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Mid-term walking ability after Charcot foot reconstruction using the Ilizarov ring fixator

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

Failed conservative treatment and complications are indications for foot reconstruction in Charcot arthropathy. External fixation using the Ilizarov principles offers a one-stage procedure for deformity correction and resection of osteomyelitic bone. The aim of this study was to determine whether external fixation with an Ilizarov ring fixator leads reliably to walking ability.

Materials and methods

29 patients treated with an Ilizarov ring fixator for Charcot arthropathy were retrospectively analyzed. Radiologic fusion at final follow up was assessed separately on conventional X-rays by two authors. The association between walking ability and the presence of osteomyelitis at the time of reconstruction, and the presence of fusion at final follow up was investigated using Fisher’s exact test.

Results

Mean follow up was 35 months (range 5.3–107) months; mean time of external fixation was 113 days. Ten patients (34.5%) reached fusion, but 19 did not (65.5%). Two patients needed below knee amputation. 26 of the remaining 27 patients maintained walking ability, 23 of those without assistive devices. Walking ability was independent from the presence of osteomyelitis at the time of reconstruction and from the presence of fusion.

Conclusion

Foot reconstruction with an Ilizarov ring fixator led to limb salvage in 93%. The vast majority (96.3%) of patients with successful limb salvage was ambulatory, independent from radiologic fusion, and presence of osteomyelitis at the time of reconstruction. These findings encourage limb salvage and deformity correction in this difficult-to-treat disease, even with underlying osteomyelitis.

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References

  1. Saltzman CL, Hagy ML, Zimmerman B, Estin M, Cooper R (2005) How effective is intensive nonoperative initial treatment of patients with diabetes and charcot arthropathy of the feet? Clin Orthop Relat Res 435:185–190. https://doi.org/10.1097/00003086-200506000-00026

    Article  Google Scholar 

  2. Wukich DK, Sadoskas D, Vaudreuil NJ, Fourman M (2017) Comparison of diabetic Charcot patients with and without foot wounds. Foot Ankle Int 38(2):140–148. https://doi.org/10.1177/1071100716673985

    Article  PubMed  Google Scholar 

  3. Rogers LC, Frykberg RG, Armstrong DG, Boulton AJ, Edmonds M, Van GH, Hartemann A, Game F, Jeffcoate W, Jirkovska A, Jude E, Morbach S, Morrison WB, Pinzur M, Pitocco D, Sanders L, Wukich DK, Uccioli L (2011) The Charcot foot in diabetes. J Am Podiatr Med Assoc 101(5):437–446

    Article  Google Scholar 

  4. Pinzur MS, Lio T, Posner M (2006) Treatment of Eichenholtz stage I Charcot foot arthropathy with a weightbearing total contact cast. Foot Ankle Int 27(5):324–329. https://doi.org/10.1177/107110070602700503

    Article  PubMed  Google Scholar 

  5. Blume PA, Sumpio B, Schmidt B, Donegan R (2014) Charcot neuroarthropathy of the foot and ankle: diagnosis and management strategies. Clin Podiatr Med Surg 31(1):151–172. https://doi.org/10.1016/j.cpm.2013.09.007

    Article  PubMed  Google Scholar 

  6. de Souza LJ (2008) Charcot arthropathy and immobilization in a weight-bearing total contact cast. J Bone Joint Surg Am 90(4):754–759. https://doi.org/10.2106/jbjs.f.01523

    Article  PubMed  Google Scholar 

  7. Osterhoff G, Boni T, Berli M (2013) Recurrence of acute Charcot neuropathic osteoarthropathy after conservative treatment. Foot Ankle Int 34(3):359–364. https://doi.org/10.1177/1071100712464957

    Article  PubMed  Google Scholar 

  8. Pinzur MS (2007) Current concepts review: Charcot arthropathy of the foot and ankle. Foot Ankle Int 28(8):952–959. https://doi.org/10.3113/fai.2007.0952

    Article  PubMed  Google Scholar 

  9. Wukich DK, Sung W (2009) Charcot arthropathy of the foot and ankle: modern concepts and management review. J Diabetes Complicat 23(6):409–426. https://doi.org/10.1016/j.jdiacomp.2008.09.004

    Article  Google Scholar 

  10. Schneekloth BJ, Lowery NJ, Wukich DK (2016) Charcot neuroarthropathy in patients with diabetes: an updated systematic review of surgical management. J Foot Ankle Surg 55(3):586–590. https://doi.org/10.1053/j.jfas.2015.12.001

