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The use of antibiotic beads as adjuvant therapy for limb salvage in foot and ankle infection
Abstracts from the 6th IFFAS Triennial Meeting / Foot and Ankle Surgery 23(S1) (2017) 29–154
86 Tibiotalocalcaneal arthrodesis with a retrograde triple bending nail – Results of the first 200 cases M. Richter ∗ , S. Zech, S.A. Meissner Department for Foot and Ankle Surgery Nuremberg and Rummelsberg, Germany Background: The aim of the study was to analyse the clinical aspects including minimum 1-year-followup of tibiotalocalcaneal arthrodeses (TTCA) with a triple-bend retrograde intramedullary nail (A3, Stryker, Airview Boulevard, MN, USA). Methods: In a prospective consecutive non-controlled clinical followup study, all patients with TTCA using A3 from October 18th, 2011 to October 10th, 2015 were analyzed. The time and accuracy of the alignment and implant position (visual analogue scale, 0–10) for implant placement, complications, radiological fusion, and Visual Analogue Scale Foot and Ankle (VAS FA) were recorded. Fusion (≥50% bony bridge at ankle and subtalar joints assessed on radiographs) was assessed at 6, 9, 12 weeks, then latest follow-up. VAS FA was recorded at latest follow-up. Results: 200 cases were included (age, 59.3 (22–83) years; VAS FA, 31.9 (0–79.3)). Indications were specified as follows (multiple possible): osteoarthritis, n = 182 (91%); instability, n = 48 (24%); deformity, n = 154 (77%), failed total ankle replacement, n = 12 (6%); failed previous fusion, n = 15 (8%), diabetes, n = 28 (14%). The time for implant preparation and positioning was 17.2 (5–32) minutes. The accuracy of alignment and implant position was 9.4 (7–10). Complications were registered in 12 (6%; n = 6 (3%) infection, n = 6 (3%) wound healing delay. One hundred and sixty-eight (84%) patients completed follow-up at 32 (12–60) months: VAS FA 60.4 (t-test (comparison with preoperative scores), p = .01)), fusion rate 96%. Conclusions: TTCA with the A3 implant system showed accurate correction and implant position. Thirty-two month (average) followup of 168 patients (84%) showed good clinical outcome scores and 96% fusion rate. http://dx.doi.org/10.1016/j.fas.2017.07.175
87 Arthroscopic ganglionectomy of a toe with color-aided visualization of the ganglion stalk T. Ogawa 1,2,∗ , Y. Seki 2 , S. Shirasawa 2 1
Tokyo Medical and Dental University Department of Orthopaedics, Japan 2 Suwa Central Hospital, Japan Ganglion cysts are common cystic lesions filled with jelly-like fluid mostly occurring in the dorsal wrist. Ganglia originating from the tendon sheath of the toe are rarer. Ganglion stalk visualization is often aided by arthroscopic techniques. Ganglions of the toe have high recurrence rates, and the detection of its stalk remains difficult. We treated a ganglion cyst of the toe with arthroscopy and the result was good without recurrence. We present a case of a 45-year-old woman with recurrent ganglion occurring in the left toe. Magnetic resonance imaging suggested the ganglion originated from the flexor hallucis longus (FHL) tendon. We performed an arthroscopic enlargement of the ganglion stalk, because the legion was refractory to conservative treatment. An arthroscope was inserted into the ganglion, and we injected methylene blue in the FHL tendon. A ganglion stalk leaking
31
methylene blue from the tendon sheath to the ganglion cyst was visualized by arthroscopy. The ganglion stalk was enlarged arthroscopically. After the operation, the ganglion cyst diminished. The patient had no uncomfortable symptom and there was no recurrence. Arthroscopic surgery with color-aid for FHL tendon sheath ganglion was effective and achieved good results. http://dx.doi.org/10.1016/j.fas.2017.07.176
