C Gunasekeran1, K Bhowmick1, B Ramasamy2, T S Jepegnanam1. 1. Department of Orthopaedics, Christian Medical College and Hospital Vellore, Vellore, India. 2. Department of Orthopaedics, Royal Adelaide Hospital, Adelaide, Australia.
Abstract
INTRODUCTION: The management of talus bone loss in trauma is difficult and unsatisfactory. This study assessed whether the height of the ankle was preserved when entire or partial talar bone loss was managed with hind foot intramedullary nail augmented with autogenous rectangular or trapezoidal cortico-cancellous bone blocks from the iliac crest in the presence of active or latent infection. MATERIALS AND METHODS: Four patients were included in the study from January 2011 to December 2017. In the first stage, all four patients underwent debridement of the ankle, total or partial excision of the talus, and antibiotic-loaded bone cement spacer (ALBC) placement in the ankle joint. The second stage of the arthrodesis procedure was initiated six to eight weeks after the primary procedure, where these patients underwent arthrodesis with hindfoot nail and bone blocks from the iliac crest. RESULTS: All patients were followed-up for an average of 17.6 months (range 12.0 - 32.0 months). The arthrodesis site had united in all these four patients. The AOFAS scores were satisfactory in all patients. One patient underwent nail removal after the arthrodesis site had united. CONCLUSIONS: The hind foot nail with iliac crest bone block maintains the ankle height and ensures successful arthrodesis. In patients with partial/ complete bone loss with suspicion or confirmation of infection, staging the arthrodesis procedure minimises the chance of complications.
INTRODUCTION: The management of talus bone loss in trauma is difficult and unsatisfactory. This study assessed whether the height of the ankle was preserved when entire or partial talar bone loss was managed with hind foot intramedullary nail augmented with autogenous rectangular or trapezoidal cortico-cancellous bone blocks from the iliac crest in the presence of active or latent infection. MATERIALS AND METHODS: Four patients were included in the study from January 2011 to December 2017. In the first stage, all four patients underwent debridement of the ankle, total or partial excision of the talus, and antibiotic-loaded bone cement spacer (ALBC) placement in the ankle joint. The second stage of the arthrodesis procedure was initiated six to eight weeks after the primary procedure, where these patients underwent arthrodesis with hindfoot nail and bone blocks from the iliac crest. RESULTS: All patients were followed-up for an average of 17.6 months (range 12.0 - 32.0 months). The arthrodesis site had united in all these four patients. The AOFAS scores were satisfactory in all patients. One patient underwent nail removal after the arthrodesis site had united. CONCLUSIONS: The hind foot nail with iliac crest bone block maintains the ankle height and ensures successful arthrodesis. In patients with partial/ complete bone loss with suspicion or confirmation of infection, staging the arthrodesis procedure minimises the chance of complications.
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