Abstract
PurposeTreatment of joint destruction of the tibiotalar and subtalar joints caused by acute or chronic infections in compromised hosts is a challenging problem. In these cases, simultaneous septic arthrodesis with the use of the Ilizarov external fixator represents a possible alternative to amputation. This case series presents the results and complications of patients with acute or chronic infection of the tibiotalar and subtalar joints.MethodsBetween 2005 and 2015, 13 patients with acute or chronic infections were treated by simultaneous single-stage debridement/arthrodesis of the tibiotalar and subtalar joints. In seven patients, there was a florid infection with fistula formation and soft tissue defects, and in six patients, there was chronic osteomyelitis with closed soft tissue. In addition to the demographic data, the time spent in the fixator, the major and minor complications and the endpoint of consolidation were reviewed.ResultsThe mean time spent in the fixator was 18 (min 15, max 26) weeks. The mean follow-up time for nine patients was 100 (min 3, max 341) weeks. Complete osseous consolidation of both the tibiotalar and subtalar joints was achieved in 10 patients (77%). In three (23%) patients, there was complete consolidation of one of the joints and partial consolidation of the other joint.ConclusionThe Ilizarov external fixator allows for simultaneous arthrodesis of the tibiotalar and subtalar joints in septic joint destruction. However, the healing rates are below the rates reported in the literature for isolated tibiotalar or tibiocalcaneal arthrodesis in comparable clinical situations.
Highlights
Since the introduction of compression arthrodesis by Charnley in 1951, several different surgical procedures have been described as treatment options for various causes of ankle destruction [1]
The demographic data included the age and sex of the patients, associated relevant concomitant diseases, the source of the infection, time spent in the fixator, the complications and bony consolidation
In addition to pin breaks and forefoot instability, our study found fixator-related soft tissue defects (2x), pseudarthrosis (1x) and one fulminant infection
Summary
Since the introduction of compression arthrodesis by Charnley in 1951, several different surgical procedures have been described as treatment options for various causes of ankle destruction [1] Internal procedures such as the use of plates [2, 3] or screws [4] as well as intramedullary fixation [5, 6], arthroscopic fusion [6, 7] or external stabilization using external fixators can be used to achieve solid arthrodesis [1, 8,9,10,11].
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