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Stone R, Caine S, Hutchinson B. Septic Ankle Fusion: A Comprehensive Overview. Clin Podiatr Med Surg 2025; 42:177-192. [PMID: 39988386 DOI: 10.1016/j.cpm.2024.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2025]
Abstract
Septic ankle arthritis is a serious, limb threatening condition that requires a prompt and comprehensive treatment approach. Treatment of a septic ankle and/or hindfoot infection can be a challenging endeavor, often complicated by concomitant deformity and patient comorbidities that prolong healing time. Eradication of the infection and stabilization of the limb are fundamental concepts when performing septic fusion, often requiring staged procedures with various fixation methods. There is a paucity of literature outlining the approach to septic fusion of the ankle/hindfoot. Herein, we review current methods of septic ankle fusion while featuring an algorithmic approach for management of this challenging pathology.
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Affiliation(s)
- Ryan Stone
- Virginia Mason Franciscan Medical Center, Burien, WA, USA.
| | - Samuel Caine
- Virginia Mason Franciscan Medical Center, Burien, WA, USA
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2
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Huang X, Li Q, Chen J, Liu T, Zhao Y, Teng Y. Clinical features of chronic tibial osteomyelitis: a single-center retrospective study of 282 cases in Xinjiang, China. BMC Musculoskelet Disord 2024; 25:823. [PMID: 39427137 PMCID: PMC11490011 DOI: 10.1186/s12891-024-07928-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 10/07/2024] [Indexed: 10/21/2024] Open
Abstract
BACKGROUND Chronic osteomyelitis is a highly prevalent and severe orthopaedic complication, representing a critical unresolved issue. The clinical symptoms of osteomyelitis are influenced by various factors, including geography, lifestyle, and pre-existing medical conditions.This study aims to provide theoretical basis for treatment and prevention of osteomyelitis by investigating and analyzing clinical features and pathogen distribution among 282 patients with chronic tibial osteomyelitis in xinjiang. METHODS A total of 282 patients with chronic tibial osteomyelitis from January 1, 2012 to January 1, 2022 in the First Affiliated Hospital of Xinjiang Medical University were retrospectively analyzed. All data were collected from electronic medical record (EMR) system including demographics, etiology, risk factors, osteomyelitis location and clinical classification. RESULTS Farmers, students, unemployed and retirees accounted for a relatively large proportion of the 282 patients. There were 233 males and 49 females with a gender ratio of 4.75:1. The average age was 40.21 ± 15.68 years and was mainly concentrated in 41-50 years, specifically, the mean age of females was slightly older than that of males. Education level was mostly primary and secondary school education, and illiteracy. Risk factors of chronic tibial osteomyelitis included history of smoking and drinking, history of multiple repeated surgeries, and impaired immunity. Frequent clinical symptoms were in the order of pain, local swelling, pus discharge and skin ulceration. Among all inflammatory markers, proportion of positive results were 30.85%, 59.93% and 53.90% for white blood cell (WBC), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), respectively. Positive rate of pathogenic microorganism culture was low and the three most common bacteria were Staphylococcus aureus (S. aureus), Pseudomonas aeruginosa (P. aeruginosa) and Escherichia coli (E. coli). The most frequent site of infection was middle tibia. According to Cierny-Mader osteomyelitis classification, the most common types were type IIIA, IVA and IIA. CONCLUSION Number of visits due to chronic osteomyelitis increased year by year, with young and middle-aged male farmers and low education level as the main groups. Smoking and drinking were two considerable risk factors that should be attached to a great importance. No significant increase was found in inflammatory markers and lower positive rate of pathogenic microorganism culture was observed. Multi-drug resistant bacteria were common and S. aureus remained the most frequent pathogen. Elevated ESR had certain diagnostic value for osteomyelitis. Type III and type IV osteomyelitis accounted for a large proportion which posed great challenges for clinical diagnosis and treatment.
