BACKGROUND: Treating infected ankles in patients with neuropathy is difficult, and complications are frequently encountered. Eradication of infection and effective arthrodesis are required for a successful outcome. The purpose of this study was to evaluate the outcomes of patients with Charcot neuropathy whose infected ankles were treated with a retrograde, antibiotic-coated, locked intramedullary nail. METHODS: We analyzed 5 patients with infected neuroarthropathy of the ankle joint. Three patients had failed treatment with the circular external fixator for infected neuroarthropathy of the ankle. The other 2 were treated primarily by this technique. All patients were treated with surgical nonunion repair, arthrodesis, and insertion of an antibiotic-coated, locked intramedullary nail. The average age was 59 years (range, 46 to 82 years). The average follow up period was 18 months (range, 12-24 months). RESULTS: The average time taken for radiological healing was 4.1 months (range, 4-4.5 months). In all patients, bony union was achieved and infection was eradicated. There were no cases of hardware failure. CONCLUSION: Antibiotic-coated nails were used to treat infected ankle nonunions and infected distal tibial fractures in Charcot patients with successful bony union, fusion, and eradication of infection. LEVEL OF EVIDENCE: Level IV, therapeutic study.
BACKGROUND: Treating infected ankles in patients with neuropathy is difficult, and complications are frequently encountered. Eradication of infection and effective arthrodesis are required for a successful outcome. The purpose of this study was to evaluate the outcomes of patients with Charcot neuropathy whose infected ankles were treated with a retrograde, antibiotic-coated, locked intramedullary nail. METHODS: We analyzed 5 patients with infected neuroarthropathy of the ankle joint. Three patients had failed treatment with the circular external fixator for infected neuroarthropathy of the ankle. The other 2 were treated primarily by this technique. All patients were treated with surgical nonunion repair, arthrodesis, and insertion of an antibiotic-coated, locked intramedullary nail. The average age was 59 years (range, 46 to 82 years). The average follow up period was 18 months (range, 12-24 months). RESULTS: The average time taken for radiological healing was 4.1 months (range, 4-4.5 months). In all patients, bony union was achieved and infection was eradicated. There were no cases of hardware failure. CONCLUSION: Antibiotic-coated nails were used to treat infected ankle nonunions and infected distal tibial fractures in Charcot patients with successful bony union, fusion, and eradication of infection. LEVEL OF EVIDENCE: Level IV, therapeutic study.
Authors: Willem-Jan Metsemakers; Austin T Fragomen; T Fintan Moriarty; Mario Morgenstern; Kenneth A Egol; Charalampos Zalavras; William T Obremskey; Michael Raschke; Martin A McNally Journal: J Orthop Trauma Date: 2020-01 Impact factor: 2.884