Hybrid Fixation for Ankle Fusion in Diabetic Charcot Arthropathy

El-Mowafi, Hani; Abulsaad, Mazen; Kandil, Yasser; El-Hawary, Ahmed; Ali, Samer

doi:10.1177/1071100717735074

Cited by 30 publications

(25 citation statements)

References 36 publications

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“…Previous small series have reported reasonable results in mild and moderate deformity. 4,8,9,21,23 We did not exclude patients with severe deformity, bone loss, or infection who were likely to fail (Figure 2). Not surprisingly, insulin use was associated with higher complication or failure rates (95% confidence interval: 0.11-1.03; P = .054).…”

Section: Discussionmentioning

confidence: 99%

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Deformity and Clinical Outcomes Following Operative Correction of Charcot Ankle

Harkin

Schneider

Murphy³

et al. 2018

Foot Ankle Int.

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Background: Deformity associated with Charcot foot arthropathy leads to a poor quality of life in affected individuals. Deformity in the midfoot appears to be predictive of clinical outcomes following operative correction. The goal of this retrospective study was to determine if that same methodology could be applied to patients treated for Charcot foot arthropathy involving the ankle joint. Methods: Fifty-six consecutive patients underwent operative reconstruction of Charcot foot deformity involving the ankle joint by a single surgeon over a 14-year period. Preoperative patient characteristics and tibiotalar alignment, were recorded. Surgical treatment included single-stage debridement of active infection and ankle arthrodesis with application of a circular external fixator when infection was present (39 of 56, 69.6%) or retrograde locked intramedullary nailing in the absence of infection (17 of 56, 30.3%). Clinical outcomes were graded based on limb salvage, resolution of infection and chronic wounds, and the ability to ambulate with therapeutic footwear or accommodative orthoses. The average follow-up was 7.5 (range 1.1-14.0) years. Results: One patient died at 134.3 weeks following surgery of unrelated causes and 8 underwent amputation. Twenty-eight of 56 patients (50.0%) achieved a favorable (excellent or good) clinical outcome. There was no significant association between pre- or postoperative alignment and clinical outcomes. Insulin-dependent diabetics were approximately 3 times more likely to have a poor clinical outcome. Conclusions: Operative correction of Charcot deformity involving the ankle joint was associated with a high complication rate and risk for failure. The lessons learned from this highly comorbid patient population with complex deformities can be used as a benchmark for applying modern surgical techniques. Level of Evidence: Level IV, case series.

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Section: Discussionmentioning

confidence: 99%

“…The diagnosis is not often clear until resolution of the swelling, when a resultant residual deformity is appreciated. 8,22,27 Patients do not generally present to an orthopedic foot and ankle surgeon until the acquired deformity leads to walking instability, tissue breakdown and / or osteomyelitis. 13,14,26,27…”

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confidence: 99%

Deformity and Clinical Outcomes Following Operative Correction of Charcot Ankle

Harkin

Schneider

Murphy³

et al. 2018

Foot Ankle Int.

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“…7,8,9,36,38,43 Clinically, it may permit earlier frame removal, enhance long-term fusion stability, and prevent complications associated with the osteopenic calcaneus such as stress fracture or IM nail migration. 9,13 Ring fixation offers a variety of fixation constructs, which make the comparison of outcomes difficult. Successful results depend on appropriately tailoring fixation to optimize bone healing, improve postoperative tolerance, and minimize detrimental forces.…”

Section: Discussionmentioning

confidence: 99%

“…external fixation include possible postoperative weightbearing, 12,19,34 deformity correction, and soft tissue access. 9 Results using combined internal and external fixation methods for the neuroarthropathic ankle limb salvage population are limited with variable techniques, results, and conclusions. 3,8,9,14 Good results using combined fixation have been more widely reported in the deformity correction and orthopedic trauma literature.…”

mentioning

confidence: 99%

“…9 Results using combined internal and external fixation methods for the neuroarthropathic ankle limb salvage population are limited with variable techniques, results, and conclusions. 3,8,9,14 Good results using combined fixation have been more widely reported in the deformity correction and orthopedic trauma literature. 1,2,4,21,25,26 Compared to traditional external fixation alone, combined fixation approaches treating other populations undergoing deformity correction have decreased external fixation duration, increased osseous consolidation, lowered complication rates, and improved postoperative patient mobility.…”

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confidence: 99%

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Combined Intramedullary Nail Coated With Antibiotic-Containing Cement and Ring Fixation for Limb Salvage in the Severely Deformed, Infected, Neuroarthropathic Ankle

Tomczak¹,

Beaman²,

Perkins

2018

Foot Ankle Int.

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Limb preservation for the severely deformed, infected, and unstable Charcot neuroarthropathic ankle is challenging. Nonoperative management may not adequately control evolving deformities, leading to nonhealing ulcerations, osteomyelitis, and amputation. Ninety percent of foot and ankle Charcot neuroarthropathy operations involve the ankle joint, 36 yet only 10% of Charcot cases occur at the ankle/ subtalar joint, 35 suggesting the difficulties with nonoperative treatment. Operative reconstruction for the neuroarthropathic ankle is appropriate for unstable, limb-threatening deformity or infection. Despite operative advancements, 43% of Charcot ankle/hindfoot fusions may have postoperative complications. 44 Intramedullary (IM) nail fixation is common for neuroarthropathic ankle reconstruction uncomplicated by wounds, infection, severe deformity, or bone loss. Coating IM nail fixation with cement-containing antibiotics may successfully treat osteomyelitis. 24,27,37,39,40,41 External fixation is an alternative method with comparable limb salvage results,

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The Neuropathic (Charcot) Ankle

Pinzur

2023

Evaluation and Surgical Management of the Ankle

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Hybrid Fixation for Ankle Fusion in Diabetic Charcot Arthropathy

Abstract: Level IV, case series.

Cited by 30 publications

References 36 publications

Deformity and Clinical Outcomes Following Operative Correction of Charcot Ankle

Deformity and Clinical Outcomes Following Operative Correction of Charcot Ankle

Combined Intramedullary Nail Coated With Antibiotic-Containing Cement and Ring Fixation for Limb Salvage in the Severely Deformed, Infected, Neuroarthropathic Ankle

The Neuropathic (Charcot) Ankle

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