{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T11:15:23Z","timestamp":1783509323679,"version":"3.55.0"},"reference-count":18,"publisher":"MDPI AG","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:p>Septic ankle joint following orthopedic surgery is a rare but limb-threatening complication that requires emergent multi-modal management. Traditionally, spacers serve as stage one of a two-stage approach involving deep infections seeding to a joint. However, a paucity of literature exists regarding the outcomes and longevity of antibiotic spacers in patients who are poor candidates for a subsequent reoperation. We present a case of an 89-year-old female who sustained an open pilon fracture treated with external fixation, and a subsequent open reduction internal fixation following a fall from a height. The patient developed surgical site dehiscence that progressed to a septic ankle joint, confirmed via single-photon emission computed tomography and a three-phase bone scanning. The patient underwent a debridement with operative wash-out and fashioning of a methylmethacrylate antibiotic spacer containing 1 g of vancomycin and 1.2 g of tobramycin. This was positioned in the ankle joint with an adapted \u201cfin\u201d extending anteriorly and proximally in the tibiofibular syndesmosis, to provide stability to the spacer, and potentially increase its longevity interpositionally. With aggressive local wound care and an oral antibiotic course, the patient proceeded to complete reepithelialization of the sinus tract 6 weeks postoperatively. Serial imaging and computed tomographic scan confirmed a well-seated spacer, without evidence of migration or extrusion, 14 months after surgery. Outcome data regarding cement ankle arthroplasties are extremely limited. Retrospective case series have quantified average retention anywhere from 6 to 62 months with varying techniques. However, in the setting of multiple comorbidities, or other factors making a patient a poor candidate for reoperation, an antibiotic spacer may serve as a definitive treatment for such an infection with satisfactory outcomes. We believe the presented method, with use of a proximal fin articulating in the tibiofibular syndesmosis, not only improves implant retention, but also, maintains a functional, plantigrade ankle joint.<\/jats:p>","DOI":"10.7547\/22-120","type":"journal-article","created":{"date-parts":[[2025,3,24]],"date-time":"2025-03-24T09:28:50Z","timestamp":1742808530000},"source":"Crossref","is-referenced-by-count":0,"title":["Use of Antibiotic Spacer with Syndesmotic \u201cFin\u201d for Treatment of Septic Ankle Joint: Two-Stage Approach or Definitive Management?"],"prefix":"10.3390","volume":"115","author":[{"given":"Samantha L.","family":"Williams","sequence":"first","affiliation":[{"name":"Department of Podiatry, JFK Medical Center, 5301 S Congress Ave, Atlantis, Florida. Dr. Williams is now with Kaiser Permanente Medical Center, Santa Clara, CA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Connolly","sequence":"additional","affiliation":[{"name":"Department of Podiatry, JFK Medical Center, 5301 S Congress Ave, Atlantis, Florida. Dr. Williams is now with Kaiser Permanente Medical Center, Santa Clara, CA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Levin","sequence":"additional","affiliation":[{"name":"Department of Podiatry, JFK Medical Center, 5301 S Congress Ave, Atlantis, Florida. Dr. Williams is now with Kaiser Permanente Medical Center, Santa Clara, CA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","reference":[{"key":"B1","series-title":"Arch Bone Jt Surg","first-page":"11","article-title":"The use of antibiotic impregnated cement spacers in the treatment of infected total joint replacement: Challenges and achievements","volume":"8","author":"Shahpari O","year":"2020","unstructured":"Shahpari O, Mousavian A, Elahpour N, et al: The use of antibiotic impregnated cement spacers in the treatment of infected total joint replacement: Challenges and achievements. Arch Bone Jt Surg 8: 11, 2020."