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Charcot reconstruction

Hai-bo Zhou, Chao Zhang, Cai-long Liu, Lei Chen
OBJECTIVE: To evaluate clinical results of plate on the metatarsal side to reconstruction of tarsometatarsal joint dislocations secondary to diabetic charcot foot. METHODS: Seven patients (9 feet) patients with tarsometatarsal joint dislocations secondary to diabetic charcot foot were treated with plating from April 2012 to December 2014. All patients were male, and 5 cases were on the unilateral side and 2 cases were on the bilateral sides. The age of patients ranged from 45 to 52 with an average of 48 years old...
June 2016: Zhongguo Gu Shang, China Journal of Orthopaedics and Traumatology
Kaj Klaue, H Zwipp, T Mittlmeier, N Espinosa
Tibiotalocalcaneal arthrodesis has recently become more popular as a form of reconstructive surgery. The precise anatomical orientation and the functional extrinsic musculature of the hindfoot are essential for a satisfactory result. Fixation of the arthrodesis is a mechanical problem. Straight and angulated nails are not anatomically or mechanically ideal. A circular arc nail can fix the tibia, the talus and the calcaneus in anatomical alignment. This is a pure "bone nail", in contrast to the "intramedullary nail," which is driven through an existing opening in long bones...
October 2016: Der Unfallchirurg
B Kinner, C Roll
OBJECTIVE: The goal of Pirogoff's amputation of the hindfoot is a weight-bearing stump with minimal loss of limb length and stable soft tissue coverage with preservation of the sensation of the sole of the heel. INDICATIONS: Non-reconstructable forefoot and midfoot after complex trauma, deep bony and soft tissue infection, infected Charcot foot, necrosis or gangrene due to vasculopathy, malignant tumors and deformities. CONTRAINDICATIONS: Possibility for reconstruction of the forefoot and midfoot, minor amputation, loss or irreversible destruction of the sole of the heel...
October 2016: Operative Orthopädie und Traumatologie
Daniel J Lee, Joseph Schaffer, Tien Chen, Irvin Oh
Internal and external fixation techniques have been described for realignment and arthrodesis of Charcot midfoot deformity. There currently is no consensus on the optimal method of surgical reconstruction. This systematic review compared the clinical results of surgical realignment with internal and external fixation, specifically in regard to return to functional ambulation, ulcer occurrence, nonunion, extremity amputation, unplanned further surgery, deep infection, wound healing problems, peri- or intraoperative fractures, and total cases with any complication...
July 1, 2016: Orthopedics
Min Zeng, Jie Xie, Yihe Hu
PURPOSE: Although total knee arthroplasty (TKA) entails diverse operative techniques and achieves varying results in patients with different knee pathologies, few studies have discussed TKA for Charcot joints. This study aimed to investigate the efficacy of TKA in patients with Charcot knees. METHODS: From 2009 to 2013, seven patients with eight Charcot knees were admitted to our institution. They were confirmed by pre-operative examination and subsequently underwent TKAs...
August 2016: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Dinesh Kadam
Background Plantar, neuropathic, or trophic ulcers are often found in patients with decreased sensation in the foot. These ulcers can be complicated by infection, deformity, and increased patient morbidity. Excision results in wider defects and local tissues are often insufficient for reconstruction Methods Total 26 free flaps were used in 25 patients to reconstruct plantar ulcers between years 2007 and 2013. The etiology included diabetic neuropathy (n = 13), leprosy (n = 3), spinal/peripheral nerve injury (n = 7), spina bifida (n = 1), and peripheral neuropathy (n = 1)...
June 2016: Journal of Reconstructive Microsurgery
Sarah Ettinger, Christian Plaass, Leif Claassen, Christina Stukenborg-Colsman, Daiwei Yao, Kiriakos Daniilidis
Charcot neuropathy (CN) is a severe joint disease that makes surgical planning very challenging, because it is combined with ankle instability, serious deformities, and recurrent ulceration. The aim of the present study was to examine the rate of bone fusion after external or internal fixation in patients with CN. We retrospectively examined 58 patients with CN who had undergone reconstruction of the ankle either with tibiotalocalcaneal or tibiocalcaneal arthrodesis. The mean age was 59.1 (range 26 to 81) years at surgery...