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Affiliation(s)
- Xiaoxia Huang
- Graduate School of Xinjiang Medical University, Urumqi, Xinjiang, China
- Department of Orthopedics, General Hospital of Xinjiang Military Command, Urumqi, Xinjiang, China
| | - Qian Li
- Department of Pharmacy, General Hospital of Xinjiang Military Region, Urumqi, Xinjiang, China
| | - Jiahan Chen
- Department of orthopaedics, First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Tao Liu
- Department of Orthopedics, General Hospital of Xinjiang Military Command, Urumqi, Xinjiang, China
| | - Yan Zhao
- Department of Microrepair and Reconstruction, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
| | - Yong Teng
- Department of Orthopedics, General Hospital of Xinjiang Military Command, Urumqi, Xinjiang, China.
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Guan S, Du H, Wu Y, Qin S. The Ilizarov Technique: A Dynamic Solution for Orthopaedic Challenges. Orthop Surg 2024; 16:2111-2114. [PMID: 39192535 PMCID: PMC11572574 DOI: 10.1111/os.14193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2024] [Revised: 07/16/2024] [Accepted: 07/24/2024] [Indexed: 08/29/2024] Open
Abstract
The Ilizarov technique is one of the most important tools that is currently employed in bone reconstruction surgeries. Its inception dates back to the mid-20th century and involves various bone reconstruction methodologies implemented using a circular external fixator system devised by G. A. Ilizarov. The key advantages of this approach include the generation of viable new bone via distraction osteogenesis, high union rates, and the functional utilization of the limb during the treatment process. The exploration of distraction osteogenesis phenomenon triggered by tensile stress with the Ilizarov device served as a catalyst for progress in bone reconstruction surgery. Subsequently, the original technique has been utilized alongside several adaptations resulting from the introduction of novel fixation tools and methods of their application, such as hexapod external fixators and motorized intramedullary lengthening nails. It is crucial to possess a precise comprehension of the Ilizarov principles of deformity correction in order to effectively utilize this fixation system. In this article, we will discuss the history of Ilizarov frame, the basic sciences behind it, the mechanical principles governing its use, and the clinical application of the fixation system in our daily practice.
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Affiliation(s)
| | - Hui Du
- Department of Foot and Ankle Surgery, Beijing Jishuitan HospitalFourth Clinical Medical College of Peking UniversityBeijingChina
| | - Yong Wu
- Department of Foot and Ankle Surgery, Beijing Jishuitan HospitalFourth Clinical Medical College of Peking UniversityBeijingChina
| | - Sihe Qin
- Department of OrthopedicsRehabilitation Hospital, National Research Center for RehabilitationBeijingChina
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Roberts RHR, Davies-Jones GR, Brock J, Satheesh V, Robertson GAJ. Surgical management of the diabetic foot: The current evidence. World J Orthop 2024; 15:404-417. [PMID: 38835689 PMCID: PMC11145970 DOI: 10.5312/wjo.v15.i5.404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/12/2024] [Accepted: 04/24/2024] [Indexed: 05/15/2024] Open
Abstract
The prevalence of diabetes mellitus and its associated complications, particularly diabetic foot pathologies, poses significant healthcare challenges and economic burdens globally. This review synthesises current evidence on the surgical management of the diabetic foot, focusing on the interplay between neuropathy, ischemia, and infection that commonly culminates in ulcers, infections, and, in severe cases, amputations. The escalating incidence of diabetes mellitus underscores the urgency for effective management strategies, as diabetic foot complications are a leading cause of hospital admissions among diabetic patients, significantly impacting morbidity and mortality rates. This review explores the pathophysiological mechanisms underlying diabetic foot complications and further examines diabetic foot ulcers, infections, and skeletal pathologies such as Charcot arthropathy, emphasising the critical role of early diagnosis, comprehensive management strategies, and interdisciplinary care in mitigating adverse outcomes. In addressing surgical interventions, this review evaluates conservative surgeries, amputations, and reconstructive procedures, highlighting the importance of tailored approaches based on individual patient profiles and the specific characteristics of foot pathologies. The integration of advanced diagnostic tools, novel surgical techniques, and postoperative care, including offloading and infection control, are discussed in the context of optimising healing and preserving limb function.
