Salvage arthrodesis for infected ankle fractures with segmental bone-loss using Ilizarov concepts: a prospective study
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ORIGINAL PAPER
Salvage arthrodesis for infected ankle fractures with segmental bone-loss using Ilizarov concepts: a prospective study Ashraf Atef 1
&
Mahmoud El-Rosasy 1 & Ahmad El-Tantawy 1
Received: 16 May 2020 / Accepted: 9 November 2020 # SICOT aisbl 2020
Abstract Purpose Complex ankle fractures accompanied with infection and segmental bone loss are a worrying issue. This prospective study was conducted to explore the effectiveness of using Ilizarov concepts in achieving salvage arthrodesis and reconstructing post-debridement defects in such complicated scenarios. Methods A total of 44 consecutive patients (mean age 35.61 ± 8.57 years, 30 males, 44 feet) of post-traumatic infected ankle fractures, who met our selection criteria, were enrolled and subjected to radical debridement and salvage arthrodesis using the bifocal bone transport concepts of Ilizarov. All patients were treated between 2012 and 2017 either by acute shortening compression of the arthrodesis site with re-lengthening (ASRL) through the created proximal metaphyseal osteotomy (group I, n = 20) or by gradual bone transport (BT) through the proximal osteotomy with gradual closure of the distal ankle defect (group II, n = 24). Plain-radiographs were used for radiological assessment. Clinically, the outcomes were objectively graded according to the Hawkins criteria, while subjectively the patients reported their satisfaction on a 1–5 points acceptance scale. Results The mean follow-up was 37.16 ± 5.31 (30–48 months). Successful fusion was achieved in 43/44 patients, with a significantly (P < 0.05) lesser needs for bone-grafting in favour of group II. The results were good in 32 cases, fair in 11, and poor in a single case with no significant difference between the two groups. The acceptance scores were significantly (P < 0.05) superior in group II (3.08 ± 1.1 points) than that group I (2.25 ± 1.4 points). Conclusions Bifocal bone transport is effective in salvaging troublesome infected ankle fractures with bone loss. BT is more comprehensive and acceptable than ASRL with lesser needs for bone grafting. Keywords Infected ankle fractures . Ilizarov concepts . ASRL . BT . Salvage arthrodesis
Introduction Ankle injuries involving the distal tibia and/or talus associated with infection and bone loss are a matter of concern and have limited treatment options. The main technical difficulties are the existence of infection, soft-tissue loss, bone defects, and leg shortening. The shortening is due either to the initial violent event or to the subsequent debridement procedures [1–3]. The goals of treatment are essentially directed for controlling infection, having a plantigrade and painless foot, and promoting rapid recovery to previous activities. It is difficult to obtain the above-mentioned goals by methods other than arthrodesis. In this concern, the internal fixation modalities, which could
* Ashraf Atef [email protected]; [email protected] 1
Tanta University, Tanta, Egypt
provide better patients’ compliance after ankle arthrod
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