2016, Number 5
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Acta Ortop Mex 2016; 30 (5)
Retrograde intramedullary nail fixation for Charcot neuroarthropathy
López-Gavito E, Gómez-Fuentes NA, Parra-Téllez P, Lezama-Peniche M, Vázquez-Escamilla J, León-Hernández SR
Language: Spanish
References: 22
Page: 223-230
PDF size: 467.63 Kb.
ABSTRACT
Charcot arthropathy is defined as an articular degenerative, chronic, progressive disease that affects one or more peripheral joints, develops as a result of a failure in the normal sensory perception (pain and proprioception) in the innervation of joints located in the foot and ankle, is characterized by destructive bone lesions without the presence of infection. Neuropathy is directly associated with diabetes mellitus type 1 and 2. Surgery is indicated when there is severe involvement of soft tissue, foot joints are unstable, at the presence of chronic or recurrent ulcers or when the foot and ankle can not fit to a normal shoe, and had limitation to perform activities of daily living.
Material and methods: Design: observational, prospective, transversal, descriptive. Sample: patients diagnosed with Charcot neuropathy type 3a of Brodsky. Surgically treated by ankle arthrodesis with an intramedullary blocked nail, from January 2010 to August 2015.
Results: 16 patients were analyzed. Preoperative AOFAS score was 35.0 ± 5.2 points. Postoperative follow-up period of 4 years to 7 months. Postoperative AOFAS scale showed an improvement of 40 points (p = 0.0001).
Conclusions: The proposed treatment allows bone stabilization, resulting in a full foot plantar support and decreases the occurrence of chronic ulcers that are difficult to treat, and is an alternative method that avoids lead to amputation.
REFERENCES
Noriega F, Villanueva P, Hansen ST: Pie de Charcot: reconstrucción funcional y procedimientos de rescate. Rev Ortop Traumatol (Madr.). 2007; 51(3): 164-72.
Mumoli N, Camaiti A: Charcot foot. CMAJ. 2012; 184(12): 1392.
Viladot-Pericé R, Viladot-Voegeli A: 20 Lecciones sobre patología de pie. Capítulo: Pie del diabético. Barcelona, Espańa: Mayo; 2009: 160-1.
Kaynak G, Birsel O, Güven MF, Oğüt T: An overview of the Charcot foot pathophysiology. Diabet Foot Ankle. 2013; 4. doi: 10.3402/dfa.v4i0.21117. Print 2013.
Eichenholtz SN: Charcot joints. Springfield, IL, USA: Charles C. Thomas; 1966.
Cinar M, Derincek A, Akpinar S: Tibiocalcaneal arthrodesis with posterior blade plate in diabetic neuroarthropthy. Foot Ankle Int. 2010; 31(6): 511-6.
Dalla-Paola L, Volpe A, Varotto D, Postorino A, Brocco E, Senesi A, et al: Use of a retrograde nail for ankle arthrodesis in Charcot neuroarthropathy: a limb salvage procedure. Foot Ankle Int. 2007; 28(9): 967-70.
Juliano PJ, Harris TG: Charcot foot: update, diagnosis, treatment, reconstruction, and limb salvage. Curr Opin Orthop. 2003; 14(2): 84-7.
Milne TE, Rogers JR, Kinnear EM, Martin HV, Lazzarini PA, Quinton TR, et al: Developing an evidence-based clinical pathway for the assessment, diagnosis and management of acute Charcot Neuro-Arthropathy: a systematic review. J Foot Ankle Res. 2013; 6(1): 30.
Armstrong DG, Todd WF, Lavery LA, Harkless LB, Bushman TR: The natural history of acute Charcot’s arthropathy in a diabetic foot specialty clinic. Diabet Med. 1997; 14(5): 357-63.
Hastings MK, Johnson JE, Strube MJ, Hildebolt CF, Bohnert KL, Prior FW, et al: Progression of foot deformity in Charcot neuropathic osteoarthropathy. J Bone Joint Surg Am. 2013; 95(13): 1206-13.
Donley BG, Pinney SJ, Colmes J: Tech foot and ankle surge. Philadelphia: Lippincott Williams & Wilkins; 2003: 35-9.
Chantelau EA, Grützner G: Is the Eichenholtz classification still valid for the diabetic Charcot foot? Swiss Med Wkly. 2014; 144: w13948.
Trepman E, Nihal A, Pinzur MS: Current topics review: Charcot neuroarthropathy of the foot and ankle. Foot Ankle Int. 2005; 26(1): 46-63.
Clouse ME, Gramm HF, Legg M, Flood T: Diabetic osteoarthropathy. Clinical and roentgenographic observations in 90 cases. Am J Roentgenol Radium Ther Nucl Med. 1974; 121(1): 22-34.
Brodsky JW: The diabetic foot. In: Couglin MJ, Mann RA, eds. Surgery of the foot and ankle. 7th ed. St Louis: Mosby; 1999: 895-969.
Hansen ST: Functional reconstruction of the foot and ankle. Philadelphia: Lippincott Williams & Wilkins; 2000: 243-56.
Jeng CL, Campbell JT, Tang EY, Cerrato RA, Myerson MS: Tibiotalocalcaneal arthrodesis with bulk femoral head allograft for salvage of large defects in the ankle. Foot Ankle Int. 2013; 34(9): 1256-66.
Herscovici D, Sammarco GJ, Sammarco VJ, Scaduto JM: Pantalar arthrodesis for post-traumatic arthritis and diabetic neuroarthropathy of the ankle and hindfoot. Foot Ankle Int. 2011; 32(6): 581-8.
Pinzur MS, Noonan T: Ankle arthrodesis with a retrograde femoral nail for Charcot ankle arthropathy. Foot Ankle Int. 2005; 26(7): 545-9.
Lowery NJ, Woods JB, Armstrong DG, Wukich DK: Surgical management of Charcot neuroarthropathy of the foot and ankle: a systematic review. Foot Ankle Int. 2012; 33(2): 113-21.
Gil J, Schiff AP, Pinzur MS: Cost comparison: limb salvage versus amputation in diabetic patients with charcot foot. Foot Ankle Int. 2013; 34(8): 1097-9.