title: Use of a definitive cement spacer for simultaneous bony and soft tissue reconstruction of mid- and hindfoot diabetic neuroarthropathy:a case report.
abstract: The prevalence of diabetes mellitus has been increasing, and ≤25.8 million people, or 8.3% of the US population, have diabetes. Diabetic Charcot arthropathy and foot ulcers are serious complications of diabetes mellitus. They have been associated with greater risks of lower extremity amputation and mortality. Studies have shown that the amputation risk relative to patients with Charcot arthropathy alone is 7 times greater for patients with a foot ulcer, and 12 times greater for patients with Charcot arthropathy and a foot ulcer. Surgical reconstruction of Charcot arthropathy of the foot is often difficult, because of bone loss, deformities, vasculopathy, and the presence of active infection with or without soft tissue loss. It will be even more challenging if >1 region of the foot has been affected, such as the mid- and hindfoot. In such situations, an amputation would usually be the surgical option. We present a case of limb-threatening Charcot deformity with instability complicated by osteomyelitis, bone loss, and a large soft tissue defect. We used a limb salvage strategy with hindfoot fusion combined with an antibiotic-impregnated cement spacer for reconstruction of the midfoot, which was performed simultaneously with a local adipofascial flap for soft tissue coverage, resulting in a plantigrade, painless, and functional foot.
authors.affiliation: University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Hospital, Singapore, Singapore. Electronic address: choonchiet@gmail.com.
authors.forename: Choon Chiet
authors.initials: CC
authors.lastname: Hong
authors.affiliation: University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Hospital, Singapore, Singapore.
authors.forename: Ken
authors.initials: K
authors.lastname: Jin Tan
authors.affiliation: University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Hospital, Singapore, Singapore.
authors.forename: Amitabha
authors.initials: A
authors.lastname: Lahiri
authors.affiliation: University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Hospital, Singapore, Singapore.
authors.forename: Aziz
authors.initials: A
authors.lastname: Nather
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001177:Arthropathy, Neurogenic / Q000209:etiology / Q000628:therapy; D001843:Bone Cements; D001862:Bone Resorption / Q000209:etiology / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D017719:Diabetic Foot / Q000209:etiology / Q000382:microbiology / Q000628:therapy*; D005260:Female; D005528:Foot; D006801:Humans; D007593:Joint Instability / Q000209:etiology / Q000628:therapy; D023821:Limb Salvage; D008875:Middle Aged; D010019:Osteomyelitis / Q000188:drug therapy; D019651:Plastic Surgery Procedures; D013203:Staphylococcal Infections / Q000209:etiology / Q000382:microbiology / Q000628:therapy; D013524:Surgical Flaps; D014947:Wounds and Injuries / Q000209:etiology / Q000628:therapy
chemical_list: D000900:Anti-Bacterial Agents; D001843:Bone Cements
keywords: Charcot arthropathy; cement spacer; diabetic foot wound; internal fixation; osteomyelitis