Arthrodesis after osteosynthesis and infection of the ankle joint

Nineteen patients with a severely infected ankle joint after previous osteo synthesis were treated with arthrodesis in our institution. Their notes and X-rays were reviewed. Goals of treatment were eradication of infection by aggressive debridement of infected tissues, obtaining adequate soft-tissue coverage, preservation/ restoration of bonelength, and finally consolidation of the arthrodesis. Thirteen men and six women were treated, with a median age of 46 (17-69) ye ars. Arthrodesis took place after a median of 6 months (0.5-40) post-accide nt, acid after one to six earlier operative procedures. Primarily there had been four bimalleolar, five trimalleolar and ten pilon tibial fractures. F ifteen fractures were open with severe soft tissue damage. Seven free muscle transfers were performed, and ten cancellous bone graftin gs. Finally 29 attempts at arthrodesis were performed. Ultimately we had to perform two amputations. After a mean follow up of 3.5 years, one patient has an aseptic but asymptomatic pseudarthrosis, for which no further surger y is scheduled. Sixteen extremities are free from infection while full weig htbearing is possible. The limb-threatening problem of deep infection after osteosynthesis of an a nkle fracture can be resolved by consistent but prolonged treatment. After successful arthrodesis a weightbearing extremity without infection remains in the majority of cases. (C) 2001 Elsevier Science Ltd. All rights reserve d.