Salvage of the first ray with concomitant septic and gouty arthritis by use of a bone block joint distraction arthrodesis and external fixation.
Gouty arthropathy about the first metatarsal-phalangeal joint with a superimposed deep infection poses a great challenge to the foot and ankle surgeon. The inflammatory nature of gout compromises the soft-tissue envelope and vasculature to the area. Acute gouty arthropathy is usually a contraindication to surgical intervention secondary to wound-healing complications and possible vasospasm leading to tissue necrosis. However, if deep infection is present this must be managed with adequate surgical débridement followed by delayed soft-tissue and osseous reconstruction to prevent amputation. The authors present an exceptional clinical manifestation of gouty arthropathy of the first metatarsal-phalangeal joint concomitant with deep abscess and osteomyelitis and the surgical approach taken to afford functional limb salvage.
Stapleton
John J
JJ
Foot and Ankle Surgery, VSAS Orthopaedics, Lehigh Valley Hospital, Cedar Crest Campus, Allentown, PA, USA.
Rodriguez
Roberto H
RH
Jeffries
Luke C
LC
Zgonis
Thomas
T
D015210:Arthritis, Gouty / Q000601:surgery*; D001170:Arthritis, Infectious / Q000601:surgery*; D001174:Arthrodesis / Q000295:instrumentation*; D016267:External Fixators; D006214:Hallux; D006801:Humans; D023821:Limb Salvage / Q000295:instrumentation*; D008683:Metatarsophalangeal Joint; D019857:Osteogenesis, Distraction / Q000295:instrumentation*