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Affiliation(s)
| | - Gareth Rhys Davies-Jones
- Department of Trauma and Orthopaedics, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry SY10 7AG, United Kingdom
| | - James Brock
- Department of Trauma and Orthopaedics, Wrexham Maelor Hospital, Wrexham LL13 7TD, United Kingdom
| | - Vaishnav Satheesh
- Department of Trauma and Orthopaedics, Wrexham Maelor Hospital, Wrexham LL13 7TD, United Kingdom
| | - Greg AJ Robertson
- Department of Trauma and Orthopaedics, Wrexham Maelor Hospital, Wrexham LL13 7TD, United Kingdom
- Department of Trauma and Orthopaedics, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry SY10 7AG, United Kingdom
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Chen ZX, Guo XW, Hong HS, Zhang C, Xie W, Sha M, Ding ZQ. Rotationplasty type BIIIb as an effective alternative to limb salvage procedure in adults: Two case reports. World J Clin Cases 2023; 11:6877-6888. [PMID: 37901010 PMCID: PMC10600845 DOI: 10.12998/wjcc.v11.i28.6877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 08/15/2023] [Accepted: 09/11/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND Rotationplasty is often performed for malignant tumors, but type BIIIb rotationplasty is rarely reported, and there needs to be more evidence of the procedure and treatment. The purpose of this case study was to report a new direction in the use of type BIIIb rotationplasty in treating patients with limb salvage and long-term non-healing infections. CASE SUMMARY Case 1: A 47-year-old man underwent radiotherapy for hemangioendothelioma in his left thigh, resulting in a femoral fracture. Despite the use of plates, intramedullary nailing, and external fixators, the femoral bone failed to unite due to infectious nonunion. Multiple operations were unable to control the infection, leaving the patient immobile. We performed a modified tibia-pelvic-constrained hip rotationplasty, utilizing a constrained prosthetic hip between the tibia and pelvis following a femur resection. Two years post-surgery, the patient was able to walk with the prosthetic device without any signs of recurring infection. The corresponding functional scores were 72 points for the Musculoskeletal Tumor Society (MSTS), 53 for the Functional Mobility Assessment (FMA), 93 for the Toronto Extremity Salvage Score (TESS), and 56 for the MOS 36-item short form health survey (SF-36). Case 2: A 59-year-old woman presented with liposarcoma in her left thigh. Magnetic resonance imaging revealed tumors in the medial, anterior, and posterior femur muscles, encircling the femoral vessels and nerves. Fortunately, there were no symptoms of sciatic dysfunction, and the tumor had not invaded the sciatic nucleus. After one year of follow-up, the patient expressed satisfaction with limb preservation post-type BIIIb rotationplasty. The corresponding functional scores were 63 points for the MSTS, 47 for the FMA, 88 for the TESS, and 52 for the SF-36. CONCLUSION Our study suggests that type BIIIb rotationplasty may be an alternative to amputation in patients with incurable infections. For malignant tumors of the lower extremities without invasion of the sciatic nerve, type BIIIb rotationplasty remains an excellent alternative to amputation. This surgical method may prevent amputation, improve functional outcomes, and facilitate biological reconstruction.