88 The use of antibiotic beads as adjuvant therapy for limb salvage in foot and ankle infection C. de Cesar Netto 1,∗ , L. Atwater 2 , Y. Chodaba 1 , E. Tan 3 , A. Chinanuvathana 4 , A.E. O’Daly 1 , E. Dein 2 , L. Schon 4 1 University of Alabama at Birmingham (UAB), Birmingham, AL, USA 2 Johns Hopkins University, Baltimore, MD, USA 3 University of Southern California, USA 4 Medstar Union Memorial Hospital, Baltimore, MD, USA
Introduction: The purpose of this study was to evaluate the clinical outcomes in the use of topic calcium-sulfate antibiotic beads as adjuvant therapy for limb salvage during the treatment of severe foot and ankle infections and osteomyelitis. Methods: We retrospectively assessed patients diagnosed with severe infection and osteomyelitis who agreed to undergo limb salvage procedures in combination with antibiotic beads. Demographic information, diagnosis, number and type of surgeries and infection causing microorganisms were recorded. Outcomes included adverse effects, development of heterotopic ossification, recurrence of infection, need for amputation or death. Results: 28 patients were included in the study (17M/11F), average age of 59 years (range, 24-85) and BMI of 33.7 kg/m2 (range, 23–50). 23 patients were neuropathic (82%), including 21 (75%) diabetics, nine of them with Charcot neuroarthropathy (32%). Mean follow-up was 10.57 months (range, 1–48 months). The most common isolated microorganisms were Staphylococcus aureus (19/28, 68%), Enterococcus faecalis (5/28, 18%) and Staphylococcus epidermidis (5/28, 18%). Patients required an average of 2.04 surgical procedures (range, 1–5 procedures). Seven patients (7/28, 25%) required some kind of amputation at an average time of 7.5 months (range, 3–23 months) after the initial surgical procedure. One patient died secondary to sepsis. No local or systemic complications related to the use of the antibiotic beads were described, including heterotopic ossification. Conclusion: The use of calcium-sulfate antibiotic impregnated beads represents a safe and promising adjuvant therapy for limb salvage procedures in the treatment of foot and ankle infections and osteomyelitis. http://dx.doi.org/10.1016/j.fas.2017.07.177
86 Tibiotalocalcaneal arthrodesis with a retrograde triple bending nail – Results of the first 200 cases M. Richter ∗ , S. Zech, S.A. Meissner Department for Foot and Ankle Surgery Nuremberg and Rummelsberg, Germany Background: The aim of the study was to analyse the clinical aspects including minimum 1-year-followup of tibiotalocalcaneal arthrodeses (TTCA) with a triple-bend retrograde intramedullary nail (A3, Stryker, Airview Boulevard, MN, USA). Methods: In a prospective consecutive non-controlled clinical followup study, all patients with TTCA using A3 from October 18th, 2011 to October 10th, 2015 were analyzed. The time and accuracy of the alignment and implant position (visual analogue scale, 0–10) for implant placement, complications, radiological fusion, and Visual Analogue Scale Foot and Ankle (VAS FA) were recorded. Fusion (≥50% bony bridge at ankle and subtalar joints assessed on radiographs) was assessed at 6, 9, 12 weeks, then latest follow-up. VAS FA was recorded at latest follow-up. Results: 200 cases were included (age, 59.3 (22–83) years; VAS FA, 31.9 (0–79.3)). Indications were specified as follows (multiple possible): osteoarthritis, n = 182 (91%); instability, n = 48 (24%); deformity, n = 154 (77%), failed total ankle replacement, n = 12 (6%); failed previous fusion, n = 15 (8%), diabetes, n = 28 (14%). The time for implant preparation and positioning was 17.2 (5–32) minutes. The accuracy of alignment and implant position was 9.4 (7–10). Complications were registered in 12 (6%; n = 6 (3%) infection, n = 6 (3%) wound healing delay. One hundred and sixty-eight (84%) patients completed follow-up at 32 (12–60) months: VAS FA 60.4 (t-test (comparison with preoperative scores), p = .01)), fusion rate 96%. Conclusions: TTCA with the A3 implant system showed accurate correction and implant position. Thirty-two month (average) followup of 168 patients (84%) showed good clinical outcome scores and 96% fusion rate. http://dx.doi.org/10.1016/j.fas.2017.07.175
