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Li W, Zhang B, Li Y, Du H, Wu Y. Outcomes of One-Stage Arthroscopic Ankle and Tibiotalocalcaneal Arthrodesis with External Fixation for Septic Ankle and Hindfoot Arthritis: A Case-Series Study. Orthop Surg 2024. [PMID: 39219009 DOI: 10.1111/os.14211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Revised: 08/04/2024] [Accepted: 08/06/2024] [Indexed: 09/04/2024] Open
Abstract
OBJECTIVES The occurrence of infection in the ankle and hindfoot presents a formidable surgical challenge. Currently, there is a lack of consensus regarding its treatment strategies. The purpose of this study was to investigate the outcomes of one-stage arthroscopic ankle and tibiotalocalcaneal (TTC) arthrodesis with external fixation in the treatment of septic ankle and hindfoot arthritis. METHODS A retrospective consecutive case-series study was conducted involving six patients diagnosed with acute or chronic septic ankle or hindfoot arthritis, who underwent operative intervention entailing thorough debridement, arthroscopically assisted one-stage ankle or TTC fusion, and external fixation. The American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score and visual analog scale (VAS) pain score were determined preoperatively and at the final follow-up. Demographic and clinical data, inclusive of perioperative and postoperative complications, were recorded. Comparisons of AOFAS ankle-hindfoot score and VAS pain score between preoperative measures and those at the final follow-up were conducted using paired t-tests or paired Wilcoxon rank-sum tests. RESULTS The study cohort comprised two males and four females, with a mean age of 48.7 years (range, 26-75) at the time of surgical intervention. At the final follow-up (mean, 26.5 months; range, 16-48), the AOFAS scores exhibited a significant improvement, ascending from an initial mean of 38.8 (range, 12-57) to 80.0 (range, 54-92) (p = 0.007). VAS scores indicated a substantial reduction in pain, decreasing from 6.5 (range, 4-9) to 0 (range, 0-5) (p = 0.046). All patients had achieved osseous consolidation, with a hindfoot infection control rate of 100%. CONCLUSION One-stage arthroscopic ankle and TTC arthrodesis with external fixation is as an effective therapeutic choice for septic ankle or hindfoot arthritis. This approach yields favorable outcomes characterized by effective infection control, favorable osseous consolidation, and significant functional restoration of the affected limb.
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Affiliation(s)
- Wenjing Li
- Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
- The Fourth Clinical Medical College of Peking University, Beijing, China
| | - Baozhou Zhang
- The Fourth Clinical Medical College of Peking University, Beijing, China
| | - Ying Li
- Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
- The Fourth Clinical Medical College of Peking University, Beijing, China
| | - Hui Du
- Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
- The Fourth Clinical Medical College of Peking University, Beijing, China
| | - Yong Wu
- Department of Foot and Ankle Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
- The Fourth Clinical Medical College of Peking University, Beijing, China
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Wang X, Gu Q, Wei W, Zi S. Surgical debridement and continuous irrigation for early surgical site infection caused by Staphylococcus aureus with a closed patella fracture surgery: A case report. Int J Surg Case Rep 2023; 113:109068. [PMID: 37988986 PMCID: PMC10667781 DOI: 10.1016/j.ijscr.2023.109068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/10/2023] [Accepted: 11/14/2023] [Indexed: 11/23/2023] Open
Abstract
