Résumé
L’enclouage transplantaire est un bon mode d’ostéosynthèse pour les arthrodèses tibiotalonaviculaires. Cependant, en cas de sepsis actif de l’articulation tibiotarsienne, la mise en place d’un matériel d’ostéosynthèse qui traverse deux articulations, le calcanéus, le talus et pénètre dans la diaphyse tibiale peut faire craindre une extension de l’infection. Cependant, un geste de curetage et de nettoyage radical de l’articulation infectée après prélèvements multiples, un montage rigoureux et stable, une antibiothérapie adaptée permettent non seulement d’obtenir la consolidation osseuse mais également la guérison de l’infection comme le montre cette courte série. Au plan technique, il est nécessaire d’aviver systématiquement l’articulation sous-talienne.
Abstract
Transplantar intramedullary nailing is a good osteosynthesis to stabilize a tibio-talo-navicular arthrodesis. Nevertheless, in the case of infected ankle joint, a hardware material going from calcaneus until tibia diaphysis through two joints may facilitate a spreading of the infection. A good cleaning and curettage of the infected joint after several bacteriological samplings, a stable osteosynthesis, and a specific antibiotherapy can lead to a fusion of the bone and a healing of the infection as demonstrated by this short series. On a technical point of view, it seems necessary to systematically make a curettage of the subtalar joint.
Références
Goldberg A, Mac Grego A, Dawson J, et al (2012) The demand incidence of symptomatic ankle osteoarthritis presenting to foot & ankle surgeons in the United Kingdom. Foot 22:163–6
Adams JC (1948) Arthrodesis of the ankle joint: experiences with the transfibular approach. J Bone Joint Surg Br 30B:506–11
Kuntscher G (1967) Combined arthrodesis of the ankle and subtalar joints. In: Trans RH, Thomas CC (eds) Practice of intramedullary nailing. Springfield, IL, pp 207–9
Kile TA, Donnely RE, Gehrke JC (1994) Tibiotalocalcaneal arthrodesis with an intramedullary device. Foot Ankle Int 15:669–73
Pinzur MS, Kelikian A (1997) Charcot ankle fusion with a retrograde locked intramedullary nail. Foot Ankle Int 18:699–704
Stone K, Helal B (1991) A method of ankle stabilization. Clin Orthop Relat Res 268:102–6
Jehan S, Shakeel M, Bing AJ, Hill SO (2011) The success of tibiotalocalcaneal arthrodesis with intramedullary nailing — a systematic review of the literature. Acta Orthop Belg 77:644–51
Thordarson DB (2004) Fusion in posttraumatic foot and ankle reconstruction. J Am Acad Orthop Surg 12:322–33
Kitaoka HB, Romness DW (1992) Arthrodesis for failed ankle arthroplasty. J Arthroplasty 7:277–84
Levine SE, Myerson MS, Lucas P, Sschon LC (1997) Salvage of pseudoarthrosis after tibiotalar arthrodesis. Foot Ankle Int 18:580–5
Klouche S, El-Masri F, Graff W, Mamoudy P (2011) Arthrodesis with Internal Fixation of the Infected Ankle. J Foot Ankle Surg 50:25–30
Kappler C, Staubach R, Abdulazim A, et al (2014) Hindfoot arthrodesis for post-infectious ankle destruction using an intramedullary retrograde hindfoot nail. Der Unfallchirurg 117:348–54
Richter D, Hahn MP, Laun RA, et al (1999) Arthrodesis of the Infected Ankle and Subtalar Joint: Technique, Indications, and Results of 45 Consecutive Cases. J Trauma 47:1072–8
Cierny G, Cook WG, Mader JT (1989) Ankle Arthrodesis in the Presence of Ongoing Sepsis. Indications, Methods, and Results. Orthop Clin North Am 20:709–21
Moore J, Berberian WS, Lee M (2015) An Analysis of 2 Fusion Methods for the Treatment of Osteomyelitis Following Fractures about the Ankle. Foot Ank Int 36:547–55
Suda AJ, Richter A, Abou-Nouar G, et al (2016) Arthrodesis for Septic Arthritis of the Ankle: Risk Factors and Complications. Arch Orthop Trauma Surg 136:1343–8
Zwipp H, Grass R, Rammelt S, Dahlen C (1999) Arthrodesis -non-union of the ankle. Arthrodesis failed. Chirurg 70:1216–24
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Dumoulin, Q., Zaharia, B., Gavanier, B. et al. Arthrodèse tibiotalocalcanéenne par enclouage transplantaire rétrograde en milieu septique : note technique ; à propos de six cas. Med Chir Pied 33, 30–34 (2017). https://doi.org/10.1007/s10243-017-0458-6
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10243-017-0458-6