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Affiliation(s)
- Zhang-Xin Chen
- Department of Orthopedics, The 909th Hospital, School of Medicine, Xiamen University, Zhangzhou 361102, Fujian Province, China
- Zhangzhou Health Vocational College, Zhangzhou 361102, Fujian Province, China
| | - Xiao-Wei Guo
- Department of Orthopedics, The 909th Hospital, School of Medicine, Xiamen University, Zhangzhou 361102, Fujian Province, China
| | - Hai-Sen Hong
- Department of Orthopedics, The 909th Hospital, School of Medicine, Xiamen University, Zhangzhou 361102, Fujian Province, China
| | - Cong Zhang
- Department of Orthopedics, The 909th Hospital, School of Medicine, Xiamen University, Zhangzhou 361102, Fujian Province, China
| | - Wei Xie
- Department of Orthopedics, The 909th Hospital, School of Medicine, Xiamen University, Zhangzhou 361102, Fujian Province, China
| | - Mo Sha
- Department of Orthopedics, The 909th Hospital, School of Medicine, Xiamen University, Zhangzhou 361102, Fujian Province, China
| | - Zhen-Qi Ding
- Department of Orthopedics, The 909th Hospital, School of Medicine, Xiamen University, Zhangzhou 361102, Fujian Province, China
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Tay KS, Langit M, Fenton C, Grupping R, Muir R, Moulder E, Sharma H. Complex Ankle Fusion With Circular Frames: Factors Influencing Outcomes, Complications, and Patient Satisfaction. Foot Ankle Int 2023; 44:403-414. [PMID: 36942403 DOI: 10.1177/10711007231157710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND Circular frames for ankle fusion are reserved for complex clinical scenarios. The literature is heterogenous and conflicting. We aim to present the indications and outcomes of this procedure. METHODS A retrospective cohort study based on a prospective database of frame surgeries performed in a tertiary institution. Inclusion criteria were patients undergoing complex ankle fusion with circular frames between 2005 and 2020, with a minimum 12-month follow-up. Data were collected on patient demographics, surgical indications, comorbidities, surgical procedures, external fixator time (EFT), length of stay (LOS), radiologic and clinical outcomes, and adverse events. Factors influencing radiologic and clinical outcomes were analyzed. RESULTS 47 patients were included, with a median follow-up of 30 months (interquartile range [IQR] 20-40). The median age at time of surgery was 63.5 years (IQR 58-71). Patients had a median of 2 previous surgeries (IQR 1-3). The median LOS was 8.5 days, and median EFT was 237 days (IQR 166-280). Simultaneous limb lengthening (median 3.3 cm, IQR 1.9-3.5) was performed in 11 patients, increasing the EFT by a mean of 4 months. Primary and final union rates were 91.5% and 95.7%, respectively. At last follow-up, ASAMI bone scores were excellent or good in 87.2%. ASAMI functional scores were good in 79.1%. Patient satisfaction was 83.7%. In addition, 97.7% of patients experienced adverse events, most commonly pin-site related, with major complications in 30.2% and reoperations in 60.5%. There were 3 amputations. Adverse events were associated with increased age, poor soft tissue condition, severe deformities, subtalar fusions, peripheral neuropathy, peripheral vascular disease, and prolonged EFT. CONCLUSION Complex ankle fusion using circular frames can achieve good outcomes, however time in frame may be prolonged with a high rate of adverse events. Identified risk factors for poorer outcomes should be considered in patient counselling and prognostication. LEVEL OF EVIDENCE Level III, prognostic.
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Affiliation(s)
| | - Mickhael Langit
- Hull University Teaching Hospitals NHS Trust, Hull, Kingston upon Hull, United Kingdom
| | - Carl Fenton
- Hull University Teaching Hospitals NHS Trust, Hull, Kingston upon Hull, United Kingdom
| | - Rachael Grupping
- Hull University Teaching Hospitals NHS Trust, Hull, Kingston upon Hull, United Kingdom
| | - Ross Muir
- Hull University Teaching Hospitals NHS Trust, Hull, Kingston upon Hull, United Kingdom
| | - Elizabeth Moulder
- Hull University Teaching Hospitals NHS Trust, Hull, Kingston upon Hull, United Kingdom
| | - Hemant Sharma
- Hull University Teaching Hospitals NHS Trust, Hull, Kingston upon Hull, United Kingdom
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Kalbas Y, Klingebiel F, Pape HC. Antibiotic coated nails: Rationale, development, indications and outcomes. J Orthop Surg (Hong Kong) 2022; 30:10225536221118521. [PMID: 36545939 DOI: 10.1177/10225536221118521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The concept of antibiotic-coated implants, mainly coated intramedullary nails, has become increasingly used for the treatment of fracture related infections. After a long period of hand-made implants, commercially fabricated implants combine several benefits. Antibiotic-coated nails constitute a solid treatment option for unstable diaphyseal infections with fractures or non-unions. They release high concentrations of antibiotics locally, while retaining reduction and providing axial stability. This review aims to provide an overview about the background, the development, the indications, the treatment strategies and the outcomes of antibiotic-coated intramedullary nails.