},{"key":"B2","series-title":"J Foot Ankle Surg","first-page":"287","article-title":"Long-term outcomes of permanent cement spacers in the infected foot","volume":"56","author":"Elmarsafi T","year":"2017","unstructured":"Elmarsafi T, Oliver NG, Steinberg JS, et al: Long-term outcomes of permanent cement spacers in the infected foot. J Foot Ankle Surg 56: 287, 2017."},{"key":"B3","series-title":"Foot Ankle Int","first-page":"173","article-title":"Cement spacer as definitive management for postoperative ankle infection","volume":"33","author":"Ferrao P","year":"2012","unstructured":"Ferrao P, Myerson MS, Schuberth JM, et al: Cement spacer as definitive management for postoperative ankle infection. Foot Ankle Int 33: 173, 2012."},{"key":"B4","series-title":"J Foot Ankle Surg","first-page":"216","article-title":"A novel technique for creating an articulating cement spacer for ankle prosthetic joint infections","volume":"59","author":"Short A","year":"2020","unstructured":"Short A, Penrose C, Adams S: A novel technique for creating an articulating cement spacer for ankle prosthetic joint infections. J Foot Ankle Surg 59: 216, 2020."},{"key":"B5","series-title":"J Clin Orthop Trauma","first-page":"721","article-title":"Role of nuclear medicine imaging in evaluation of orthopedic infections, current concepts","volume":"10","author":"Seltzer A","year":"2019","unstructured":"Seltzer A, Xiao R, Fernandez M, et al. Role of nuclear medicine imaging in evaluation of orthopedic infections, current concepts. J Clin Orthop Trauma 10: 721, 2019."},{"key":"B6","series-title":"Int J Surg Case Rep","first-page":"174","article-title":"Viability of permanent PMMA spacer with combined free fasciocutaneous tissue transfer for failed charcot reconstruction: A 38 month prospective case report","volume":"41","author":"Elmarsafi T","year":"2017","unstructured":"Elmarsafi T, Steinberg JS, Kim PJ, et al: Viability of permanent PMMA spacer with combined free fasciocutaneous tissue transfer for failed charcot reconstruction: A 38 month prospective case report. Int J Surg Case Rep 41: 174, 2017."},{"key":"B7","series-title":"BMC Infect Dis","first-page":"239","article-title":"Morbimortality in adult patients with septic arthritis: a three-year hospital-based study","volume":"16","author":"Ferrand J","year":"2016","unstructured":"Ferrand J, El Samad Y, Brunschweiler B, et al: Morbimortality in adult patients with septic arthritis: a three-year hospital-based study. BMC Infect Dis 16: 239, 2016."},{"key":"B8","series-title":"Clin Orthop Relat Res","first-page":"8","article-title":"Comparison of the clinical efficacy and tolerance of gentamicin PMMA beads on surgical wire versus combined and systemic therapy for osteomyelitis","volume":"295","author":"Blaha JD","year":"1993","unstructured":"Blaha JD, Calhoun JH, Nelson CL, et al: Comparison of the clinical efficacy and tolerance of gentamicin PMMA beads on surgical wire versus combined and systemic therapy for osteomyelitis. Clin Orthop Relat Res 295: 8, 1993."},{"key":"B9","series-title":"Clin Orthop Relat Res","first-page":"3141","article-title":"Sufficient release of antibiotic by a spacer 6 weeks after implantation in two-stage revision of infected hip prostheses","volume":"469","author":"Fink B","year":"2011","unstructured":"Fink B, Vogt S, Reinsch M, et al: Sufficient release of antibiotic by a spacer 6 weeks after implantation in two-stage revision of infected hip prostheses. Clin Orthop Relat Res 469: 3141, 2011."},{"key":"B10","series-title":"Curr Rev Musculoskelet Med","first-page":"373","article-title":"The use of spacers (static and mobile) in infection knee arthroplasty","volume":"8","author":"Mazzucchelli L","year":"2015","unstructured":"Mazzucchelli L, Rosso F, Marmotti A, et al: The use of spacers (static and mobile) in infection knee arthroplasty. Curr Rev Musculoskelet Med 8: 373, 2015."},{"key":"B11","series-title":"Arthroplast Today","first-page":"171","article-title":"Static vs articulating spacers for two-stage revision total knee arthroplasty: Minimum five-year review","volume":"13","author":"Vasarhelyi E","year":"2022","unstructured":"Vasarhelyi E, Sidhu SP, Somerville L, et al: Static vs articulating spacers for two-stage revision total knee arthroplasty: Minimum five-year review. Arthroplast Today 13: 171, 2022."