title: Deep infection in the sinus tarsi after triple arthrodesis in rheumatoid patients: a case report.
abstract: BACKGROUND
  Triple arthrodesis can be used to correct hindfoot deformities in rheumatoid patients. Postoperative deep infections after triple arthrodesis are challenging to treat often requiring both operative debridement and antimicrobial therapy. The purpose of the present study was to review the treatment of deep infections in the sinus tarsi region in rheumatoid patients after triple arthrodesis using antimicrobial therapy and Papineau bone grafting or local muscle flap.
  
  
  METHODS
  Seven rheumatoid patients out of 97 who underwent triple arthrodesis between January 1997 and June 2006 had a deep postoperative infection in the sinus tarsi region. These infections were treated with systemic antibiotic therapy combined with open cancellous bone grafting (Papineau technique) in four cases and with a local muscle flap (adductor digiti minimi) in three cases.
  
  
  RESULTS
  The median time from diagnosis of the deep infection to complete healing in six patients averaged 22 weeks, while one patient developed sepsis and died one year later. The most common pathogens were staphylococcus epidermis and staphylococcus aureus; a total of 15 pathogens were found. The average number of revision operations before the infection was considered to have resolved completely was seven.
  
  
  CONCLUSIONS
  The rate of deep infections was 7.2% among rheumatoid patients. Infections are challenging to treat and cause prolonged morbidity. Surgical debridement and systemic antibiotic therapy combined with Papineau grafting or a local muscle flap usually yielded successful results after postoperative deep infection of the sinus tarsi region in rheumatoid patients.
authors.affiliation: Department of Surgery, Division of Orthopaedic and Trauma Surgery, Oulu University Hospital, Oulu, Finland, PL 21, 90029 OYS, Oulu, Finland. tuukka.niinimaki@ppshp.fi
authors.forename: Tuukka
authors.initials: T
authors.lastname: Niinimäki
authors.forename: Susanna
authors.initials: S
authors.lastname: Yli-Luukko
authors.forename: Hannu
authors.initials: H
authors.lastname: Syrjälä
authors.forename: Outi
authors.initials: O
authors.lastname: Kaarela
authors.forename: Juhana
authors.initials: J
authors.lastname: Leppilahti
mesh_terms: D000328:Adult; D001172:Arthritis, Rheumatoid / Q000601:surgery*; D001174:Arthrodesis / Q000009:adverse effects*; D001424:Bacterial Infections / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018461:Soft Tissue Infections / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D013529:Surgical Wound Dehiscence / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D013640:Tarsal Joints