Use of a retrograde nail for ankle arthrodesis in Charcot neuroarthropathy: a limb salvage procedure.
BACKGROUND
Charcot neuroarthropathy is a serious complication associated with diabetic neuropathy. This complication probably is most serious when the ankle is involved because of the instability and progressive deformity, which often leads to ulceration, osteomyelitis, and amputation. Arthrodesis before the ulcerated lesion appears is considered a limb salvage treatment. One of the most effective techniques for an unstable ankle in Charcot neuroarthropathy is retrograde transcalcaneal nailing.


METHODS
Eighteen diabetic patients, without a history of ulceration, were treated from July, 2003, to November, 2005, with panarthrodesis of the ankle using intramedullary retrograde transcalcaneal nailing. The average follow up was 14 +/- 10.1 months. All patients completed the unloaded postoperative period with a fiberglass cast (3 months nonweightbearing and 3 months partial weightbearing) and commenced walking in shoes with a stiff rocker sole and a molded insole.


RESULTS
During the followup period there were no major complications. In three patients, removal of one of the proximal screws used for anchoring the nail to the tibia was done because of protrusion causing skin breakdown. Fourteen patients had a stable fusion and four patients had fibrous union. The percentage of limb salvage was 100% in the followup period.


CONCLUSIONS
Our study confirms that this operative technique is effective and safe.
Dalla Paola
Luca
L
Abano Terme Hospital, Diabetic Foot Department, Piazza Cristoforo Columbo 1, Abano Terme, Padova 35031, Italy. 1dallapaola@libero.it
Volpe
Antonio
A
Varotto
Davide
D
Postorino
Andrea
A
Brocco
Enrico
E
Senesi
Antonella
A
Merico
Maurizio
M
De Vido
Daniele
D
Da Ros
Roberto
R
Assaloni
Roberta
R
D000368:Aged; D000843:Ankle Joint / Q000601:surgery*; D001174:Arthrodesis / Q000295:instrumentation* / Q000379:methods; D001177:Arthropathy, Neurogenic / Q000150:complications / Q000601:surgery*; D001858:Bone Nails; D002111:Calcaneus / Q000601:surgery; D003929:Diabetic Neuropathies / Q000150:complications*; D005260:Female; D006801:Humans; D023821:Limb Salvage / Q000295:instrumentation / Q000379:methods; D008297:Male; D015203:Reproducibility of Results