The letter that Mr Calder dictated while I was in the appointment arrived today. Here it is, lovingly re-typed by my own fair hand, with some personal details omitted.
The Catterall UnitOverall, continue to be quite pleased with how it's all going, but waiting for the letter from Mary to get the ball rolling, as it were.
Date of Clinic: 13th April 2010
Date of Typing: 14th April 2010
Consultant Orthopaedic Surgeon
RE: Katherine F. DOB
Thank you for asking me to see Ms F. As you aware she is a 23 year old lady who is training to become a medical secretary. In 2001 she came under the care of Mr Cannon for an osteoclastoma affecting the right distal tibia. This was initially curetted in Peterborough and bone grafted but there was a recurrence requiring a second operation in October 2001. Mr Cannon excised the tumour and placed in cavity cement.
This has been successful in that there has been no recurrence. She has always had pain in her ankle since the surgery which improved up to 4 years following this curettage but since that time has become much worse especially over the last year. The pain is felt mainly in the joint. In December of last year you performed a local anaesthetic injection within the joint which competely obliterated her symptoms.
She is currently on no medications and has no known allergies. She has no past medical history of note. She is a non smoker and drinks little alcohol. She currently lives with her parents in a house and walk with a reciprocating gait. She uses a stick for long journeys and is able to walk through the pain. She can drive. She appreciates that she has minimal range of motion from her ankle.
Clinically today there is no distal neurovascular deficit. Well healed curved medial incision and anterlateral incision with no evidence of ongoing infection. There is a jog of movement in the ankle joint which causes very little discomfort today. Good range of motion of subtaler and mid foot joints.
Radiographs you have taken a large cementoma filling the whole of the metaphysis and epiphysis of the distal tibia [sic]. There is significant joint space narrowing.
I agree that from a reconstruction point of view excision of the distal tibia of approximately 7cm and removal of the top of the talus would allow bone transport to form a tibiotalar fusion. I have been able to go over the concept of this including showing pictures of the frame, the method of distraction osteogenesis and the risks including infection, nerve injury, bleeding, poor bone formation and need for further surgery especially at the docking site.
At present Ms F. is quite keen to consider the surgery. I do not feel there is another way of obtaining a solid fusion and that amputation is another option but she is adamant that she does not wish to consider this at this stage.
Therefore I will ask Mary Chasseaud our clinical nurse specialist to see Ms F. to discuss the social implications of having a frame. Following this consultation she will either come back to see to plan a date for surgery or we will book one for admission [sic].
Many thanks for asking me to see her.
With kind regards.
Mr Peter Calder
Consultant Orthopaedic Surgeon
cc GP, Patient, Clinic Nurse