The role of circular fixation in the treatment of Charcot foot

Abstract

Charcot neuroarthropathy of the foot and ankle is a challenging clinical dilemma. No clear consensus exists regarding the timing of surgical intervention or the method of treatment. Over the last decade, circular ring fixation has gained favor in the treatment of the Charcot foot. Review of the literature reveals that most series report favorable results and low amputation rates. This is based largely on retrospective case series and not prospective randomized control trials. Circular fixators also have inherent complications such as pin breakage and infection. The use of circular ring fixation, however, is a useful method in the surgical management of selected patients with Charcot neuroarthropathy.

The use of circular frame external fixation in the treatment of ankle/hindfoot Charcot Neuroarthropathy

“…14 Surgical treatment ranges from exostectomy and ulcer excision to major reconstruction with corrective osteotomies, arthrodeses and soft-tissue balancing. 24 Patients with ankle and hindfoot CN deformities are highly prone to ulceration due to prominent malleoli therefore more likely requiring early limb salvage surgery 7,15 Figs. 1.…”

“…They found that patients with diabetes mellitus carried a seven-fold risk of postoperative complication. They concluded that circular fixation, especially in a high-risk population, carries with it an inherent risk of postoperative complications 24…”

“…Despite this high complication rate, overall patient satisfaction was 80%, and limb salvage was achieved in 97% of patients 15 CFEF's most common complication is pin site infection. 24,31 Pin site infection is associated with loosening and may be related to the patients lack of proprioception and can be decreased with a period of non-weight bearing. 2,22 Diabetics have a 7-fold risk for any wire complication compared to patients without diabetes.…”

Surgical management of Charcot neuroarthropathy of the ankle and hindfoot in patients with diabetes

“…internal or external fixation) depends on several factors. (Figure ) The main determinant is the presence or absence of an open wound with infection. Internal fixation is not recommended in the setting of active osteomyelitis or soft tissue infection.…”