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Computer-Assisted Gradual Correction of Charcot Foot Deformities: An In-Depth Evaluation of Stage One of a Planned Two-Stage Approach to Charcot Reconstruction.
J Foot Ankle Surg. 2020 Jul - Aug; 59(4):841-848.JF

Abstract

The surgical treatment of Charcot foot is a widely debated topic, with issues ranging from when to operate to how to properly correct a deformity. Historically, correction of a severe deformity was attempted in 1 acute surgical procedure that frequently required open reduction and internal fixation through large incisions. This 1-time procedure would often result in complications including under- or overcorrection of the deformity, neurovascular injury, or incision dehiscence leading to possible soft-tissue infection or osteomyelitis. This retrospective case series aims to evaluate stage 1 of a planned 2-stage approach to Charcot deformity correction, consisting of gradual modification with the use of computer-assisted external fixation. The purpose of using gradual correction was to safely and accurately correct the Meary and calcaneal inclination angles, which were measured using preoperative and postoperative digital radiographs. The procedure was performed on 18 Charcot foot deformities in 18 patients. Each of the feet had a notably significant rocker bottom deformity and most contained an ulceration. Complete ulcer healing was noted in 100% (13/13) of feet with an ulcer, and a statistically significant corrected Meary's (p < .05) and calcaneal inclination angle (p < .05) to within a normal range was achieved in all deformity corrections with few postoperative problems and complications noted. Average patient follow-up was 39.6 months with a minimum of at least 12 months necessary for inclusion in the study. Therefore, gradual Charcot deformity correction through the use of computer-assisted hexapod external fixation, demonstrates safe, accurate, and reproducible characteristics that adequately prepares the lower extremity for stage 2, the implantation of rigid internal fixation.

Authors+Show Affiliations

Attending Staff Surgeon, Scripps Mercy Hospital San Diego Foot and Ankle Residency Program, San Diego, CA.Resident Physician, Scripps Mercy Hospital San Diego Foot and Ankle Residency Program, San Diego, CA. Electronic address: kriger.stephen@scrippshealth.org.Attending Staff Surgeon, Scripps Mercy Hospital San Diego Foot and Ankle Residency Program, San Diego, CA.Student, University of California, San Diego, La Jolla, CA.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

32146113

Citation

Wrotslavsky, Philip, et al. "Computer-Assisted Gradual Correction of Charcot Foot Deformities: an In-Depth Evaluation of Stage One of a Planned Two-Stage Approach to Charcot Reconstruction." The Journal of Foot and Ankle Surgery : Official Publication of the American College of Foot and Ankle Surgeons, vol. 59, no. 4, 2020, pp. 841-848.
Wrotslavsky P, Kriger SJ, Hammer-Nahman SM, et al. Computer-Assisted Gradual Correction of Charcot Foot Deformities: An In-Depth Evaluation of Stage One of a Planned Two-Stage Approach to Charcot Reconstruction. J Foot Ankle Surg. 2020;59(4):841-848.
Wrotslavsky, P., Kriger, S. J., Hammer-Nahman, S. M., & Kwok, J. G. (2020). Computer-Assisted Gradual Correction of Charcot Foot Deformities: An In-Depth Evaluation of Stage One of a Planned Two-Stage Approach to Charcot Reconstruction. The Journal of Foot and Ankle Surgery : Official Publication of the American College of Foot and Ankle Surgeons, 59(4), 841-848. https://doi.org/10.1053/j.jfas.2019.06.008
Wrotslavsky P, et al. Computer-Assisted Gradual Correction of Charcot Foot Deformities: an In-Depth Evaluation of Stage One of a Planned Two-Stage Approach to Charcot Reconstruction. J Foot Ankle Surg. 2020 Jul - Aug;59(4):841-848. PubMed PMID: 32146113.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Computer-Assisted Gradual Correction of Charcot Foot Deformities: An In-Depth Evaluation of Stage One of a Planned Two-Stage Approach to Charcot Reconstruction. AU - Wrotslavsky,Philip, AU - Kriger,Stephen J, AU - Hammer-Nahman,Samuel M, AU - Kwok,James G, Y1 - 2020/03/05/ PY - 2019/04/08/received PY - 2019/06/18/accepted PY - 2020/3/9/pubmed PY - 2021/6/25/medline PY - 2020/3/9/entrez KW - Charcot KW - Hexapod KW - deformity KW - external fixation KW - peripheral neuropathy KW - rocker bottom foot KW - surgery SP - 841 EP - 848 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 - 59 IS - 4 N2 - The surgical treatment of Charcot foot is a widely debated topic, with issues ranging from when to operate to how to properly correct a deformity. Historically, correction of a severe deformity was attempted in 1 acute surgical procedure that frequently required open reduction and internal fixation through large incisions. This 1-time procedure would often result in complications including under- or overcorrection of the deformity, neurovascular injury, or incision dehiscence leading to possible soft-tissue infection or osteomyelitis. This retrospective case series aims to evaluate stage 1 of a planned 2-stage approach to Charcot deformity correction, consisting of gradual modification with the use of computer-assisted external fixation. The purpose of using gradual correction was to safely and accurately correct the Meary and calcaneal inclination angles, which were measured using preoperative and postoperative digital radiographs. The procedure was performed on 18 Charcot foot deformities in 18 patients. Each of the feet had a notably significant rocker bottom deformity and most contained an ulceration. Complete ulcer healing was noted in 100% (13/13) of feet with an ulcer, and a statistically significant corrected Meary's (p < .05) and calcaneal inclination angle (p < .05) to within a normal range was achieved in all deformity corrections with few postoperative problems and complications noted. Average patient follow-up was 39.6 months with a minimum of at least 12 months necessary for inclusion in the study. Therefore, gradual Charcot deformity correction through the use of computer-assisted hexapod external fixation, demonstrates safe, accurate, and reproducible characteristics that adequately prepares the lower extremity for stage 2, the implantation of rigid internal fixation. SN - 1542-2224 UR - https://www.unboundmedicine.com/medline/citation/32146113/Computer_Assisted_Gradual_Correction_of_Charcot_Foot_Deformities:_An_In_Depth_Evaluation_of_Stage_One_of_a_Planned_Two_Stage_Approach_to_Charcot_Reconstruction_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1067-2516(20)30010-7 DB - PRIME DP - Unbound Medicine ER -