Treatment of hindfoot and ankle infections with Ilizarov external fixator or spacer, followed by secondary arthrodesis

Hartmann, Rebecca; Grubhofer, Florian; Waibel, Felix W A; Götschi, Tobias; Viehöfer, Arnd; Wirth, Stephan

doi:10.1002/jor.24938

Cited by 4 publications

(7 citation statements)

References 48 publications

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“… 8 They reported that infection after hindfoot surgery was a significant problem and could result in significant complications that may require revision surgeries, including amputation. 12 , 14 Saibaba and Gopinathan 25 reported that limited vascularity combined with the force going through the hindfoot including calcaneus could predispose it to infection. However, there is no consensus for why hindfoot surgery is more risky in postoperative infection compared with the forefoot/midfoot surgery.…”

Section: Discussionmentioning

confidence: 99%

Do We Need Routine Postoperative Prophylactic Oral Antibiotics in Elective Foot and Ankle Surgery?

Lachance,

Giro,

Edelstein

et al. 2024

Foot & Ankle Orthopaedics

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Background: Previous studies about antibiotic prophylaxis in foot and ankle surgery have focused on perioperative intravenous administration, with few studies reporting on the efficiency of postoperative oral antibiotics. The purpose of this study is to investigate differences in the rate of postoperative infection and wound complications between patients with and without postoperative oral antibiotics and to identify independent risk factors for these complications following foot and ankle surgeries. Methods: A retrospective review of all elective foot and ankle surgeries with at least a 6-month follow-up was performed over a 2-year time span. Patients were divided into 2 groups based on if they received postoperative oral antibiotics. We compared the rates of postoperative infections and wound complications between the 2 groups. The surgical site, the number of Current Procedural Terminology codes, and the number of surgical incisions were also noted. Multivariable logistic regression analysis was performed to identify independent risk factors of postoperative infection and wound complications. Results: A total of 366 patients were included in this study—240 with antibiotics and 126 without antibiotics. There was no significant difference in the rates of postoperative infection and wound complications between the 2 groups. The rate of superficial infection, deep infection, and wound complications was 1.7%, 0.8%, and 5.8% in the antibiotic group vs 3.2%, 0.0%, and 4.0% in patients without antibiotics, respectively. Multivariable logistic regression analysis identified independent risk factors of postoperative infection and wound complications as follows: smoking (OR: 4.7), male (OR: 4.0), history of neoplasm (OR: 6.7), and multiple incisions (OR: 4.1). Conclusion: Our results suggest that routine postoperative prophylactic oral antibiotics are not needed following elective foot and ankle surgeries. However, certain risk factors may increase the risk for postoperative infection and wound complications in foot and ankle surgery. Level of Evidence: Level III, case-control study.

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Section: Discussionmentioning

confidence: 99%

Do We Need Routine Postoperative Prophylactic Oral Antibiotics in Elective Foot and Ankle Surgery?

Lachance,

Giro,

Edelstein

et al. 2024

Foot & Ankle Orthopaedics

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“…Ankle arthrodesis combined with radical debridement may be the most suitable option to eradicate an infection and salvage the limb [12,19,21,22,27,34,37,39]. Although numerous fusion methods have been proposed, there is controversy about the most effective technique [9,21,26,27,34]. To explore whether ankle arthrodesis using an Ilizarov external fixator is an effective treatment for septic ankle arthritis, we assessed the fusion rate, complications, reoperations, and patient-reported outcome measures of patients in our study after a minimum of 6 years of follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…In most patients-more than 90%-treated with an Ilizarov external fixator for ankle arthrodesis to treat septic ankle arthritis, osseous fusion was achieved by 12 months. Few studies we know of have described ankle arthrodesis in patients with septic ankle arthritis, and the fusion rate ranged from 61% to 100% in previous studies [4,9,12,19,21,22,27,33,34,37,39]. Good soft tissue condition, eradication of infection, and rigid fixation are key factors to achieve bony fusion [12,21,39].…”

Section: Percentage Of Patients Who Achieved Bony Fusionmentioning

confidence: 99%

“…For septic ankle arthritis, the principle of treatment is to restore foot stability and function [12,34]. To our knowledge, few studies have detailed the patient-reported outcomes of ankle arthrodesis in patients with septic ankle arthritis [6,9,17,19,37]. El-Alfy [6] performed ankle arthrodesis with an Ilizarov external fixator in 21 patients with infection or poor bone stock, and after a mean follow-up of 29 months, the AOFAS score ranged from 55 to 86, with an average of 78.…”

Section: Patient-reported Outcomesmentioning

confidence: 99%

“…However, because of the rarity of this condition, only a few studies we know of have reported the short-term or mid-term outcomes of ankle arthrodesis in patients with septic ankle arthritis [6,19,22,27,34,39]. Because these studies were limited by small size, insufficient length of follow-up, and varying therapeutic managements, there is still no consensus on the management of septic ankle arthritis [9,21,27,34].…”

