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Combined Intramedullary Nail Coated With Antibiotic-Containing Cement and Ring Fixation for Limb Salvage in the Severely Deformed, Infected, Neuroarthropathic Ankle.
Foot Ankle Int. 2019 Jan; 40(1):48-55.FA

Abstract

BACKGROUND:

The severely deformed, infected, and unstable neuroarthropathic ankle is challenging to treat. We evaluated our preliminary experience and results of combined internal and external ring fixation for a complex neuropathic population.

METHODS:

We retrospectively reviewed medical records and radiographs for 8 patients with unilateral severely deformed ankle neuroarthropathy associated with infection and ulceration. Treatment included single-stage reconstruction arthrodesis with an interlocked intramedullary nail coated with antibiotic-containing cement combined with ring fixation. Taylor Spatial Frame™ technology was used when the deformity was not amenable to acute correction (5 patients). Protected postoperative weightbearing was permitted. Their mean age averaged 55.6 (range, 42-66) years with an average body mass index of 38.4 (range, 28.7-49.6) kg/m2.

RESULTS:

Seven patients achieved limb preservation. Average time for fusion healing was 15.2 (range, 12.2-22.2) weeks, frame time was 17.7 (range, 12.2-23.0) weeks, and follow-up was 34.1 (range, 24.1-68.8) months. All presenting wounds and infection successfully resolved. Reinker and Carpenter scale was excellent for 2 patients, good for 2 patients, and fair for 3 patients. Foot and Ankle Ability Measure averaged 59.0% (range, 39.3%-87.5%). One patient developed a recalcitrant calcaneal ulcer with osteomyelitis that required a transtibial amputation 17 months after successful ankle arthrodesis.

CONCLUSIONS:

Combined use of interlocked intramedullary nail and ring external fixation for neuroarthropathic ankle arthrodesis achieved a functional and clinically stable salvaged lower limb for most patients.

LEVEL OF EVIDENCE:

Level IV, retrospective case series.

Authors+Show Affiliations

1 Summit Orthopaedics, Portland, OR, USA.1 Summit Orthopaedics, Portland, OR, USA.2 Legacy Institute for Surgical Education & Innovation, Legacy Research Institute, Portland, OR, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30264587

Citation

Tomczak, Cassandra, et al. "Combined Intramedullary Nail Coated With Antibiotic-Containing Cement and Ring Fixation for Limb Salvage in the Severely Deformed, Infected, Neuroarthropathic Ankle." Foot & Ankle International, vol. 40, no. 1, 2019, pp. 48-55.
Tomczak C, Beaman D, Perkins S. Combined Intramedullary Nail Coated With Antibiotic-Containing Cement and Ring Fixation for Limb Salvage in the Severely Deformed, Infected, Neuroarthropathic Ankle. Foot Ankle Int. 2019;40(1):48-55.
Tomczak, C., Beaman, D., & Perkins, S. (2019). Combined Intramedullary Nail Coated With Antibiotic-Containing Cement and Ring Fixation for Limb Salvage in the Severely Deformed, Infected, Neuroarthropathic Ankle. Foot & Ankle International, 40(1), 48-55. https://doi.org/10.1177/1071100718800836
Tomczak C, Beaman D, Perkins S. Combined Intramedullary Nail Coated With Antibiotic-Containing Cement and Ring Fixation for Limb Salvage in the Severely Deformed, Infected, Neuroarthropathic Ankle. Foot Ankle Int. 2019;40(1):48-55. PubMed PMID: 30264587.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Combined Intramedullary Nail Coated With Antibiotic-Containing Cement and Ring Fixation for Limb Salvage in the Severely Deformed, Infected, Neuroarthropathic Ankle. AU - Tomczak,Cassandra, AU - Beaman,Douglas, AU - Perkins,Serene, Y1 - 2018/09/28/ PY - 2018/9/29/pubmed PY - 2020/1/15/medline PY - 2018/9/29/entrez KW - Charcot KW - ankle KW - deformity correction KW - external fixation KW - limb salvage KW - neuroarthropathy KW - neuropathy KW - osteomyelitis SP - 48 EP - 55 JF - Foot & ankle international JO - Foot Ankle Int VL - 40 IS - 1 N2 - BACKGROUND:: The severely deformed, infected, and unstable neuroarthropathic ankle is challenging to treat. We evaluated our preliminary experience and results of combined internal and external ring fixation for a complex neuropathic population. METHODS:: We retrospectively reviewed medical records and radiographs for 8 patients with unilateral severely deformed ankle neuroarthropathy associated with infection and ulceration. Treatment included single-stage reconstruction arthrodesis with an interlocked intramedullary nail coated with antibiotic-containing cement combined with ring fixation. Taylor Spatial Frame™ technology was used when the deformity was not amenable to acute correction (5 patients). Protected postoperative weightbearing was permitted. Their mean age averaged 55.6 (range, 42-66) years with an average body mass index of 38.4 (range, 28.7-49.6) kg/m2. RESULTS:: Seven patients achieved limb preservation. Average time for fusion healing was 15.2 (range, 12.2-22.2) weeks, frame time was 17.7 (range, 12.2-23.0) weeks, and follow-up was 34.1 (range, 24.1-68.8) months. All presenting wounds and infection successfully resolved. Reinker and Carpenter scale was excellent for 2 patients, good for 2 patients, and fair for 3 patients. Foot and Ankle Ability Measure averaged 59.0% (range, 39.3%-87.5%). One patient developed a recalcitrant calcaneal ulcer with osteomyelitis that required a transtibial amputation 17 months after successful ankle arthrodesis. CONCLUSIONS:: Combined use of interlocked intramedullary nail and ring external fixation for neuroarthropathic ankle arthrodesis achieved a functional and clinically stable salvaged lower limb for most patients. LEVEL OF EVIDENCE:: Level IV, retrospective case series. SN - 1944-7876 UR - https://www.unboundmedicine.com/medline/citation/30264587/Combined_Intramedullary_Nail_Coated_With_Antibiotic_Containing_Cement_and_Ring_Fixation_for_Limb_Salvage_in_the_Severely_Deformed_Infected_Neuroarthropathic_Ankle_ L2 - https://journals.sagepub.com/doi/10.1177/1071100718800836?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -