title: Limb salvage in Charcot foot and ankle osteomyelitis: combined use single stage/double stage of arthrodesis and external fixation.
abstract: BACKGROUND
  Charcot neuroarthropathy of the foot/ankle is a devastating complication of diabetes. Along with neuroarthropathy, osteomyelitis can occur which can result in amputation. This prospective study evaluated a limb salvage procedure as an alternative to amputation through surgical treatment of osteomyelitis of the midfoot or the ankle and stabilization with external fixation.
  
  
  METHODS
  Forty-five patients with Charcot arthropathy and osteomyelitis underwent debridement and attempted fusion with an external fixator. Chart and radiograph review was performed to assess the success of the fusion and eradication of infection.
  
  
  RESULTS
  Out of 45 patients, 39 patients healed using emergent surgery to drain an acute manifestation of the infection while maintaining the fixation for an average of 25.7 weeks. Two patients were treated with intramedullary nail in a subsequent surgical procedure. In four patients, the infection could not be controlled, therefore a major amputation was carried out.
  
  
  CONCLUSIONS
  For select patients, external fixation proved to be a reasonable alternative to below-knee amputation.
authors.affiliation: ULSS 12 Veneziana, Ospedale dell'angelo, Diabetic Foot Unit, Venezia, Italy. ldallapaola@libero.it
authors.forename: Luca
authors.initials: L
authors.lastname: Dalla Paola
authors.forename: Enrico
authors.initials: E
authors.lastname: Brocco
authors.forename: Tanja
authors.initials: T
authors.lastname: Ceccacci
authors.forename: Sasa
authors.initials: S
authors.lastname: Ninkovic
authors.forename: Sara
authors.initials: S
authors.lastname: Sorgentone
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Marinescu
authors.forename: Antonio
authors.initials: A
authors.lastname: Volpe
mesh_terms: D000368:Aged; D000671:Amputation, Surgical; D000843:Ankle Joint / Q000601:surgery*; D001174:Arthrodesis / Q000379:methods*; D001177:Arthropathy, Neurogenic / Q000150:complications / Q000601:surgery*; D003646:Debridement; D017719:Diabetic Foot / Q000150:complications; D016267:External Fixators; D005260:Female; D006801:Humans; D023821:Limb Salvage / Q000379:methods*; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy; D010019:Osteomyelitis / Q000150:complications / Q000601:surgery*; D017211:Treatment Failure