Enríquez CJA, García HA, Pastrana F, López VA, Romo CFJ, González TA, Hernández YJ

Language: Spanish
References: 16
Page: 199-205
PDF size: 309.06 Kb.

ABSTRACT

Objective. To determine the value of an interlocked trans-calcaneal nail for stabilizing the bone-fixation surgery in unstable neuropathic hindfoot. Material and methods. This is a bi-institutional series of 11 patients, 8 female and 3 male, (12 feet), who had ankle and foot arthrosis because of Charcot’s neuropathic arthropaty, as a result of diabetes mellitus in 5, nerve injury in 5 and myelomeningocele in 1. Age was 16 to 84 years with an average of 42. A remodeling ankle and subtalar arthrodesis were performed. A tunnel is drilled with a burr, trespassing calcaneus, talus and the tibia, then a transcalcaneal interlocked nail (TIN) in inserted all the way through and interlocked by cortical 4.5 mm screws in tibia, talus and calcaneus, in a 5 degree of equinus position. Bone grafting from malleolus is applied in arthrodesis. Drainage and a Jones dressing are removed after 48 hours and a cast is borne for 8 weeks, which is followed by splinting or a caliper for a somewhat longer span as required. Follow-up was from 4 to 31 months. Results. Bone union in arthrodesis was obtained in 8 ankles (66 %) at an average of 6 months. At closing time 2 cases had fibrous union, realizing bone union was in progress. Late satisfactory alignment and plantar support were seen in 10 cases. Complications. There was a complete failure because of soft tissues infection and bony loss of the calcaneus. Another case sustained a late deep bone infection after 4 months of removing fixation materials and a second fixation was applied after 6 more months. Interlocking procedure was difficult in 5 cases, so it must be done by open vision. Conclusion. Interlocking fixation for hindfoot is advised as a fair safety method for treatment of neuropathic arthropaty, after a reasonable mid term of immobilization and care.

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