Outcomes and Management of Infected Intramedullary Nails After Tibiotalocalcaneal Arthrodesis in Limb Salvage: A Retrospective Case Series

Powers, Nicholas S.; Brandão, Roberto A.; John, Jason M. St.; Burns, Patrick R.

doi:10.1053/j.jfas.2018.11.036

Cited by 4 publications

(6 citation statements)

References 23 publications

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“…21 Powers et al, in the largest series of revision TTCA secondary to infection to date, used an antibiotic impregnated bone cement nail to achieve a limb salvage rate of 73.68% in 19 patients. 17 Importantly, several patients ambulated on the antibiotic impregnated bone cement nail without second stage operations successfully. 17 Given the last line of limb salvage is often primary TTCA, these results show the utility of the antibiotic impregnated bone cement nail in the dire setting of infected primary TTCA.…”

Section: Possible Concerns Future Of the Techniquementioning

confidence: 99%

“…17 Importantly, several patients ambulated on the antibiotic impregnated bone cement nail without second stage operations successfully. 17 Given the last line of limb salvage is often primary TTCA, these results show the utility of the antibiotic impregnated bone cement nail in the dire setting of infected primary TTCA. In this technique, the use of guidewire from the IM nail set, which comes in a length of 1000 mm, provided with intraoperative flexibility to accommodate longer lengths of TTC nails and greater coverage of the IM canal when required.…”

Section: Possible Concerns Future Of the Techniquementioning

confidence: 99%

“…1,[13][14][15] In few instances, implications of infection could be devastating with amputation of the affected extremity and loss of functional independence. 16,17 One of the most frequently observed complications of TTCA is infection which may even become limb threatening in select cases. 1,13,14,16 In such instances, use of an antibiotic impregnated bone cement nail provides many advantages over other surgical management options.…”

Section: Historical Perspectivementioning

confidence: 99%

“…The use of retrograde nail in tibiotalocalcaneal (TTC) arthrodesis has been associated with a plethora of complications such as delay in wound healing, postoperative infection (immediate or delayed), pseudoarthrosis, malunion, nonunion, fracture, implant prominence, and implant failure 1,13–15. In few instances, implications of infection could be devastating with amputation of the affected extremity and loss of functional independence 16,17…”

Section: Historical Perspectivementioning

confidence: 99%

“…Correspondingly, multiple studies have documented that single stage surgery is able to avert drawbacks like prolonged hospital stay, risks associated with multiple anesthesia procedures, preoperative anxiety which are commonly associated with multiple stage surgery and have also been found to be more feasible for difficult cases 21. Powers et al, in the largest series of revision TTCA secondary to infection to date, used an antibiotic impregnated bone cement nail to achieve a limb salvage rate of 73.68% in 19 patients 17. Importantly, several patients ambulated on the antibiotic impregnated bone cement nail without second stage operations successfully 17.…”

Section: Possible Concerns Future Of the Techniquementioning

confidence: 99%

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Retrograde Intramedullary Antibiotic Impregnated Cement Nailing for Treatment of Infected Primary Tibiotalocalcaneal Arthrodesis

Agarwal¹,

Andrews²,

Young³

et al. 2022

Techniques in Foot &Amp; Ankle Surgery

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The management of infected primary tibiotalocalcaneal arthrodesis (TTCA) is a daunting task for foot and ankle surgeons. For the last 2 decades, antibiotic bone cement nails have become a method to treat intramedullary infections, such as those seen in infected TTCA, as they provide the dual benefits of eluting high amounts of antibiotics into medullary canal while providing some stability to the bone. Studies have demonstrated the effectiveness of this salvage technique in treating infected primary TTCA. Because of the lack of commercially available antibiotic impregnated nails for this procedure, there is significant variation in techniques utilized. In addition, the rarity of these cases can make execution of this technique difficult and time consuming. To date there is no comprehensive technique guide for this procedure. We present a detailed photographic record and technical details of a modified technique for employing an antibiotic spacer nail for a 64-year-old female patient undergoing revision TTCA. The patient had an uncomplicated postoperative clinical course with no evidence of wound infection. Her osteomyelitis subsequently resolved, and she was able to ambulate with minimal pain with a Charcot Restraint Orthotic Walker. Surgeons can utilize the technical pearls presented herein to help reduce the amount of time spent in the operating room performing these clinically challenging revisions.

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Section: Possible Concerns Future Of the Techniquementioning

confidence: 99%

Section: Possible Concerns Future Of the Techniquementioning

confidence: 99%

Section: Historical Perspectivementioning

confidence: 99%

Section: Historical Perspectivementioning

confidence: 99%

Section: Possible Concerns Future Of the Techniquementioning

confidence: 99%

See 3 more Smart Citations

Retrograde Intramedullary Antibiotic Impregnated Cement Nailing for Treatment of Infected Primary Tibiotalocalcaneal Arthrodesis

Agarwal¹,

Andrews²,

Young³

et al. 2022

Techniques in Foot &Amp; Ankle Surgery

View full text Add to dashboard Cite

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Tibiotalocalcaneal Arthrodesis in Severe Hindfoot Deformities

Martínez-de-Albornoz

Monteagudo²

2022

Foot and Ankle Clinics

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Structural Antibiotic-Coated Hindfoot Nail Preparation: A Technique Guide

Wireman,

Hale,

Poynter

et al. 2024

Techniques in Foot &Amp; Ankle Surgery

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The current guide describes a technique that has been in place at the University of Louisville for several years and has been utilized to create structural antibiotic hindfoot nails. This has the intention of creating a stable construct that can be utilized in the setting of previous osteomyelitis, or that is at high risk of developing infections in the postoperative state. This technique guide provides a reproducible way to apply an antibiotic delivery system to a tibiotalocalcaneal nail at the time of definitive surgical intervention. It described our method at rural state level one trauma hospital of utilizing antibiotic-impregnated polymethylmethacrylate around a nail for both antibiotic properties as well as structural properties. Antibiotic delivery systems are a well-researched surgical tool, combining this with a hindfoot nail offers definitive surgical management of otherwise complicated surgical cases. Although this technique has been in use at the University of Louisville for many years, additional research should be done to determine long-term outcomes. Level of Evidence: Diagnostic Level 7. See Instructions for Authors for a complete description of levels of evidence.

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Outcomes and Management of Infected Intramedullary Nails After Tibiotalocalcaneal Arthrodesis in Limb Salvage: A Retrospective Case Series

Cited by 4 publications

References 23 publications

Retrograde Intramedullary Antibiotic Impregnated Cement Nailing for Treatment of Infected Primary Tibiotalocalcaneal Arthrodesis

Retrograde Intramedullary Antibiotic Impregnated Cement Nailing for Treatment of Infected Primary Tibiotalocalcaneal Arthrodesis

Tibiotalocalcaneal Arthrodesis in Severe Hindfoot Deformities

Structural Antibiotic-Coated Hindfoot Nail Preparation: A Technique Guide

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