Closed arthrodesis in infected neuropathic ankles using Ilizarov ring fixation

Abstract

Aims Infected and deformed neuropathic feet and ankles are serious challenges for surgical management. In this study we present our experience in performing ankle arthrodesis in a closed manner, without surgical preparation of the joint surfaces by cartilaginous debridement, but instead using an Ilizarov ring fixator (IRF) for deformity correction and facilitating fusion, in arthritic neuropathic ankles with associated osteomyelitis. Methods We retrospectively reviewed all the patients who underwent closed ankle arthrodesis (CAA) in Ilizarov Scientific Centre from 2013 to 2018 (Group A) and compared them with a similar group of patients (Group B) who underwent open ankle arthrodesis (OAA). We then divided the neuropathic patients into three arthritic subgroups: Charcot joint, Charcot-Maire-Tooth disease, and post-traumatic arthritis. All arthrodeses were performed by using an Ilizarov ring fixator. All patients were followed up clinically and radiologically for a minimum of 12 months to assess union and function. Results The union rate for Group A was 81% (17/21) while it was 84.6% (33/39) for Group B. All the nonunions in Group A underwent revision with an open technique and achieved 100% union. Mean duration of IRF was 71.5 days (59 to 82) in Group A and 69 days (64.8 to 77.7) in Group B. The American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score was similar in both groups. The postoperative hospital stay was shorter in Group A (21 days (SD 8)) than Group B (28 days (SD 9)). In the latter Group there were more problems with wound healing and greater requirement for antibiotic treatment. The mean operating time was 40 minutes (SD 9) in Group A compared to 80 minutes (SD 13) in Group B. Recurrence of infection occurred in 19% (4/21) and 15.5% (6/39) for Group A and Group B respectively. Conclusion We found CAA using an IRF to be an effective method for ankle arthrodesis in infected neuropathic foot and ankle cases and afforded comparable results to open methods. Due to its great advantages, Ilizarov method of CAA should always be considered for neuropathic ankles in suitable patients. Cite this article: Bone Joint J 2020;102-B(4):470–477.

Management of septic non union and discrepancy of humerus in a child: A case report

“…Other authors, start distraction in closed non union site and will perform lengthening firstly and this is the case of Jupiter [ 5 ] which he reported an excellent result with this procedure in a 19-year-old male patient. Alammar [ 8 ] in a recent study of 60 patients, demonstrated that IL is an effective method for closed arthrodesis in infected ankle comparing to open methods. In our case we used the method of Jupiter [ 5 ] and that Alammar [ 8 ] combined, indeed we perform the distraction of the non union without opening the pseudathrosis site.…”

“…Alammar [ 8 ] in a recent study of 60 patients, demonstrated that IL is an effective method for closed arthrodesis in infected ankle comparing to open methods. In our case we used the method of Jupiter [ 5 ] and that Alammar [ 8 ] combined, indeed we perform the distraction of the non union without opening the pseudathrosis site. Cattaneo [ 4 ] described a humeral lengthening using IF in 43 cases varied from 5 cm to 16 cm with different etiology of defect bones included achondroplasia, congenital shortening, bone infection and fracture with an excellent outcome in most patients.…”

Foot Assessment Clinical Scales in Charcot-Marie-Tooth Patients: A Scoping Review

“…FHSQ is a selfadministered questionnaire developed and validated to measure the quality of life related to foot health in a population suffering from minor foot conditions, such as skin and nail disorders (Bennett et al, 1998). AOFAS-AHES was used in nine orthopedic studies to evaluate a cohort of CMT patients (Gordon et al, 2013;Kołodziej et al, 2013;Dreher et al, 2014;Napiontek and Pietrzak, 2015;Ettinger et al, 2016;Ergun and Yildirim, 2019;Klerken et al, 2019;Simon et al, 2019;Alammar et al, 2020) while MFS and FHSQ were both employed only once (Crosbie et al, 2008;Faldini et al, 2015).…”

What is new in limb reconstruction?

“…We were therefore interested to hear from colleagues at the home of Ilizarov in Kurgan (Siberia), who retrospectively presented their results of closed ankle arthrodesis with a circular ring fixator. 1 The authors compared outcomes in Researchers from Yunnan (China) take an alternative approach to limb salvage in an attempt to avoid the need for microsurgery.…”