Poor prognosis for infectious complications of surgery for ankle and hindfoot fracture and dislocation. A 34-case series.

INTRODUCTION

Ankle and hindfoot fractures are associated with high rates of complications, and of infection in particular, for which rates of 1% to 48% are reported.

HYPOTHESIS: Treatment of bone and joint infection (BJI) secondary to surgery for ankle or hindfoot fracture is at high risk of failure. We analyzed results of treatment of BJI in this context.

MATERIAL AND

METHODS

33 patients (34 cases) were treated for ankle or hindfoot BJI between 2010 and 2015. Cure was defined by absence of fistula and of local or general inflammatory signs and by normal C-reactive protein level, at a minimum 2 years' follow-up. Fusion without infection was counted as success; recurrent infection and amputation were counted as failure. Mean age at trauma was 52 years (range, 16-85 years). Median time to diagnosis of BJI was 44 days (range, 2-830 days).

RESULTS

Mean follow-up was 20 months (range, 3-59 months). Twenty-two patients were cured (65%). Seven cases required joint fusion (21%). The failure rate was 15%, including 5 transtibial amputations. Skin cover flap was required for 15 patients (44%), at a median 33 days (range, 0-167 days).

DISCUSSION: Despite its retrospective design and small numbers, the present study confirmed the poor prognosis of BJI following surgery for ankle and/or hindfoot fracture. Patients need to be informed of this.

TYPE OF STUDY AND LEVEL OF EVIDENCE: IV, retrospective observational.