Limb Salvage in Charcot Foot and Ankle Osteomyelitis: Combined Use Single Stage/Double Stage of Arthrodesis and External Fixation

Abstract

For select patients, external fixation proved to be a reasonable alternative to below-knee amputation.

Limb salvage for spreading midfoot osteomyelitis following diabetic foot surgery

“…Second, the total contact cast was changed weekly in order to allow evaluation of the foot and monitor complications such as spreading infection, necrosis or pressure ulcers. Other authors have reported limb salvage using arthrodesis and external fixation in patients with Charcot feet complicated with osteomyelitis [12]. We propose that immobilization of the foot was critical in the cases presented here, because it served to decrease inflammation, in agreement with results observed in cases of Charcot neuroarthropathy [13,14], and because inflammation is enhanced in well-vascularized feet [15].…”

Complex Ankle Arthrodesis Using the Ilizarov Method Yields High Rate of Fusion

“…Shorter external fixation times have been associated with poor results, particularly in patients with Charcot neuroarthropathy [11]. Ankle fusion has been challenging in patients with Charcot neuroarthropathy, often requiring external fixation [6,20]. In our study, there were three subtalar complications in the patients with Charcot neuroarthropathy who otherwise had successful tibiotalar arthrodesis.…”

“…Ankle fusion using circular fixation has been regarded as a last resort, limb-salvage procedure [3,5,6,8,10,11,14,16,17,20,21,23,25,[28][29][30][31] (Table 5). We asked whether (1) smoking and other comorbidities (Charcot neuroarthropathy, Type B hosts), (2) time wearing the frame, or (3) tibial lengthening affected union rate after ankle arthrodesis surgery?…”

“…Although not shown in the literature, performing a tibial osteotomy in the setting of an ankle fusion has been thought to enhance healing at the arthrodesis site [19]. The Ilizarov method [19] has been used in these complex cases [3,5,6,8,10,11,14,16,17,20,21,23,25,[28][29][30][31]. An improved understanding of the contributions of each complex variable (smoking, diabetes, Charcot neuroarthropathy, osteomyelitis, time wearing the external fixator, limb length discrepancy [LLD], and tibial lengthening) to the healing of ankle fusions would be valuable to provide information for patients' and surgeons'.…”

The role of circular fixation in the treatment of Charcot foot

“…Dalla Paola et al 18 published their results using arthrodesis with hybrid ring fixation for the definitive treatment of Charcot deformity with ankle osteomyelitis. Forty-five patients were treated with Achilles tendon lengthening and infection was eradicated with surgical means.…”