271. ANKLE ARTHRODESIS BY INTERNAL FIXATION IN A SEPTIC CONTEXT: RESULTS AT MORE THAN TWO YEARS FOLLOW-UP

Abstract

Purpose of the study: Arthrodesis is the treatment of choice for advanced-stage infection involving the tibiotarsal joint. In aseptic conditions, clinical and biomechanical experiments have shown that internal fixation can lead to a better rate of bone fusion. In septic conditions, external fixation, or a hybrid system, is preferred by many authors. The purpose of this retrospective study was to report the outcomes obtained with tibiotarsal arthrodesis with exclusive internal fixation in a septic environment.

Material and methods: From March 1992 to October 2005, twenty patients underwent tibiotarsal arthrodesis for the treatment of septic arthritis, 18 in a one-phase procedure and two in a two-phase procedure with bone graft. The series included four women and 16 men, mean age 50±15 years. The joint lesions were posttraumatic in 15 cases, related to primary osteonecrosis of the talus in one and to primary arthritis in four. Mean duration of the infection was 2.5 years. Resection of infected bone and soft tissue, to a zone considered healthy, was systematic. Arthrodesis used the Méary technique (n=9) or the Crawford-Adams technique (n=11). Fixation was achieved with screws, staples or both. Mean duration of antibiotics was 97.5±37.5.

Results: The clinical and functional outcome was assessed with the Kitaoka score. The x-rays included an ap and lateral view of the ankle and Méary views. All patients were reviewed at mean 64±36 months; none of the patients were lost to follow-up. The patients were considered cured if clinical and radiographic signs of infection were absent; deep samples confirmed relapse (same germ) or reinfection (different germ).

Discussion: The healing rate for infection was 90% (91% for Crawford-Adams). Radiographic bone fusion was achieved in 90% (100% for Crawford-Adams) with a mean delay of 4.8 months (range 3–11). The mean Kitaoka was improved 45±18.

Conclusion: Tibiotarsal arthrodesis in a septic context can be achieved by internal fixation alone. This method allows good position for the bone fusion and cure of the infection in 90% of cases.