Section: Introductionmentioning

confidence: 99%

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Is Ankle Arthrodesis With an Ilizarov External Fixator an Effective Treatment for Septic Ankle Arthritis? A Study With a Minimum of 6 Years of Follow-up

Wang

et al. 2022

Clin Orthop Relat Res

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Background Septic ankle arthritis is a devastating clinical problem with a high potential for permanent disability and amputation. Successful treatment of septic ankle arthritis remains a challenge for the surgeon and patient. Ankle arthrodesis combined with radical debridement may be an effective option to eradicate infection and salvage the limb. Although numerous fusion methods have been proposed, there is controversy about the most effective technique. Questions/purposes At a minimum follow-up of 6 years after ankle arthrodesis performed using an Ilizarov external fixator, we asked, ( 1) In what proportion of patients was bony fusion achieved? (2) What complications were observed, and what reoperations were performed in these patients? (3) How much did patient-reported outcomes improve from before surgery to the most recent follow-up in this group? Methods Between April 2010 to March 2015, we treated 59 patients for septic ankle arthritis. Of those, we considered patients who were at least 18 years of age with irreversible destruction of the joint as potentially eligible. During that time period, all patients met the prespecified criteria and were treated with ankle arthrodesis using an Ilizarov external fixator. Two percent (one of 59) of patients were excluded because they died in the second year after surgery for reasons unrelated to the procedure, and another 7% (four of 59) of patients were excluded because they were lost before the minimum study follow-up interval of 6 years. Finally, 92% (54 of 59) of patients were analyzed at a mean follow-up time of 9 6 1 years. A total of 61% (33 of 54) were men, and they had a mean age of 48 6 12 years. Forty-six percent (25 of 54) of patients were smokers, and 13% (seven of 54) of patients had Type 2 diabetes mellitus. All patients received radical debridement and primary arthrodesis with an Ilizarov external fixator, followed by antibiotic therapy. Postoperatively, patients were instructed to perform lower extremity functional exercises and external fixator care; weightbearing ambulation as tolerated was encouraged as early as possible. Fusion was assessed with a radiographic review that was performed by an individual who was not involved in the surgical care of these patients. We defined bony fusion as continuous trabeculae and complete cortical bridging in the fusion interface achieved before 9 months; delayed union was defined as fusion achieved by 9 to 12 months; and nonunion was defined as patients in whom This work was supported by the National Natural Science Foundation of China (numbers 51537004 and 81874002). Each author certifies that there are no funding or commercial associations (consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article related to the author or any immediate family members. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication ...

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Compromiso de las articulaciones vecinas en la evolución alejada de la artrodesis de tobillo

Macklin Vadell,

Sperone,

Bigatti

et al. 2024

Rev. Asoc. Arg. Ort. y Traumatol

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Introducción: La artrodesis tibioastragalina es una opción para tratar la artrosis de tobillo en pacientes que no responden a las medidas conservadoras. Su principal desventaja es el compromiso a mediano y largo plazo de las articulaciones vecinas. Objetivo: Determinar el compromiso de las articulaciones vecinas a mediano y largo plazo, y su impacto sobre los resultados funcionales en los pacientes con artrodesis de tobillo. Materiales y Métodos: Se evaluó a una serie de 11 pacientes (6 mujeres y 5 hombres). El diagnóstico inicial era artrosis postraumática (9 casos), artritis séptica (1 caso) y lesión osteocondral de astrágalo (1 caso). El promedio de edad al operarse era de 50 años. La media de seguimiento fue de 9 años. Se evaluó el compromiso radiográfico de las articulaciones vecinas. La función se valoró mediante la escala analógica visual para dolor, la escala de la AOFAS y un cuestionario simple de satisfacción. Resultados: Diez pacientes (91%) tenían artrosis en alguna de las articulaciones vecinas. El puntaje medio en la escala analógica visual fue de 2,6 y el de la escala de la AOFAS, de 71. Nueve refirieron estar muy satisfechos; uno, medianamente satisfecho y otro se manifestó insatisfecho. Conclusión: El compromiso de las articulaciones vecinas es muy frecuente a largo plazo, pero esto no repercute directamente en los resultados funcionales.

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Treatment of hindfoot and ankle infections with Ilizarov external fixator or spacer, followed by secondary arthrodesis

Cited by 4 publications

References 48 publications

Do We Need Routine Postoperative Prophylactic Oral Antibiotics in Elective Foot and Ankle Surgery?

Do We Need Routine Postoperative Prophylactic Oral Antibiotics in Elective Foot and Ankle Surgery?

Is Ankle Arthrodesis With an Ilizarov External Fixator an Effective Treatment for Septic Ankle Arthritis? A Study With a Minimum of 6 Years of Follow-up

Compromiso de las articulaciones vecinas en la evolución alejada de la artrodesis de tobillo

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