- Biomechanical Comparison of Intramedullary Beaming and Plantar Plating Methods for Stabilizing the Medial Column of the Foot: An In Vitro Study. [Journal Article]
- JFJ Foot Ankle Surg 2018 Nov - Dec; 57(6):1073-1079
- Charcot neuroarthropathy often results in a rocker-bottom foot deformity, which leads to ulceration, infection, and amputation. Surgical techniques to reconstruct the medial column include intramedul...
Charcot neuroarthropathy often results in a rocker-bottom foot deformity, which leads to ulceration, infection, and amputation. Surgical techniques to reconstruct the medial column include intramedullary beaming and plantar plating, with disagreement regarding which approach provides a stronger construct with superior stability and fixation. The objective of the present cadaveric study was to compare the construct rigidity and strength of beaming and plantar plating of the medial column of 5 paired bilateral feet. Cannulated titanium beams and plates were implanted in the right and left feet, respectively. The specimens underwent interval testing to generate load-displacement and load-strain curves, cyclic loading at low loads, and then were loaded to failure. The beamed and plated specimens had statistically similar stiffness (p = .80) with a mean of 11.1 ± 3.9 N/mm and 11.3 ± 5.9 N/mm, respectively. The beamed and plated specimens had a statistically similar mean strain of -164 ± 75.1 µε and -208 ± 87.8 µε on the dorsal (p = .45) and 92 ± 90.4 µε and 221 ± 100.5 µε on the plantar (p = .08) surfaces of the first metatarsal. Three beamed specimens failed from talus fracture (60%), and 2 beams plastically deformed (40%). Two plated specimens failed from talus fracture (40%), and 3 experienced screw pullout (60%). The beamed and plated specimens withstood a mean load to failure of 234 ± 111.4 N and 140 ± 68.9 N, respectively, with the difference statistically significant (p = .04). Overall, beaming was more robust than plantar plating, because it was less sensitive to specimen size and bone quality.
- Charcot arthropathy of the shoulder joint as a presenting feature of basilar impression with syringomyelia: A case report and literature review. [Case Reports]
- MMedicine (Baltimore) 2018; 97(28):e11391
- CONCLUSIONS: Taken together with 34 previous reports identified from a PubMed search, an analysis of 35 cases of Charcot arthropathy was conducted. Surgical decompression is an effective treatment, but the optimal treatment remains controversial. Thus, the aim of this literature review was to remind us to diagnose the potential cause as early as possible and we should spare no efforts on the exploration of etiology and adjuvant therapy for this disease.
- Diabetic foot syndrome: Charcot arthropathy or osteomyelitis? Part I: Clinical picture and radiography. [Review]
- JUJ Ultrason 2018; 18(72):42-49
- One of significant challenges faced by diabetologists, surgeons and orthopedists who care for patients with diabetic foot syndrome is early diagnosis and differentiation of bone structure abnormaliti...
One of significant challenges faced by diabetologists, surgeons and orthopedists who care for patients with diabetic foot syndrome is early diagnosis and differentiation of bone structure abnormalities typical of these patients, i.e. osteitis and Charcot arthropathy. In addition to clinical examination, the patient's medical history and laboratory tests, imaging plays a significant role. The evaluation usually begins with conventional radiographs. In the case of osteomyelitis, radiography shows osteopenia, lytic lesions, cortical destruction, periosteal reactions as well as, in the chronic phase, osteosclerosis and sequestra. Neurogenic arthropathy, however, presents an image resembling rapidly progressing osteoarthritis combined with aseptic necrosis or inflammation. The image includes: bone destruction with subluxations and dislocations as well as pathological fractures that lead to the presence of bone debris, osteopenia and, in the later phase, osteosclerosis, joint space narrowing, periosteal reactions, grotesque osteophytes and bone ankylosis. In the case of an unfavorable course of the disease and improper or delayed treatment, progression of these changes may lead to significant foot deformity that might resemble a "bag of bones". Unfortunately, radiography is non-specific and frequently does not warrant an unambiguous diagnosis, particularly in the initial phase preceding bone destruction. For these reasons, alternative imaging methods, such as magnetic resonance tomography, scintigraphy, computed tomography and ultrasonography, are also indicated.
