Arthrodesis of the diabetic neuropathic ankle joint.
At the authors' institution from 1964 to 1984, ankle arthrodesis was performed in 13 patients with insulin-dependent diabetes mellitus who had a history of ankle sprain or fracture. Nine patients were diagnosed by clinical exam as having a peripheral neuropathy; nine patients had roentgenographic evidence of neuropathic arthropathy prior to surgery. Follow-up study with examination and roentgenograms averaged 42 months. Clinical and roentgenographic union was achieved in seven ankles at an average of 16 weeks. Two patients developed a nonunion, three had an amputation, and one died at two months postoperatively. Thirteen complications occurred in eight of the 13 patients (62%). Twenty reoperations, excluding pin removal, were performed in eight patients (62%). A satisfactory result was achieved in only 50% overall and in only 38% of patients with roentgenographic changes of neuropathic arthropathy. Neuropathic arthropathy contributes to the inordinate complication and failure rates. Ankle arthrodesis should be considered with caution in the diabetic patient.
Stuart
M J
MJ
Department of Orthopedics, Mayo Clinic, Rochester, MN 55905.
Morrey
B F
BF
D000328:Adult; D000368:Aged; D000843:Ankle Joint / Q000601:surgery*; D001174:Arthrodesis; D003922:Diabetes Mellitus, Type 1 / Q000503:physiopathology*; D003929:Diabetic Neuropathies / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D012086:Reoperation