The Utilization of Retrograde Intramedullary Nails in Cases of Chronic Osteomyelitis

Abstract

Küntscher's tibiotalocalcaneal arthrodesis is an established technique for the treatment of post-traumatic arthritis. Chronic osteomyelitis following tibial pilon fractures is another complex clinical problem for which the retrograde nail arthrodesis offers a good therapeutic option. We reviewed the management of six of these cases in which tibiotalocalcaneal fusion was performed with a retrograde nail. All the patients were Cierny-Mader stage IV without signs of systemic compromise. Hypertension and diabetes were present in two of the six patients, one of the patients had significant coronary artery disease requiring angioplasty, and five of the six patients smoked one to two packs per day. Trauma was the originating factor in each case, and erythema with purulent drainage was the most common presentation. The treatment regimen consists of removal of infected hardware, aggressive irrigation and debridement, systemic antibiotics, and placement of antibiotic bead chains and/or antibiotic intramedullary nails. Once the acute infection had subsided, an intramedullary nail was placed to stabilize the ankle joint with continuation of suppressive antibiotic therapy. The procedure is analogous to nailing an infected long bone pseudarthrosis. This regimen produced good results for this difficult problem.

Key words

Infection - pseudarthrosis - non-union - pilon - fractures

References

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