- Neuropathic Arthropathy of the Glenohumeral Joint A Review of the Literature. [Case Reports]
- BHBull Hosp Jt Dis (2013) 2018; 76(2):88-99
- Neuropathic arthropathy, also known as Charcot arthropathy, is a degenerative disorder most commonly characterized by rapid destruction of the joint with extensive involvement of the bone and soft ti...
Neuropathic arthropathy, also known as Charcot arthropathy, is a degenerative disorder most commonly characterized by rapid destruction of the joint with extensive involvement of the bone and soft tissue. The underlying pathophysiology is thought to be due to loss of nociception (pain sensation), most frequently caused by diabetes mellitus, syphilitic myelopathy, or syringomyelia. A neuropathic shoulder is rare, with historic case series forming the bulk of the literature. The purpose of this review is to better understand the pathogenesis, clinical presentation, and management of neuropathic arthropathy of the glenohumeral joint. It should be stressed that the identification and management of the underlying etiology is paramount if the disease process is to be positively impacted. Although the mainstay of orthopedic management is non-surgical, little evidence exists to support the use of any specific therapeutic intervention. Recent literature suggests surgical reconstruction may be considered in very select patients.
- Prognostic Scoring System for Patients Undergoing Reconstructive Foot and Ankle Surgery for Charcot Neuroarthropathy: The Charcot Reconstruction Preoperative Prognostic Score. [Journal Article]
- JFJ Foot Ankle Surg 2018 May - Jun; 57(3):451-455
- Charcot neuroarthropathy is a destructive process that occurs in patients with peripheral neuropathy, often due to poorly controlled diabetes mellitus. Surgical reconstruction can be necessary to pro...
Charcot neuroarthropathy is a destructive process that occurs in patients with peripheral neuropathy, often due to poorly controlled diabetes mellitus. Surgical reconstruction can be necessary to provide a plantigrade foot that is wound free. A risk of major amputation exists after a Charcot event and after attempted reconstruction. We retrospectively reviewed the data from 34 patients (36 reconstructions) who had undergone reconstructive surgery for Charcot neuroarthropathy. The mean patient age was 56.44 years. The mean follow-up period was 56 months. We collected patient age, body mass index, presence of wound or osteomyelitis, anatomic location, activity of disease, and hemoglobin A1c. Using these data, each patient was given a score using our novel prognostic scoring system, the Charcot Reconstruction Preoperative Prognostic Score (CRPPS). Our primary outcome measure was no wound and no major amputation at the final follow-up visit. The limb salvage rate was 89% (32 of 36), and 78% (28 of 36) had no wound at the final follow-up examination. For patients without a wound or major amputation at the final follow-up visit, the mean CRPPS was 2.96 ± 1.23. The mean CRPPS for those with a wound or major amputation at the final follow-up visit was 4.33 ± 1.07 (p = .0024). Univariate logistic regression revealed 2 statistically significant predictors of wound and/or amputation: anatomic location (odds ratio [OR] 5.0, 95% confidence interval [CI] 1.051 to 23.789; p = .043) and CRPPS (OR 2.724, 95% CI 1.274 to 5.823, p = .01). A CRPPS of ≥4 was also predictive of a negative outcome (OR 7.286, 95% CI 1.508 to 35.211; p = .013). This scoring system, with a sensitivity of 75%, specificity of 71%, and negative predictive value of 85%, is a potential starting point when educating patients and making treatment decisions in this exceptionally challenging group.
- Mid-term follow-up of patients with hindfoot arthrodesis with retrograde compression intramedullary nail in Charcot neuroarthropathy of the hindfoot. [Journal Article]
- BJBone Joint J 2018; 100-B(2):190-196
- CONCLUSIONS: The use of retrograde intramedullary compression nail results in good rates of limb salvage when used for hindfoot reconstruction in patients with Charcot arthropathy. Cite this article:Bone Joint J2018;100-B:190-6.
- Genotype-phenotype investigation of 35 patients from 11 unrelated families with camptodactyly-arthropathy-coxa vara-pericarditis (CACP) syndrome. [Journal Article]
- MGMol Genet Genomic Med 2018; 6(2):230-248
- CONCLUSIONS: With this study, we contribute to the catalog of CACP causing variants. We confirm that the skeletal component of this disease worsens with age, and presents the potential mechanisms for interfamily variability, by discussing the influence of a modifier gene and escape from nonsense-mediated mRNA decay. We believe that this report will increase awareness of this familial arthropathic condition and the characteristic clinical and radiological findings will facilitate the differentiation from the common childhood rheumatic diseases such as juvenile idiopathic arthritis.
