Robert Rochman1, James Jackson Hutson, Oladapo Alade. 1. The Center for Bone and Joint Surgery of the Palm Beaches, 12989 Southern Blvd, Building 3, Suite 101, Wellington, FL 33470, USA. robert.rochman@boneandjoint.org
Abstract
BACKGROUND: Infected nonunions and extrusions of the talus can often lead to below-knee amputation. Limb-salvage procedures have goals of eradicating infection and creating a painless, stable limb. Often, a tibiocalcaneal fusion is the best option; however, in the presence of infection and bone loss, it can be difficult to achieve a successful outcome using internal fixation. We review the results of circular ring external fixation to obtain a tibiocalcaneal arthrodesis despite these obstacles. METHODS: A retrospective review of 11 patients who underwent tibiocalcaneal arthrodesis using an Ilizarov external fixator for infected talar nonunions or extrusions was performed. Each patient had a debridement of all nonviable talus. The bony surfaces were prepared for the fusion followed by application of a circular ring fixator. Clinical outcomes were measured using the AOFAS ankle-hindfoot scale. There was a mean followup of 35 months. RESULTS: Nine of the 11 patients had successful fusions. One fused successfully after a revision and the other developed a stable pseudoarthrosis. Eight patients underwent concomitant lengthening with the Ilizarov fixator. Mean AOFAS score at final followup was 65. This was out of a maximum of 86 since the tibiotalar and subtalar joint motion were removed. There were no recurrent deep infections or amputations. CONCLUSIONS: Tibiocalcaneal arthrodesis using the Ilizarov technique is a viable alternative to amputation in patients with infected nonunions or large bone loss of the talus.
BACKGROUND: Infected nonunions and extrusions of the talus can often lead to below-knee amputation. Limb-salvage procedures have goals of eradicating infection and creating a painless, stable limb. Often, a tibiocalcaneal fusion is the best option; however, in the presence of infection and bone loss, it can be difficult to achieve a successful outcome using internal fixation. We review the results of circular ring external fixation to obtain a tibiocalcaneal arthrodesis despite these obstacles. METHODS: A retrospective review of 11 patients who underwent tibiocalcaneal arthrodesis using an Ilizarov external fixator for infected talar nonunions or extrusions was performed. Each patient had a debridement of all nonviable talus. The bony surfaces were prepared for the fusion followed by application of a circular ring fixator. Clinical outcomes were measured using the AOFAS ankle-hindfoot scale. There was a mean followup of 35 months. RESULTS: Nine of the 11 patients had successful fusions. One fused successfully after a revision and the other developed a stable pseudoarthrosis. Eight patients underwent concomitant lengthening with the Ilizarov fixator. Mean AOFAS score at final followup was 65. This was out of a maximum of 86 since the tibiotalar and subtalar joint motion were removed. There were no recurrent deep infections or amputations. CONCLUSIONS: Tibiocalcaneal arthrodesis using the Ilizarov technique is a viable alternative to amputation in patients with infected nonunions or large bone loss of the talus.
Authors: Austin T Fragomen; Eugene Borst; Lindsay Schachter; Stephen Lyman; S Robert Rozbruch Journal: Clin Orthop Relat Res Date: 2012-07-10 Impact factor: 4.176