J Korean Foot Ankle Soc.  2015 Sep;19(3):118-121. 10.14193/jkfas.2015.19.3.118.

Surgery for Synovial Fistula after Excision of the Lateral Malleolar Bursitis of the Ankle: A Case Report

• Jang HS
• Choi HJ

• KMID: 2045016
• DOI: http://doi.org/10.14193/jkfas.2015.19.3.118

Abstract

Lateral malleolar bursitis of the ankle is a commonly encountered disease in the department of orthopedic surgery. Although most cases of lateral malleolar bursitis are managed by conservative treatments, operative treatment is considered in cases of infected bursitis or complication after surgery. There are several potential complications associated with operative treatment, including wound healing problem, skin necrosis, nerve injury, or recurrence. However, synovial fistula of the ankle as a complication after surgery for lateral malleolar bursitis has not been previously reported. The author experienced the complication of synovial fistula after surgery for lateral malleolar bursitis and obtained a satisfactory result in revision surgery for the complication, which was coverage of the fistular formation with a periosteal flap from the distal fibula.

Keyword

Bursitis; Fistula; Infectious arthritis; Ankle

MeSH Terms

Ankle*
Arthritis, Infectious
Bursitis*
Fibula
Fistula*
Necrosis
Orthopedics
Recurrence
Skin
Wound Healing

Figure

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  Figure 1. Ultrasonography shows 3.3×1.2×3.3 cm sized bursa suspicious communicated with talofibular joint (arrow).

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  Figure 2. On axial (A) and sagittal (B) view of the magnetic resonance imaging, the bursitis is communicated with ankle joint space and synovial thickening is visible from anterior ankle joint to posterior subtalar area with joint effusion.

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  Figure 3. Arthroscopic finding presents diffuse synovial thickening and hypertrophy of the anterior tibiotalar joint (A) as well as posterior compartment (B).

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  Figure 4. Arthroscopic fluid comes pouring out through the fistula track (A) and large bursitis is visible (B).

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  Figure 5. About 1×2 cm sized defect of the talofibular joint capsule is confirmed after complete excision of the bursa.

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  Figure 6. After harvesting the distal fibular periosteum (A), the defect is covered with the periosteal free graft (B).

Reference

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