Aim

The incidence of deep infections after internal fixation of ankle and lower leg fractures is estimated 1 to 2%. Hindfoot arthrodesis by retrograde intramedullary nailing (IMN) is a potential alternative to external fixation for post-infectious ankle destruction. The aim of this study was to evaluate the clinical results, complications and effects of soft tissue management with this treatment modality.

Aim

Spinal infections with and without aSCI represent a severe disease with a high lethality rate of up to 17%. The current treatment recommendations include an antimicrobial therapy and if necessary in combination with operative procedures. Aims of this study are the analysis of risk factors and treatment concepts and to compare the outcome of patients suffering a spinal infection with and without an aSCI.

Introduction: Open fractures with severe soft tissue damage, uncovered osteosynthesis material and chronic soft tissue defect due to infection as well as its consequences represent a special challenge for the therapeutic strategy.

In these cases the soft tissue coverage has a particular importance.

Patients: Within a 24-month period (2005 to 2006) 145 open fractures of the lower leg and foot were treated. 34 of these showed a 1 °, 74 a 2 ° and 37 patients with 3 ° soft tissue damage. Furthermore, data on 16 patients with chronic soft tissue defect by infection, which had a flap coverage, have been evaluated.

Score: The average age was 43.3 years (6 to 68), the ratio of women to men 2:1. Primary definitive osteosynthesis was performed in 68 patients (47%). In 19 patients a local muscle flaps plastic (Soleus, Gastrocnemius, peroneus brevis) was carried out. Three of these were already covered in the context of the primary treatment. Fasciocutaneous flaps were performed in 17 patients.

In the most cases the defect site was closed by primary would healing, additional procedures (excision of skin necrosis, mesh grafting) were necessary in 8 cases. In one case we saw a complete loss of the muscle flap.

Conclusion: In addition to an adequate diagnosis (X-Rays, MRI) the soft tissue reconstruction of acute or chronic soft tissue defects, where the osteosynthesis material or the septic bone is uncovered, is also necessary. In the lower extremities local muscle flaps (M. soleus, M. gastrocnemius) or for smaller defects fasciocutaneous flaps (suralis) are particularly suitable.

Aim: Because of the low prevalence, there is a poor evidence on the effective management of bone and joint infections of the carpus and metacarpus. We therefore studied the outcomes of patients undergoing surgical treatment at our department.

Method: We conducted a retrospective study on all patients operated on because of osteomyelitis of the carpus and metacarpus between January 1998 and June 2004. Main study endpoint were the infection controll rate at end of treatment and at time of follow-up.

Results: Of eleven subjects (nine men, two women) with a median age of 43 years (range, 19 to 79 years) serial débridement with temporary wound closure and surgical fixation proved successful in ten cases. We identified causative pathogens in ten cases (S. aureus: n=3, P. aeruginosa: n=3, mixed: n=4) by intraoperative biopsy. Eight subjects received local or free tissue flaps. A 73 year old man died in hospital.

Follow-up information was available for eight patients after a median of 19,5 months (range: 3 to 61 months). Seven of them did not show signs of recurrent infection.

Conclusion: Adhering to accepted standards of treating osteomyelitis, satisfactory control rates in carpal and metacarpal infection can be achieved while salvaging the hand.