Two-stage operation to treat destructive midfoot tuberculosis: 14 cases experience

Short-term outcomes of one-stage debridement and fusion for ankle joint tuberculosis

PURPOSE

Tuberculosis remains a worldwide health problem, as well as its complications including arthritis in various joints. End-stage arthritis in weight-bearing joint would require surgery either arthroplasty or arthrodesis, in order to achieve painless and stable gait. In general, staged surgery consisted of debridement and subsequent definitive procedure is accepted. However, multiple surgery would be disadvantageous in terms of clinical and economic burdens. This study reported the short-term result of one-stage debridement and fusion for ankle joint tuberculosis.

METHODS

Retrospective evaluation of twenty-six patients with history of one-stage debridement and ankle fusion was conducted. Basic anthropometric measurement, local status, and surgical technique were recorded. Functional score using Foot and Ankle Ability Measures (FAAM) activities of daily living (ADL) was assessed pre-operatively and at two and half year post-surgery follow-up visit along with radiological fusion rate. Paired t test was used to analyse the improvement of the clinical scores.

RESULTS

There was improvement in FAAM score from 43.38 ± 9.51 to 62.19 ± 6.63% (p < 0.001). All sinuses had been subsided, albeit at various time spans. Modified radiographic union score for tibia (RUST) revealed various fusion rate results, ranged from 5 to 11.

CONCLUSION

One-stage debridement and fusion is proven efficacious for end-stage joint tuberculosis, with less surgery occasion compared with staged surgery. However, patient selection is important since any comorbidities or secondary infection may complicate the fusion.

Induced Membrane Technique (Masquelet) for Bone Defects in the Distal Tibia, Foot, and Ankle: Systematic Review, Case Presentations, Tips, and Techniques

Bone defects to the distal tibia, foot, and ankle can be challenging to reconstruct. The induced membrane (Masquelet) technique has become an established method of repair for challenging areas of bone loss. It has been applied in acute open fractures, chronic nonunion, osteomyelitis, and gout erosion. This article presents a systematic review of distal tibia, foot, and ankle results using the Masquelet procedure, which should be considered in cases of challenging critical bone loss. Further work is needed to present large studies of the procedure on foot and ankle patients to consolidate current knowledge.

Three-Stage Masquelet Technique and One-Stage Reconstruction to Treat Foot and Ankle Tuberculosis

BACKGROUND

The purpose of this article was to report the feasibility and effectiveness of 3-stage Masquelet technique and 1-stage operation for different stages of foot and ankle tuberculosis (TB).

METHODS

Ten consecutive patients with foot and ankle TB were retrospectively analyzed between January 2014 and December 2018. Five patients were treated with the 3-stage Masquelet technique, including thorough debridement with vacuum sealing drainage, implantation of antibiotic cement spacer, and subsequent reconstruction. Five patients were treated with a 1-stage reconstruction. The American Orthopaedic Foot & Ankle Society (AOFAS) and visual analog scale (VAS) pain scores were recorded at the last follow-up. The follow-up was 30.3 ± 17.8 months.

RESULTS

No reactivation of TB was observed in any patients. For the 3-stage operation group, 1 patient developed a distal tibia fracture. The duration of anti-TB therapy was 12.0 ± 0.8 months. The AOFAS score increased from 39.5 ± 9.9 preoperatively to 75.3 ± 7.0 postoperatively (P < .05). The VAS pain score decreased from 6.3 ± 1.9 to 1.5 ± 1.3 (P < .05). For the 1-stage operation, 1 patient had wound necrosis. The duration of anti-TB therapy was 13.8 ± 1.1 months. The AOFAS score increased from 51.8 ± 15.0 to 81.8 ± 6.3 (P < .05). The VAS pain score decreased from 5.4 ± 1.1 to 1.0 ± 0.7 (P < .05).

CONCLUSION

Three-stage operation was effective for foot and ankle TB with stage IV, sinus tracts or other infections, and 1-stage reconstruction was effective for early-stage TBs.

LEVEL OF EVIDENCE

Level IV, case series.

Facile Fabrication of Composite Scaffolds for Long-Term Controlled Dual Drug Release

Bone tuberculosis (TB) caused by mycobacterium tuberculosis continues to present a formidable challenge to humans. To effectively cure serious bone TB, a novel kind of composite scaffolds with long-term dual drug release behaviours were prepared to satisfy the needs of both bone regeneration and antituberculosis drug therapy. In virtue of an improved O/W emulsion technique, water-soluble isoniazid (INH)-loaded gelatin microparticles were obtained by tailoring the content of β-tricalcium phosphate (β-TCP), which played significant roles in INH entrapment efficiency and drug release behaviours. By mixing with the poly(ε-caprolactone)-block-poly (lactic-co-glycolic acid) (b-PLGC) solution containing oil-soluble rifampicin (RFP) via the particle leaching combined with phase separation technique, the dual drugs-loaded composite scaffolds were fabricated, which possessed interconnected porous structures and achieved the steady release of INH and RFP drugs for three months. Moreover, this dual drugs-loaded system could basically achieve their expectant roles of respective drugs without obvious influences with each other. This strategy on preparation of intelligent composite scaffolds with the multi-drugs loading capacity and controlled long-term release behaviour will be potential and promising substrates in clinical treatment of bone tuberculosis.