Tibio-Talo-Calcaneal Arthrodesis for Limb Salvage in a Case of Combined Osteomyelitis and Avascular Necrosis of the Talus

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Tibio-Talo-Calcaneal Arthrodesis for Limb Salvage in a Case of Combined Osteomyelitis and Avascular Necrosis of the Talus

By Daniel Pérez-Prieto FEATURING Lluis Puig, albert alier, Daniel Pérez-Prieto

1,215 views

January 26, 2021

A case of avascular necrosis along with osteomyelitis of the talus after open enucleation is ...
read more ↘ here presented. A salvage procedure was proposed consisting in a 2 stage "Masquelet-like" tibio-talo-calcaneal (TTC) arthrodesis.
In the first stage, an extensive, agressive and thorough debridement and talus excesion was performed (+ External Fixator). Since MRI confirmed that infection did not involve the fibula, it was left in place to provide lateral stability. The void was filled with antibiotic-loaded bone cement: 40g COPAL G+C (Heraeus Medical) + 6g of manually added vancomycin powder.
In the second stage, a TTC arthrodesis with a T2 nail (Stryker) was performed. Medial stability (tibio-calcaneal and tibio-scafoid) was achieved by means of tantalum cilinders (Zimmer-Biomed). Dead-space was managed with 10ml of Cerament V + 5ml of Cerament G (BoneSupport) and finally bone marrow autograft obtained from the femoral shaft by means of RIA (Synthes) was also added. The Masquelet membrane was completely close and the microvascular ALT flat provide the sof tissue coverage.
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