Total ankle arthroplasty in an adolescent who suffered hematogenous osteomyelitis of tibia

Abstract

Introduction Acute hematogenous osteomyelitis can persist as chronic infection in pediatric patients due to delayed diagnosis and treatment. An extended bone defect of the limb caused by osteomyelitic destruction is a rare clinical scenario in pediatric surgery. Metaepiphyseal and articular involvement suggests specific and long-term treatment with a high risk of disability. The objective was to report a clinical case of a teenager who suffered chronic hematogenous osteomyelitis of the tibial bones and raise awareness of primary diagnosis and treatment. Material and methods A clinical case of a teenager treated for extensive destruction of the tibial bones caused by chronic hematogenous osteomyelitis is reported. Clinical and functional evaluation of the effectiveness was produced at the stages of treatment. Results A positive functional result was achieved due to staged surgical treatment including radical debridement of the chronic infection nidus followed by total ankle arthroplasty. Discussion Acute hematogenous osteomyelitis persisting as chronic infection could be caused either by a wait-and-see strategy when the patient first sought medical help or a long-term follow-up. There is no consensus on the use of reconstruction or replacement of large long bone defects extended to the joints caused by chronic infection. Staged treatment including total joint replacement with custom-made endoprosthesis can be one of the options. Conclusion Staged surgical treatment including radical debridement followed by delayed total joint replacement with custom-made endoprosthesis provided satisfactory functionality for the limb without signs of infectious and inflammatory activity at a follow-up period of more than a year.

Keywords

• joint replacement
• ankle joint
• osteomyelitis
• cement spacer
• surgical site infection
• pediatric orthopaedics
• clinical case