Ankle and foot osteomyelitis: Treatment protocol and clinical results

Abstract

Introduction A management protocol for ankle and foot osteomyelitis and the outcome in 84 patients treated in a unit with special interest in musculoskeletal infection, is presented Patients and methods Patients' mean age was 507 +/- 165 years and mean follow-up 31 5 +/- 18 2 months Systemic antibiotics were administered initially empirically, and later according to cultures Surgical treatment included surgical debridement and bead-pouch technique, minor amputation (ray or toe), below knee amputation, and joint fusion "Second-look" procedures were per formed after 48-72 h Vascularised grafts or Ilizaiov's technique were used for bone defect reconstruction Soft tissues were managed according the 'reconstructive ladder' concept Results Host-type (Cierny's classification) was A in 25. B in 53 and C in 6 patients Seventy-six infections were chronic Causes were: open trauma without fracture (45/84), open fractures (9/84). ORIF of closed fractures (25/84) and elective surgery (5/84) Patients underwent 30 +/- 15 (range 1-10) operative procedures and spent 148 +/- 122 (range 3-60) days in hospital Two (host-C) patients died. Complications requiring reoperations occurred in 20/84 (2/25 host-A. 16/53 host-B, 2/6 host-C: significant difference between host-A versus host-B and -C patients, p < 0.001) Infection recurrence occurred in 12 (none host-A, significant difference between host-A versus host-B and -C patients. p < 0001) Multiple organisms were isolated in 39/84 Ankle arthrodesis using external fixation was performed in 9 (fusion rate 8/9) The free vascularised fibula graft was used in 2 and distraction osteogenesis in 8 patients with a mean bone defect of 5.4 cm (range 3-13) Below knee amputations were performed in 5/84 (3/53 host-B. 2/6 host-C) and foot ray amputations in 8/84(6/53 host-B, 2/6 host-C). Soft tissue coverage required free muscle flap transfer in 6/84, reverse soleus flap in 1/84. local fasciocutaneous flaps in 7/84, split thickness skin grafts in 5/84, and vacuum assisted closure in 5/84 patients Eighty-two surviving patients, including amputees. were able to mobilise independently and were satisfied with the result of treatment Conclusions Host-B and -C patients had more complications and infection recurrences and occasionally required amputations Reconstructive procedures were performed for limb salvage in patients with soft tissue and bone defects and restoration of a functional limb was achieved (C) 2009 Elsevier Ltd All rights reserved