Download presentation
Presentation is loading. Please wait.
1
Infections in foot and ankle surgery – where are we now?
Dr Matthew Hope Orthopaedic Surgeon – Foot and Ankle
3
Disclosures Chairman QLD RACS Trauma Committee
Member of Surgical Advisory Committee, QH Research at PAH and Jamieson Trauma Institute No conflicts of interests
4
Summary – foot and ankle infection
History Who is at risk? Principles New technologies Case examples
5
History Ancient Pre-antibiotic Modern
6
Pre-antibiotic
10
Who is at risk? Diabetes Vascular disease Trauma
S Kuys et. al. What are the key conditions associated with lower limb amputations in a major Australian teaching hospital? Journal of Foot and Ankle Research :12
11
Musculoskeletal infection in children
CM. Parry et. al. The Epidemiology of Pediatric Bone and Joint Infections in Cambodia, 2007–11 Journal of Tropical Pediatrics, , 2013
12
Principles Host factors – immunocompromised, IV drug use
Bacteriology – ideal - deep samples, off antibiotics Vascularity Surgery Remove dead, devitalised infected tissue Anti-biotic coverage Reconstruct or amputate
13
New technologies – team approach
Diagnosis - PCR - Kingella kingae Imaging - MRI - CT- PET Wound Care - dressings / ointments - negative pressure therapy Anti-microbial - local - systemic Reconstruction Amputation blue =septic arthritis, light blue = osteomyelitis, orange = endocarditis, yellow = bacteraemia, grey = unknown source We recommend the use of a K. kingae PCR in all children under 4 years of age with a possible osteoarticular infection. T. Walls. Kingella kingae carriage in New Zealand Journal of Paediatrics and Child Health (2016).
14
New technologies – team approach
Diagnosis - PCR - Kingella kingae Imaging - MRI - PET - CT Wound Care - dressings / ointments - negative pressure therapy Anti-microbial - local - systemic Reconstruction Amputation
15
New technologies – team approach
Diagnosis - PCR - Kingella kingae Imaging - MRI - PET - CT Wound Care - dressings / ointments - negative pressure therapy Anti-microbial - local - systemic Reconstruction Amputation
16
New technologies – team approach
Diagnosis - PCR - Kingella kingae Imaging - MRI - PET - CT Wound Care - dressings / ointments - negative pressure therapy Anti-microbial - local - systemic Reconstruction Amputation
17
New technologies – team approach
Diagnosis - PCR - Kingella kingae Imaging - MRI - PET - CT Wound Care - dressings / ointments - negative pressure therapy Anti-microbial - local - systemic Reconstruction Amputation
18
New technologies – team approach
Diagnosis - PCR - Kingella kingae Imaging - MRI - PET - CT Wound Care - dressings / ointments - negative pressure therapy Anti-microbial - local - systemic Reconstruction Amputation
19
Case 1. 45yr male fall from ladder Open ankle fracture. ORIF ankle
Case 1. 45yr male fall from ladder Open ankle fracture. ORIF ankle. Persisting infection.
21
Micro: Polymicrobial including E
Micro: Polymicrobial including E.cloacae, Aeromonas hydrophlia, Serratia marcescens, E.coli, Strep agalactiae. Staph hominis scant (?significance)
23
One month Five months
24
Case 2. 55 yr male. Diabetic. Medial ankle cellulitis and ulcer
Case yr male. Diabetic. Medial ankle cellulitis and ulcer. Recent MSSA sepsis and ICU admission.
25
bone scan and WC labelled scan consistent with OM, septic arthritis
26
bone scan and WC labelled scan consistent with OM, septic arthritis
- debridement, bone biopsy and joint aspirate - ulcer tissue GPC, GNB, Pseudomonas aeruginosa. Bone and joint aspirate cultures negative.
27
Off-antibiotics, ulcer has healed
Patient is well But….Ankle continues to deteriorate In cast for - Charcot Arthropathy
28
Case 3. 12 year old with distal leg pain, + ve blood culture and 1 x pyrexia. CRP = 30
MRI appearances raise the possibility of fasciitis extending from the level of the left distal tibia diaphysis, to the level of the medial tibial epiphysis. No current features to suggest osteomyelitis. No collection or abscess
29
The appearance is consistent with severe osteomyelitis of the distal left tibial metaphysis. Abnormal areas of avid enhancement and non-enhancement of the distal tibial metaphysis, with central nonenhancement likely representing bone necrosis +/- abscess.
30
Foot and ankle - Infection
Advances in all areas of diagnosis and management. Team approach Diabetic patients remain the largest risk group prevention Surgical principles Deep tissue biopsy and adequate debridement Reconstruction options Consider amputation and rehabilitation
31
Infections in foot and ankle surgery – where are we now?
Dr Matthew Hope Orthopaedic Surgeon – Foot and Ankle
Similar presentations
© 2025 SlidePlayer.com. Inc.
All rights reserved.