A unilateral external fixator combined with bone transport and tibia-talar fusion for the treatment of severe postoperative infection of peri-ankle fractures

Abstract Background To investigate the clinical effects of a unilateral external fixator combined with bone transport and tibial-talar fusion in the treatment of severe postoperative infection of peri-ankle fractures. Methods The clinical data of 32 patients (22 men and 10 women) with severe postoperative infection of peri-ankle fractures were retrospectively analyzed. Patients’ age ranged from 26 to 62 (mean, 42 ± 9.5) years old. The types of fractures were as follows: distal tibial fracture in 25 cases, distal tibial and fibula fracture in 5 cases, and talus fracture in 2 cases. All patients underwent treatment with unilateral external fixation combined with bone transport and tibia-talar fusion. In the initial stage, 6 patients with severe infection received treatment involving focal debridement and external fixation. In the second stage, they underwent osteotomy and bone transport. The remaining 26 patients underwent debridement, external fixation, and osteotomy simultaneously. The length of bone transport, total fixation time of the external fixator, and postoperative complications were recorded for all patients. The efficacy of the treatment was assessed using the American Association of Foot and Ankle Society (AOFAS) ankle-hindfoot score. Results Patients were followed up for 16–36 months, with an average follow-up time of 24 months. The length of tibial bone transport ranged from 5 to 15 cm, with a mean length of 8.5 cm. The external fixator was applied for 12–24 months, with an average duration of 16 months. One patient experienced a re-fracture of the tibial-talar fusion after the removal of the external fixation, while eventually recovered well. No complications, such as recurrent infection, poor mineralization, refracture, or fusion failure, were found in the remaining patients. The preoperative AOFAS ankle hindfoot function score was 40.0 ± 3.8 (range, 30–52)points, and it increased to 75.0 ± 3.0 (range, 67–78) points at the last follow-up. Conclusion A unilateral external fixator combined with bone transport and tibial-talar fusion is an effective method for treating severe postoperative infection of peri-ankle fractures. This approach is capable of reconstructing large bone defects that remain after clearing the infected lesion. Additionally, it provides stability to the ankle, enhances ankle-hindfoot function, and improves the patient’s quality of life.