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International Orthopaedics
Published in: International Orthopaedics 1/2021

01-01-2021 | Ankle Fracture | Original Paper

Salvage arthrodesis for infected ankle fractures with segmental bone-loss using Ilizarov concepts: a prospective study

Authors: Ashraf Atef, Mahmoud El-Rosasy, Ahmad El-Tantawy

Published in: International Orthopaedics | Issue 1/2021

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Abstract

Purpose

Complex ankle fractures accompanied with infection and segmental bone loss are a worrying issue. This prospective study was conducted to explore the effectiveness of using Ilizarov concepts in achieving salvage arthrodesis and reconstructing post-debridement defects in such complicated scenarios.

Methods

A total of 44 consecutive patients (mean age 35.61 ± 8.57 years, 30 males, 44 feet) of post-traumatic infected ankle fractures, who met our selection criteria, were enrolled and subjected to radical debridement and salvage arthrodesis using the bifocal bone transport concepts of Ilizarov. All patients were treated between 2012 and 2017 either by acute shortening compression of the arthrodesis site with re-lengthening (ASRL) through the created proximal metaphyseal osteotomy (group I, n = 20) or by gradual bone transport (BT) through the proximal osteotomy with gradual closure of the distal ankle defect (group II, n = 24). Plain-radiographs were used for radiological assessment. Clinically, the outcomes were objectively graded according to the Hawkins criteria, while subjectively the patients reported their satisfaction on a 1–5 points acceptance scale.

Results

The mean follow-up was 37.16 ± 5.31 (30–48 months). Successful fusion was achieved in 43/44 patients, with a significantly (P < 0.05) lesser needs for bone-grafting in favour of group II. The results were good in 32 cases, fair in 11, and poor in a single case with no significant difference between the two groups. The acceptance scores were significantly (P < 0.05) superior in group II (3.08 ± 1.1 points) than that group I (2.25 ± 1.4 points).

Conclusions

Bifocal bone transport is effective in salvaging troublesome infected ankle fractures with bone loss. BT is more comprehensive and acceptable than ASRL with lesser needs for bone grafting.
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Metadata
Title
Salvage arthrodesis for infected ankle fractures with segmental bone-loss using Ilizarov concepts: a prospective study
Authors
Ashraf Atef
Mahmoud El-Rosasy
Ahmad El-Tantawy
Publication date
01-01-2021
Publisher
Springer Berlin Heidelberg
Published in
International Orthopaedics / Issue 1/2021
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-020-04874-6

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