    Article  PubMed  Google Scholar 

  11. Pinzur MS (2016) Surgical treatment of the Charcot foot. Diabetes Metab Res Rev 32(Suppl 1):287–291. https://doi.org/10.1002/dmrr.2750

    Article  PubMed  Google Scholar 

  12. Pinzur MS, Gil J, Belmares J (2012) Treatment of osteomyelitis in charcot foot with single-stage resection of infection, correction of deformity, and maintenance with ring fixation. Foot Ankle Int 33(12):1069–1074. https://doi.org/10.3113/FAI.2012.1069

    Article  PubMed  Google Scholar 

  13. Pinzur MS (2015) Circular Fixation for the nonplantigrade Charcot foot. Hosp Pract 38(3):56–62. https://doi.org/10.3810/hp.2010.06.316

    Article  Google Scholar 

  14. Jolly GP, Zgonis T, Polyzois V (2003) External fixation in the management of Charcot neuroarthropathy. Clin Podiatr Med Surg 20(4):741–756. https://doi.org/10.1016/s0891-8422(03)00071-5

    Article  PubMed  Google Scholar 

  15. El-Mowafi H, Abulsaad M, Kandil Y, El-Hawary A, Ali S (2018) Hybrid fixation for ankle fusion in diabetic Charcot arthropathy. Foot Ankle Int 39(1):93–98. https://doi.org/10.1177/1071100717735074

    Article  PubMed  Google Scholar 

  16. Volkering C, Kriegelstein S, Kessler S, Walther M (2015) Treatment of hindfoot instability in Charcot foot using a hybrid technique of internal and external fixation. Oper Orthop Traumatol 27(2):101–113. https://doi.org/10.1007/s00064-014-0339-7

    Article  CAS  PubMed  Google Scholar 

  17. Kriegelstein S, Volkering C, Altenberger S, Kessler S, Walther M (2015) Management of midfoot instability in Charcot foot with the ring fixator : use of a hybrid technique with internal and external stabilization. Oper Orthop Traumatol 27(2):129–138. https://doi.org/10.1007/s00064-014-0337-9

    Article  CAS  PubMed  Google Scholar 

  18. Zarutsky E, Rush SM, Schuberth JM (2005) The use of circular wire external fixation in the treatment of salvage ankle arthrodesis. J Foot Ankle Surg 44(1):22–31. https://doi.org/10.1053/j.jfas.2004.11.004

    Article  PubMed  Google Scholar 

  19. Fragomen AT, Borst E, Schachter L, Lyman S, Rozbruch SR (2012) Complex ankle arthrodesis using the Ilizarov method yields high rate of fusion. Clin Orthop Relat Res 470(10):2864–2873. https://doi.org/10.1007/s11999-012-2470-9

    Article  PubMed  PubMed Central  Google Scholar 

  20. El-Gafary KA, Mostafa KM, Al-Adly WY (2009) The management of Charcot joint disease affecting the ankle and foot by arthrodesis controlled by an Ilizarov frame: early results. J Bone Jt Surg Br 91(10):1322–1325. https://doi.org/10.1302/0301-620x.91b10.22431

    Article  CAS  Google Scholar 

  21. Yousry AH, Abdalhady AM (2010) Management of diabetic neuropathic ankle arthropathy by arthrodesis using an Ilizarov frame. Acta Orthop Belg 76(6):821–826

    PubMed  Google Scholar 

  22. Eylon S, Porat S, Bor N, Leibner ED (2007) Outcome of Ilizarov ankle arthrodesis. Foot Ankle Int 28(8):873–879. https://doi.org/10.3113/FAI.2007.0873

    Article  PubMed  Google Scholar 

  23. Prokuski LJ, Saltzman CL (1998) External fixation for the treatment of Charcot arthropathy of the ankle: a case report. Foot Ankle Int 19(5):336–341. https://doi.org/10.1177/107110079801900514

    Article  CAS  PubMed  Google Scholar 

  24. Farber DC, Juliano PJ, Cavanagh PR, Ulbrecht J, Caputo G (2002) Single stage correction with external fixation of the ulcerated foot in individuals with Charcot neuroarthropathy. Foot Ankle Int 23(2):130–134. https://doi.org/10.1177/107110070202300209

