PMC6536806_01
AP (A) and lateral (B) radiograph demonstrating hardware failure and destruction of the tibiotalar joint with severe valgus deformity and non-union
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F1
Upon presentation to our clinic, he was noted to have a severe planovalgus alignment, two draining sinuses, radiographic hardware failure (Figure 1), and elevated inflammatory markers including a white blood cell (WBC) count of 11 K/mm3, C-reactive protein (CRP) of 18.7 mg/L, and Erythrocyte Sedimentation Rate (ESR) of 18 mm/hr.
AP (A) and lateral (B) radiographs following removal of hardware, placement of tibiotalar antibiotic spacer and ringed external fixator
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F2
At our index surgery, the patient underwent a complete hardware removal with the exception of a broken screw tip from the most proximal fibular screw, extensive debridement of the ankle including excision of 11 centimeters (cm) of diseased distal fibula, 1.5cm of tibial plafond, and 0.5cm of talar dome, placement of an antibiotic spacer to the residual tibiotalar joint (impregnated with 2 grams of vancomycin and 2.4 grams of tobramycin per 40 grams of cement), and application of a ringed (Ilizarov) external fixator (Figure 2).
AP (A) and lateral (B) radiographs following definitive ankle fusion after eradication of infection
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F3
During the procedure, no purulence was encountered, iliac crest autograft was utilized to augment the tibiotalar fusion and compression through the joint was achieved through the ringed external fixator (Figure 3).
Right lower extremity (A-C) following successful infection eradication and tibiotalar fusion demonstrating healing of prior surgical sites and sinus tracts.
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F4
Six months postoperatively, he had a successful fusion with no sinus tracts or drainage (Figure 4).
AP (A) and Lateral (B) radiographs with same day clinical appearance of extremity (C & D) 1-year following fusion demonstrating a solid tibiotalar fusion mass and well healed incisions with no evidence of infection recurrence.
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F5
He was able to have his ringed external fixator removed and one year postoperatively the patient continues to do well, fully weightbearing through the extremity and has not shown any signs of recurrence (Figure 5).