Comparative analysis of uniplanar external fixator and retrograde intramedullary nailing for ankle arthrodesis in diabetic Charcot’s neuroarthropathy

Abstract

Background:Charcot's neuroarthropathy of ankle leads to instability, destruction of the joint with significant morbidity that may require an amputation. Aim of surgical treatment is to achieve painless stable plantigrade foot through arthrodesis. Achieving surgical arthrodesis in Charcot's neuroarthropathy has a high failure rate. This is a retrospective nonrandomized comparative study assessing the outcomes of tibio-talar arthrodesis for Charcot's neuroarthropathy treated by uniplanar external fixation assisted by external immobilization or retrograde intramedullary interlocked nailing.Materials and Methods:Records of the authors′ institution were reviewed to identify those patients who had undergone ankle fusion for diabetic neuroarthropathy from January 1998 to December 2008. A total of11 patients (six males and five females) with a mean age of 56 year and diabetes of a mean duration of 15.4 years with ankle tibio-talar arthrodesis using retrograde nailing or external fixator for Charcot's neuroarthropathy were enrolled for the analysis. Neuropathy was clinically diagnosed, documented and substantiated using the monofilament test. All procedures were performed in Eichenholz stage II/III.Six patients were treated with uniplanar external fixator, while the remaining five underwent retrograde intramedullary interlocking nail. The outcomes were measured for union radiologically, development of complications and clinical follow-up, according to digital archiving systems and old case notes.Results:All five (100%) patients treated by intramedullary nailing achieved radiological union on an average follow-up of 16 weeks. The external fixation group had significantly higher rate of complications with one amputation, four non unions (66.7%) and a delayed union which went on to full osseous union.Conclusion:The retrograde intramedullary nailing for tibio-talar arthrodesis in Charcot's neuroarthropathy yielded significantly better outcomes as compared to the use of uniplanar external fixator.

Intramedullary nail versus external fixator for ankle arthrodesis in Charcot neuroarthropathy: A meta-analysis of comparative studies

“…Using the JBI checklist tool, the total of “no” answers was zero for three studies. For Shah and De study, 16 there was one “no” answer in relation to the statement of strategies dealing with confounding factors. Table 2 presents the detailed quality items of each study.…”

Functional Outcome of Hindfoot Arthrodesis in Charcot Arthropathy

“…While IEF offers the advantage of earlier weight bearing, the authors delayed weight bearing in the CN group, worrying about failure of the construct. When comping the hindfoot nail to a uniplanar fixation though, the complication rate was significantly higher in the uniplanar method as well as a reduced union rate in which 100% by using nail & 66.7% with external fixation (Shah & De 2011). Complications associated with the uniplanar external fixation include pin tract loosening, pin site infection, and wound breakdown.…”

“…Depending on the areas of involvement, surgical fusion options include external fixation, which is either multi or uni-planar, internal fixation with nails or plates and screws. A study by Shah & De described that a nail fusion has less complications compared to external fixators (Shah & De 2011).…”

Transfbular ankle arthrodesis: A novel method for ankle fusion — A short term retrospective study

“…We excluded Charcot's neuroarthropathy of the ankle as it independently can influence the overall outcome of the procedure and it is best treated by retrograde intramedullary nailing. 24 In more complex trauma around the ankle joint, a humeral locking plate fixation technique described by Zhang et al . may be indicated.…”