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Midfoot and hindfoot arthrodeses in diabetic Charcot arthropathy.
Can J Surg. 2000 Dec; 43(6):449-55.CJ

Abstract

OBJECTIVES

To review the clinical outcome of arthrodesis of the foot in patients with diabetic Charcot arthropathy and to review the pathophysiology, clinical and radiographic features of Charcot arthropathy.

DESIGN

A retrospective review and clinical follow-up of a series of patients.

SETTING

St. Michael's Hospital, Toronto, a tertiary care teaching hospital.

PATIENTS

Ten diabetic patients treated between 1996 and 1998 who required an arthrodesis of the midfoot or hindfoot secondary to deformity of diabetic neuropathic joints.

INTERVENTIONS

Three midfoot (Lisfranc) and 7 hindfoot arthrodeses with autogenous iliac-crest bone grafting and internal fixation.

OUTCOME MEASURES

Patient satisfaction, maintenance of the correction of the deformity and avoidance of amputation. Western Ontario/McMaster University score and midfoot/hindfoot American Orthopaedic Foot and Ankle Society foot ratios. Clinical examination including E-MED pedographic examination. Correction and evidence of bony or fibrous union assessed radiologically.

RESULTS

The postoperative correction was maintained, no further skin ulceration occurred and amputation was avoided in 9 of 10 patients. Because this is a salvage procedure and there was often significant concomitant illness, the results of clinical rating systems were poor. Five of 9 patients had clinical and radiographic evidence of a solid bony arthrodesis; 4 had a stable fibrous union.

CONCLUSIONS

With careful surgical technique, a reasonable number of feet can be salvaged by an arthrodesis of a diabetic neuropathic joint when nonoperative measures fail. Patient selection is important because there is a significant complication rate.

Links

Publisher Full Text
ncbi.nlm.nih.gov
canjsurg.ca
PMC Free PDF

Authors+Show Affiliations

Stone NC
Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ont.
Daniels TR
No affiliation info available

MeSH

AgedArthrodesisArthropathy, NeurogenicDiabetic FootFemaleFootHumansIliumMaleMiddle AgedPatient SatisfactionRadiographyRetrospective StudiesSalvage TherapySeverity of Illness IndexTreatment Outcome

Pub Type(s)

Journal Article

Language

eng

PubMed ID

11129834

Citation

Stone, N C., and T R. Daniels. "Midfoot and Hindfoot Arthrodeses in Diabetic Charcot Arthropathy." Canadian Journal of Surgery. Journal Canadien De Chirurgie, vol. 43, no. 6, 2000, pp. 449-55.
Stone NC, Daniels TR. Midfoot and hindfoot arthrodeses in diabetic Charcot arthropathy. Can J Surg. 2000;43(6):449-55.
Stone, N. C., & Daniels, T. R. (2000). Midfoot and hindfoot arthrodeses in diabetic Charcot arthropathy. Canadian Journal of Surgery. Journal Canadien De Chirurgie, 43(6), 449-55.
Stone NC, Daniels TR. Midfoot and Hindfoot Arthrodeses in Diabetic Charcot Arthropathy. Can J Surg. 2000;43(6):449-55. PubMed PMID: 11129834.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Midfoot and hindfoot arthrodeses in diabetic Charcot arthropathy. AU - Stone,N C, AU - Daniels,T R, PY - 2000/12/29/pubmed PY - 2001/2/28/medline PY - 2000/12/29/entrez SP - 449 EP - 55 JF - Canadian journal of surgery. Journal canadien de chirurgie JO - Can J Surg VL - 43 IS - 6 N2 - OBJECTIVES: To review the clinical outcome of arthrodesis of the foot in patients with diabetic Charcot arthropathy and to review the pathophysiology, clinical and radiographic features of Charcot arthropathy. DESIGN: A retrospective review and clinical follow-up of a series of patients. SETTING: St. Michael's Hospital, Toronto, a tertiary care teaching hospital. PATIENTS: Ten diabetic patients treated between 1996 and 1998 who required an arthrodesis of the midfoot or hindfoot secondary to deformity of diabetic neuropathic joints. INTERVENTIONS: Three midfoot (Lisfranc) and 7 hindfoot arthrodeses with autogenous iliac-crest bone grafting and internal fixation. OUTCOME MEASURES: Patient satisfaction, maintenance of the correction of the deformity and avoidance of amputation. Western Ontario/McMaster University score and midfoot/hindfoot American Orthopaedic Foot and Ankle Society foot ratios. Clinical examination including E-MED pedographic examination. Correction and evidence of bony or fibrous union assessed radiologically. RESULTS: The postoperative correction was maintained, no further skin ulceration occurred and amputation was avoided in 9 of 10 patients. Because this is a salvage procedure and there was often significant concomitant illness, the results of clinical rating systems were poor. Five of 9 patients had clinical and radiographic evidence of a solid bony arthrodesis; 4 had a stable fibrous union. CONCLUSIONS: With careful surgical technique, a reasonable number of feet can be salvaged by an arthrodesis of a diabetic neuropathic joint when nonoperative measures fail. Patient selection is important because there is a significant complication rate. SN - 0008-428X UR - https://www.unboundmedicine.com/medline/citation/11129834/Midfoot_and_hindfoot_arthrodeses_in_diabetic_Charcot_arthropathy_ L2 - https://www.canjsurg.ca/lookup/pmidlookup?view=long&pmid=11129834 DB - PRIME DP - Unbound Medicine ER -