N C Stone1, T R Daniels. 1. Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ont.
Abstract
OBJECTIVES: To review the clinical outcome of arthrodesis of the foot in patients with diabetic Charcot arthropathy and to review the pathophysiology, clinical and radiographic features of Charcot arthropathy. DESIGN: A retrospective review and clinical follow-up of a series of patients. SETTING: St. Michael's Hospital, Toronto, a tertiary care teaching hospital. PATIENTS: Ten diabetic patients treated between 1996 and 1998 who required an arthrodesis of the midfoot or hindfoot secondary to deformity of diabetic neuropathic joints. INTERVENTIONS: Three midfoot (Lisfranc) and 7 hindfoot arthrodeses with autogenous iliac-crest bone grafting and internal fixation. OUTCOME MEASURES: Patient satisfaction, maintenance of the correction of the deformity and avoidance of amputation. Western Ontario/McMaster University score and midfoot/hindfoot American Orthopaedic Foot and Ankle Society foot ratios. Clinical examination including E-MED pedographic examination. Correction and evidence of bony or fibrous union assessed radiologically. RESULTS: The postoperative correction was maintained, no further skin ulceration occurred and amputation was avoided in 9 of 10 patients. Because this is a salvage procedure and there was often significant concomitant illness, the results of clinical rating systems were poor. Five of 9 patients had clinical and radiographic evidence of a solid bony arthrodesis; 4 had a stable fibrous union. CONCLUSIONS: With careful surgical technique, a reasonable number of feet can be salvaged by an arthrodesis of a diabetic neuropathic joint when nonoperative measures fail. Patient selection is important because there is a significant complication rate.
OBJECTIVES: To review the clinical outcome of arthrodesis of the foot in patients with diabetic Charcot arthropathy and to review the pathophysiology, clinical and radiographic features of Charcot arthropathy. DESIGN: A retrospective review and clinical follow-up of a series of patients. SETTING: St. Michael's Hospital, Toronto, a tertiary care teaching hospital. PATIENTS: Ten diabeticpatients treated between 1996 and 1998 who required an arthrodesis of the midfoot or hindfoot secondary to deformity of diabetic neuropathic joints. INTERVENTIONS: Three midfoot (Lisfranc) and 7 hindfoot arthrodeses with autogenous iliac-crest bone grafting and internal fixation. OUTCOME MEASURES: Patient satisfaction, maintenance of the correction of the deformity and avoidance of amputation. Western Ontario/McMaster University score and midfoot/hindfoot American Orthopaedic Foot and Ankle Society foot ratios. Clinical examination including E-MED pedographic examination. Correction and evidence of bony or fibrous union assessed radiologically. RESULTS: The postoperative correction was maintained, no further skin ulceration occurred and amputation was avoided in 9 of 10 patients. Because this is a salvage procedure and there was often significant concomitant illness, the results of clinical rating systems were poor. Five of 9 patients had clinical and radiographic evidence of a solid bony arthrodesis; 4 had a stable fibrous union. CONCLUSIONS: With careful surgical technique, a reasonable number of feet can be salvaged by an arthrodesis of a diabetic neuropathic joint when nonoperative measures fail. Patient selection is important because there is a significant complication rate.
Authors: Lee C Rogers; Robert G Frykberg; David G Armstrong; Andrew J M Boulton; Michael Edmonds; Georges Ha Van; Agnes Hartemann; Frances Game; William Jeffcoate; Alexandra Jirkovska; Edward Jude; Stephan Morbach; William B Morrison; Michael Pinzur; Dario Pitocco; Lee Sanders; Dane K Wukich; Luigi Uccioli Journal: Diabetes Care Date: 2011-09 Impact factor: 19.112