Use of a Retrograde Nail for Ankle Arthrodesis in Charcot Neuroarthropathy: A Limb Salvage Procedure

Abano Terme Hospital, Diabetic Foot Department, Piazza Cristoforo Columbo 1, Abano Terme, Padova 35031, Italy.
Foot & Ankle International (Impact Factor: 1.51). 10/2007; 28(9):967-70. DOI: 10.3113/FAI.2007.0967
Source: PubMed


Charcot neuroarthropathy is a serious complication associated with diabetic neuropathy. This complication probably is most serious when the ankle is involved because of the instability and progressive deformity, which often leads to ulceration, osteomyelitis, and amputation. Arthrodesis before the ulcerated lesion appears is considered a limb salvage treatment. One of the most effective techniques for an unstable ankle in Charcot neuroarthropathy is retrograde transcalcaneal nailing.
Eighteen diabetic patients, without a history of ulceration, were treated from July, 2003, to November, 2005, with panarthrodesis of the ankle using intramedullary retrograde transcalcaneal nailing. The average follow up was 14 +/- 10.1 months. All patients completed the unloaded postoperative period with a fiberglass cast (3 months nonweightbearing and 3 months partial weightbearing) and commenced walking in shoes with a stiff rocker sole and a molded insole.
During the followup period there were no major complications. In three patients, removal of one of the proximal screws used for anchoring the nail to the tibia was done because of protrusion causing skin breakdown. Fourteen patients had a stable fusion and four patients had fibrous union. The percentage of limb salvage was 100% in the followup period.
Our study confirms that this operative technique is effective and safe.

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    • "The high rate of a stable union obtained in our series compares favorably to data from previous studies29–33 that also used an intramedullary device to obtain a stable ankle joint. One of the reasons for poor outcomes among external fixator group was the use of uniplanar Charnley external/AO type fixation with its limitations for providing a stable construct. "
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    ABSTRACT: Charcot's neuroarthropathy of ankle leads to instability, destruction of the joint with significant morbidity that may require an amputation. Aim of surgical treatment is to achieve painless stable plantigrade foot through arthrodesis. Achieving surgical arthrodesis in Charcot's neuroarthropathy has a high failure rate. This is a retrospective nonrandomized comparative study assessing the outcomes of tibio-talar arthrodesis for Charcot's neuroarthropathy treated by uniplanar external fixation assisted by external immobilization or retrograde intramedullary interlocked nailing. Records of the authors' institution were reviewed to identify those patients who had undergone ankle fusion for diabetic neuroarthropathy from January 1998 to December 2008. A total of11 patients (six males and five females) with a mean age of 56 year and diabetes of a mean duration of 15.4 years with ankle tibio-talar arthrodesis using retrograde nailing or external fixator for Charcot's neuroarthropathy were enrolled for the analysis. Neuropathy was clinically diagnosed, documented and substantiated using the monofilament test. All procedures were performed in Eichenholz stage II/III.Six patients were treated with uniplanar external fixator, while the remaining five underwent retrograde intramedullary interlocking nail. The outcomes were measured for union radiologically, development of complications and clinical follow-up, according to digital archiving systems and old case notes. All five (100%) patients treated by intramedullary nailing achieved radiological union on an average follow-up of 16 weeks. The external fixation group had significantly higher rate of complications with one amputation, four non unions (66.7%) and a delayed union which went on to full osseous union. The retrograde intramedullary nailing for tibio-talar arthrodesis in Charcot's neuroarthropathy yielded significantly better outcomes as compared to the use of uniplanar external fixator.
    No preview · Article · Jul 2011 · Indian Journal of Orthopaedics
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    ABSTRACT: Hintergrund Der Extremitätenerhalt nach Operationen mit Infektverlauf am Sprunggelenk gelingt oft durch die Rückfußarthrodese. Ziel der Studie war die Untersuchung der intramedullären retrograden Rückfußarthrodese bei postinfektiöser Sprunggelenkdestruktion. Material und Methoden Zwischen 2007 und 2010 wurden 58 Patienten (Durchschnittsalter 58 Jahre) mittels Arthrodesennagel versorgt. 44 tibiotalokalkaneare Arthrodesen (TTC) und 14 tibiokalkaneare Arthrodesen (TC). Der AOFAS- sowie der SF-12-Score wurden ermittelt. Ergebnisse Nach durchschnittlich 18 Monaten wurden 49 Patienten (35 Männer, 14 Frauen) untersucht. Bei 85,7% lag eine stabile Arthrodese vor; 10,2% erlitten einen Reinfekt. Die statistische Auswertung zeigte eine signifikant höhere Ausheilung für TTC-Arthrodesen. Pseudarthrosen korrelierten signifikant mit Reinfekt und Diabetes. Der AOFAS betrug durchschnittlich 56 Punkte, der SF-12 betrug 39,1 in der körperlichen und 46,1 in der psychischen Summenskala. 32 Patienten waren mit der Behandlung zufrieden. Schlussfolgerung Die intramedulläre Rückfußarthrodese bei postinfektiöser Sprunggelenkdestruktion weist eine hohe Fusionsrate mit akzeptabler Reinfektrate und guter Patientenakzeptanz auf.
    No preview · Article · Apr 2013 · Der Unfallchirurg
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