Single-Stage Tibiotalocalcaneal Arthrodesis With Use of an Antibiotic-Coated Intramedullary Nail for Limb Salvage Following an Open Pilon Fracture Complicated by Osteomyelitis: A Case Report

• Published in: The Journal of foot and ankle surgery 2019-09, Vol.58 (5), p.984-988
• Main Authors: Wadehra, Ashim, Douthett, Steven, Fallat, Lawrence M.
• Format: Article
• Language: English
• Subjects: Ankle Fractures - complications; Ankle Fractures - diagnostic imaging; Ankle Fractures - surgery; Anti-Bacterial Agents - therapeutic use; antibiotic; Arthrodesis - instrumentation; Female; Fracture Fixation, Intramedullary - instrumentation; Fractures, Open - diagnostic imaging; Fractures, Open - surgery; Humans; intramedullary nail; Limb Salvage; Middle Aged; osteomyelitis; Osteomyelitis - complications; Osteomyelitis - drug therapy; Osteomyelitis - surgery; tibiotalocalcaneal arthrodesis
• ISSN: 1067-2516; 1542-2224
• DOI: 10.1053/j.jfas.2018.12.018

Severe limb deformity can create a major disability, which can ultimately lead to a nonambulatory lifestyle. Limb deformities created by open fractures not only put a patient at risk for a nonfunctional lifestyle but also may lead to gross contamination and osteomyelitis of the osseous structures. At times, these deformities require amputation for better functionality. It is our belief, however, that an attempt at limb salvage should always be considered. When encountering limb deformities with osteomyelitis, most literature refers to a staged technique in which 2 procedures need to be performed: this includes external fixation and/or a temporary antibiotic spacer followed by a permanent intramedullary nail after complete resolution of the infection. Staged procedures prolong the non-weightbearing status of the patient, often decreasing quality of life. The use of a single-stage antibiotic-coated nail has rarely been discussed in the literature. Here we discuss a single-stage technique that may be an option for major deformity limb salvage in the setting of chronic osteomyelitis. This is a case report presenting a 60-year-old female who suffered an open pilon fracture resulting in osteomyelitis and was successfully treated with use of an antibiotic-coated intramedullary nail in a single stage.