Management of Neurologic Deformity of the Ankle and Foot With Concurrent Osteomyelitis With the Ilizarov Method

Клюшин, Н. М.; Sudnitsyn, A.S.; Subramanyam, Koushik Narayan; George, Jefferson

doi:10.1177/1071100717739396

Cited by 16 publications

(19 citation statements)

References 28 publications

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“…A AC constitui uma preocupação relevante para os ortopedistas, uma vez que envolve um processo destrutivo osteoarticular que frequentemente acomete o pé e o tornozelo de pacientes com neuropatia periférica devido ao curso prolongado da doença (1,2,4,5,(7)(8)(9)11,(15)(16)(17)(18)(19)(20) . A perda da sensibilidade protetora dos pés faz com que lesões traumáticas não reconhecidas pelo paciente induzam à fragmentação óssea, desarranjo e destruição osteoarticular que, frequentemente, resultam em deformidades grosseiras e acentuada instabilidade, impossibilitando o apoio do peso corporal e a marcha independente (19) .…”

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“…Consequentemente, podem se formar proeminências ósseas que predispõem ao surgimento de úlceras de pressão localizadas nas áreas salientes dos pés insensíveis (2,5,8,11,15,17) . A insistência do paciente em tentar apoiar-se sobre a extremidade instável e deformada leva à formação de úlceras de pressão recorrentes costumeiramente relacionadas com a sequência de eventos que resultam na amputação da extremidade (5,(19)(20)(21)(22)(23)(24)(25) .…”

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Evaluation of the prognosis of type IV Charcot arthropathy treatment

Chakkour

Neto

2018

Sci J Foot Ankle

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Objective: To evaluate the prognosis of specialized orthopedic treatment to obtain a functional foot and ankle in diabetic patients with neglected Charcot arthropathy (NCA). Methods: Sixty-five patients with NCA were treated in the period between 2000 and 2017, according to a systematized protocol adopted atour institution. Six patients (9%) were lost to follow-up, and the remaining 59 patients had a total of 63 affected extremities (four patients were bilaterally affected). The mean follow-up time was 72 months (range 12 to 132 months), and the mean age was 54 years (range 30 to 80 years). We considered the results satisfactory when the patient was able to walk independently, fully supporting the foot on the ground. We considered the results unsatisfactory when the affected extremity presented a frank instability and was deformed to the point that it was not possible to accommodate it in a stabilizing orthesis or support it during gait or when amputation was necessary. Results: We obtained an unsatisfactory result in 31 of the 59 patients (53%). Only 31 of the 63 extremities (49%) were considered functional after treatment. Conclusion: The prognosis of NCA treatment using the systematized treatment protocol is poor. Only half of the treated extremities were capable of plantar support and independent gait. Level of Evidence IV; Prognostic Studies; Case Series.

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Section: Introductionunclassified

Evaluation of the prognosis of type IV Charcot arthropathy treatment

Chakkour

Neto

2018

Sci J Foot Ankle

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“…Their incidence is reported to be as high as 1 % to 4 % [5]. The standard treatment of chronic osteomyelitis involves thorough debridement of infected bone, options to retain or remove the infected implant and replace it with different hardware, and systemic antibiotic administration [1,5,6,7]. Often patients with chronic osteomyelitis receive prolonged antibiotic therapy with high doses rather than debridement for removal of all infective and necrotic material [2,3].…”

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“…Often patients with chronic osteomyelitis receive prolonged antibiotic therapy with high doses rather than debridement for removal of all infective and necrotic material [2,3]. Antibiotics might need to be replaced in some cases when antimicrobial therapy starts before cultures have been obtained, usually at the time of debridement [1,2,3,5,6,7].…”

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Diagnosis of chronic osteomyelitis complicated with mycotic infection