- Functionally compromised synovium-derived mesenchymal stem cells in Charcot neuroarthropathy. [Journal Article]
- EMExp Mol Pathol 2018; 104(1):82-88
- Charcot neuroarthropathy (CNA) often presents as a diabetic foot complication. The role of synovial mesenchymal stem cells (syn-MSCs) in the pathogenesis of CNA is unclear. Synovial samples were coll...
Charcot neuroarthropathy (CNA) often presents as a diabetic foot complication. The role of synovial mesenchymal stem cells (syn-MSCs) in the pathogenesis of CNA is unclear. Synovial samples were collected, for isolation of syn-MSCs, from diabetic patients with CNA (n=7) and non-diabetic patients with intra-articular fracture or normal joints (non-CNA; n=7) during foot surgery. The syn-MSCs in the CNA and non-CNA groups were characterized comparatively. The average number of colonies formed in the CNA group was 6±3.5 per half plate (10mm in diameter), while it was 43±21.6 in the non-CNA group (p<0.05). The average size (pixels) of the colonies in the CNA group was smaller than that in the non-CNA group. When the colonies were stratified into high-, medium- and low-density subgroups, colonies in the high-density subgroup of the CNA group were reduced in density. Expression of PPAR-γ, RUNX2, Sox9 and type II collagen by syn-MSCs in the CNA group was decreased during adipogenic, osteogenic and chondrogenic differentiation as compared with the non-CNA group. In conclusion, syn-MSCs in CNA joints were reduced in number, with declined differentiation potentials. The high-density subpopulation of the syn-MSCs was particularly affected by the pathology of CNA.
- High Incidence of Recurrent Ulceration and Major Amputations Associated With Charcot Foot. [Journal Article]
- JFJ Foot Ankle Surg 2018 Mar - Apr; 57(2):301-304
- Few studies have evaluated the long-term clinical outcomes of Charcot foot. The present study evaluated the long-term effects of Charcot foot in a population treated with early weightbearing in a rem...
Few studies have evaluated the long-term clinical outcomes of Charcot foot. The present study evaluated the long-term effects of Charcot foot in a population treated with early weightbearing in a removable Charcot restraint orthotic walker. A retrospective study of 62 consecutive patients (74 feet) treated for Charcot foot from January 2003 to March 2014 was conducted. Of the 74 affected feet, 48 (64.9%) had developed an ulcer. The total amputation rate was 25.7% (19 feet), and 11 feet (14.9%) underwent major amputations. The mortality rate was 19.4% (12 patients). Low Short-Form 36-item scores for all subcomponents were found. The major amputation rate was significantly greater for hindfoot than for midfoot manifestations. Charcot foot results in a high risk of chronic ulceration. The hindfoot Charcot manifestation was associated with a high rate of major amputations. Early weightbearing in a Charcot restraint orthotic walker as treatment of Charcot foot was not supported by the results from the present study.
New Search Next
- Ruptured Pseudoaneurysm of the Lateral Plantar Artery After Tibiotalocalcaneal Fusion With Retrograde Nail-A Rare Complication. [Case Reports]
- JFJ Foot Ankle Surg 2018 Mar - Apr; 57(2):393-395
- We report a rare presentation of a ruptured pseudoaneurysm of the lateral plantar artery following tibiotalocalcaneal fusion with a retrograde nail at 1 month after the index surgery. Although case r...
We report a rare presentation of a ruptured pseudoaneurysm of the lateral plantar artery following tibiotalocalcaneal fusion with a retrograde nail at 1 month after the index surgery. Although case reports of pseudoaneurysms of larger arteries such as the anterior tibial artery and posterior tibial artery after ankle surgery (e.g., ankle arthroscopy, implant removal, Ilizarov application) have been reported, we report a rare complication of a pseudoaneurysm of the lateral plantar artery. We discuss the anatomic considerations of the lateral plantar artery in the foot and the entry point of the retrograde nail to avoid this unusual complication.