},{"key":"B12","series-title":"Orthopedics","first-page":"e512","article-title":"Use of a functional antibiotic spacer in treating infected shoulder arthroplasty","volume":"38","author":"Levy JC","year":"2015","unstructured":"Levy JC, Triplet J, Everding N: Use of a functional antibiotic spacer in treating infected shoulder arthroplasty. Orthopedics 38: e512, 2015."},{"key":"B13","series-title":"JBJS Case Connect","first-page":"e122","article-title":"Use of a Hinged antibiotic-loaded cement spacer for an infected periprosthetic fracture in a total elbow arthroplasty: A novel construct utilizing ilizarov rods: a case report","volume":"4","author":"Liporace FA","year":"2014","unstructured":"Liporace FA, Kaplan D, Stickney W, et al: Use of a Hinged antibiotic-loaded cement spacer for an infected periprosthetic fracture in a total elbow arthroplasty: A novel construct utilizing ilizarov rods: a case report. JBJS Case Connect 4: e122, 2014."},{"key":"B14","series-title":"J Arthroplasty","first-page":"1232","article-title":"Biological and biomechanical effects of vancomycin and meropenem in acrylic bone cement","volume":"23","author":"Baleani M","year":"2008","unstructured":"Baleani M, Persson C, Zolezzi C, et al: Biological and biomechanical effects of vancomycin and meropenem in acrylic bone cement. J Arthroplasty 23: 1232, 2008."},{"key":"B15","series-title":"J Arthroplasty","first-page":"331","article-title":"Long-term elution of antibiotics form bone-cement: an in vivo study using the prosthesis of antibiotic-loaded acrylic cement (PROSTALAC) system","volume":"13","author":"Masri BA","year":"1998","unstructured":"Masri BA, Duncan CP, Beauchamp CP: Long-term elution of antibiotics form bone-cement: an in vivo study using the prosthesis of antibiotic-loaded acrylic cement (PROSTALAC) system. J Arthroplasty 13: 331, 1998."},{"key":"B16","series-title":"Arch Bone Jt Surg","first-page":"11","article-title":"The use of antibiotic impregnated cement spacers in the treatment of infected total joint replacement: challenges and achievements","volume":"8","author":"Shahpari O","year":"2020","unstructured":"Shahpari O, Mousavian A, Elahpour N, et al: The use of antibiotic impregnated cement spacers in the treatment of infected total joint replacement: challenges and achievements. Arch Bone Jt Surg 8: 11, 2020."},{"key":"B17","series-title":"Knee Surg Sports Traumatol Arthrosc","first-page":"2445","article-title":"Two-stage revision of septic knee prosthesis with articulating knee spacers yields better infection eradication rate than one-stage or two-stage revision with static spacers","volume":"20","author":"Roman\u00f2 CL","year":"2012","unstructured":"Roman\u00f2 CL, Gala L, Logoluso N, et al: Two-stage revision of septic knee prosthesis with articulating knee spacers yields better infection eradication rate than one-stage or two-stage revision with static spacers. Knee Surg Sports Traumatol Arthrosc 20: 2445, 2012."},{"key":"B18","series-title":"J Bone Joint Surg Am","first-page":"1468","article-title":"Cement arthroplasty for ankle joint destruction","volume":"96","author":"Lee HS","year":"2014","unstructured":"Lee HS, Ahn JY, Lee JS, et al: Cement arthroplasty for ankle joint destruction. J Bone Joint Surg Am 96: 1468, 2014."}],"container-title":["Journal of the American Podiatric Medical Association"],"original-title":[],"link":[{"URL":"https:\/\/japmaonline.org\/view\/journals\/apms\/115\/1\/22-120.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/japmaonline.org\/downloadpdf\/journals\/apms\/115\/1\/22-120.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/japmaonline.org\/downloadpdf\/journals\/apms\/115\/1\/22-120.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T10:19:56Z","timestamp":1783505996000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1930-8264\/115\/1\/22120"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1]]},"references-count":18,"journal-issue":{"issue":"1"},"URL":"https:\/\/doi.org\/10.7547\/22-120","relation":{},"ISSN":["8750-7315"],"issn-type":[{"value":"8750-7315","type":"print"}],"subject":[],"published":{"date-parts":[[2025,1]]}}}