87 Arthroscopic ganglionectomy of a toe with color-aided visualization of the ganglion stalk T. Ogawa 1,2,∗ , Y. Seki 2 , S. Shirasawa 2 1
Tokyo Medical and Dental University Department of Orthopaedics, Japan 2 Suwa Central Hospital, Japan Ganglion cysts are common cystic lesions filled with jelly-like fluid mostly occurring in the dorsal wrist. Ganglia originating from the tendon sheath of the toe are rarer. Ganglion stalk visualization is often aided by arthroscopic techniques. Ganglions of the toe have high recurrence rates, and the detection of its stalk remains difficult. We treated a ganglion cyst of the toe with arthroscopy and the result was good without recurrence. We present a case of a 45-year-old woman with recurrent ganglion occurring in the left toe. Magnetic resonance imaging suggested the ganglion originated from the flexor hallucis longus (FHL) tendon. We performed an arthroscopic enlargement of the ganglion stalk, because the legion was refractory to conservative treatment. An arthroscope was inserted into the ganglion, and we injected methylene blue in the FHL tendon. A ganglion stalk leaking
31
methylene blue from the tendon sheath to the ganglion cyst was visualized by arthroscopy. The ganglion stalk was enlarged arthroscopically. After the operation, the ganglion cyst diminished. The patient had no uncomfortable symptom and there was no recurrence. Arthroscopic surgery with color-aid for FHL tendon sheath ganglion was effective and achieved good results. http://dx.doi.org/10.1016/j.fas.2017.07.176
88 The use of antibiotic beads as adjuvant therapy for limb salvage in foot and ankle infection C. de Cesar Netto 1,∗ , L. Atwater 2 , Y. Chodaba 1 , E. Tan 3 , A. Chinanuvathana 4 , A.E. O’Daly 1 , E. Dein 2 , L. Schon 4 1 University of Alabama at Birmingham (UAB), Birmingham, AL, USA 2 Johns Hopkins University, Baltimore, MD, USA 3 University of Southern California, USA 4 Medstar Union Memorial Hospital, Baltimore, MD, USA
Introduction: The purpose of this study was to evaluate the clinical outcomes in the use of topic calcium-sulfate antibiotic beads as adjuvant therapy for limb salvage during the treatment of severe foot and ankle infections and osteomyelitis. Methods: We retrospectively assessed patients diagnosed with severe infection and osteomyelitis who agreed to undergo limb salvage procedures in combination with antibiotic beads. Demographic information, diagnosis, number and type of surgeries and infection causing microorganisms were recorded. Outcomes included adverse effects, development of heterotopic ossification, recurrence of infection, need for amputation or death. Results: 28 patients were included in the study (17M/11F), average age of 59 years (range, 24-85) and BMI of 33.7 kg/m2 (range, 23–50). 23 patients were neuropathic (82%), including 21 (75%) diabetics, nine of them with Charcot neuroarthropathy (32%). Mean follow-up was 10.57 months (range, 1–48 months). The most common isolated microorganisms were Staphylococcus aureus (19/28, 68%), Enterococcus faecalis (5/28, 18%) and Staphylococcus epidermidis (5/28, 18%). Patients required an average of 2.04 surgical procedures (range, 1–5 procedures). Seven patients (7/28, 25%) required some kind of amputation at an average time of 7.5 months (range, 3–23 months) after the initial surgical procedure. One patient died secondary to sepsis. No local or systemic complications related to the use of the antibiotic beads were described, including heterotopic ossification. Conclusion: The use of calcium-sulfate antibiotic impregnated beads represents a safe and promising adjuvant therapy for limb salvage procedures in the treatment of foot and ankle infections and osteomyelitis. http://dx.doi.org/10.1016/j.fas.2017.07.177