Hybrid Fixation for Ankle Fusion in Diabetic Charcot Arthropathy

• Published in: Foot & ankle international 2018-01, Vol.39 (1), p.93-98
• Main Authors: El-Mowafi, Hani, Abulsaad, Mazen, Kandil, Yasser, El-Hawary, Ahmed, Ali, Samer
• Format: Article
• Language: English
• Subjects: Amputation; Ankle; Ankle Joint - surgery; Arthrodesis - methods; Arthropathy, Neurogenic - surgery; Diabetic Neuropathies - physiopathology; External Fixators; Humans; Lower Extremity
• ISSN: 1071-1007; 1944-7876
• DOI: 10.1177/1071100717735074

Background: Ankle fusion is difficult to achieve in the diabetic Charcot ankle Brodsky type 3a because of the poor quality of the bone and the inability to achieve a stable biomechanical construct. The aim of this study was to report the outcome of ankle fusion using a combination of an intramedullary nail and a circular external fixator in patients with diabetic Charcot arthropathy. Methods: We prospectively studied 24 patients with diabetic Charcot arthropathy of the ankle who were treated by fusion of the tibiotalar joint using a combined retrograde intramedullary nail and Ilizarov external fixator. Their mean age was 50.7 ± 6.9 (range, 43-62) years. The mean follow-up after surgery was 36.4 ± 5.8 (range, 24-98) months. Results: Twenty-two patients (92%) achieved clinical and radiographic solid bony fusion. No patients in this series needed amputation. All the patients were pain free, and the mean American Orthopaedic Foot & Ankle Society Score (AOFAS) improved significantly from 34.6 ± 6.8 to 66.4 ± 4.5 at the last follow-up. Two patients developed an ulcer over the heel due to a prominent nail. The ulcer healed after nail removal. Eight patients developed pin tract infection. Conclusion: We report a successful outcomes of ankle fusions using combined intramedullary nail locked only proximally and ring external fixator (hybrid fixation) in patients with diabetic Charcot arthropathy. Level of Evidence: Level IV, case series.