Salvage of diffuse ankle
osteomyelitis, especially in compromised hosts, is a challenging problem. The purpose of this report was to evaluate early complications and results using a standardized salvage protocol. Eight patients with diffuse ankle
osteomyelitis were treated by resection of all infected tiissue and hybrid-frame compression
arthrodesis. At presentation, five had open
wounds. According to the Cierny/Mader classification, all had diffuse anatomic involvement and six of eight were compromised hosts. Seven had central distal tibial column involvement and one had primarily talar involvement. Surgical technique involved a two-inicision approach, removal of all infected materialand application of a compression circumferential frame with five thin wires across the foot, two across the tibia and two half-pins in the tibia. Fusion of eight ankles and four subtalar joints was attempted. All patients received six weeks of intravenous
antibiotics. Open
wounds were treated with
wound vacuum assisted closure (VACs) devices until closure was achieved. Frames were removed at three months and walking casts were appliedfor one to two more months. Ankle
sepsis was eradicated in all patients. Seven of eight ankles fused at an average of 13.5 weeks (range, 10 to 16 weeks). One limb required below-knee
amputation (BKA) at five weeks due to nonreconstructible vascular insufficiency. Three of four subtalar joints fused. Fixation problems included two pin-track
infections cleared with oral
cephalexin and one broken half-pin. Two diabetic Charcot patients required long-term ankle-
foot orthosis (AFO) use due to subtalar instability. At average 3.4-year follow-up, none of the seven fused ankles has required further surgery. Use of this standardized
salvage treatment protocol for these difficult problems in selected patients was effective with a relatively low associated complication rate.