Combined Midfoot Arthrodesis, Muscle Flap Coverage, and Circular External Fixation for the Chronic Ulcerated Charcot Deformity

The role of an extended medial column arthrodesis for Charcot midfoot neuroarthropathy

“…The main reasons that usually determine the choice of fixation are often dependent on cortical integrity, presence of bone defects and dislocations, soft tissue envelope, history of deep infection, and body mass index of the patient. This approach has been corroborated by others, using various fixation techniques (4, 9–15). The authors also advocate stabilization of the subtalar and ankle joints in the presence of subjective instability and arthrodesis of these joints if significant concomitant deformity exists.…”

“…Hybrid or offloading external fixation augments the stability of the surgical construct by resisting torsional and axial stresses, and thereby shields the midfoot arthrodesis. Additionally, the external fixator inherently prevents heel decubitus ulceration, allows quiescence of the soft tissues, and offloading of any adjunctive soft tissue reconstructive procedures (9). In some cases, it may also act as a deterrent for premature weight-bearing.…”

Lower Extremity Amputation and Mortality Rates in the Reconstructed Diabetic Charcot Foot and Ankle With External Fixation

“…1-3 Although several studies exist demonstrating the potential benefits of surgical reconstruction for diabetic CN, it is difficult to compare results or make firm conclusions based on several factors, including lack of sufficient number of subjects, influence of medical comorbidities, differing opinions on clinical indications for surgical reconstruction, varied fixation techniques, and lack of long-term outcomes. 4-9 Our study is unique since it provides specific information regarding lower extremity amputation and mortality pertaining to surgical reconstruction of diabetic foot and/or ankle CN using circular external fixation alone in the presence or absence of ulcerations and/or osteomyelitis.…”

“…Surgical indications for reconstruction of the diabetic CN foot and/or ankle may include and are not limited to severe joint(s) instability, gross deformities, fracture/dislocations, presence of ulceration with or without osteomyelitis, septic arthritis, and recurrent infections. 4-7 Many studies have reported on the fixation methods for the acute and chronic diabetic CN that may include and are not limited to internal fixation (screws, plates, intramedullary nailing or beaming), external fixation in the form of circular, hybrid or computer based constructs and finally a combination of both internal and external fixation. 8-11 However, even though there is a plethora of surgical techniques and methods for the diabetic CN of the foot and/or ankle, there is no overall consistency in the definitive surgical fixation method and utilization.…”

The Biology of Bone and Ligament Healing

“…Most external devices use tensioned wires to stabilize multiple planes and promote inter-fragmentary compression to prevent implant loosing, neutralize stress placed on the foot, and assist in deformity correction. 112,120,121 Complications resulting from external fixation are more common in diabetic patients and include pin loosening, pin breakage, pin failure, stress fractures, osteomyelitis, and pin tract infections. 122 If surgical correction requires arthrodesis, the use of bone graft and/or adjuvants may be necessary.…”