Ankle Injury Undiagnosed 8 Years After MVA
Ankle Injuries and Trauma
A traumatic motor vehicle accident (MVA) resulted in severe compound distal Tibia and Fibula fractures. This required 3 plates and 22 screws during orthopedic surgery. Her postoperative course was complicated and lengthy. She never was fully pain-free. Progressively, over time her pain was more localized to her ankle, and her walking became more difficult, as well as standing for any period of time.8 years later she presented to Dennis M. Lox M.D., a Sports and Regenerative Medicine expert. Dr. Lox was immediately concerned no medical attention or workup had been done to her ankle. She had all the hardware 3 plates and screws removed, except 2 remained in her distal tibia. Dr. Lox ordered a special MRI with noise-reducing software to help minimize metallic artifact from the remaining 2 screws.
Evaluation of Each Patient is Important
The MRI revealed advanced degenerative arthritis of the ankle joint Dr. Lox also spoke directly with the radiologist about some traumatically induced problems such as a talar dome fracture or AVN, however, the radiologist noted that with the extensive degenerative arthritis and erosion of the bone at the tibia and talus, after 8 years these diagnoses could not be made. At the time of her MVA accident, all attention was directed towards her compound fracture and surgical intervention, that evaluation of her ankle was not done. Additionally, with the placement of 3 plates and 22 screws, an ankle MRI would not be possible due to metallic artifact. Now her problem was advanced degenerative arthritis of her ankle at age 30, the development of early arthritis of her other ankle from abnormal walking over 8 years, and know what to do about it. Some times being an expert is not easy.
Ankle AVN
Ongoing ankle pain after trauma should alert the physician to the possibility of ankle AVN. AVN or Avascular necrosis occurs when the blood supply to a region of bone is impaired. This results in bone cell death or necrosis. The most feared consequence of AVN is the collapse of the area of necrotic bone. This can lead to rapid joint destruction or accelerated degenerative arthritis. As the ankle does not do well with ankle replacement, ankle fusion is often considered. This leads to an altered walking pattern, leading to accelerated wear of adjacent joints. This just compounds the already difficult problem. Understanding AVN and early detection are very important. Unfortunately, AVN after trauma is not readily considered, and the diagnosis is often prolonged. This is why AVN collapse is often seen. It is very important to consult with an expert in the evaluation and treatment of AVN.
