Skip to main content
SpringerLink
Log in

Tibiotalokalkaneare Korrekturarthrodese bei Charcot-Arthropathie des oberen Sprunggelenks mit dem retrograden Nagel

Tibiotalocalcaneal corrective arthrodesis in Charcot arthropathy of the ankle with a retrograde nail

  • Operative Techniken
  • Published:
Operative Orthopädie und Traumatologie Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Die Charcot-Osteoarthropathie (diabetische polyneuropathische Osteoarthropathie, DNOAP, Charcot-Fuß) des Rückfußes ist durch ihre hohe Instabilität, den Kollaps von Sprunggelenk und Rückfuß sowie die hohe Komplikationsrate gekennzeichnet. Chronische Ulzerationen über den Malleoli führen häufig zu Major-Amputationen.

Operationsziel

Ziel der Operation ist die stabile Fixation des Komplexes aus oberem Sprunggelenk (OSG) und subtalarer Gelenkfläche bei möglichst vollständiger Korrektur der Fehlstellung.

Indikationen

Instabile Charcot-Osteoarthropathie des Rückfußes mit oder ohne Weichteilulzerationen sowie Pseudarthrosen nach vorausgegangenen Arthrodesen.

Kontraindikationen

Akute Osteitis oder Osteomyelitis, Weichteilinfekte im Zugangsgebiet. Ausgedehnte Achsabweichungen der distalen Tibia. In diesen Fällen wäre entweder eine einzeitige Korrekturosteotomie der distalen Tibiafehlstellung oder ein alternatives Fixationsverfahren (Plattenosteosynthese, Fixateur externe) indiziert.

Operationstechnik

Anlage eines transfibularen Zugangs, Aufbereiten der Gelenkflächen von OSG und Subtalargelenk. Korrektur der Fehlstellungen in allen Ebenen, Spongiosaplastik der Defekte, stabile Osteosynthese des Rückfußes mit einem anatomisch konfigurierten retrograden Verriegelungsnagel.

Nachbehandlung

Postoperative Anlage einer Unterschenkellagerungsorthese, nach Wundheilung Mobilisation im Unterschenkelcast oder in einer Unterschenkelgehorthese für mindesten 12 Wochen. Über 6 Wochen Bodenkontakt, ab der 7. Woche stufenweise Aufbelastung. Vollbelastung frühestens nach 12 Wochen. Röntgenkontrollen nach 2, 6 und 12 Wochen. Ab der 13. Woche Anfertigung einer Zweischalen-Unterschenkel-Gehorthese bis zur sicheren knöchernen Konsolidierung.

Abstract

Background

Involvement of the ankle joint in Charcot osteoarthropathy is most often associated with severe instability and fracture or collapse of the talus. Caused by malalignment, ulcerations over both malleoli are associated with increased risk of major amputation.

Objective

The goal of the operation is to realign the hind foot, gain a stable osteosynthesis, and prevent major amputation.

Indications

Charcot osteoarthropathy of the ankle joint with instability, with or without soft tissue involvement, failure of the primary arthrodesis of the ankle or subtalar joint.

Contraindications

Acute osteitis/osteomyelitis, severe malalignment of the distal tibia, soft tissue infection close to the ankle joint.

Surgical technique

Realignment of the hind foot, preparation of the joint surfaces using a transfibular approach. Bone grafting of the defects, stable osteosynthesis with an anatomically shaped retrograde locking nail.

