Combination Ilizarov technique with tibiotalar or tibiocalcanean arthrodesis for one-stage treatment of ankle joints infection and bone defects_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Lei ¹ ,  WANG Xinwei ¹ , CHEN Yusheng ² , WAN Mingcai ¹ , CHEN Jiangfei ¹

1. The 1st Department of Osteomyelitis, Henan Luoyang Orthopedic-Traumatological Hospital, Henan Orthopedic Hospital, Luoyang Henan, 471002, P.R.China;
2. Department of VIP, the Second Affiliated Hospital of Henan University of Science Technology, Luoyang Henan, 471000, P.R.China;

Corresponding author：

WANG Xinwei, Email: lywxw188@163.com

Keywords：

Ankle joint infection; bone defect; Ilizarov technique; ankle joint; arthrodesis

DOI：

10.7507/1002-1892.201610019

Video：

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Objective To evaluate the effectiveness of Ilizarov technique and tibiotalar or tibiocalcanean arthrodesis for one-stage treatment of ankle joints infection and bone defects. Methods Between January 2014 and April 2016, 14 patients with ankle joints infection and bone defects were treated by Ilizarov technique and tibiotalar or tibiocalcanean arthrodesis for one-stage. There were 12 males and 2 females with an average age of 39.8 years (range, 25-61 years). The causes of ankle infection included falling from height injury in 5 cases, falling injury in 4 cases, traffic accident injury in 1 case, crushing injury in 1 case, sprain injury in 1 case, and hematogenous reason in 2 cases. All the patients received surgery for 0-8 times (mean, 3.7 times) before admission. The modified American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score was 30.25±3.54 before operation. The disease duration was 1-30 months (mean, 10.3 months). Results All the incisions healed by first intension without recurrence of infection, and two-stage bone grafting operation did not performed. One case felt slight local pain and swell of ankle joint after weight-bearing walking more than 30 minutes, and without special treatment. All the patients had different degree skin redness and swelling of Kirschner wire pinhole for 0-3 times, and relieved after symptomatic treatment. All the patients were followed up 6-27 months (mean, 16.8 months). Except for 2 cases who did not remove the external fixator (with external fixation time of 6 months and 8 months respectively), the other patients removed the external fixator at 6-14 months (mean, 9 months) after operation, all patients recovered the walk function and without ankle pain. The modified AOFAS ankle and hindfoot score after removal of external fixator (70.92±1.0) was significantly higher than preoperative one (t=–10.992, P=0.000). Conclusion It is a simple and effective method for one-stage treatment of ankle joints infection and bone defects by Ilizarov technique and tibiotalar or tibiocalcanean arthrodesis.

Citation： ZHANG Lei, WANG Xinwei, CHEN Yusheng, WAN Mingcai, CHEN Jiangfei. Combination Ilizarov technique with tibiotalar or tibiocalcanean arthrodesis for one-stage treatment of ankle joints infection and bone defects. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(9): 1059-1063. doi: 10.7507/1002-1892.201610019 Copy

1.	Sood A, Khamsi B, Datiashvili R, et al. Use of cross-leg flap for wound complications resulting from open pilon fracture. Am J Orthop (Belle Mead NJ), 2015, 44(3): 131-134.
2.	Beaman DN, Gellman R. Fracture reduction and primary ankle arthrodesis: a reliable approach for severely comminuted tibial pilon fracture. Clin Orthop Relat Res, 2014, 472(12): 3823-3834.
3.	黄雷, 王慎东, 滕星, 等. 牵拉成骨技术结合胫距或胫跟融合术治疗踝关节周围感染性骨折不愈合. 中华外科杂志, 2015, 53(6): 405-409.
4.	Kastsenis D, Bhave A, Paley D, et al. Treatment of malunion and nonunion at the site of an ankle fusion with the Ilirazov apparatus. J Bone Joint Surg (Am), 2005, 87(2): 302-309.
5.	Simpson AH, Deskin M, Latiham JM. Chroic osteomyelitis. The effett of the extent of surgical resection on infection-free survival. J Bone Joint Surg (Br), 2001, 83(3): 403-407.
6.	郁耀平, 俞光荣. 胫距跟关节融合术的研究进展. 外科研究与新技术, 2013, 2(1): 59-61.
7.	Wolcott RD, Runbaugh, James G, et al. Biofilm maturity studies indicate sharp debridement opens a time-dependent therapeutic window. Wound Care, 2010, 19(8): 320-328.
8.	Schnettler R, Steinau HU. 感染性骨与关节外科治疗. 侯春林, 曾炳芳, 主审. 徐林, 主译. 北京: 人民卫生出版社, 2012: 239-245.
9.	Wu CC. Single-stage surgical treatment of infected nonunion of the distal tibia. J Orthop Trauma, 2011, 25(3): 156-161.
10.	Solomin LN. Liizarov 技术基本原理及应用. 曾炳芳, 主审. 康庆林, 张长青, 柴益民, 编译. 北京: 人民军医出版社, 2012: 208-216.
11.	Gessmann J, Baecker H, Jettkant B, et al. Direct and indirect loading of the Ilizarov external fixator:the effect on the interfragmentary movements and compressive loads. Strategies Trauma Limb Reconstr, 2011, 6(1): 27-31.
12.	郑学建, 秦泗河, 彭爱民, 等. Ilizarov 技术同期治疗胫骨缺损合并马蹄足畸形. 中华创伤骨科杂志, 2013, 15(10): 863-866.
13.	Madhusudhan TR, Ramesh B, Manjunath K, et al. Outcomes of Ilizarov ring fixation inrecalcitrant infected tibial nonunions-a prospective study. Trauma Manag Outcomes, 2008, 2(1): 6.
14.	焦绍锋, 秦泗河, 王振军, 等. Ilizarov 技术治疗四肢畸形并发症分析. 中华骨科杂志, 2012, 32(3): 245-248.
15.	秦泗河. Ilivzarov 技术概论. 中华骨科杂志, 2006, 26(9): 642-645.