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Affiliation(s)
- Yannik Kalbas
- Department of Trauma Surgery and Harald-Tscherne Laboratory, 27243University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Felix Klingebiel
- Department of Trauma Surgery and Harald-Tscherne Laboratory, 27243University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Hans-Christoph Pape
- Department of Trauma Surgery and Harald-Tscherne Laboratory, 27243University of Zurich, University Hospital Zurich, Zurich, Switzerland
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Abstract
There are many similarities between nondiabetic and diabetic Charcot neuroarthropathy (CN) but many of the underlying causes causing nondiabetic neuropathy and CN are associated with poor bone quality. Patient workup for nondiabetic CN should include the underlying cause of the neuropathy and optimization of bony healing, such as vitamin D supplementation and bisphosphonate or calcitonin administration. Surgical reconstruction should include the most robust fixation possible, as nondiabetic patients with CN are more prone to delayed union.
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Kold S, Fridberg M, Bue M, Rölfing J. Host factors and risk of pin site infection in external fixation: A systematic review examining age, body mass index, smoking, and comorbidities including diabetes. JOURNAL OF LIMB LENGTHENING & RECONSTRUCTION 2022. [DOI: 10.4103/jllr.jllr_32_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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10
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Ismat A, Walter N, Baertl S, Mika J, Lang S, Kerschbaum M, Alt V, Rupp M. Antibiotic cement coating in orthopedic surgery: a systematic review of reported clinical techniques. J Orthop Traumatol 2021; 22:56. [PMID: 34940945 PMCID: PMC8702599 DOI: 10.1186/s10195-021-00614-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 11/17/2021] [Indexed: 11/30/2022] Open
Abstract
Background Antibiotic-containing cement and bone graft substitute-coated orthopedic implants provide the advantages of simultaneous local antibiotic delivery and internal stable fixation, aiding in both infection eradication and osseous healing. Standardized protocols pertaining to implant coating techniques in various clinical and particularly intraoperative settings are scarce, and available literature is limited. This systematic review aims to provide a summary of the available current literature reporting on custom-made coating techniques of orthopedic implants, indications, outcomes, and associated complications in clinical use. Methods A systematic search of the literature in PubMed, Medline, Embase, and Cochrane Library databases was performed in accordance with PRISMA guidelines. Articles reporting specifically on custom-made coating techniques of orthopedic implants in a clinical setting were eligible. Results A total of 41 articles with a cumulative total number of 607 cases were included. Indications for treatment mostly involved intramedullary infections after previous plate osteosynthesis or nailing. A variety of implants ranging from intramedullary nails, plates, wires, and rods served as metal cores for coating. Polymethylmethacrylate (PMMA) bone cement was most commonly used, with vancomycin as the most frequently added antibiotic additive. Chest tubes and silicone tubes were most often used to mold. Common complications are cement debonding and breakage of the metallic implant. Conclusion Adequate coating techniques can reduce the burden of treatment and be associated with favorable outcomes. Lack of general consensus and heterogeneity in the reported literature indicate that the perfect all-in-one implant coating method is yet to be found. Further efforts to improve implant coating techniques are warranted. Level of evidence III.