    Article  PubMed  Google Scholar 

  25. Rogers LC, Bevilacqua NJ, Frykberg RG, Armstrong DG (2007) Predictors of postoperative complications of Ilizarov external ring fixators in the foot and ankle. J Foot Ankle Surg 46(5):372–375. https://doi.org/10.1053/j.jfas.2007.06.004

    Article  PubMed  Google Scholar 

  26. Wukich DK, Belczyk RJ, Burns PR, Frykberg RG (2008) Complications encountered with circular ring fixation in persons with diabetes mellitus. Foot Ankle Int 29(10):994–1000. https://doi.org/10.3113/FAI.2008.0994

    Article  PubMed  Google Scholar 

  27. Hegewald KW, Wilder ML, Chappell TM, Hutchinson BL (2016) Combined internal and external fixation for diabetic Charcot reconstruction: a retrospective case series. J Foot Ankle Surg 55(3):619–627. https://doi.org/10.1053/j.jfas.2015.04.016

    Article  PubMed  Google Scholar 

  28. Ettinger S, Stukenborg-Colsman C, Plaass C, Yao D, Claassen L, Berger S, Waizy H, Becher CM, Daniilidis K (2016) Tibiocalcaneal arthrodesis as a limb salvage procedure for complex hindfoot deformities. Arch Orthop Trauma Surg 136(4):457–462. https://doi.org/10.1007/s00402-016-2420-1

    Article  PubMed  Google Scholar 

  29. Ettinger S, Plaass C, Claassen L, Stukenborg-Colsman C, Yao D, Daniilidis K (2016) Surgical management of Charcot deformity for the foot and ankle-radiologic outcome after internal/external fixation. J Foot Ankle Surg 55(3):522–528. https://doi.org/10.1053/j.jfas.2015.12.008

    Article  PubMed  Google Scholar 

  30. Armstrong DG, Lavery LA, Harkless LB (1998) Validation of a diabetic wound classification system. The contribution of depth, infection, and ischemia to risk of amputation. Diabetes Care 21(5):855–859. https://doi.org/10.2337/diacare.21.5.855

    Article  CAS  PubMed  Google Scholar 

  31. Morasiewicz P, Dejnek M, Urbanski W, Dragan SL, Kulej M, Dragan SF (2017) Radiological evaluation of ankle arthrodesis with Ilizarov fixation compared to internal fixation. Injury 48(7):1678–1683. https://doi.org/10.1016/j.injury.2017.04.013

    Article  PubMed  Google Scholar 

  32. Glazebrook M, Beasley W, Daniels T, Evangelista PT, Donahue R, Younger A, Pinzur MS, Baumhauer JF, DiGiovanni CW (2013) Establishing the relationship between clinical outcome and extent of osseous bridging between computed tomography assessment in isolated hindfoot and ankle fusions. Foot Ankle Int 34(12):1612–1618. https://doi.org/10.1177/1071100713504746

    Article  PubMed  Google Scholar 

  33. Yasui Y, Hannon CP, Seow D, Kennedy JG (2016) Ankle arthrodesis: a systematic approach and review of the literature. World J Orthop 7(11):700–708. https://doi.org/10.5312/wjo.v7.i11.700

    Article  PubMed  PubMed Central  Google Scholar 

  34. Finkler ES, Kasia C, Kroin E, Davidson-Bell V, Schiff AP, Pinzur MS (2015) Pin tract infection following correction of Charcot foot with static circular fixation. Foot Ankle Int 36(11):1310–1315. https://doi.org/10.1177/1071100715593476

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors would like to thank Luigi Maggio, certified orthopedic shoemaker at Balgrist Tec, Zurich, Switzerland, for his contributions to this study.

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Authors and Affiliations

  1. Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland

    Stephan H. Wirth, Arnd F. Viehöfer, Timo Tondelli, Rebecca Hartmann & Felix W. A. Waibel

  2. Divison of Technical Orthopaedics, Department of Orthopaedic Surgery, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland

    Martin C. Berli, Thomas Böni & Felix W. A. Waibel

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  1. Stephan H. Wirth
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Correspondence to Felix W. A. Waibel.

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Wirth, S.H., Viehöfer, A.F., Tondelli, T. et al. Mid-term walking ability after Charcot foot reconstruction using the Ilizarov ring fixator. Arch Orthop Trauma Surg 140, 1909–1917 (2020). https://doi.org/10.1007/s00402-020-03407-5

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  • DOI: https://doi.org/10.1007/s00402-020-03407-5

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