1. Sood A, Khamsi B, Datiashvili R, et al. Use of cross-leg flap for wound complications resulting from open pilon fracture. Am J Orthop (Belle Mead NJ), 2015, 44(3): 131-134.
2. Beaman DN, Gellman R. Fracture reduction and primary ankle arthrodesis: a reliable approach for severely comminuted tibial pilon fracture. Clin Orthop Relat Res, 2014, 472(12): 3823-3834.
3. 黄雷, 王慎东, 滕星, 等. 牵拉成骨技术结合胫距或胫跟融合术治疗踝关节周围感染性骨折不愈合. 中华外科杂志, 2015, 53(6): 405-409.
4. Kastsenis D, Bhave A, Paley D, et al. Treatment of malunion and nonunion at the site of an ankle fusion with the Ilirazov apparatus. J Bone Joint Surg (Am), 2005, 87(2): 302-309.
5. Simpson AH, Deskin M, Latiham JM. Chroic osteomyelitis. The effett of the extent of surgical resection on infection-free survival. J Bone Joint Surg (Br), 2001, 83(3): 403-407.
6. 郁耀平, 俞光荣. 胫距跟关节融合术的研究进展. 外科研究与新技术, 2013, 2(1): 59-61.
7. Wolcott RD, Runbaugh, James G, et al. Biofilm maturity studies indicate sharp debridement opens a time-dependent therapeutic window. Wound Care, 2010, 19(8): 320-328.
8. Schnettler R, Steinau HU. 感染性骨与关节外科治疗. 侯春林, 曾炳芳, 主审. 徐林, 主译. 北京: 人民卫生出版社, 2012: 239-245.
9. Wu CC. Single-stage surgical treatment of infected nonunion of the distal tibia. J Orthop Trauma, 2011, 25(3): 156-161.
10. Solomin LN. Liizarov 技术基本原理及应用. 曾炳芳, 主审. 康庆林, 张长青, 柴益民, 编译. 北京: 人民军医出版社, 2012: 208-216.
11. Gessmann J, Baecker H, Jettkant B, et al. Direct and indirect loading of the Ilizarov external fixator:the effect on the interfragmentary movements and compressive loads. Strategies Trauma Limb Reconstr, 2011, 6(1): 27-31.
12. 郑学建, 秦泗河, 彭爱民, 等. Ilizarov 技术同期治疗胫骨缺损合并马蹄足畸形. 中华创伤骨科杂志, 2013, 15(10): 863-866.
13. Madhusudhan TR, Ramesh B, Manjunath K, et al. Outcomes of Ilizarov ring fixation inrecalcitrant infected tibial nonunions-a prospective study. Trauma Manag Outcomes, 2008, 2(1): 6.
14. 焦绍锋, 秦泗河, 王振军, 等. Ilizarov 技术治疗四肢畸形并发症分析. 中华骨科杂志, 2012, 32(3): 245-248.
15. 秦泗河. Ilivzarov 技术概论. 中华骨科杂志, 2006, 26(9): 642-645.

Chinese Journal of Reparative and Reconstructive Surgery

Combination Ilizarov technique with tibiotalar or tibiocalcanean arthrodesis for one-stage treatment of ankle joints infection and bone defects

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