J Korean Foot Ankle Soc.  2021 Dec;25(4):190-194. 10.14193/jkfas.2021.25.4.190.

Negative-Pressure Wound Therapy for Septic Ankle Arthritis Following Intractable Lateral Malleolar Bursitis: A Case Report

• Kim J
• Jang J
• Chung SH

• KMID: 2523302
• DOI: http://doi.org/10.14193/jkfas.2021.25.4.190

Abstract

A bursa is an obstructive sac filled with synovial fluid and usually occurs in any area of the body exposed to friction. The bursa of the ankle is not a normal anatomical structure and is caused by repetitive trauma, constant friction, or inflammatory disease of the ankle. Bursitis can occur in any bursa in the human body; however it rarely progresses to septic arthritis. We report a rare case of septic ankle arthritis following intractable lateral malleolar bursitis successfully treated with negative-pressure wound therapy.

Keyword

Ankle; Bursitis; Septic arthritis; Negative-pressure wound therapy

Figure

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  Figure. 1 Gross images (A, B) of left lateral malleolar bursitis at initial visit. There was an about 1-cm sized wound opening with pus-like discharge. Anteroposterior radiograph of both ankle joints (C) and lateral radiograph of left ankle joint (D) at initial visit. It showed soft tissue swelling around the left ankle joint without osteolytic bone lesion.

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  Figure. 2 Intraoperative gross images at 3 days after the initial operation in our hospital. (A) The wound was sutured only from the distal 1/2 of the wound with the proximal part of the wound open for negative pressure wound therapy. (B) The interface material (foam) was cut to be smaller than the width of the wound because the area around the wound easily macerated. (C, D) The suction head was positioned forward rather than lateral side of the ankle joint to prevent chronic pressure on the lateral malleolus.

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  Figure. 3 Coronal T2 (A), axial T1 (B), and sagittal T2 (C) -weighted magnetic resonance images showing joint effusion with synovial enhancement and normal signal intensity of bone. Three phase bone scan (D) shows increased uptake with hyperemia of the left ankle joint.

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  Figure. 4 Arthroscopic finding showed hypertrophic synovial membrane on the posterior (A) and lateral (B) ankle joint. Because the ankle joint communicated with the outside through the wound, a non-absorbable suture was used on the front of the distal fibula from the skin to the periosteum (C).

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  Figure. 5 Gross images of left lateral malleolus at 4 weeks (A) and 5 weeks (B) after the initial operation at our hospital. (B) At 5 weeks, granulation tissue was formed in the wound and the wound was completely closed with non-absorbable sutures. (C) Gross image shows complete healing of the wound at 6-month follow-up.

Reference

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