title: Successful treatment of nonunion with an Ilizarov ring fixator after ankle fracture for Charcot arthropathy: a case report.
abstract: BACKGROUND
  Ankle fractures in patients with diabetes mellitus have long been recognized as a challenge to orthopedic surgeons. Nonunion and lengthy wound healing in high-risk patients with diabetes, particularly patients with peripheral arterial disease and renal failure, occur secondary to several clinical conditions and are often fraught with complications. Whether diabetic ankle fractures are best treated noninvasively or surgically is controversial.
  
  
  METHODS
  A 53-year-old Japanese man fractured his right ankle. The fractured ankle was treated nonsurgically with a plaster cast. Although he remained non-weight-bearing for 3 months, radiography at 3 months showed nonunion. The nonunion was treated by Ilizarov external fixation of the ankle. The external fixator was removed 99 days postoperatively, at which time the patient exhibited anatomical and functional recovery and was able to walk without severe complications.
  
  
  CONCLUSIONS
  In patients with diabetes mellitus, severe nonunion of ankle fractures with Charcot arthropathy in which the fracture fragment diameter is very small and the use of internal fixation is difficult is a clinical challenge. Ilizarov external fixation allows suitable fixation to be achieved using multiple Ilizarov wires.
authors.affiliation: Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan. kk-nozaka@mue.biglobe.ne.jp.
authors.forename: Koji
authors.initials: K
authors.lastname: Nozaka
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Shimada
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Kimura
authors.forename: Shin
authors.initials: S
authors.lastname: Yamada
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kashiwagura
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Sakuraba
authors.forename: Ikuko
authors.initials: I
authors.lastname: Wakabayashi
mesh_terms: D064386:Ankle Fractures / Q000150:complications / Q000601:surgery*; D001177:Arthropathy, Neurogenic / Q000150:complications*; D016267:External Fixators; D006801:Humans; D008297:Male; D008875:Middle Aged
references.citation: Int Orthop. 2012 Oct;36(10):2133-8
references.pmid: 22820713
references.citation: Foot Ankle Int. 1994 Apr;15(4):182-5
references.pmid: 7951951
references.citation: Foot Ankle Int. 2011 Feb;32(2):120-30
references.pmid: 21288410
references.citation: J Bone Joint Surg Br. 1998 Jul;80(4):689-92
references.pmid: 9699839
references.citation: Injury. 2008 Feb;39(2):196-202
references.pmid: 18241864
references.citation: J Am Acad Orthop Surg. 2011 Oct;19(10):612-22
references.pmid: 21980026
references.citation: J Bone Joint Surg Br. 2008 Jul;90(7):906-14
references.pmid: 18591601
references.citation: J Am Acad Orthop Surg. 2008 Mar;16(3):159-70
references.pmid: 18316714
references.citation: Strategies Trauma Limb Reconstr. 2009 Apr;4(1):1-6
references.pmid: 19296203
references.citation: J Orthop Trauma. 1993;7(6):489-96
references.pmid: 8308599
references.citation: J Pediatr Orthop. 2000 Mar-Apr;20(2):163-5
references.pmid: 10739275
references.citation: Menopause Int. 2007 Jun;13(2):60-4
references.pmid: 17540135
references.citation: J Bone Joint Surg Am. 1996 Nov;78(11):1646-57
references.pmid: 8934478
references.citation: J Orthop Trauma. 2007 Jul;21(6):404-6
references.pmid: 17621000