INTRODUCTION Management of postoperative surgical site infection (SSI) is a huge challenge to orthopedic surgeons, and significantly impacts patients and their families due to long treatment cycles and associated discomfort experiences. PRESENTATION OF CASE A 68-year-old woman without a medical history of any comorbidities, diabetes, hypertension, allergies, or tuberculosis, was admitted to our hospital complaining of right knee pain following a fall. X-ray and CT scans revealed a closed right patella fracture. The patient underwent open reduction and internal fixation with tension band wiring and circle wire. Preoperative assessment showed normal nutritional status. Prophylactic cefazolin sodium pentahydrate was administered 30 min preoperatively and maintained for 24 h post-operation to prevent infection. The patient was discharged 3 days after the operation. However, the wound exhibited signs of infection: redness, swelling, and the presence of secretions. Outpatient dressings and oral antibiotics were prescribed but failed to control the infection, leading to rehospitalization. Surgical debridement and continuous articular irrigation were implemented to address the infection. Secretion cultures were taken to identify the causative bacteria. Levofloxacin and Rifampicin were used according to drug sensitivity tests. However, the patient experienced severe knee swelling and an iodine irritative reaction subsequently. Anti-allergic treatment and normal saline dressings were applied to alleviate swelling, pain, and skin irritation. MRI results indicated arthroedema and possible infection necessitating further surgical debridement, the patient rejected additional surgery and requested discharge. Levofloxacin and Rifampicin were used for a month to control the infection after discharge, accompanied by regular rehabilitation exercises. Fortunately, the infection was successfully managed, and knee function was satisfactorily restored. DISCUSSION SSI after patella fracture surgery can lead to a worse quality of life, serious economic burden, and psychological distress. Therefore, effective treatment methods for managing postoperative SSIs are very important. CONCLUSION Sufficient surgical debridement is vital to remove infection tissue of early SSI caused by Staphylococcus aureus with a closed patella fracture surgery. Continuous articular irrigation and sensitive antibiotics help control infection, and active rehabilitation training improves knee function recovery.
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Affiliation(s)
- Xiong Wang
- Department of Orthopedics, Shanghai Baoshan Luodian Hospital, Baoshan District, Shanghai 201908, China
| | - Qing Gu
- Department of Orthopedics, Shanghai Baoshan Luodian Hospital, Baoshan District, Shanghai 201908, China
| | - Wenqiang Wei
- Department of Orthopedics, Shanghai Baoshan Luodian Hospital, Baoshan District, Shanghai 201908, China
| | - Shuming Zi
- Department of Orthopedics, Shanghai Baoshan Luodian Hospital, Baoshan District, Shanghai 201908, China.
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Fu J, Wang X, Wang S, Chen Z, Shen J, Li Z, Xie Z. Induced membrane technique combined with a retrograde intramedullary nail for the treatment of infected bone defects of the ankle. Sci Rep 2023; 13:6690. [PMID: 37095232 PMCID: PMC10126119 DOI: 10.1038/s41598-023-34014-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 04/22/2023] [Indexed: 04/26/2023] Open
Abstract
In this study, we treated infected ankle bone defects with the induced membrane two-stage technique. The ankle was fused with a retrograde intramedullary nail in the second stage, and the aim of this study was to observe the clinical effect. We retrospectively enrolled patients with infected bone defects of the ankle admitted to our hospital between July 2016 and July 2018. In the first stage, the ankle was temporarily stabilized with a locking plate, and antibiotic bone cement was used to fill the defects after debridement. In the second stage, the plate and cement were removed, the ankle was stabilized with a retrograde nail, and tibiotalar-calcaneal fusion was performed. Then, autologous bone was used to rebuild the defects. The infection control rate, fusion success rate and complications were observed. Fifteen patients were enrolled in the study with an average follow-up of 30 months. Among them, there were 11 males and 4 females. The average bone defect length after debridement was 5.3 cm (2.1-8.7 cm). Finally, 13 patients (86.6%) achieved bone union without recurrence of infection, and 2 patients experienced recurrence after bone grafting. The average ankle-hindfoot function score (AOFAS) increased from 29.75 ± 4.37 to 81.06 ± 4.72 at the last follow-up. The induced membrane technique combined with a retrograde intramedullary nail for the treatment of infected bone defects of the ankle after thorough debridement is an effective treatment method.
