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Acta Ortopédica Mexicana

ISSN 2992-8036 (Electronic)
ISSN 2306-4102 (Print)
Órgano Oficial del Colegio Mexicano de Ortopedia y Traumatología
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2018, Number 1

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Acta Ortop Mex 2018; 32 (1)

Treatment algorithm for Charcot foot and surgical technique with circular external fixation

Rios-Ruh JM, Martin-Oliva X, Santamaría-Fumas A, Domínguez-Sevilla A, López-Capdevila L, Vilà y Rico J, Sales-Pérez JM
Full text How to cite this article

Language: English
References: 27
Page: 7-12
PDF size: 321.61 Kb.


Key words:

Charcot neuroarthropathy, diabetes, algorithm, static circular fixation, osteomyelitis, ulcer.

ABSTRACT

Background: Charcot neuroarthropathy (CNA), commonly known as Charcot foot, is one of the most debilitating complications of diabetes mellitus. Patients with plantar ulcer and osteomyelitis (OM) due to Charcot foot represent a high cost for health systems and society in general. The amputation risk for ulcerated Charcot patients is 12 times higher than general population under 65 years old. Material and methods: In this article we present the CNA treatment protocol we use in our center. We also make a detailed description of the surgical technique «single stage surgery» with circular external fixation. Results: Our CNA treatment protocol covers the most common presentations of this severe neuropathic complication. With the «single stage surgery» using circular external fi xation we achieve an ulcer-free foot, successful treatment of the OM, correction of the deformity, diminished the cost of treatment, avoided amputation and prevented recurrence of the ulcer. Conclusions: The use of a treatment algorithm based on the current literature, can be an invaluable tool in the treatment of these complex patients. The circular external fixation has proven to be the only reliable tool for treating complex Charcot foot in the context of poor bone stock, active ulcers, soft tissues problems and OM.


REFERENCES

  1. Batista F, Magalhães AA, Gamba M, Nery C, Cardoso C: Ten years of a multidiscipli-nary diabetic foot team approach in Sao Paulo, Brazil. Diabetic Foot Ankle. 2010; 1.

  2. Soriguer F, Goday A, Bosch-Comas A, Bordiú E, Calle-Pascual A, Carmena R, et al: Prevalence of diabetes mellitus and impaired glucose regulation in Spain: the Di@ bet. es Study. Diabetologia. 2012; 55(1): 88-93.

  3. Global report on diabetes. World Health Organization. [Consulted 02/07/2016]. Available in: http://www.who.int/diabetes/globalreport

  4. Rogers LC, Frykberg RG, Armstrong DG, Boulton AJ, Edmonds M, Van GH, et al: The Charcot foot in diabetes. Diabetes Care. 2011; 34(9): 2123-9.

  5. Armstrong DG, Todd WF, Lavery LA, Harkless LB, Bushman TR. The natural history of acute Char-cot’s arthropathy in a diabetic foot specialty clinic. J Am Podiatr Med Assoc. 1997; 87(6): 272-8.

  6. Trepman E, Nihal A, Pinzur MS: Current topics review: Charcot neuroarthropathy of the foot and ankle. Foot Ankle Int. 2055; 26(1): 46-63.

  7. Sohn MW, Stuck RM, Pinzur MS, Lee TA, Budiman-Mak E: Lowerextremity amputation risk after Charcot arthropathy and diabetic foot ulcer. Diabetes Care. 2010; 33(1): 98-100. doi: 10.2337/dc09-1497. Epub 2009 Oct 13.

  8. Eichenholtz SN. Charcot Joints. Springfield, IL, USA: Charles C. Thomas; 1966.

  9. Brodsky JW. Management of Charcot joints of the foot and ankle in diabetes. Semin Arthroplasty. 1992; 3: 58-62.

  10. Pinzur M: Surgical versus accommodative treatment for Charcot arthropathy of the midfoot. Foot Ankle Int. 2004; 25(8): 545-9.

  11. Schneekloth BJ, Lowery NJ, Wukich DK: Charcot neuroarthropathy in patients with diabetes: an up-dated systematic review of surgical management. J Foot Ankle Surg. 2016; 55(3): 586-90.

  12. Wukich DK, Raspovic KM, Hobizal KB, Rosario B: Radiographic analysis of diabetic midfoot Charcot neuroarthropathy with and without midfoot ulceration. Foot Ankle Int. 2014; 35(11): 1108- 15.

  13. Yousry AH, Abdalhady AM: Management of diabetic neuropathic ankle arthropathy by arthrodesis using an Ilizarov frame. Acta Orthop Belg. 2010; 76(6): 821-6.

  14. Williams MO: Long-term cost comparison of major limb salvage using the Ilizarov method versus amputation. Clin Orthop Related Res. 1994; 301: 156-8.

  15. Sammarco VJ, Sammarco GJ, Walker EW, Guiao RP: Midtarsal arthrodesis in the treatment of Charcot midfoot arthropathy. J Bone Joint Surg. 2009; 91(1): 80-91.

  16. Pinzur MS, Gil J, Belmares J: Treatment of osteomyelitis in Charcot foot with single-stage resection of infection, correction of deformity, and maintenance with ring fixation. Foot Ankle Int. 2012; 33(12): 1069-74.

  17. Conway JD: Charcot salvage of the foot and ankle using external fi xation. Foot Ankle Int. 2008; 13(1): 157-73.

  18. Schaper NC, Van Netten JJ, Apelqvist J, Lipsky BA, Bakker K; International Working Group on the Diabetic Foot (IWGDF). Prevention and management of foot problems in diabetes: a Summary Guidance for Daily Practice 2015, based on the IWGDF Guidance Documents. Diabetes Res Clin Pract. 2017; 124: 84-92.

  19. Armstrong DG, Wrobel J, Robbins JM: Guest editorial: are diabetesrelated wounds and amputations worse than cancer. Int Wound J. 2007; 4(4): 286-7.

  20. Yoho RM, Frerichs J, Dodson NB, Greenhagen R, Geletta S: A comparison of vitamin D levels in nondiabetic and diabetic patient populations. J Am Podiatr Med Assoc. 2009; 99(1): 35-41.

  21. Cozen L: Does diabetes delay fracture healing? Clin Orthop Rel Res. 1972; 82: 134-40.

  22. 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.

  23. Pinzur MS: Surgical treatment of the Charcot foot. Diabetes Metab Res Rev. 2016; 32(S1): 287-91.

  24. Jones CP, Youngblood CS, Waldrop N, Davis WH, Pinzur MS: Tibial stress fracture secondary to half-pins in circular ring external fi xation for Charcot foot. Foot Ankle Int. 2014; 35(6): 572-7.

  25. Dalla Paola L, Ceccacci T, Ninkovic S, Sorgentone S, Marinescu MG: Limb salvage in Charcot foot and ankle osteomyelitis: combined use single stage/double stage of arthrodesis and external fi xation. Foot Ankle Int. 2009; 30(11): 1065-70.

  26. Rogers LC, Bevilacqua NJ, Frykberg RG, Armstrong DG: Predictors of postoperative complications of Ilizarov external ring fi xators in the foot and ankle. J Foot Ankle Surg. 2007; 46(5): 372-5.

  27. El-Moatasem EHM, El-Ghazaly S: Diabetic neuropathic foot and ankle instability: early mini-incision closed fusion using the Ilizarov ring fi xator. A pilot study. Current Orthopaedic Practice. 2016; 27(1): 77-83.




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Acta Ortop Mex. 2018 Ene-Feb;32