title: Conservative Surgical Treatment of Infected Ulceration of the First Metatarsophalangeal Joint With Osteomyelitis in Diabetic Patients.
abstract: Ulceration of the plantar aspect of the first metatarsophalangeal joint is a common localization in the diabetic foot. Conservative treatment of this lesion is a challenging problem, performed through the soft tissues and osseous debridement. The present study included a cohort of 28 patients affected by diabetes mellitus and a first ray lesion penetrating the bone. After surgical debridement with removal of the infected bone, we positioned antibiotic-loaded bone cement and stabilized the treated area with an external fixator. All patients with critical limb ischemia had their vascular disease treated before the procedure. The mean follow-up was 12.2 ± 6.9 months. Four patients developed a relapse of the ulceration after the procedure. In the postoperative period, 1 patient (3.57%) developed dehiscence of the surgical site and underwent a second procedure. In the follow-up period, 2 patients (7.14%) experienced bone cement dislocation. In 1 of these patients, a new ulceration was observed dorsally to the surgical site. The approach was surgical revision with bone cement replacement and stabilization with a new external fixator. In the other patient, given the absence of ulcerations, the cement was removed, and arthrodesis with internal stabilization using 2 cannulated screws was performed. One patient (3.57%), who had developed a relapse of ulceration after recurrent critical ischemia, underwent a percutaneous revascularization procedure and transmetatarsal amputation. During the follow-up period, no ulceration recurrences, transfer ulcerations, shoe fit problems, or gait abnormalities were detected in the other 24 patients. Our study presents the results of a technique requiring a 1-stage surgical approach to a relatively common problem, which is often difficult to solve.
authors.affiliation: Diabetic Foot Department, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy. Electronic address: ldallapaola@gvmnet.it.
authors.forename: Luca
authors.initials: L
authors.lastname: Dalla Paola
authors.affiliation: Diabetic Foot Department, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Carone
authors.affiliation: Laboratory of Histopathology, Sant Maria delle Croci Hospital, Ravenna, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Morisi
authors.affiliation: Diabetic Foot Department, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Cardillo
authors.affiliation: Diabetic Foot Department, Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Pattavina
mesh_terms: D000671:Amputation, Surgical; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001174:Arthrodesis; D001843:Bone Cements; D015331:Cohort Studies; D003646:Debridement; D017719:Diabetic Foot / Q000628:therapy*; D016267:External Fixators; D005260:Female; D005500:Follow-Up Studies; D006214:Hallux; D006801:Humans; D008297:Male; D008683:Metatarsophalangeal Joint / Q000382:microbiology* / Q000601:surgery*; D008875:Middle Aged; D010019:Osteomyelitis / Q000209:etiology / Q000628:therapy*; D011183:Postoperative Complications; D012086:Reoperation
chemical_list: D000900:Anti-Bacterial Agents; D001843:Bone Cements
keywords: amputation; bone infection; diabetic foot; foot ulcer; great toe; hallux; surgery