Large Osteochondral Defects of the Distal Tibia Plafond After Septic Arthritis of the Ankle Joint Treated by Arthrodiastasis and Iliac Bone Graft: A Case Report

Abstract

Bone defects after septic arthritis of the ankle joint result in arthrodesis and severe loss of ankle motion. This must be prevented in young athletes. We report the case of a 17-year-old male patient with large osteochondral defects in the distal tibia plafond after septic arthritis, in whom iliac bone graft and arthrodiastasis were performed to preserve ankle motion. He was diagnosed with septic arthritis of the ankle joint postoperatively at the age of 16 years. After irrigation and hardware removal, C-reactive protein level was normal. However, he experienced continuous pain and could not walk; he was referred to our hospital. Computed tomography showed large osteochondral defects in the medial tibia plafond occupying ∼30% of the plafond articular surface. Simultaneous iliac bone block graft and arthrodiastasis with an external fixator were performed. We placed iliac bone graft into the defect in the medial tibia plafond using the anterior approach, and we placed an external fixator with hinge and tractioned and fixed the ankle joint. One week postoperatively, range of motion training of the ankle was started. We removed the foot ring at 3 months and the external fixator at 4 months postoperatively. The patient started jogging at 8 months and performing long jump at 1 year postoperatively. The Japanese Society for Surgery of the Foot ankle/hindfoot scale improved from 56 to 97 points at 2-year follow-up. Despite large osteochondral defects with septic arthritis, arthrodiastasis and iliac bone graft were beneficial for preserving the ankle joint and its function.

Keywords: arthrodiastasis; distraction arthroplasty; iliac bone graft; osteochondral defect; plafond; septic ankle.