Tanta University, Tanta, Egypt.
Int Orthop. 2021 Jan;45(1):233-240. doi: 10.1007/s00264-020-04874-6. Epub 2020 Nov 16.
Complex ankle fractures accompanied with infection and segmental bone loss are a worrying issue. This prospective study was conducted to explore the effectiveness of using Ilizarov concepts in achieving salvage arthrodesis and reconstructing post-debridement defects in such complicated scenarios.
A total of 44 consecutive patients (mean age 35.61 ± 8.57 years, 30 males, 44 feet) of post-traumatic infected ankle fractures, who met our selection criteria, were enrolled and subjected to radical debridement and salvage arthrodesis using the bifocal bone transport concepts of Ilizarov. All patients were treated between 2012 and 2017 either by acute shortening compression of the arthrodesis site with re-lengthening (ASRL) through the created proximal metaphyseal osteotomy (group I, n = 20) or by gradual bone transport (BT) through the proximal osteotomy with gradual closure of the distal ankle defect (group II, n = 24). Plain-radiographs were used for radiological assessment. Clinically, the outcomes were objectively graded according to the Hawkins criteria, while subjectively the patients reported their satisfaction on a 1-5 points acceptance scale.
The mean follow-up was 37.16 ± 5.31 (30-48 months). Successful fusion was achieved in 43/44 patients, with a significantly (P < 0.05) lesser needs for bone-grafting in favour of group II. The results were good in 32 cases, fair in 11, and poor in a single case with no significant difference between the two groups. The acceptance scores were significantly (P < 0.05) superior in group II (3.08 ± 1.1 points) than that group I (2.25 ± 1.4 points).
Bifocal bone transport is effective in salvaging troublesome infected ankle fractures with bone loss. BT is more comprehensive and acceptable than ASRL with lesser needs for bone grafting.
伴有感染和节段性骨丢失的复杂踝关节骨折是一个令人担忧的问题。本前瞻性研究旨在探讨使用伊利扎洛夫概念在实现此类复杂情况下的挽救性关节融合和重建清创后缺损方面的有效性。
共纳入 44 例（平均年龄 35.61 ± 8.57 岁，男性 30 例，44 足）创伤后感染性踝关节骨折患者，符合我们的选择标准，采用伊利扎洛夫双焦点骨搬运概念进行彻底清创和挽救性关节融合。所有患者均于 2012 年至 2017 年接受治疗，通过在创建的近侧干骺端骨切开术处进行急性短缩压缩再延长（ASRL）（I 组，n = 20）或通过近端骨切开术进行逐渐骨搬运（BT）并逐渐闭合远端踝关节缺损（II 组，n = 24）。采用 X 线平片进行影像学评估。临床上，根据 Hawkins 标准对结果进行客观分级，而患者则根据 1-5 分的接受程度量表主观报告满意度。
平均随访 37.16 ± 5.31（30-48 个月）。44 例患者中有 43 例成功融合，组 II 明显（P < 0.05）需要更少的植骨。结果在 32 例中为良好，在 11 例中为中等，在 1 例中为差，两组之间无显著差异。组 II（3.08 ± 1.1 分）的接受评分明显（P < 0.05）高于组 I（2.25 ± 1.4 分）。
双焦点骨搬运术对于治疗有问题的感染性踝关节骨折伴骨丢失是有效的。BT 比 ASRL 更全面、更能被接受，植骨需求更少。
