Die Arthrodese des Sprunggelenks in Infektsituationen: Ergebnisse mit dem Ilizarov-Ringfixateur

Geßmann, Jan; Özokyay, L.; Fehmer, T.; Muhr, G.; Seybold, D.

doi:10.1055/s-0030-1250360

Cited by 22 publications

(19 citation statements)

References 24 publications

(44 reference statements)

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“…Ankle fusion using circular fixation has been regarded as a last resort, limb-salvage procedure [3,5,6,8,10,11,14,16,17,20,21,23,25,[28][29][30][31] (Table 5). We asked whether (1) smoking and other comorbidities (Charcot neuroarthropathy, Type B hosts), (2) time wearing the frame, or (3) tibial lengthening affected union rate after ankle arthrodesis surgery?…”

Section: Discussionmentioning

confidence: 99%

“…Although not shown in the literature, performing a tibial osteotomy in the setting of an ankle fusion has been thought to enhance healing at the arthrodesis site [19]. The Ilizarov method [19] has been used in these complex cases [3,5,6,8,10,11,14,16,17,20,21,23,25,[28][29][30][31]. An improved understanding of the contributions of each complex variable (smoking, diabetes, Charcot neuroarthropathy, osteomyelitis, time wearing the external fixator, limb length discrepancy [LLD], and tibial lengthening) to the healing of ankle fusions would be valuable to provide information for patients' and surgeons'.…”

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confidence: 99%

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Complex Ankle Arthrodesis Using the Ilizarov Method Yields High Rate of Fusion

Fragomen

Borst

Schachter

et al. 2012

Clinical Orthopaedics &Amp; Related Research

104

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Background Ankle arthrodesis may be achieved using the Ilizarov method. Comorbidities, such as diabetes, Charcot neuroarthropathy, osteomyelitis, leg length discrepancy, and smoking, can make an ankle fusion complex and may be associated with lower rates of healing. Questions/Purposes We asked if (1) smoking and other comorbidities led to lower fusion rates, (2) time wearing the frame affected outcome, and (3) simultaneous tibial lengthening improved fusion rates. Methods We retrospectively studied 101 patients who underwent complex ankle fusion using the Ilizarov technique. The median time wearing the frame was 25 weeks (range, 10-65 weeks). Twenty-four patients had simultaneous tibial lengthening. The minimum followup for 91 of the 101 patients was 27 months (median, 65 months; range, 27-134 months). Results Fusion was achieved in 76 of 91 patients. Smoking was associated with a 54% rate of nonunion. Fifteen of 19 patients with Charcot neuroarthropathy achieved union but had a high rate of subsequent subtalar joint failure. Time wearing the frame did not affect union rates. Tibial lengthening did not improve ankle fusion rates. Conclusion Smokers should be warned of the high risk of nonunion and we recommend they quit smoking. We also recommend surgeons recognize the higher nonunion rate in patients with Charcot neuroarthropathy. We believe tibial lengthening should not be performed to enhance healing at the fusion site.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Complex Ankle Arthrodesis Using the Ilizarov Method Yields High Rate of Fusion

Fragomen

Borst

Schachter

et al. 2012

Clinical Orthopaedics &Amp; Related Research

104

View full text Add to dashboard Cite

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“…It was modified because of the elimination of tibiotalar and subtalar motion. Therefore, the maximum possible score for our patients with a successful tibiocalcaneal fusion was 86 [9,12].…”

Section: Methodsmentioning

confidence: 99%

“…Since the introduction of compression arthrodesis by Charney in 1951, several different surgical procedures have been described as treatment options for ankle destruction of various etiologies [1]. Today, external Ilizarov arthrodesis represents an established and effective procedure in compromised hosts with acute or chronic infections, soft tissue defects, axial malpositions (varus/valgus) and comorbidities (diabetes mellitus, polyneuropathy, peripheral vascular disease, and alcohol abuse) [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. Some authors even consider the Ilizarov method to be the "gold standard" in these difficult situations [2].…”

Section: Introductionmentioning

confidence: 99%

Tibiocalcaneal arthrodesis using the Ilizarov fixator in compromised hosts: an analysis of 19 patients

Reinke

Lotzien

Yılmaz

et al. 2021

Arch Orthop Trauma Surg

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Introduction Salvage of joint destruction of the tibiotalar and subtalar joint with necrosis or infection of the talus in compromised hosts is a challenging problem. In these cases, tibiocalcaneal arthrodesis using the Ilizarov external fixator represents a possible alternative to amputation. This retrospective study presents the results and complications of this salvage procedure. Materials and methods Between 2005 and 2015, 19 patients were treated with tibiocalcaneal arthrodesis using the Ilizarov external fixator. Ten patients received tibiocalcaneal arthrodesis due to an acute or chronic infection with joint destruction. The other nine patients presented posttraumatic necrosis of the talus or Charcot arthropathy. In addition to demographic data, the time spent in the fixator, the major and minor complications and the endpoint of the consolidation were evaluated retrospectively. Furthermore, clinical outcomes were measured using the modified American Orthopedic Foot and Ankle Society (AOFAS) score. Results The average time spent in the fixator was 22 (range 14–34) weeks. The average follow-up in 17 patients was 116 (range 4–542) weeks. Two patients were lost to follow-up. Complete osseous consolidation was achieved in 14 out of 19 patients. One patient presented partial consolidation, and in four patients, pseudarthrosis could be detected. The mean modified AOFAS score at the final follow-up was 53 out of 86 possible points. Conclusion Tibiocalcaneal arthrodesis using the Ilizarov fixator is a possible salvage procedure even in compromised hosts. However, the healing rates are below the rates reported in the literature for tibiotalar arthrodesis in comparable clinical situations.

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“…Over the years, many techniques have been described with increasing success with regards to fusion rates. Successful fusion rates can be expected to range from 86-100% depending on patient characteristics and surgical techniques [68,[72][73][74][75][76][77][78][79][80][81][82][83]. The most commonly used techniques utilize internal fixation.…”

Section: Global Osteoarthritismentioning

confidence: 99%