PXB - Percutaneous X-ray Guided Internal Brace

Ankle instability treated using PXB technique - Percutaneous X-ray Guided Internal Brace.

1) Make an incision and percutaneous identify the fibula

2) Drill hole for 4.75 mm SwiveLock

3) Tap fibula

4) Insert 4.75 mm SwiveLock

5) Mark and drill talus

6) Tap talus

7) Insert 4.75 mm SwiveLock in talus and tension fiber tape appropriately

8) Post-op incisions

Pre and post-op stress X-rays:

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Tracking Outcomes - AOFAS Ankle-Hindfoot Scale

In an effort to track outcomes for our patients we will be using the AOFAS Ankle/Hindfoot Scale.  I have attached the AOFAS Ankle/Hindfoot scoring sheet.  If you are a patient it would be appreciated if you could fill out this form on your first and subsequent visits.

AOFAS Ankle-Hindfoot Scale PDF

Clinical Prediction Rules

Darryl Yardley - one of my physiotherapy colleagues asked me if I could list some Clinical Prediction Rules / Indications for Surgery.

My main clinical indications are the following:

1) Ankle pain and instability for greater than 1 year despite non-operative management / physiotherapy.

2) Clear 2+ anterior drawer sign

3) Evident varus / valgus instability with stress testing

4) Palpable crepitus in the ankle (this can be caused by an OCD lesion or Ankle Osteoarthritis).

Ankle Arthroscopy + Brostrum Video

I have attached 2 videos that are quite representative of the surgery performed.  These videos are by Dr. Brian Weatherby of Steadman Hawkins Clinic of the Carolinas.

Management of Acute and Chronic Ankle Instability

I have attached a 2008 article from JAAOS summarizing the management options for Acute and Chronic Ankle Instability.

Ankle Instability - Dr. Christopher Lu

Ankle Instability is a common problem affecting both athletes and non-athletes a like. Most patient's have had an ankle sprain, the problem arises when you do not get better after a simple sprain. With a simple sprain you are usually able to get better after 3 to 6 months.  However, if you do not get better during this initial time frame, you might want to see your Family Physician and have your ankle examined.  Initial management consists of physiotherapy with ROM, proprioception and strengthening exercises.

If you have persistent anterior ankle pain, difficulty with uneven ground and a sensation of your ankle giving way, you might benefit from an x-ray of your ankle, followed by an MRI.  Specifically we are looking for an injury to the talar surface or ATFL (anteriortalofibular ligament - the main stabilizer of the ankle).  It should be noted that some patient's have a normal MRI, but still have instability symptoms.  These patient's also benefit from a tensioning procedure.

I have a sub-speciality interest in Ankle Instability surgery and have created a regional centre of excellence for the treatment of Ankle Instability.  If you happen to live in Canada simply have your Family Physician / Sports Medicine Physician / Orthopaedic Surgeon fax a referral to our office.  International patients are asked to contact our office for further information / pre-clearance.

Surgery is performed at Georgetown Hospital - which is located 30 minutes from Toronto Pearson Airport.  Ankle instability procedures are routinely performed as a day surgery procedure.  We routinely use a local anaesthetic block and sedation as our mode of anaesthetic.

Preferred work up for patients would be: Ankle X-ray (AP, Lateral, Mortise) + Ankle MRI.

If you have any of these injuries and are interested in reconstructive surgery please have your Family Physician / Sports Medicine Physician / Orthopaedic Surgeon refer you to:

Dr. Christopher Lu MBchB FRCSC
Assistant Clinical Professor (Adjunct) - McMaster University

Orthopaedic Foot and Ankle Surgeon

Unit 200 - 1A Princess Anne Drive

Georgetown, Ontario
Canada
L7G 4W4

Phone: 905-873-8883

Fax: 289-801-2239

Linkedin profile:

http://www.linkedin.com/in/chrisluortho

E-consult available via Champlain LHIN / Mississauga Halton LHIN E-consult service (family physician needs to be registered with E-consult service)

E-consult

RateMD reviews:
https://www.ratemds.com/doctor-ratings/3570242/Dr-Christopher-Lu-Georgetown-ON.html

Ankle Osteochondral Defects / OCD

Osteochondral defects are a common source of pain in the ankle.  There is limited space inside the ankle joint, when you have an OCD lesion it can often feel like you have a pebble inside your shoe, with a very disconcerting crunching noise.  Once this lesion is removed and micro-fractured the results are often dramatic.  However, there is a limitation to how much pain relief can be achieved - we cannot make you better than the uninjured side.  Once damage has been done to the chondral surface - the body heals the surface with fibrocartilage, not the rock hard hyaline cartilage that you were born with.  With microfracture alone this technique is 90% effective.

I have attached imaging of some recent osteochondral lesions that have been treated at our hospital.

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