2025 AOFAS Annual Meeting-Resident Case Discussion

Video Transcription

Video Summary

This session at the University of Wisconsin focused on advanced foot and ankle cases, primarily targeting resident scholars in orthopedic training. The discussion began with a detailed examination of Lisfranc injuries via an 18-year-old hockey player’s lateral midfoot dislocation following an ATV accident. Attendees debated treatment goals focusing on anatomical reduction to prevent skin compromise and arthritis, weighing pros and cons of operative fixation versus primary fusion, especially in young athletes. The second case involved a 51-year-old farmer with ligamentous Lisfranc injury managed by primary fusion due to comminution and subluxation evidencing risk for arthritis, highlighting individualized decision-making.<br /><br />The discussion transitioned to ankle arthritis with a 43-year-old female presenting with post-steroid avascular necrosis and advanced arthritis. Non-operative treatments such as bracing and injections were reviewed, followed by joint-sparing approaches like distraction arthroplasty. Joint-sacrificing options—ankle fusion, total ankle replacement, and tibiotalocalcaneal fusion—were extensively debated regarding pros, cons, risks (including non-union, infection, amputation), and patient-centered decision-making.<br /><br />Next, a 62-year-old female post-ORIF with ankle arthritis prompted evaluation for infection and surgical planning involving hardware removal and prophylactic maneuvers alongside ankle replacement.<br /><br />Lastly, a complex case of a 66-year-old male with progressive adult acquired flat foot deformity (posterior tibial tendon dysfunction) was reviewed. Examination, imaging (including weight-bearing CT), and surgical strategy discussions underscored the importance of assessing deformity flexibility and extent. Treatment involved osteotomies, tendon transfers, lateral column lengthening, and fusions tailored to deformity severity and patient activity.<br /><br />Throughout, emphasis was placed on individualized care, thorough imaging, the spectrum of surgical options, setting realistic expectations, and shared decision-making between surgeons and patients.

Asset Subtitle

There are periods of silence during this recording while the participants engaged in discussions at their tables.

Asset Caption

Case Discussion
Case 1: 18-year-old with right foot pain and deformity after ATV crash

Case 2: 43-year-old female with right ankle pain for 3 years

Case 3: 66-year-old male with chronic pain in the left foot and ankle

Keywords

Lisfranc injuries

foot and ankle cases

orthopedic resident training

lateral midfoot dislocation

operative fixation

primary fusion

ankle arthritis

avascular necrosis

distraction arthroplasty

ankle fusion

total ankle replacement

tibiotalocalcaneal fusion

adult acquired flat foot deformity

posterior tibial tendon dysfunction

shared decision-making