Method of Treatment of Purulent Arthritis of the Ankle

Abstract

Aims.The aim of the study was the development and clinical approbation of the method of treatment of purulent arthritis with the formation of ankle ankylosis. Materials and MethodsTwenty-two patients underwent surgery after ankle trauma complicated by inflammation (18 male and 4 females ranging in age from 28 to 62). To open the ankle joint, an anterior approach was used. After opening the cavity of the joint, surgical treatment of the purulent-necrotic focus with necrotic sequestrectomy and resection of the tibia and talus bones were performed within the limits of healthy bone tissue, after which a compression/distraction device was applied. Distraction in the area of the resection of the tibia and talus bones artificially created a cavity in the ankle joint simultaneously. Through additional punctures in the projection of external and internal ankle bones, a perforated drain was placed in the created cavity. [Bonesaw-lines] of the tibia and talus bones were drawn together to the dimensions of the drain tube. In the postoperative period, sanitation of the purulent-necrotic focus was performed by means of continuous draining of the created cavity with antiseptic solutions. After the bacterial inoculation cultures were negative three times, the draining tube was removed, and gradually the tibia and talus bones were moved closer. The external fixation device was switched to the mode of consistent stabilisation with the possibility of putting weight on the damaged extremity. Fixation in the device continued until the X-ray picture of bone ankylosis in the ankle was obtained ResultsFor all patients we were able to achieve stable remission of the inflammation process and formation of a strong bone ankylosis in the ankle. The sanitation period of the purulent-necrotic focus was 14-16 days. After removal of the drain and compression in the external fixation device, the patients were allowed to move on crutches with moderate weight on the operated extremity. Duration of fixation in the device was 16-20 weeks. During 5 years of continuous follow-up, no relapses of inflammation in the ankle joint were observed. Conclusions.The suggested method makes it possible to solve the problem of ending inflammation in the ankle by means of forming bone ankylosis during surgical treatment of purulent osteoarthritis.