Using hand-held smartphone video of an examinee standing and walking, a lot of information can be determined regarding the examinee’s potential for long-term issues post ankle injury and ankle arthritis.
A 60+ year old person suffered a right ankle fracture dislocation after a motor vehicle accident. The examinee had ankle surgery for ORIF & Bimalleolar fracture reconstruction that consisted of a displaced right ankle bimalleolar fracture dislocation with high lateral malleolar fracture with anatomic reduction with simple intramedullary stabilization and fixation of the medial malleolus with a single lag screw.
The examinee also has significant comorbidities consisting of: Chronic heart failure; Acute Kidney failure; Cigarette Smoker with Nicotine dependence; Hypertension; Status Post Coronary artery bypass x 2; Cardiac pacemaker with an automated implantable cardioverter defibrillator; Atrial fibrillation; and Peripheral vascular disease.
Xray ankle images from 3 months post injury show continued demineralization of the distal segments of the fibular malleolus and distal medial malleolus and some early signs of diffuse ankle joint arthritis with a medial talar osteophyte and some asymmetric joint space narrowing of the ankle mortise.
A review was done of a smart phone video of the examinee walking with a cane approximately 10 months post injury that clearly showed that the examinee lateralizes their trunk despite being supported by the cane and leans away from their injured right ankle. The video shows a significant antalgic, asymmetric walking gait that is very taxing to the examinee.
Regarding posttraumatic ankle fracture, a peer reviewed article states that 80% of ankle arthritis is posttraumatic, mainly secondary to malleolar fractures. The article further states, “Ankle instability increases the peak joint contact stresses of the ankle joint, resulting in cartilage deterioration that ultimately leads to ankle OA.”
After review of the medical records and with the addition of the smart phone video that shows the examinees chronic right sided gait dysfunction necessitating the use of a cane, it is my medical opinion that the examinee’s gait will continue to deteriorate with great potential to cause increased risk of falls as well as other musculoskeletal problems that will continue to affect their quality of life and exacerbate their peripheral and cardiovascular disease, all of which can lead to an increased risk of morbidity and mortality.
This case was settled via arbitration to the satisfaction of the examinee and their representative.
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