Non-metal locking construct for hindfoot and ankle arthrodesis using intramedullary fibular allograft strut in cases with prior infection

Few reports have been published regarding septic ankle or charcot neuroarthropathy deformities with a fibular strut allograft construct. A retrospective review was conducted to examine the radiographic and clinical outcomes of using fibular allograft struts as intramedullary fixation to assist in hindfoot and ankle arthrodesis for limb salvage in patients with prior infections. 6 patients were identified, 5 patients met the inclusion and exclusion criteria. Three (60 %) patients had an initial diagnosis of Charcot neuroarthropathy with two (20 %) patients having an initial diagnosis of septic arthritis. All the patients (100 %) had various stages of wounds prior to surgery. Four patients had multiplanar external fixator devices applied prior to hindfoot arthrodesis with fibular strut allograft (Index procedure). One patient had an external fixator applied at the same time as the index procedure. External fixator devices were applied on average of 4.5 months (range, 3.97–5.33), were applied an average of 27 days before surgery (range, 4–60), and removed 3.9 months after surgery (range, 3.3–4.7). After external fixators were removed patients were placed into a fiberglass short leg cast for an average of 2.5 months (range, 1.4–4.2). At a 6 month postoperative CT scan, 80 % of patients achieved osseous union. This complex patient population has been shown to have poor union rates. Overall, the microvascular and macrovascular disease secondary to the uncontrolled hyperglycemia in diabetic patients, poor blood flow in patients with peripheral vascular disease, and suboptimal outcomes in cases of infection contributes to increased nonunion rates. This technique demonstrates a novel and viable approach in prior ankle and hindfoot infection cases. A locking, nonmetal construct in combination with fibular strut autograft needs to be considered routinely in this patient population as many of these patients either are faced with nonsurgical options or face amputation.

Level of evidence

3.