Individual Reparative and Restorative Approach to the Treatment of Patients with Purulent Arthritis of Ankle Joint

А.А. Schadko

Abstract


One of the important problems of modern traumatology and orthopedics is the treatment of post-traumatic purulent arthritis of ankle joint. Prevalence of purulent lesions of ankle joint is about 38.5 % of all pyoinflammatory lesions of the large joints.
The complexity of the anatomy of ankle joints promotes fast development and severe clinical course of purulent process, which is associated with long periods of hospital treatment, temporary disability of patients, a large percentage of disability. However, of the total number of patients with this pathology, patients of working age make-up 50–80 %.
The aim of the study was to improve treatment outcomes in patients with purulent arthritis of ankle joint by introducing individual reparative and restorative approach.
From 2005 to 2012 we observed 143 patients, who were treated in the department of osseo-purulent infection in Regional trauma hospital of Donetsk.
An algorithm of treatment of these patients, which improves treatment outcomes, has been offered. This algorithm is based on individual reparative and restorative approach to the treatment of purulent lesions of ankle joint. Components of surgical intervention are sanitation of the lesion and rehabilitation of limb as organ of support and organ of movement.
Sanitation part means radical treatment of the inflammation and the creation of conditions for the restoration of previous support of the limbs — synostosis or plasty of defect.
During a surgical intervention we tried to combine the following principles: radicality, low invasiveness, early safe plasty of the defect, stable fixation, early recovery of support ability.
From the study of clinical parameters of treatment of patients with purulent arthritis of ankle joint, can be summarized as: the proposed individual reconstructive approach can significantly improve the results of treatment. This is reflected in a significant reduction in the average time of treatment, a smaller percentage of postoperative complications. Was also reduced the proportion of recurrence of osteomyelitis. When analyzing anatomical and functional outcomes of patients with purulent arthritis of ankle joint in the main group of patients and in the control group, it can be concluded that good outcomes were achieved in 67.6 % of patients in the main group and in 52.2 % of patients with a comparison group. The share of satisfactory outcome was 25.6 % of patients in the intervention group and 27.5 in patients with a comparison group. Poor treatment outcomes were observed in 6.8 % of patients in the main group and in 20.3 % of patients with a comparison group.
Developed an algorithm of the treatment of patients with with purulent arthritis of ankle joint, which includes developed a new method of surgical treatment and reasonable medical therapy in the postoperative period.
As a result of the proposed treatment strategy were reduced average time of treatment: from 178 days to 139 days, in patients with a comparison group and study group, respectively.
The proposed method is simple and treatment is available, does not require expensive hardware and equipment, reduces complications and reduce the recurrence of the disease, and significantly reduces the treatment of patients with purulent arthritis of ankle joint.


Keywords


purulent arthritis; treatment

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DOI: https://doi.org/10.22141/1997-2938.1.20.2013.87569

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