Tibiocalcaneal arthrodesis using the Ilizarov technique in the presence of bone loss and infection of the talus.
BACKGROUND
Infected nonunions and extrusions of the talus can often lead to below-knee amputation. Limb-salvage procedures have goals of eradicating infection and creating a painless, stable limb. Often, a tibiocalcaneal fusion is the best option; however, in the presence of infection and bone loss, it can be difficult to achieve a successful outcome using internal fixation. We review the results of circular ring external fixation to obtain a tibiocalcaneal arthrodesis despite these obstacles.


METHODS
A retrospective review of 11 patients who underwent tibiocalcaneal arthrodesis using an Ilizarov external fixator for infected talar nonunions or extrusions was performed. Each patient had a debridement of all nonviable talus. The bony surfaces were prepared for the fusion followed by application of a circular ring fixator. Clinical outcomes were measured using the AOFAS ankle-hindfoot scale. There was a mean followup of 35 months.


RESULTS
Nine of the 11 patients had successful fusions. One fused successfully after a revision and the other developed a stable pseudoarthrosis. Eight patients underwent concomitant lengthening with the Ilizarov fixator. Mean AOFAS score at final followup was 65. This was out of a maximum of 86 since the tibiotalar and subtalar joint motion were removed. There were no recurrent deep infections or amputations.


CONCLUSIONS
Tibiocalcaneal arthrodesis using the Ilizarov technique is a viable alternative to amputation in patients with infected nonunions or large bone loss of the talus.
Rochman
Robert
R
The Center for Bone and Joint Surgery of the Palm Beaches, 12989 Southern Blvd, Building 3, Suite 101, Wellington, FL 33470, USA. robert.rochman@boneandjoint.org
Jackson Hutson
James
J
Alade
Oladapo
O
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001174:Arthrodesis / Q000379:methods*; D002111:Calcaneus / Q000601:surgery*; D003646:Debridement; D005260:Female; D005500:Follow-Up Studies; D005599:Fractures, Ununited / Q000601:surgery; D006801:Humans; D018889:Ilizarov Technique; D023821:Limb Salvage; D008297:Male; D008875:Middle Aged; D019857:Osteogenesis, Distraction; D010019:Osteomyelitis / Q000150:complications / Q000601:surgery; D012189:Retrospective Studies; D013977:Tibia / Q000601:surgery*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents