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Intramedullary Nailing and External Ring Fixation for Tibiotalocalcaneal Arthrodesis in Charcot Arthropathy.
Foot Ankle Int. 2017 Feb; 38(2):149-152.FA

Abstract

BACKGROUND

Surgical strategies to address deformities of the ankle and hindfoot in patients with Charcot arthropathy include the use of retrograde intramedullary nails and ring fixators. The literature has not shown superiority of one technique over the other. This study presents a single surgeon's case series of Charcot arthropathy patients treated with either a ring fixator or retrograde intramedullary nail to achieve tibiotalocalcaneal arthrodesis.

METHODS

We performed a retrospective analysis of 27 consecutive patients with Charcot arthropathy who underwent a tibiotalocalcaneal arthrodesis using either a retrograde intramedullary (IM) nail (n = 16 patients) or a ring fixator (RF) (n = 11 patients) by a single surgeon. We report the rates of limb salvage complications requiring secondary surgery and fusion in both groups. The patient demographics and presence of medical comorbidities known to increase the risk of surgical complications were similar between groups. The mean duration of follow-up for the retrograde nail group was 3.6 years and 2.2 years for the ring fixator group.

RESULTS

The mean time to discharge from the hospital after the index surgical procedure was 2.7 days for the IM group and 4.6 days for the RF group. For the patients treated with a ring fixator, the mean time to removal of the frame after the initial application was 13.3 ± 1.8 weeks. The limb salvage rate for the RF group was 9 of 11 patients whereas it was 15 of 16 in the IM group. Complications including deep infection, hardware failure, and symptomatic nonunion requiring revision surgery were common in the IM group, with 11 of 16 patients requiring further surgery. Seven patients in the IM group required removal of the implant at a mean of 117.2 weeks after the index procedure because of the development of deep infection or nail cutout. In the RF group, only 1 patient required revision surgery. Fusion rates were similar between both groups, with 10 of 16 patients fusing in the IM group and 7 of 11 in the RF group.

CONCLUSION

Use of a retrograde intramedullary rod or ring fixator resulted in high rates of successful limb salvage when used for tibiotalocalcaneal arthrodesis in patients with Charcot arthropathy. However, in this study, the need for revision surgery was more frequent in the retrograde nail group compared to the ring fixator group.

LEVEL OF EVIDENCE

Level III, retrospective comparative series.

Authors+Show Affiliations

1 Department of Orthopaedics, Mount Sinai Hospital, New York, NY, USA.1 Department of Orthopaedics, Mount Sinai Hospital, New York, NY, USA.1 Department of Orthopaedics, Mount Sinai Hospital, New York, NY, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27698177

Citation

Richman, James, et al. "Intramedullary Nailing and External Ring Fixation for Tibiotalocalcaneal Arthrodesis in Charcot Arthropathy." Foot & Ankle International, vol. 38, no. 2, 2017, pp. 149-152.
Richman J, Cota A, Weinfeld S. Intramedullary Nailing and External Ring Fixation for Tibiotalocalcaneal Arthrodesis in Charcot Arthropathy. Foot Ankle Int. 2017;38(2):149-152.
Richman, J., Cota, A., & Weinfeld, S. (2017). Intramedullary Nailing and External Ring Fixation for Tibiotalocalcaneal Arthrodesis in Charcot Arthropathy. Foot & Ankle International, 38(2), 149-152. https://doi.org/10.1177/1071100716671884
Richman J, Cota A, Weinfeld S. Intramedullary Nailing and External Ring Fixation for Tibiotalocalcaneal Arthrodesis in Charcot Arthropathy. Foot Ankle Int. 2017;38(2):149-152. PubMed PMID: 27698177.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intramedullary Nailing and External Ring Fixation for Tibiotalocalcaneal Arthrodesis in Charcot Arthropathy. AU - Richman,James, AU - Cota,Adam, AU - Weinfeld,Steven, Y1 - 2016/10/03/ PY - 2016/10/5/pubmed PY - 2017/8/22/medline PY - 2016/10/5/entrez KW - Charcot arthropathy KW - arthrodesis KW - retrograde intramedullary nail KW - ring external fixation SP - 149 EP - 152 JF - Foot & ankle international JO - Foot Ankle Int VL - 38 IS - 2 N2 - BACKGROUND: Surgical strategies to address deformities of the ankle and hindfoot in patients with Charcot arthropathy include the use of retrograde intramedullary nails and ring fixators. The literature has not shown superiority of one technique over the other. This study presents a single surgeon's case series of Charcot arthropathy patients treated with either a ring fixator or retrograde intramedullary nail to achieve tibiotalocalcaneal arthrodesis. METHODS: We performed a retrospective analysis of 27 consecutive patients with Charcot arthropathy who underwent a tibiotalocalcaneal arthrodesis using either a retrograde intramedullary (IM) nail (n = 16 patients) or a ring fixator (RF) (n = 11 patients) by a single surgeon. We report the rates of limb salvage complications requiring secondary surgery and fusion in both groups. The patient demographics and presence of medical comorbidities known to increase the risk of surgical complications were similar between groups. The mean duration of follow-up for the retrograde nail group was 3.6 years and 2.2 years for the ring fixator group. RESULTS: The mean time to discharge from the hospital after the index surgical procedure was 2.7 days for the IM group and 4.6 days for the RF group. For the patients treated with a ring fixator, the mean time to removal of the frame after the initial application was 13.3 ± 1.8 weeks. The limb salvage rate for the RF group was 9 of 11 patients whereas it was 15 of 16 in the IM group. Complications including deep infection, hardware failure, and symptomatic nonunion requiring revision surgery were common in the IM group, with 11 of 16 patients requiring further surgery. Seven patients in the IM group required removal of the implant at a mean of 117.2 weeks after the index procedure because of the development of deep infection or nail cutout. In the RF group, only 1 patient required revision surgery. Fusion rates were similar between both groups, with 10 of 16 patients fusing in the IM group and 7 of 11 in the RF group. CONCLUSION: Use of a retrograde intramedullary rod or ring fixator resulted in high rates of successful limb salvage when used for tibiotalocalcaneal arthrodesis in patients with Charcot arthropathy. However, in this study, the need for revision surgery was more frequent in the retrograde nail group compared to the ring fixator group. LEVEL OF EVIDENCE: Level III, retrospective comparative series. SN - 1944-7876 UR - https://www.unboundmedicine.com/medline/citation/27698177/Intramedullary_Nailing_and_External_Ring_Fixation_for_Tibiotalocalcaneal_Arthrodesis_in_Charcot_Arthropathy_ L2 - https://journals.sagepub.com/doi/10.1177/1071100716671884?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -