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Die Rückfußarthrodese bei postinfektiöser Sprunggelenkdestruktion mit einem intramedullären retrograden Arthrodesennagel

Hindfoot arthrodesis for post-infectious ankle destruction using an intramedullary retrograde hindfoot nail

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Zusammenfassung

Hintergrund

Der Extremitätenerhalt nach Operationen mit Infektverlauf am Sprunggelenk gelingt oft durch die Rückfußarthrodese. Ziel der Studie war die Untersuchung der intramedullären retrograden Rückfußarthrodese bei postinfektiöser Sprunggelenkdestruktion.

Material und Methoden

Zwischen 2007 und 2010 wurden 58 Patienten (Durchschnittsalter 58 Jahre) mittels Arthrodesennagel versorgt. 44 tibiotalokalkaneare Arthrodesen (TTC) und 14 tibiokalkaneare Arthrodesen (TC). Der AOFAS- sowie der SF-12-Score wurden ermittelt.

Ergebnisse

Nach durchschnittlich 18 Monaten wurden 49 Patienten (35 Männer, 14 Frauen) untersucht. Bei 85,7% lag eine stabile Arthrodese vor; 10,2% erlitten einen Reinfekt. Die statistische Auswertung zeigte eine signifikant höhere Ausheilung für TTC-Arthrodesen. Pseudarthrosen korrelierten signifikant mit Reinfekt und Diabetes. Der AOFAS betrug durchschnittlich 56 Punkte, der SF-12 betrug 39,1 in der körperlichen und 46,1 in der psychischen Summenskala. 32 Patienten waren mit der Behandlung zufrieden.

Schlussfolgerung

Die intramedulläre Rückfußarthrodese bei postinfektiöser Sprunggelenkdestruktion weist eine hohe Fusionsrate mit akzeptabler Reinfektrate und guter Patientenakzeptanz auf.

Abstract

Background

Limb salvage after operations with deep infections of the ankle is often successful using arthrodesis of the hindfoot. The aim of this study was to evaluate the results of arthrodesis using a retrograde intramedullary nail following post-infectious ankle destruction.

Patients and methods

Between 2007 and 2010 a total of 44 patients were treated with tibiotalocalcaneal (TTC) arthrodesis and 14 patients with tibiocalcaneal (TC) arthrodesis using a retrograde hindfoot nail after quieting of infection. Evaluation included the American Orthopaedic Foot and Ankle Society (AOFAS) and the short-form 12-item (SF-12) scores.

Results

Of the 58 patients 49 (35 male and 14 female) could be followed-up. The average time of follow-up was 18 months and the mean age was 58 years. In 85.7 % bony union could be achieved and 10.2 % suffered from reinfections. The mean results achieved in the different scores were AOFAS 56 and SF-12 39.1 (physical health summary scale) and 46.1 (mental health summary scale). Statistical analysis showed a significantly higher rate of bony fusion for TTC arthrodesis. Bony non-union showed a significant correlation to patients with reinfection and to diabetic patients.

Conclusions

Hindfoot arthrodesis for treatment of septic arthritis after infections is possible by using an intramedullary nail. The results show a high rate of fusion with an acceptable reinfection rate and good patient acceptance.

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Authors and Affiliations

  1. Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstraße 430, 60389, Frankfurt, Deutschland

    C. Kappler, R. Staubach, A. Abdulazim, M. Kemmerer, G. Walter & R. Hoffmann

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  1. C. Kappler
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  2. R. Staubach
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  3. A. Abdulazim
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  4. M. Kemmerer
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  5. G. Walter
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  6. R. Hoffmann
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Correspondence to C. Kappler.

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Kappler, C., Staubach, R., Abdulazim, A. et al. Die Rückfußarthrodese bei postinfektiöser Sprunggelenkdestruktion mit einem intramedullären retrograden Arthrodesennagel. Unfallchirurg 117, 348–354 (2014). https://doi.org/10.1007/s00113-012-2341-6

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  • DOI: https://doi.org/10.1007/s00113-012-2341-6

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