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Combined Internal and External Fixation for Diabetic Charcot Reconstruction: A Retrospective Case Series.
J Foot Ankle Surg. 2016 May-Jun; 55(3):619-27.JF

Abstract

Diabetic Charcot neuroarthropathy is a complex, limb-threatening disease process with major lifestyle-altering repercussions for patients. When Charcot neuroarthropathy leads to unstable deformity, ulceration, and potential infection despite conservative therapies, foot and ankle surgeons often consider reconstructive limb salvage procedures to restore function. The purpose of the present study was to evaluate the clinical and radiographic outcomes of diabetic Charcot reconstruction using combined internal and external fixation. A total of 22 patients were reviewed; 16 (72.73%) midfoot and 6 (27.27%) tibiotalocalcaneal arthrodesis procedures were consecutively performed from March 2009 to May 2013. All surgical procedures were performed in nonacute phases of the Charcot process in patients with diagnosed diabetes mellitus and documented peripheral neuropathy. Patients were excluded from the study if they were not diabetic despite having undergone Charcot reconstruction, regardless of the fixation method, or if they did not complete radiographic imaging. During a mean follow-up period of 58.60 ± 42.37 (range 16 to 164) weeks, limb salvage was achieved in 20 patients (90.91%), and 2 (9.09%) required below-the-knee amputation at a mean of 42 ± 14.14 weeks. Wound dehiscence occurred in 8 (36.36%), pin tract infection in 10 (45.45%), and superficial wound infection in 9 (40.91%) and peaked in bimodal fashion at 4 and 8 weeks postoperatively. Radiographic analysis of the pre- versus postoperative alignment showed statistically significant changes in the lateral talo-first metatarsal angle (p = .02) and lateral talar declination angle (p = .01). The limb salvage rates with diabetic Charcot reconstruction are improving in part because of the continued development of increasingly superior modalities for both internal and external fixation.

Authors+Show Affiliations

Fellow, Silicon Valley Reconstructive Foot and Ankle Fellowship, Palo Alto Medical Foundation, Mountain View, CA. Electronic address: Kenneth.W.Hegewald@dmu.edu.Resident, Franciscan Foot and Ankle Institute, CHI Franciscan Health, Federal Way, WA.Resident, Franciscan Foot and Ankle Institute, CHI Franciscan Health, Federal Way, WA.Director, Franciscan Foot and Ankle Institute, and Medical Director, Foot and Ankle Service, CHI Franciscan Health, Federal Way, WA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26188625

Citation

Hegewald, Kenneth W., et al. "Combined Internal and External Fixation for Diabetic Charcot Reconstruction: a Retrospective Case Series." The Journal of Foot and Ankle Surgery : Official Publication of the American College of Foot and Ankle Surgeons, vol. 55, no. 3, 2016, pp. 619-27.
Hegewald KW, Wilder ML, Chappell TM, et al. Combined Internal and External Fixation for Diabetic Charcot Reconstruction: A Retrospective Case Series. J Foot Ankle Surg. 2016;55(3):619-27.
Hegewald, K. W., Wilder, M. L., Chappell, T. M., & Hutchinson, B. L. (2016). Combined Internal and External Fixation for Diabetic Charcot Reconstruction: A Retrospective Case Series. The Journal of Foot and Ankle Surgery : Official Publication of the American College of Foot and Ankle Surgeons, 55(3), 619-27. https://doi.org/10.1053/j.jfas.2015.04.016
Hegewald KW, et al. Combined Internal and External Fixation for Diabetic Charcot Reconstruction: a Retrospective Case Series. J Foot Ankle Surg. 2016 May-Jun;55(3):619-27. PubMed PMID: 26188625.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Combined Internal and External Fixation for Diabetic Charcot Reconstruction: A Retrospective Case Series. AU - Hegewald,Kenneth W, AU - Wilder,Megan L, AU - Chappell,Todd M, AU - Hutchinson,Byron L, Y1 - 2015/07/15/ PY - 2014/01/13/received PY - 2015/7/20/entrez PY - 2015/7/21/pubmed PY - 2017/7/20/medline KW - Charcot KW - Ilizarov KW - bone KW - comorbidity KW - external fixation KW - infection KW - tarsal SP - 619 EP - 27 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 - 55 IS - 3 N2 - Diabetic Charcot neuroarthropathy is a complex, limb-threatening disease process with major lifestyle-altering repercussions for patients. When Charcot neuroarthropathy leads to unstable deformity, ulceration, and potential infection despite conservative therapies, foot and ankle surgeons often consider reconstructive limb salvage procedures to restore function. The purpose of the present study was to evaluate the clinical and radiographic outcomes of diabetic Charcot reconstruction using combined internal and external fixation. A total of 22 patients were reviewed; 16 (72.73%) midfoot and 6 (27.27%) tibiotalocalcaneal arthrodesis procedures were consecutively performed from March 2009 to May 2013. All surgical procedures were performed in nonacute phases of the Charcot process in patients with diagnosed diabetes mellitus and documented peripheral neuropathy. Patients were excluded from the study if they were not diabetic despite having undergone Charcot reconstruction, regardless of the fixation method, or if they did not complete radiographic imaging. During a mean follow-up period of 58.60 ± 42.37 (range 16 to 164) weeks, limb salvage was achieved in 20 patients (90.91%), and 2 (9.09%) required below-the-knee amputation at a mean of 42 ± 14.14 weeks. Wound dehiscence occurred in 8 (36.36%), pin tract infection in 10 (45.45%), and superficial wound infection in 9 (40.91%) and peaked in bimodal fashion at 4 and 8 weeks postoperatively. Radiographic analysis of the pre- versus postoperative alignment showed statistically significant changes in the lateral talo-first metatarsal angle (p = .02) and lateral talar declination angle (p = .01). The limb salvage rates with diabetic Charcot reconstruction are improving in part because of the continued development of increasingly superior modalities for both internal and external fixation. SN - 1542-2224 UR - https://www.unboundmedicine.com/medline/citation/26188625/Combined_Internal_and_External_Fixation_for_Diabetic_Charcot_Reconstruction:_A_Retrospective_Case_Series_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1067-2516(15)00179-9 DB - PRIME DP - Unbound Medicine ER -