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Our Experience with Internal Fixation of Unstable Charcot Foot with Intramedullary Nail and Plate

Frangez I, Klar H, Nizic Kos T

Background: Charcot neuroarthropathy is potentially a limb-threatening disease, most commonly associated with diabetes mellitus. Early diagnosis is a key factor in the management and plays a central role in the prevention of severe deformity. Conservative treatment remains the gold standard for most patients with acute stage of the Charcot neuroarthropathy. Surgery is usually reserved for patients with severe or unstable deformities that are refractory to conservative treatment. The aim of this article is to provide a brief overview of the Charcot neuroarthropathy and to present our experience in surgical treatment of patients with this condition.
Methods: 14 patients with Charcot neuroarthropathy and clinically unstable foot with a major dislocation in Lisfranc joint, stadius Eichenholz II, treated from January 2016 to September 2017 at University Medical Centre Ljubljana, were included in the study. Primary they were treated conservatively, until the acute edema, increased local temperature and redness were gone. All patients underwent an open reduction and internal fixation with plates or with intramedullary nails and plates.
Results: Successful recovery was obtained in all 14 cases, achieving stable foot. No postoperative complications were observed during the follow-ups.
Conclusion: Successful surgical treatment with internal fixation with plates or with intramedullary nail or plate, improved our patients quality of life. Based on our experience delayed open reduction and internal fixation of acute unstable Charcot foot is good and appropriate technique especially for patients without coexisting infections or macroangiopathy.