Sudnitsyn¹,

Клюшин²,

Migalkin³

et al. 2019

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Introduction In the last decade, there has been an increase in the incidence rate of mycoses in patients after injuries and/ or operations performed on limb segments and major joints. Mycoses are difficult to diagnose early because the mycotic flora may mimic the bacterial flora being present in the osteomyelitic nidus and primarily identified in the wound exudate. Objective To develop diagnostic criteria for osteomyelitis complicated with mycotic infection. Methods We performed a retrospective study of 28 patients (17 males and 11 females) aged 21 to 76 years (49 ± 16 years) who were treated for purulent inflammatory lesions of bones and/or joints at the clinic of osteology infection between 2000 and 2018. Results Mycotic infection was pathomorphologically detected in the osteomyelitis nidus of all patients. Patients were treated according to the established protocol including radical sequestrectomy, diagnostic biopsy and postoperative administration of antimicrobial and antifungal therapy. Discussion The study allowed identification of several diagnostic criteria for osteomyelitis complicated by mycotic infection. Pathomorphological examination of surgical specimen from purulent inflammatory nidus was shown to be the keystone in diagnosis of osteomyelitis complicated with mycoses.

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“…наиболее частыми причинами его развития являются сахарный диабет, послед-ствия травм и оперативных вмешательств, нейрогенные нарушения нижних конечностей. Больные с нейрогенными расстройствами нижних конечностей, сопровождающимися деформациями стоп и осложненными хроническим остеомиелитом, в 60% случаев имеют в анамнезе spina bifida (тип myelomeningocele) [8].…”

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Some Morphological and Functional Aspects of Chronic Osteomyelitis in Patients with Neurogenic Foot Deformities

Sudnitsyn

Щурова

Варсегова

et al. 2019

Traumatology and Orthopedics of Russia

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Relevance. Neurological disorders are one the most frequent cause for developing of chronic foot inflammation. Analysis of pathological picture of chronic osteomyelitis in patients with neurogenic foot deformities, including cases of spina bifida, is not adequately addressed.Purpose of the study — to examine morpho-functional aspects of chronic osteomyelitis in patients with multicomponent foot deformities and with spina bifida.Materials and Methods. The present paper is based on the study of 30 patients with multicomponent neurological foot deformities complicated by chronic osteomyelitis who had medical history of spina bifida (myelomeningocele type). Histology was used to examine resected fragments of affected bone tissue, bone sequestration and skin adjacent to osteomyelitis area. Laser doppler flowmetry was used to study capillary cutaneous blood flow on plantar foot surface. Thermal and pain sensitivity was assessed by electric sensimeter in L4, L5, S1 dermatomas on the right and on the left sides.Results. Biopsy skin specimens harvested at osteomyelitis area demonstrated signs of parakeratosis, absence of stratum lucidum, epidermis acanthosis with 25% thickness increase (р = 0,04), 2,2 times increase of density for microvessels of the dermis (р = 0,73Е-4) and increased rate of capillary blood flow at 81,6±14,2% (р = 0,0004), fibrosis and dermis thinning at 19,1% (р = 0,03), 1,37 times increase in bulk density of perspiratory glands (р= 0,04), loss of adipose tissue and degeneration of nerve fibers in the majority of nerve stems of the dermis. Above factors were accompanied by disorders in thermal and pain sensitivity in 100% of cases and in 29% of those sensitivity was missing. Morphological picture of bone tissue in osteomyelitic area was manifested by multiple destruction cavities with pyogenic membrane, granular tissue of varying maturity, combined chronic and acute stages of the process, and by poor restorative bone formation.Conclusion. Disorders or lack of thermal and pain sensitivity in dermatomas L4, L5, S1, of safety sense and motion control, resulting chronic load on atypical foot segments, as well as patho-histological skin alterations contribute to ulcer formation and osteomyelitis in patients with spina bifida and multicomponent foot deformities. Morphological picture of foot bony tissue at osteomyelitic site indicates typical patho-morphological signs of chronic inflammation with poor restorative bone formation.

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Management of Neurologic Deformity of the Ankle and Foot With Concurrent Osteomyelitis With the Ilizarov Method

Abstract: Level IV, retrospective case series.

Cited by 16 publications

References 28 publications

Evaluation of the prognosis of type IV Charcot arthropathy treatment

Evaluation of the prognosis of type IV Charcot arthropathy treatment

Diagnosis of chronic osteomyelitis complicated with mycotic infection

Some Morphological and Functional Aspects of Chronic Osteomyelitis in Patients with Neurogenic Foot Deformities

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