May 2016: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
Michael S Pinzur
With the increased number of diabetics worldwide and the increased incidence of morbid obesity in more prosperous cultures, there has become an increased awareness of Charcot arthropathy of the foot and ankle. Outcome studies would suggest that patients with deformity associated with Charcot Foot arthropathy have impaired health related quality of life. This awareness has led reconstructive-minded foot and ankle surgeons to develop surgical strategies to treat these acquired deformities. This article outlines the current clinical approach to this disabling medical condition...
January 2016: Diabetes/metabolism Research and Reviews
Martinus Richter, Thomas Mittlmeier, Stefan Rammelt, Per-Henrik Agren, Sarah Hahn, Anica Eschler
BACKGROUND: Charcot osteo-neuroarthropathy (CN) of the foot can induce severe instability and deformity. Results of a consecutive clinical multi-centre study with Midfoot Fusion Bolt (MFB, Synthes GmbH, Oberdorf, Switzerland) are reported. METHODS: All patients (aged 18 years and older) treated between 2009 and 2013 with surgical reconstruction of the midfoot with MFB for CN were included. Demographics, pre-surgical health status, details of foot pathology, details of surgery, postoperative treatment, treatment failure, and adverse events were registered...
December 2015: Foot and Ankle Surgery: Official Journal of the European Society of Foot and Ankle Surgeons
Dane K Wukich, Katherine M Raspovic, Kimberlee B Hobizal, David Sadoskas
BACKGROUND: Charcot neuroarthropathy (CN) of the ankle and hindfoot (Sanders/Frykberg Type IV) is challenging to treat surgically or nonsurgically. The deformities associated with ankle/hindfoot CN are often multiplanar, resulting in sagittal, frontal and rotational malalignment. In addition, shortening of the limb often occurs from collapse of the distal tibia, talus and calcaneus. These deformities also result in significant alterations in the biomechanics of the foot. For example, a varus ankle/hindfoot results in increased lateral column plantar pressure of the foot, predisposing the patient to lateral foot ulceration...
January 2016: Diabetes/metabolism Research and Reviews
Vijay Viswanathan, Satyavani Kumpatla, V Narayan Rao
OBJECTIVE: People with diabetic neuropathy are frequently prone to several bone and joint abnormalities. Simple radiographic findings have been proven to be quite useful in the detection of such abnormalities, which might be helpful not only for early diagnosis but also in following the course of diabetes through stages of reconstruction of the ulcerated foot.The present study was designed to identify the common foot abnormalities in south Indian diabetic subjects with and without neuropathy using radiographic imaging...
November 2014: Journal of the Association of Physicians of India
Crystal L Ramanujam, David Han, Thomas Zgonis
UNLABELLED: The aim of this study was to determine the lower extremity amputation and mortality rates of a group of patients who underwent reconstructive surgery using circular external fixation for treatment of diabetic Charcot neuroarthropathy (CN) of the foot and/or ankle. Existing studies regarding lower extremity amputation or mortality rates for diabetic CN of the foot and/or ankle have been performed on mostly conservatively treated patients. The objective of the statistical analysis in this studied population was to understand the difference in overall amputation and mortality rates between the 2 main groups: one with foot and/or ankle ulceration (group 1), and the other without ulceration or osteomyelitis (group 2, control group)...
April 2016: Foot & Ankle Specialist
Tomáš Kučera, Jaromír Šrot, Josef Roubal, Pavel Šponer
The basic prerequisite for the successful treatment of the diabetic foot is a multidisciplinary approach. Ideally, the diagnosis and treatment is managed by a podiatrist, who is also responsible for a cost-effective and well-managed setting. General concern of diabetics is the fear of losing a limb. On the basis of multidisciplinary approach is pos-sible to prevent major amputations in many cases, or in case of them to ensure the prosthetic and rehabilitation care. New possibilities of revascularization and cooperation with antibiotic centers increase the success of surgical treatment of diabetic foot syndrome...
