Increased Arthrodesis Rates in Charcot Neuroarthropathy Utilizing Distal Tibial Distraction Osteogenesis Principles

Abstract

Charcot neuroarthropathy of the hindfoot and ankle poses substantial challenges due to deformity, segmental bone loss, chronic infection, and difficulty with bracing. Hindfoot or ankle arthrodesis is often employed at high rates of complications and nonunion. This study reports 15 consecutive patients with Charcot neuroarthropathy who underwent tibiotalocalcaneal or tibiocalcaneal fusion with simultaneous distal tibial distraction osteogenesis with a mean follow-up period of 20.2 ± 5.66 months. Arthrodesis rate was 93.3% (14 patients) with mean time to fusion of 4.75 ± 3.4 months. One hypertrophic nonunion occurred at the arthrodesis site. Complete consolidation of 4 cortices was achieved at the distraction site in 93.3% of patients (14 patients) with a mean duration to consolidation of 9.8 ± 3.3 months. One patient experienced hypertrophic nonunion at the regeneration site. The authors report a technique to enhance arthrodesis rates in Charcot neuroarthropathy by combining distal tibial distraction osteogenesis with simultaneous tibiotalocalcaneal or tibiocalcaneal arthrodesis for hindfoot fusion and salvage. Distraction osteogenesis supports enhanced vascularity to the arthrodesis site. Level of Clinical Evidence: Level 4

Bone Defect Replacement in Diabetic Neuropathic Osteoarthropathy (Charcot Foot): Review

“…Данный способ замещения объемного дефекта костной ткани является наиболее проверенным временем, в том числе и при лечении ДНОАП. В некоторых работах зарубежных авторов описан опыт выполнения артродеза заднего отдела стопы и пяточно-большеберцового артродеза с удлинени ем большеберцовой кости за счет дистракционно го остеогенеза [41,42,43,44]. Таким образом про исходит компенсация произошедшего укорочения конечности.…”