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

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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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Authors and Affiliations

  1. Tanta University, Tanta, Egypt

    Ashraf Atef, Mahmoud El-Rosasy & Ahmad El-Tantawy

Authors
  1. Ashraf Atef
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  2. Mahmoud El-Rosasy
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  3. Ahmad El-Tantawy
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Correspondence to Ashraf Atef.

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All procedures performed were in accordance with the ethical standards of our institutional ethical committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consents were obtained from all patients before their participation.

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Atef, A., El-Rosasy, M. & El-Tantawy, A. Salvage arthrodesis for infected ankle fractures with segmental bone-loss using Ilizarov concepts: a prospective study. International Orthopaedics (SICOT) 45, 233–240 (2021). https://doi.org/10.1007/s00264-020-04874-6

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