June 2015: Vnitr̆ní Lékar̆ství
Elissa S Finkler, Christopher Kasia, Ellen Kroin, Victoria Davidson-Bell, Adam P Schiff, Michael S Pinzur
BACKGROUND: The traditional nonsurgical accommodative treatment for diabetes-associated Charcot foot arthropathy has been unsuccessful in improving the quality of life in affected individuals. This has led to the growing interest in surgical correction of the acquired deformity with either "super construct" internal fixation implants or fine-wire static circular external fixation. The use of static circular external fixation without implants has been demonstrated to achieve high rates of deformity correction with low complication rates...
November 2015: Foot & Ankle International
Paul Dayton, Mindi Feilmeier, Mitchell Thompson, Paul Whitehouse, Rachel A Reimer
The surgical reconstruction of Charcot deformity can be a challenge for foot and ankle surgeons. Consensus is lacking among surgeons regarding the best method of surgical fixation to be used in reconstruction, and clear strong evidence is also lacking in published studies. We undertook a systematic review of electronic databases and other relevant sources in an attempt to better understand the complications and outcomes associated with internal and external fixation for Charcot foot and ankle reconstruction...
November 2015: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
Tomoya Sato, Shigeru Ichioka
Charcot foot is a serious complication of diabetes, characterized by deformity and overlying ulceration. The condition most commonly affects the midfoot. However, little information is available on the use of a medial plantar artery flap to treat diabetic midfoot ulceration. The purpose of the present study was to evaluate the versatility of ostectomy and medial plantar flap reconstruction for midfoot plantar ulceration associated with rocker-bottom deformity secondary to Charcot foot. Four patients underwent ostectomy and medial plantar flap reconstruction...
May 2016: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
Kenneth W Hegewald, Megan L Wilder, Todd M Chappell, Byron L Hutchinson
Diabetic Charcot neuroarthropathy is a complex, limb-threatening disease process with major lifestyle-altering repercussions for patients. When Charcot neuroarthropathy leads to unstable deformity, ulceration, and potential infection despite conservative therapies, foot and ankle surgeons often consider reconstructive limb salvage procedures to restore function. The purpose of the present study was to evaluate the clinical and radiographic outcomes of diabetic Charcot reconstruction using combined internal and external fixation...
May 2016: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
Takumi Matsumoto, Selene G Parekh
UNLABELLED: Reconstructive surgeries for Charcot foot are challenging due to complicated conditions and comorbidities including poor bone quality, sensory abnormalities, poor vascularity, and immunity impairment. Although various fixation devices, including screws, plates, and external fixators, have been used in the surgical reconstruction of the Charcot midfoot, all of these devices are associated with some disadvantages. This study aims to evaluate the outcome of the Multi-Axial Correction (MAC) monolateral external fixation system for the reconstructive surgery of midfoot Charcot neuroarthropathy...
December 2015: Foot & Ankle Specialist
Ryan T Scott, William T DeCarbo, Christopher F Hyer
Patients with diabetic neuropathy that develop unstable Charcot neuroarthropathy not only have an autoimmune disease that prolongs the healing process, they also often have an inability to maintain a non-weight bearing status. Charcot neuroarthopathy is often devastating to the structure and stability of the foot and ankle. This disease may require permanent bracing, reconstructive surgical stabilization, and in some cases lower leg amputation. Successful management of Charcot neuroarthopathy requires diligence and surveillance by physician and patient alike...
July 2015: Clinics in Podiatric Medicine and Surgery
D A Butt, T Hester, A Bilal, M Edmonds, V Kavarthapu
Charcot neuro-osteoarthropathy (CN) of the midfoot presents a major reconstructive challenge for the foot and ankle surgeon. The Synthes 6 mm Midfoot Fusion Bolt is both designed and recommended for patients who have a deformity of the medial column of the foot due to CN. We present the results from the first nine patients (ten feet) on which we attempted to perform fusion of the medial column using this bolt. Six feet had concurrent hindfoot fusion using a retrograde nail. Satisfactory correction of deformity of the medial column was achieved in all patients...
June 2015: Bone & Joint Journal
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