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Affiliation(s)
- Jingshu Fu
- Department of Orthopedics, Banan Hospital of Chongqing Medical University, Chongqing, 401320, People's Republic of China
| | - Xiaohua Wang
- National & Regional United Engineering Laboratory of Tissue Engineering, Department of Orthopaedics, First Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, People's Republic of China
| | - Shulin Wang
- National & Regional United Engineering Laboratory of Tissue Engineering, Department of Orthopaedics, First Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, People's Republic of China
| | - Zenggang Chen
- Department of Orthopedics, Banan Hospital of Chongqing Medical University, Chongqing, 401320, People's Republic of China
| | - Jie Shen
- National & Regional United Engineering Laboratory of Tissue Engineering, Department of Orthopaedics, First Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, People's Republic of China
| | - Zhengyun Li
- Department of Orthopedics, Banan Hospital of Chongqing Medical University, Chongqing, 401320, People's Republic of China.
| | - Zhao Xie
- National & Regional United Engineering Laboratory of Tissue Engineering, Department of Orthopaedics, First Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, People's Republic of China.
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Zhang S, Yang K, Wang Q, Hou J, Zang H, Luo S, Zhang T, Zhang X. Treatment of Fractures of Metatarsal Shaft Using a Cemented K-wire Frame. J Foot Ankle Surg 2021; 60:42-46. [PMID: 33218864 DOI: 10.1053/j.jfas.2020.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 12/17/2019] [Accepted: 05/11/2020] [Indexed: 02/03/2023]
Abstract
The purpose of this retrospective study was to report on percutaneous reduction and fixation for the treatment of fractures of metatarsal shaft. Between March 2015 and October 2017, 29 patients (37 fractures of metatarsal shaft) were treated using a cemented Kirschner wire (K-wire) frame. The accuracy of reduction of the fragments was assessed as anatomic (0 to 8 points), good (9 to 11 points), fair (12 to 15 points), or poor (>15 points). The Maryland foot score was used to assess pain and functional outcomes. All fractures were reduced using percutaneous techniques. Anatomic reduction was achieved in 31 metatarsal fractures (84%), and good reduction was achieved in 6 (16%). The average bone healing time was 7 weeks (range, 4 to 16). Pin tract infection was noted in 2 metatarsal bones, which healed with pin site care. The mean cost of the cemented K-wire frame was US$335 (range, $283 to $385) per patient. Based on the Maryland foot score, there were 26 excellent results (90%) and 3 good results (10%). The cemented K-wire frame is a useful external fixator and can be an alternative for treating fractures of metatarsal shaft, especially when open surgeries are a major concern owing to severely damaged soft-tissue envelope. The system is cheap and easy to apply and provides rigid fixation, resulting in good function of the foot.
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Affiliation(s)
- Shenghua Zhang
- Professor, Department of Orthopaedics, Qinhuangdao Orthopaedics Hospital, Qinhuangdao, Hebei, China
| | - Kun Yang
- Orthopedic Surgeon, Department of Orthopaedics, Qinhuangdao Orthopaedics Hospital, Qinhuangdao, Hebei, China
| | - Qi Wang
- Professor, Department of Orthopaedics, Qinhuangdao Orthopaedics Hospital, Qinhuangdao, Hebei, China
| | - Jiguang Hou
- Orthopedic Surgeon, Department of Orthopaedics, Qinhuangdao Orthopaedics Hospital, Qinhuangdao, Hebei, China
| | - Hongwei Zang
- Orthopedic Surgeon, Department of Orthopaedics, Qinhuangdao Orthopaedics Hospital, Qinhuangdao, Hebei, China
| | - Shi Luo
- Orthopedic Surgeon, Department of Orthopaedics, Qinhuangdao Orthopaedics Hospital, Qinhuangdao, Hebei, China
| | - Tao Zhang
- Orthopedic Surgeon, Department of Orthopaedics, Qinhuangdao Orthopaedics Hospital, Qinhuangdao, Hebei, China
| | - Xu Zhang
- Professor, Department of Hand Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
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