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Affiliation(s)
- Abdullah Ismat
- Department of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Nike Walter
- Department of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Susanne Baertl
- Department of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Joerg Mika
- Experimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkliniken Eisenberg GmbH, Klosterlausnitzer Strasse 81, 07607, Eisenberg, Germany
| | - Siegmund Lang
- Department of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Maximilian Kerschbaum
- Department of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Volker Alt
- Department of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Markus Rupp
- Department of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
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Malkova TA, Borzunov DY. International recognition of the Ilizarov bone reconstruction techniques: Current practice and research (dedicated to 100 th birthday of G. A. Ilizarov). World J Orthop 2021; 12:515-533. [PMID: 34485099 PMCID: PMC8384611 DOI: 10.5312/wjo.v12.i8.515] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/08/2021] [Accepted: 07/09/2021] [Indexed: 02/06/2023] Open
Abstract
The Ilizarov method is one of the current methods used in bone reconstruction. It originated in the middle of the past century and comprises a number of bone reconstruction techniques executed with a ring external fixator developed by Ilizarov GA. Its main merits are viable new bone formation through distraction osteogenesis, high union rates and functional use of the limb throughout the course of treatment. The study of the phenomenon of distraction osteogenesis induced by tension stress with the Ilizarov apparatus was the impetus for advancement in bone reconstruction surgery. Since then, the original method has been used along with a number of its modifications developed due to emergence of new fixation devices and techniques of their application such as hexapod external fixators and motorized intramedullary lengthening nails. They gave rise to a relatively new orthopedic subspecialty termed "limb lengthening and reconstruction surgery". Based on a comprehensive literature search, we summarized the recent clinical practice and research in bone reconstruction by the Ilizarov method with a special focus on its modification and recognition by the world orthopedic community. The international influence of the Ilizarov method was reviewed in regard to the origin country of the authors and journal's rating. The Ilizarov method and other techniques based on distraction osteogenesis have been used in many countries and on all populated continents. It proves its international significance and confirms the greatest contribution of Ilizarov GA to bone reconstruction surgery.
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Affiliation(s)
- Tatiana A Malkova
- Department of Medical Information and Analysis, Ilizarov National Medical Research Center for Traumatology and Orthopedics, Kurgan 640014, Russia
| | - Dmitry Y Borzunov
- Department of Traumatology and Orthopedics, Ural State Medical University, Ekaterinburg 620109, Russia
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Liu JZ, Crist BD. Coated nails: is their use supported by the literature? OTA Int 2021; 4:e110(1-4). [PMID: 37609482 PMCID: PMC10441681 DOI: 10.1097/oi9.0000000000000110] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/05/2020] [Accepted: 12/11/2020] [Indexed: 08/24/2023]
Abstract
Antibiotic-coated intramedullary nails have been popularized in recent decades for treating long-bone infections. They are especially useful in treating diaphyseal infections requiring stability, such as those involving fractures and nonunions. The nails are made by injecting antibiotic-impregnated polymethylmethacrylate or "cement" around a metal core using a silicone tube as a mold. There are a variety of techniques that can be used to customize the nail to the affected site. Antibiotic cement has long been demonstrated as an effective local antibiotic delivery system. It is able to elute high concentrations of antibiotics while having little systemic toxicity. Several case series have reported good outcomes using this technique, defined by bone union and infection control. Further research is needed to determine the amount of weight that can safely be transferred through the nail and to optimize antibiotic elution.
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Affiliation(s)
- Jane Z Liu
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO
| | - Brett D Crist
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO
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Martin B, Chow J. The use of circular frame external fixation in the treatment of ankle/hindfoot Charcot Neuroarthropathy. J Clin Orthop Trauma 2021; 16:269-276. [PMID: 33717964 PMCID: PMC7932891 DOI: 10.1016/j.jcot.2021.02.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 02/13/2021] [Accepted: 02/16/2021] [Indexed: 11/28/2022] Open
Abstract
Charcot Neuroarthropathy (CN) of the ankle/hindfoot is a devastating condition that results in a loss of alignment, bony malleolar protrusions and frequently leads to ulceration, infection, and amputation. Major limb amputations in this patient population has a 5-year mortality rate approximating 39%-68%. The treatment goal for CN of the ankle/hindfoot is to provide stability with a plantigrade foot that is infection free, shoeable and allows independent weight bearing. The use of a circular frame external fixator is often required when treating patients with CN of the ankle/hindfoot because they often present late with deformity, soft tissue compromise and infection which are contraindications to primary internal fixation. These patients require urgent surgical attention to salvage the limb or risk amputation. In this narrative review article we will discuss the indications, management options, surgical technique, evidence and describe our experience in the use of circular frame external fixation in patients with ankle/hindfoot Charcot Neuroarthropathy.
