Tibiotalocalcaneal Fusion With Antibiotic Cement-Coated Nails for Refractory Deep Infection After Ankle ORIF

Abstract

Background: Deep infection after open reduction internal fixation (ORIF) of ankle fractures represents a challenge to the orthopaedic surgeon, particularly in patients in whom conventional surgical treatments have failed. The aim of this study was to assess the results of a modified technique of tibiotalocalcaneal fusion using a retrograde locked intramedullary nail covered in cement with antibiotics. Methods: Six patients treated using the authors’ technique were analyzed retrospectively. All patients had deep infection after ankle osteosynthesis and several surgical procedures (debridement, external fixation, etc) had failed. Radiographs were analyzed to confirm the healing of the bone. Outcome was measured by maintained construct stability and eradication of infection (no clinical signs of infection and normal values of laboratory markers). The average age of the series was 64.2 (range, 50-75) years, and the average follow-up period was 19.5 (range, 8-41) months. Results: Tibiotalocalcaneal stability and eradication of the infection were achieved in all patients, along with the normalization of clinical and radiologic parameters. In the patient who underwent a talectomy, one of the calcaneal locking screws broke, with no clinical repercussions. Conclusion: Tibiotalocalcaneal fusion with antibiotic cement-coated retrograde nails was useful in providing clinically acceptable results in the control of chronic infection in complex patients after the failure of previous surgeries. Level of Evidence: Level IV, therapeutic study.

Impression fracture of the lateral condyle of tibial plateau complicated by acute peri-implant infection: a case report

“…Авторы сообщают о возможности выполнения нескольких ревизий. Так, например, для санации очагов инфекции после осложнений остеосинтеза переломов лодыжек M. Herrera-Pérez с соавторами говорят о том, что количество ревизионных вмешательств у каждого пациента варьировало от 3 до 7 при среднем количестве 5 операций [15]. В нашем случае было выполнено три последовательных ревизии, и только последняя из них была завершена полным укрытием раны.…”

Effect of Antibacterial Enoxacin on the Properties of Injectable Nano-hydroxyapatite/Polyurethane Cement for Bone Repairing

“…It was reported that the BAI rate was between 2.6 and 45% if tibial plateau fractures managed with Open Reduction and Internal Fixation (ORIF) in bone fracture fixation clinically [3,4]. A new type of treatment strategy that antibiotic-loaded bone cement was covered on intramedullary nail achieved significant effect for deep infection after ORIF of ankle fractures [5]. Bone cement can form a strong bond in situ with bone tissue to create a mechanically stable interface under the influence of tensile, compressive, and shear forces [6].…”

Treatment of Infected Nonunions With Bone Defects Using Autologous Bone Graft and Absorbable Antibiotic-Loaded Calcium Sulfate–Hydroxyapatite Paste

“…Revision arthrodesis or fixation in the presence of current or previous infection carries a high risk of recurrence and persistence of an infected nonunion, thus presenting significant challenge. 23 In revision surgery, technical issues arise from the osseous voids left behind because of the required resection of diseased bone and tissue back to healthy, bleeding margins. Successful arthrodesis and bone healing requires preservation of bone and structural support to bridge any achieve stable fixation and compression of opposing bone interfaces for union.…”