Interphanlangeal and First Metatarsophalangeal Joint Fusion for Osteomyelitis and Septic Arthritis in Patients with Forefoot Diabetic Foot Ulcers

CATEGORY: Diabetes, infection INTRODUCTION/PURPOSE: In cases of Diabetic Foot ulcers over joints with assocuated septic arthritis or osteomylitis, the erradication of the infection can be difficult to achieve. In order to avoid amputations which are often associated with reduced quality of life, we try to be as conservative as possible in order to save as many big toes as possible. The backbone of our noval treatment protocol involve performing a thorough soft tissue and bony debridement, stabilizing the infected bones or joint by fusing them in the acute phase, and closing the skin over the infected ulcer. We present our experience of this concept. METHODS: Retrospective study between the years 2012-2016, in a single centre, treating diabetic foot patients. 29 patients, 31 feet, were identified with IPj or 1st MTPJ fusion for Infection. All patients had a combination of bone and soft tissue infections. All patients had a preoperative radiograph, 22patients had a pre-operative MRI scan to define the extent of the bony and soft-tissue infection. In all cases the involved joint was fused in the acute phase using screws, kw’s, plates, combination of the above fusion techniques. In all cases the skin was closed above the infected ulcer. RESULTS: Closed ulcers of the fitst ray after fusing the infected joint were achieved in 26 patients (84%) by 12 months after surgery. The radiographic fusion rate was 55% by one year after surgery while 77% of the cases were clinically stable by 1 year after surgery. 5 patients (16%) endend up with an amputation. In 4 of them the base of the proximal phalangx could be left to ensure the biomechanical properties as good as possible. 1 patient needed a BKA. In 26 patients, pathogens could be identified; in 77%, polymicrobial flora were found. CONCLUSION: Arthrodesis of IPJ- or 1st MTPJ in diabetic foot patients presents a successful way of treatmentin order to achieve a stable situation which allow healing of bony and soft-tissue problems. Fusing an infected joint is a safe procedure that allows maintaining functional capabilities.