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Affiliation(s)
- Brian Martin
- Nepean Foot and Ankle Reconstruction Unit, Nepean Hospital, Derby Street, Kingswood, 2747, NSW, Australia
| | - Jason Chow
- Nepean Foot and Ankle Reconstruction Unit, Nepean Hospital, Derby Street, Kingswood, 2747, NSW, Australia
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14
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Quinnan S, Seiter M, Al-Barghouthi A, Milne E, Latta L, Travascio F. Does coating an intramedullary nail with polymethylmethacrylate improve mechanical stability at the fracture site? Clin Biomech (Bristol, Avon) 2021; 83:105293. [PMID: 33588134 DOI: 10.1016/j.clinbiomech.2021.105293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 02/04/2021] [Accepted: 02/05/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Treatment of tibia diaphyseal fractures with intramedullary nail fixation has proven to be effective. An increasingly popular practice is to coat the nail with bone cement incorporating antibiotics for the purpose of treating and/or preventing infection. To date, the effect of coating on the mechanical performance of the intramedullary nail once implanted is unknown. We hypothesize that cement coating does not change the cross-sectional stiffness of the nail, so that, when fixing tibia diaphyseal fracture with gapping, cement coated intramedullary nail provide stiffness comparable to that of standard conventional uncoated ones. METHODS Tests of 4-point bending were conducted to compare the cross-sectional stiffness of uncoated to coated nails. In addition, mechanical tests of compression and torsion on tibia bone phantoms instrumented with coated and uncoated nails were performed, and the proximal-to-distal bone fragment rotations were compared. FINDINGS The 4-point bending tests indicated that the cross-sectional stiffness of coated nails was not significantly different from that of the uncoated ones (p-value >0.05). Mechanical tests of compression and torsion corroborated these results by showing no statistical difference in the proximal-to-distal bone rotations attained with uncoated nails when compared to those measured for the coated ones (p-value >0.05). INTERPRETATION Cement coating on the nail cannot be relied upon for increased mechanical stiffness of the implant, and should be solely considered as a vehicle for topic delivery of antibiotics.
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Affiliation(s)
- Stephen Quinnan
- Department of Orthopaedics, University of Miami, Miami, FL, USA
| | - Max Seiter
- Department of Orthopaedics, University of Miami, Miami, FL, USA
| | - Abeer Al-Barghouthi
- Max Biedermann Institute for Biomechanics, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Edward Milne
- Max Biedermann Institute for Biomechanics, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Loren Latta
- Department of Orthopaedics, University of Miami, Miami, FL, USA; Max Biedermann Institute for Biomechanics, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Francesco Travascio
- Department of Orthopaedics, University of Miami, Miami, FL, USA; Max Biedermann Institute for Biomechanics, Mount Sinai Medical Center, Miami Beach, FL, USA; Department of Mechanical and Aerospace Engineering, University of Miami, Coral Gables, FL, USA.
