Tibiocalcaneal arthrodesis using the Ilizarov fixator in compromised hosts: an analysis of 19 patients

Abstract

Introduction: Salvage of joint destruction of the tibiotalar and subtalar joint with necrosis or infection of the talus in compromised hosts is a challenging problem. In these cases, tibiocalcaneal arthrodesis using the Ilizarov external fixator represents a possible alternative to amputation. This retrospective study presents the results and complications of this salvage procedure.

Materials and methods: Between 2005 and 2015, 19 patients were treated with tibiocalcaneal arthrodesis using the Ilizarov external fixator. Ten patients received tibiocalcaneal arthrodesis due to an acute or chronic infection with joint destruction. The other nine patients presented posttraumatic necrosis of the talus or Charcot arthropathy. In addition to demographic data, the time spent in the fixator, the major and minor complications and the endpoint of the consolidation were evaluated retrospectively. Furthermore, clinical outcomes were measured using the modified American Orthopedic Foot and Ankle Society (AOFAS) score.

Results: The average time spent in the fixator was 22 (range 14-34) weeks. The average follow-up in 17 patients was 116 (range 4-542) weeks. Two patients were lost to follow-up. Complete osseous consolidation was achieved in 14 out of 19 patients. One patient presented partial consolidation, and in four patients, pseudarthrosis could be detected. The mean modified AOFAS score at the final follow-up was 53 out of 86 possible points.

Conclusion: Tibiocalcaneal arthrodesis using the Ilizarov fixator is a possible salvage procedure even in compromised hosts. However, the healing rates are below the rates reported in the literature for tibiotalar arthrodesis in comparable clinical situations.

Keywords: Arthrodesis; External fixator; Ilizarov; Limb salvage; Tibiocalcaneal.

Figs. 1

Figs. 1, 2: Patient 1—a 49-year-old woman presented with florid infection and destruction of the subtalar joint and talus and preexisting arthrodesis of the ankle after an initial fracture and multiple operations. When the patient was referred to our hospital, antibiotic chains were still present in the subtalar joint. Figs. 3, 4: Patient 1—x-ray image after talus resection, extensive debridement and placement of an AO fixator. The talus was completely destroyed due to infection, which is why it was completely removed. After initial VAC therapy, a plastic flap covering with the anterior lateral thigh (ALT) flap was necessary. Figs. 5, 6: Patient 1—after the soft tissue was successfully covered, the Ilizarov fixator was installed. Figs. 7, 8: Patient 1—after the fixator had been worn for 33 weeks, it was removed and consolidation was observed. Figs. 9, 10: Patient 1—clinical picture at the last follow-up examination after 121 months. The woman was able to walk, and the AOFAS score was 62 of 86 possible points

Figs. 2

Figs. 1, 2, 3: Patient 2—a 61-year-old patient with previous Weber C fracture and chronic osteomyelitis and multiple previous operations abroad presented with acute soft tissue and bone infection. The patient had known diabetes mellitus, polyneuropathy and coronary artery disease. Figs. 4, 5: Patient 2—in the first procedure at our facility, resection of the talus and detailed debridement were carried out while leaving the talus head. A two-stage procedure with insertion of a cement spacer containing antibiotics and attachment of an AO fixator was performed. Figs. 6, 7: Patient 2—after addressing the infection and conditioning the soft tissue, the Ilizarov ring fixator was installed. Figs. 8, 9: Patient 2—with bony consolidation, the Ilizarov fixator was removed after 7 months