Outcomes and Management of Infected Intramedullary Nails After Tibiotalocalcaneal Arthrodesis in Limb Salvage: A Retrospective Case Series.

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  • Additional Information
    • Affiliation:
      Resident, Podiatric Medicine and Surgery Residency Program, University of Pittsburgh Medical Center Mercy, Pittsburgh, PA
      Associate, Centers for Advanced Orthopaedics, Catonsville, MD
      Associate, Foot Healthcare Associates, Livonia, MI
      Assistant Professor, Podiatric Medicine and Surgery Residency, Department of Orthopedic Surgery, University of Pittsburgh Medical Center Mercy, University Pittsburgh School of Medicine, Pittsburgh, PA
    • Subject Terms:
    • Subject Terms:
    • Abstract:
      Retrograde intramedullary nails are often used for tibiotalocalcaneal arthrodesis to correct severe hindfoot deformities in high-risk patient populations. The purposes of the current study are to report outcomes of patients undergoing staged management of infection after intramedullary nail fixation for tibiotalocalcaneal arthrodesis and to review the surgical approach to management of this limb-threatening complication. The authors reviewed patients who underwent hindfoot intramedullary nailing with subsequent revision for infection between January 2006 and December 2016. Staged protocol with antibiotic nail for the management of deep infection was used in 19 patients. The mean follow-up was 115.87 ± 92.80 (range 2.29 to 341.86) weeks. Twelve of the patients had diabetes, 10 had Charcot neuroarthropathy, and 7 had arthrodesis for equinovarus deformity. Sixteen had peripheral neuropathy and 13 had history of ulceration on the operated extremity. Limb salvage with the use of this protocol was achieved in 14 (73.68%) of 19 patients. Five (26.32%) patients had proximal amputation with 3 (15.79%) deaths within the follow-up period. Amputation was more likely in the nonsmoking (p =.01) and insulin-dependent (odds ratio = 22, p =.02) patient cohorts, whereas death was associated only with higher body mass index (p =.03). Time to revision was greater in patients with external bracing postoperatively as well (p =.004). Outcomes, including total number of procedures and retained antibiotic rods, were not associated with any of the preoperative variables or indications. In high-risk patient populations, the presented staged management of infected intramedullary hindfoot nails showed promising outcomes for limb preservation.
    • Journal Subset:
      Biomedical; Peer Reviewed; USA
    • ISSN:
      1067-2516
    • MEDLINE Info:
      NLM UID: 9308427
    • Publication Date:
      20200228
    • Publication Date:
      20200310
    • DOI:
      http://dx.doi.org/10.1053/j.jfas.2018.11.036
    • Accession Number:
      141917837
  • Citations
    • ABNT:
      POWERS, N. S. et al. Outcomes and Management of Infected Intramedullary Nails After Tibiotalocalcaneal Arthrodesis in Limb Salvage: A Retrospective Case Series. Journal of Foot & Ankle Surgery, [s. l.], v. 59, n. 2, p. 431–435, 2020. DOI 10.1053/j.jfas.2018.11.036. Disponível em: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=rzh&AN=141917837. Acesso em: 13 ago. 2020.
    • AMA:
      Powers NS, Brandao RA, St. John JM, Burns PR. Outcomes and Management of Infected Intramedullary Nails After Tibiotalocalcaneal Arthrodesis in Limb Salvage: A Retrospective Case Series. Journal of Foot & Ankle Surgery. 2020;59(2):431-435. doi:10.1053/j.jfas.2018.11.036
    • APA:
      Powers, N. S., Brandao, R. A., St. John, J. M., & Burns, P. R. (2020). Outcomes and Management of Infected Intramedullary Nails After Tibiotalocalcaneal Arthrodesis in Limb Salvage: A Retrospective Case Series. Journal of Foot & Ankle Surgery, 59(2), 431–435. https://doi.org/10.1053/j.jfas.2018.11.036
    • Chicago/Turabian: Author-Date:
      Powers, Nicholas S., Roberto A. Brandao, Jason M. St. John, and Patrick R. Burns. 2020. “Outcomes and Management of Infected Intramedullary Nails After Tibiotalocalcaneal Arthrodesis in Limb Salvage: A Retrospective Case Series.” Journal of Foot & Ankle Surgery 59 (2): 431–35. doi:10.1053/j.jfas.2018.11.036.
    • Harvard:
      Powers, N. S. et al. (2020) ‘Outcomes and Management of Infected Intramedullary Nails After Tibiotalocalcaneal Arthrodesis in Limb Salvage: A Retrospective Case Series’, Journal of Foot & Ankle Surgery, 59(2), pp. 431–435. doi: 10.1053/j.jfas.2018.11.036.
    • Harvard: Australian:
      Powers, NS, Brandao, RA, St. John, JM & Burns, PR 2020, ‘Outcomes and Management of Infected Intramedullary Nails After Tibiotalocalcaneal Arthrodesis in Limb Salvage: A Retrospective Case Series’, Journal of Foot & Ankle Surgery, vol. 59, no. 2, pp. 431–435, viewed 13 August 2020, .
    • MLA:
      Powers, Nicholas S., et al. “Outcomes and Management of Infected Intramedullary Nails After Tibiotalocalcaneal Arthrodesis in Limb Salvage: A Retrospective Case Series.” Journal of Foot & Ankle Surgery, vol. 59, no. 2, Mar. 2020, pp. 431–435. EBSCOhost, doi:10.1053/j.jfas.2018.11.036.
    • Chicago/Turabian: Humanities:
      Powers, Nicholas S., Roberto A. Brandao, Jason M. St. John, and Patrick R. Burns. “Outcomes and Management of Infected Intramedullary Nails After Tibiotalocalcaneal Arthrodesis in Limb Salvage: A Retrospective Case Series.” Journal of Foot & Ankle Surgery 59, no. 2 (March 2020): 431–35. doi:10.1053/j.jfas.2018.11.036.
    • Vancouver/ICMJE:
      Powers NS, Brandao RA, St. John JM, Burns PR. Outcomes and Management of Infected Intramedullary Nails After Tibiotalocalcaneal Arthrodesis in Limb Salvage: A Retrospective Case Series. Journal of Foot & Ankle Surgery [Internet]. 2020 Mar [cited 2020 Aug 13];59(2):431–5. Available from: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=rzh&AN=141917837