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Morrison SG, Georgiadis AG, Dahl MT. What's New in Limb Lengthening and Deformity Correction. J Bone Joint Surg Am 2020; 102:1391-1396. [PMID: 32544124 DOI: 10.2106/jbjs.20.00531] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Stewart G Morrison
- The Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Orthopaedic Surgery, Gillette Children's Specialty Healthcare, St. Paul, Minnesota
| | - Andrew G Georgiadis
- Department of Orthopaedic Surgery, Gillette Children's Specialty Healthcare, St. Paul, Minnesota
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Mark T Dahl
- Department of Orthopaedic Surgery, Gillette Children's Specialty Healthcare, St. Paul, Minnesota
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota
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16
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Abstract
It is now well accepted that diabetic patients with clinically and radiographically nonplantigrade Charcot foot arthropathy are best managed with correction of the acquired deformity. Several investigations have demonstrated a high probability for a favorable clinical outcome when the deformity is in the midfoot. Unstable deformity at the subtalar or ankle joints portends a far worse clinical outcome. The goal of this discussion was to describe the author's approach to this highly challenging clinical problem.
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Alammar Y, Sudnitsyn A, Neretin A, Leonchuk S, Kliushin NM. Closed arthrodesis in infected neuropathic ankles using Ilizarov ring fixation. Bone Joint J 2020; 102-B:470-477. [PMID: 32228076 DOI: 10.1302/0301-620x.102b4.bjj-2019-1158.r1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
AIMS Infected and deformed neuropathic feet and ankles are serious challenges for surgical management. In this study we present our experience in performing ankle arthrodesis in a closed manner, without surgical preparation of the joint surfaces by cartilaginous debridement, but instead using an Ilizarov ring fixator (IRF) for deformity correction and facilitating fusion, in arthritic neuropathic ankles with associated osteomyelitis. METHODS We retrospectively reviewed all the patients who underwent closed ankle arthrodesis (CAA) in Ilizarov Scientific Centre from 2013 to 2018 (Group A) and compared them with a similar group of patients (Group B) who underwent open ankle arthrodesis (OAA). We then divided the neuropathic patients into three arthritic subgroups: Charcot joint, Charcot-Maire-Tooth disease, and post-traumatic arthritis. All arthrodeses were performed by using an Ilizarov ring fixator. All patients were followed up clinically and radiologically for a minimum of 12 months to assess union and function. RESULTS The union rate for Group A was 81% (17/21) while it was 84.6% (33/39) for Group B. All the nonunions in Group A underwent revision with an open technique and achieved 100% union. Mean duration of IRF was 71.5 days (59 to 82) in Group A and 69 days (64.8 to 77.7) in Group B. The American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score was similar in both groups. The postoperative hospital stay was shorter in Group A (21 days (SD 8)) than Group B (28 days (SD 9)). In the latter Group there were more problems with wound healing and greater requirement for antibiotic treatment. The mean operating time was 40 minutes (SD 9) in Group A compared to 80 minutes (SD 13) in Group B. Recurrence of infection occurred in 19% (4/21) and 15.5% (6/39) for Group A and Group B respectively. CONCLUSION We found CAA using an IRF to be an effective method for ankle arthrodesis in infected neuropathic foot and ankle cases and afforded comparable results to open methods. Due to its great advantages, Ilizarov method of CAA should always be considered for neuropathic ankles in suitable patients. Cite this article: Bone Joint J 2020;102-B(4):470-477.
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Affiliation(s)
- Yaser Alammar
- Foot & Ankle Unit, Al-Razi Orthopaedic Hospital, Kuwait City, Kuwait
| | - Anatoliy Sudnitsyn
- Purulent Osteology Clinic, Bone Infection Department No. 2, Russian Ilizarov Scientific Centre for Restorative Traumatology and Orthopaedics, Kurgan, Russia
| | - Andrey Neretin
- Traumatology & Orthopaedist Department No. 5, Russian Ilizarov Scientific Centre for Restorative Traumatology and Orthopaedics, Kurgan, Russia
| | - Sergey Leonchuk
- Traumatology & Orthopaedic Department No. 6, Russian Ilizarov Scientific Centre for Restorative Traumatology and Orthopaedics, Kurgan, Russia
| | - Nikolay Mikhailovich Kliushin
- Purulent Osteology Clinic, Russian Ilizarov Scientific Centre for Restorative Traumatology and Orthopaedics, Kurgan, Russia
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