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

Abstract

Purpose: Ankle Charcot neuroarthropathy presents a great challenge for treatment. While conservative treatments yield poor results, arthrodesis is considered the treatment of choice for unstable Charcot ankles. There are two methods used for ankle fusion: retrograde intramedullary nail (IMN) and external fixator (EF). Literature reports inconclusive results on which method is better for arthrodesis. Methods: The aim of this meta-analysis is to look for significant difference between the two techniques in terms of fusion rate and complications. Four comparative studies including 117 patients (117 interventions) were located and analyzed. Results: IMN was found to yield double fusion rate than EF (p ¼ 0.2) with 5 weeks less time to heal (p ¼ 0.4). While no significance was noted for revision surgery and amputation rates, EF yielded higher rates of hardware infection (p ¼ 0.01) and wound infection (p ¼ 0.01). The IMN method seems to offer quicker and better fusion rate when compared to EF with significantly lower postoperative infection rates. Conclusion: In the clinical context of high-risk patients such as the diabetic population, IMN technique could be a better option in the case of ulcer-free ankles/feet or in the presence of medial/lateral ulcers. In case of presence of plantar ulcers, EF might be a better choice to avoid the plantar approach for nail insertion. Future research with bigger sample sized and randomized studies are warranted for validation.

Long‐term outcome of persons with diabetic and non‐diabetic neuro‐osteoarthropathy after foot correction using external fixation

“…Yammine and Assi 18 showed no definitive superiority in their review of four comparable studies with a total of 117 participants. In the case of plantar ulcers and infected Charcot feet, external fixation offers the possibility of surgical eradication of infection together with correction of foot deformities 18–20 . In our study, we had many infected ulcers and osteomyelitis.…”

“…Both methods have shown advantages and disadvantages in previous studies and so far, no superiority has been found 17 . Yammine and Assi 18 showed no definitive superiority in their review of four comparable studies with a total of 117 participants. In the case of plantar ulcers and infected Charcot feet, external fixation offers the possibility of surgical eradication of infection together with correction of foot deformities 18–20 .…”

Different approach to charcot neuroarthropathy: A case report

“…It is still controversial whether internal or external fixation as the most suitable method. The argument is that internal fixation reduces the risk of infection, which is a major problem in CN foot caused by the diabetic condition [ 9 , 10 ]. For the second case the team choose a single distal tibia locking plate for the arthrodesis of the tibiocalcaneal joint planted in the anterior part of the foot.…”

A Systematic Review And Meta-Analysis: Postoperative Outcome Comparison Of Intramedullary Nailing And External Fixation In Charcot Neuroarthropathy

“…Since no cast is usually required following ring fixator, swelling and ulcer recurrence could be monitored. On the other hand, advocates of retrograde nails cite the high incidence of pin tract infections, risk of tibia fracture, and the need for a second surgery for EF removal as reasons to choose a nail over EF [1,2,3]. The aim of the present study was to compare the results of EF and retrograde IMN in ankle arthrodesis for patients with Charcot neuroarthropathy of the ankle joint.…”

“…Charcot neuropathic osteoarthropathy or neuroarthropathy of the foot and ankle is due to sensory and motor neuropathies which lead to a chronic and progressive destruction of the foot architecture involving bones, joints, and soft tissues. Secondary fractures and dislocations predispose to deformity and ulceration with a great decrease of the gait-related quality of life and an increasing potential for major amputation [1]. Fusion is usually the surgical treatment which is indicated in severe, progressive, unstable deformity of the hindfoot.…”