Management and Treatment Strategies for Distal Tibia and Ankle Infections: Our Clinical Experience

Background: The management of infections involving the distal tibia and ankle is a significant challenge in orthopedic surgery due to complex anatomy and the high risk of complications. The study aims to present our clinical experience in managing these infections and focusing on surgical strategies, infection control, and functional outcomes over a minimum 24-month follow-up period. Methods: This is an observational, retrospective case series of 17 patients treated for osteoarticular infections of the distal tibia and/or ankle between January 2020 and May 2023, in a second-level referral trauma center. A staged surgical approach was employed, including radical debridement, temporary stabilization with external fixation, and, in most cases, implantation of a cement spacer loaded with antibiotics. Functional outcomes were assessed using scores such as EQ-5D-5L. Results: The cohort was predominantly male (76.5%), with a high prevalence of elevated BMI and comorbidities. Infection onset was most frequently associated with open fractures (64.7%). Staphylococcus aureus was the most common isolated pathogen (41.2%), and infections caused by Gram-negative or multidrug-resistant bacteria were associated with more reoperations. Overall, complications occurred in 10 patients (58.8%), requiring reintervention in 9 patients (52.9%). Limb salvage was achieved in 16 of 17 patients (94.1%). Conclusions: Our study highlights the critical role of a tailored, multidisciplinary approach in managing these complex infections. Meticulous surgical planning and proactive management of complications are essential for optimizing patient outcomes.