laughs]
You're awesome, you guys have been so great to me
and I really appreciate it.
It was a long hard battle to get here but he was miserable.
But once we found you, yeah, it's been awesome.
Cool, well I really appreciate you guys.
You guys are doing really well, continue as you were, continue AFO, see you back in
6 months, okay?
Yeah.
He will be here.
Thank you for everything.
I really appreciate it.