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A two-stage percutaneous approach to charcot diabetic foot reconstruction.
J Foot Ankle Surg. 2010 Nov-Dec; 49(6):517-22.JF

Abstract

The goals of Charcot deformity correction are to restore osseous alignment, regain pedal stability, and prevent ulceration. Traditional reconstructive surgical approaches involve large, open incisions to remove bone and the use of internal fixation to attempt to fuse dislocated joints. Such operations can result in shortening of the foot and/or incomplete deformity correction, fixation failure, incision healing problems, infection, and the longterm use of casts or braces. We recommend a minimally invasive surgical technique for the treatment of Charcot deformity, which we performed on 11 feet in 8 patients. Osseous realignment was achieved through gradual distraction of the joints with external fixation, after which minimally invasive arthrodesis was performed with rigid internal fixation. Feet were operated on at various stages of Charcot deformity: Eichenholtz stage I (1 foot), Eichenholtz stage II (6 feet), and Eichenholtz stage III (4 feet). When comparing the average change in preoperative and postoperative radiographic angles, the transverse plane talar-first metatarsal angle (P = .02), sagittal plane talar-first metatarsal angle (P = .008), and calcaneal pitch angle (P = .001) were all found to be statistically significant. Complications included 3 operative adjustments of external or internal fixation, 4 broken wires or half-pins, 2 broken rings, and 11 pin tract infections. Most notably, no deep infection, no screw failure, and no recurrent ulcerations occurred and no amputations were necessary during an average follow-up of 22 months. Gradual Charcot foot correction with the Taylor spatial frame plus minimally invasive arthrodesis is an effective treatment.

Authors+Show Affiliations

International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, MD 21215, USA. blamm@lifebridgehealth.orgNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20864361

Citation

Lamm, Bradley M., et al. "A Two-stage Percutaneous Approach to Charcot Diabetic Foot Reconstruction." The Journal of Foot and Ankle Surgery : Official Publication of the American College of Foot and Ankle Surgeons, vol. 49, no. 6, 2010, pp. 517-22.
Lamm BM, Gottlieb HD, Paley D. A two-stage percutaneous approach to charcot diabetic foot reconstruction. J Foot Ankle Surg. 2010;49(6):517-22.
Lamm, B. M., Gottlieb, H. D., & Paley, D. (2010). A two-stage percutaneous approach to charcot diabetic foot reconstruction. The Journal of Foot and Ankle Surgery : Official Publication of the American College of Foot and Ankle Surgeons, 49(6), 517-22. https://doi.org/10.1053/j.jfas.2010.07.014
Lamm BM, Gottlieb HD, Paley D. A Two-stage Percutaneous Approach to Charcot Diabetic Foot Reconstruction. J Foot Ankle Surg. 2010 Nov-Dec;49(6):517-22. PubMed PMID: 20864361.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A two-stage percutaneous approach to charcot diabetic foot reconstruction. AU - Lamm,Bradley M, AU - Gottlieb,H David, AU - Paley,Dror, PY - 2009/10/17/received PY - 2010/9/25/entrez PY - 2010/9/25/pubmed PY - 2011/3/25/medline SP - 517 EP - 22 JF - The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons JO - J Foot Ankle Surg VL - 49 IS - 6 N2 - The goals of Charcot deformity correction are to restore osseous alignment, regain pedal stability, and prevent ulceration. Traditional reconstructive surgical approaches involve large, open incisions to remove bone and the use of internal fixation to attempt to fuse dislocated joints. Such operations can result in shortening of the foot and/or incomplete deformity correction, fixation failure, incision healing problems, infection, and the longterm use of casts or braces. We recommend a minimally invasive surgical technique for the treatment of Charcot deformity, which we performed on 11 feet in 8 patients. Osseous realignment was achieved through gradual distraction of the joints with external fixation, after which minimally invasive arthrodesis was performed with rigid internal fixation. Feet were operated on at various stages of Charcot deformity: Eichenholtz stage I (1 foot), Eichenholtz stage II (6 feet), and Eichenholtz stage III (4 feet). When comparing the average change in preoperative and postoperative radiographic angles, the transverse plane talar-first metatarsal angle (P = .02), sagittal plane talar-first metatarsal angle (P = .008), and calcaneal pitch angle (P = .001) were all found to be statistically significant. Complications included 3 operative adjustments of external or internal fixation, 4 broken wires or half-pins, 2 broken rings, and 11 pin tract infections. Most notably, no deep infection, no screw failure, and no recurrent ulcerations occurred and no amputations were necessary during an average follow-up of 22 months. Gradual Charcot foot correction with the Taylor spatial frame plus minimally invasive arthrodesis is an effective treatment. SN - 1542-2224 UR - https://www.unboundmedicine.com/medline/citation/20864361/A_two_stage_percutaneous_approach_to_charcot_diabetic_foot_reconstruction_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1067-2516(10)00289-9 DB - PRIME DP - Unbound Medicine ER -