Limb salvage in Charcot foot and ankle osteomyelitis: combined use single stage/double stage of arthrodesis and external fixation.
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.
Dalla Paola
Luca
L
ULSS 12 Veneziana, Ospedale dell'angelo, Diabetic Foot Unit, Venezia, Italy. ldallapaola@libero.it
Brocco
Enrico
E
Ceccacci
Tanja
T
Ninkovic
Sasa
S
Sorgentone
Sara
S
Marinescu
Maria Grazia
MG
Volpe
Antonio
A
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