title: [Hindfoot fusion for Charcot osteoarthropathy with a curved retrograde nail].
abstract: BACKGROUND
  Charcot osteoarthropathy of the hindfoot with considerable dislocation and instability represents a therapeutic dilemma. The treatment goal is a plantigrade, stable foot that is free of infection and ulceration with the ability to ambulate in special footwear.
  
  
  METHODS
  Over a period of 6 years, we performed 23 hindfoot fusions in 21 patients with manifest Charcot arthropathy with the help of a curved retrograde nail (HAN). All patients suffered from insulin-dependent diabetes mellitus with polyneuropathy; 12 patients had additional peripheral vasculopathy. An average of 3.5 previous surgeries had been performed prior to hindfoot fusion.
  
  
  RESULTS
  Complete tibiotalocalcaneal fusion was obtained in 16 of 21 patients (76 %). Of these 21 patients, 18 (86 %) were followed clinically and radiologically for an average of 2 years. Overall, 16 patients (89 %) reported a substantial subjective improvement compared to the preoperative state. Hardware failure occurred in 7 cases (30 %) that could be brought to consolidation with exchange of the locking bolts or the complete nail. In 5 cases (22 %), a postoperative hematoma had to be removed and in 8 cases (35 %) wound edge necrosis was treated with local wound care. In 2 cases (9 %), a secondary or reactivated osteitis occurred that finally required below knee amputation.
  
  
  CONCLUSIONS
  Tibiotalocalcaneal fusion with a curved retrograde intramedullary nail (HAN) is an effective treatment option in highly unstable and deforming Charcot osteoarthropathy of the hindfoot. It is an alternative to external or other internal fixation methods and helps to avoid below knee amputation in more than 90 % of cases.
authors.affiliation: UniversitätsCentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Carl Gustav Carus der TU Dresden, Fetscherstrasse 74, 01307, Dresden, Deutschland, jaroslaw.pyrc@uniklinikum-dresden.de.
authors.forename: J
authors.initials: J
authors.lastname: Pyrc
authors.forename: A
authors.initials: A
authors.lastname: Fuchs
authors.forename: H
authors.initials: H
authors.lastname: Zwipp
authors.forename: S
authors.initials: S
authors.lastname: Rammelt
mesh_terms: D001174:Arthrodesis / Q000295:instrumentation* / Q000379:methods*; D001177:Arthropathy, Neurogenic / Q000175:diagnosis / Q000601:surgery*; D001858:Bone Nails; D017719:Diabetic Foot / Q000175:diagnosis / Q000601:surgery*; D019544:Equipment Failure Analysis; D005529:Foot Bones / Q000601:surgery*; D006801:Humans; D011474:Prosthesis Design; D016896:Treatment Outcome