Services d'orthopédie et traumatologie 1 et 2, faculté de médecine, université de Tours, CHU de Trousseau, avenue de la République, 37170 Chambray-les-Tours, France.
Services d'orthopédie et traumatologie 1 et 2, faculté de médecine, université de Tours, CHU de Trousseau, avenue de la République, 37170 Chambray-les-Tours, France.
Orthop Traumatol Surg Res. 2019 Oct;105(6):1119-1124. doi: 10.1016/j.otsr.2019.06.006. Epub 2019 Jul 30.
Ankle and hindfoot fractures are associated with high rates of complications, and of infection in particular, for which rates of 1% to 48% are reported.
Treatment of bone and joint infection (BJI) secondary to surgery for ankle or hindfoot fracture is at high risk of failure. We analyzed results of treatment of BJI in this context.
33 patients (34 cases) were treated for ankle or hindfoot BJI between 2010 and 2015. Cure was defined by absence of fistula and of local or general inflammatory signs and by normal C-reactive protein level, at a minimum 2 years' follow-up. Fusion without infection was counted as success; recurrent infection and amputation were counted as failure. Mean age at trauma was 52 years (range, 16-85 years). Median time to diagnosis of BJI was 44 days (range, 2-830 days).
Mean follow-up was 20 months (range, 3-59 months). Twenty-two patients were cured (65%). Seven cases required joint fusion (21%). The failure rate was 15%, including 5 transtibial amputations. Skin cover flap was required for 15 patients (44%), at a median 33 days (range, 0-167 days).
Despite its retrospective design and small numbers, the present study confirmed the poor prognosis of BJI following surgery for ankle and/or hindfoot fracture. Patients need to be informed of this.
IV, retrospective observational.
踝关节和后足骨折并发症发生率较高，尤其是感染的发生率，报道的感染发生率为 1%至 48%。
踝关节或后足骨折手术后的骨和关节感染（BJI）的治疗失败风险很高。我们分析了这种情况下 BJI 的治疗结果。
2010 年至 2015 年期间，我们治疗了 33 例（34 例）踝关节或后足 BJI 患者。治愈定义为至少 2 年随访时无瘘管和局部或全身炎症迹象以及正常 C 反应蛋白水平。融合无感染视为成功；复发感染和截肢视为失败。创伤时的平均年龄为 52 岁（范围 16-85 岁）。BJI 的中位诊断时间为 44 天（范围 2-830 天）。
平均随访时间为 20 个月（范围 3-59 个月）。22 例患者治愈（65%）。7 例需要关节融合（21%）。失败率为 15%，包括 5 例经胫骨截肢。15 例患者（44%）需要皮瓣覆盖，中位时间为 33 天（范围 0-167 天）。
尽管本研究为回顾性设计且样本量较小，但仍证实了踝关节和/或后足骨折手术后 BJI 的预后较差。需要告知患者这一点。
IV 级，回顾性观察。
