Ankle arthrodesis with a retrograde femoral nail for Charcot ankle arthropathy.
ABSTRACT Tibiocalcaneal arthrodesis with retrograde intramedullary nailing has gained acceptance as a salvage procedure for a multitude of ankle and hindfoot disorders and is frequently used in Charcot arthropathy of the ankle. Because of the severe osteopenia often associated with Charcot arthropathy of the ankle, an area of stress concentration leading to stress fracture at the proximal aspect of the nail has been identified.
To determine if this potential complication can be avoided, nine consecutive diabetic individuals with Charcot arthropathy of the ankle had ankle arthrodesis with a longer retrograde femoral nail. The average age of the patients was 52.3 years. Their average weight was 102.6 kg.
Fusion was evident on radiographs in all nine patients at an average of 10.5 weeks. None of the patients developed a stress fracture or evidence of stress concentration at the proximal metaphyseal tip of the nails. One wound infection resolved after debridement and antibiotic therapy, and one postoperative hematoma resolved without surgery. At an average 32-month followup, all patients were ambulatory, using commercially available therapeutic footwear. None had developed a new foot ulcer, infection, or new episode of Charcot arthropathy.
The use of a retrograde femoral nail for ankle arthrodesis in patients with Charcot arthropathy appears to decrease the risk of stress fracture compared with shorter nails without increasing the risk of other complications.
Full-textDOI: · Available from: Michael S Pinzur, Nov 03, 2014
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ABSTRACT: Tibiotalocalcaneal/Tibiocalcaneal arthrodesis with intramedullary nail fixation is a useful and stable means through which to address complex rearfoot deformities. In this manuscript, we have critically analyzed the modalities and surgical outcomes within existing literature comparing each to our institutional results and have found a critical void in information. In tracking and addressing variables such as smoking cessation, glucose control, weight management, vascular stability, extremity ulcerations and postoperative pedorthics we have observed improved operative outcomes and fusion rates. In reviewing the literature, we have found bone union rates of 79.6%, non-union rates of 7.6%, fracture rates of 1.4% and amputation rates of 4.7%. Those results were then compared to our rates of 88.88%, 11.12%, 0% and 0% respectively. Yet, while our institution noted improved results, a meaningful meta-analysis was difficult to achieve considering that most literature failed to make note of the aforementioned variables. Accordingly, we offer that a strict preoperative regimen of glycemic control, vascular patency, weight management and smoking cessation, in conjunction with strict postoperative non-weight bearing and aggressive wound management will improve overall results. Furthermore, it is our suggestion that future research address these topics.The Foot and Ankle Online Journal 01/2012; Volume 5(Issue 7). · 1.47 Impact Factor
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ABSTRACT: Tibiotalocalcaneal arthrodesis is aimed to block the ankle joint motion in cases of severe osteoarthritis, avascular necrosis of the talus and/or failure of arthroplasty operations. This systematic review was carried out to evaluate the clinical outcome after tibiotalocalcaneal arthrodesis using intramedullary nail either open and arthroscopically assisted. Focus was on the success rate of the procedure in terms of union and complications and on the comparison between the techniques. The databases PubMed (Medline), EMBASE and Cochrane Library were searched in order to retrieve relevant studies. All therapeutic level 1-4 studies involving humans with intramedullary nail fixation technique were included. Only studies written in English, Italian, French, Spanish and German were included. Data related to the type of surgery, complications and clinical outcomes were extracted and analysed. A total of 83 studies were identified, of which 32 studies were eligible for inclusion; 31 case series and one randomized controlled trial. The main reported outcome score was the American Orthopaedic Foot and Ankle Society scale. Almost, all the included studies reported higher than 50 % union rates and a significant improvement in terms of the clinical and mechanical ankle function after treatment. Results suggest that satisfactory outcomes can be achieved by tibiotalocalcaneal arthrodesis using intramedullary nailing. Low complication rates contribute to make this a safe procedure. No comparison can be done between arthroscopic and open technique, due to the lack of scientific works on the first one. LEVEL OF EVIDENCE: IV.Knee Surgery Sports Traumatology Arthroscopy 02/2015; DOI:10.1007/s00167-015-3548-1 · 2.84 Impact Factor
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ABSTRACT: Tibiotalocalcaneal arthrodesis is a treatment modality for severe arthrosis and malalignment of the hindfoot. Complications, such as delayed union and nonunion, are well-known risks of the procedure. Arthrodesis can be done with a plate, screws, an external fixator, or an intramedullary nail. Compression with an intramedullary nail was the focus of this report. Thirty-four consecutive patients (23 men and 11 women) with an average age range of 57 (range 25-77) years had tibiotalocalcaneal arthrodesis using retrograde intramedullary compression nail fixation. Mean followup was 24 (range 6 to 43) months. One patient died of an unrelated cause, but 30 (91%) of the remaining 33 patients answered the questionnaire. Bony consolidation was achieved in 26 (76%) patients, the mean time to fusion being 16 weeks. Five patients (15%) had complications and seven (20%) had repeat surgery. Of the 30 patients who responded to the questionnaire, three patients (10%) evaluated the overall result subjectively as being of no benefit and 27 (90%) as improved. The visual analog scale (VAS) score for preoperative pain was 66 at rest and 83 when walking, and the mean postoperative scores were 19 and 32, respectively (p<0.001). Tibiotalocalcaneal arthrodesis with a compressive retrograde intramedullary nail is an effective and safe procedure for patients with severe malalignment or arthrosis of the hindfoot. It is essentially a salvage procedure, and most patients benefit from it, but excellent results are rare.Foot & Ankle International 05/2007; 28(4):431-4. DOI:10.3113/FAI.2007.0431 · 1.63 Impact Factor