Postoperative management

Walker or cast for at least 12 weeks, 6 weeks no weight bearing. Partial weight bearing starting from week 7. X-ray control at 2, 6, and 12 weeks. After 12 weeks, walking in an ankle brace until fully consolidated.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6
Abb. 7
Abb. 8
Abb. 9
Abb. 10
Abb. 11
Abb. 12
Abb. 13
Abb. 14
Abb. 15
Abb. 16
Abb. 17
Abb. 18
Abb. 19
Abb. 20
Abb. 21

Literatur

  1. Kessler SB, Kalteis TA, Botzlar A (1999) Principles of surgical treatment of diabetic neuropathic osteoarthropathy. Internist (Berl) 40(10):1029–1035

  2. Sanders LJ, Frykberg R (2008) The Charcot foot. In: Bowker JH, Pfeifer M (eds) Levin and O’Neils’s The diabetic foot. Mosby Elsevier, Philadelphia, S 257–283

  3. Shah LC PW (2010) Charcot arthropathy. emedicine 13

  4. Sinha S, Munichoodappa CS, Kozak GP (1972) Neuro-arthropathy (Charcot joints) in diabetes mellitus (clinical study of 101 cases). Medicine (Baltimore) 51(3):191–210

  5. Johnsen B (2007) Acute Charcot’s arthropathy: a difficult diagnosis. JAAPA 20(7):22–26

    PubMed  Google Scholar 

  6. Sanders LJ (2004) The Charcot foot: historical perspective 1827–2003. Diabetes Metab Res Rev 20(Suppl 1):4–8

    Article  Google Scholar 

  7. Sommer TC, Lee TH (2001) Charcot foot: the diagnostic dilemma. Am Fam Physician 64(9):1591–1598

    CAS  PubMed  Google Scholar 

  8. Jeffcoate WJ (2005) Theories concerning the pathogenesis of the acute charcot foot suggest future therapy. Curr Diabetes Rep 5(6):430–435

    Article  Google Scholar 

  9. Jeffcoate WJ (2005) Abnormalities of vasomotor regulation in the pathogenesis of the acute charcot foot of diabetes mellitus. Int J Low Extrem Wounds 4(3):133–137

    Article  PubMed  Google Scholar 

  10. Jeffcoate WJ, Game F, Cavanagh PR (2005) The role of proinflammatory cytokines in the cause of neuropathic osteoarthropathy (acute Charcot foot) in diabetes. Lancet 366(9502):2058–2061

    Article  CAS  PubMed  Google Scholar 

  11. Ven A van der, Chapman CB, Bowker JH (2009) Charcot neuroarthropathy of the foot and ankle. J Am Acad Orthop Surg 17(9):562–571

    PubMed  Google Scholar 

  12. Eichenholtz SN (1966) Charcot joints. Springfield, Ill.,: C. C. Thomas

  13. Sanders LJ, Frykberg RG (1991) The Charcot foot. In: Frykberg RG (Hrsg) The high risc foot in diabetes mellitus. Churchill Livingstone, New York, S 325–335

  14. Wukich DK, Sung W (2009) Charcot arthropathy of the foot and ankle: modern concepts and management review. J Diabetes Complications 23(6):409–426

    Article  PubMed  Google Scholar 

  15. Berend ME, Glisson RR, Nunley JA (1997) A biomechanical comparison of intramedullary nail and crossed lag screw fixation for tibiotalocalcaneal arthrodesis. Foot Ankle Int 18(10):639–643

    Article  CAS  PubMed  Google Scholar 

  16. Jehan S, Shakeel M, Bing AJ, Hill SO (2011) The success of tibiotalocalcaneal arthrodesis with intramedullary nailing – a systematic review of the literature. Acta Orthop Belg 77(5):644–651

    PubMed  Google Scholar 

  17. Scranton PE Jr (1985) Use of internal compression in arthrodesis of the ankle. J Bone Joint Surg Am 67(4):550–555

    PubMed  Google Scholar 

  18. Budnar VM, Hepple S, Harries WG et al (2010) Tibiotalocalcaneal arthrodesis with a curved, interlocking, intramedullary nail. Foot Ankle Int 31(12):1085–1092

    Article  PubMed  Google Scholar 

  19. Frigg A, Nigg B, Davis E et al (2010) Does alignment in the hindfoot radiograph influence dynamic foot-floor pressures in ankle and tibiotalocalcaneal fusion? Clin Orthop Relat Res 468(12):3362–3370

    Article  PubMed Central  PubMed  Google Scholar 

  20. Caravaggi C, Cimmino M, Caruso S, Dalla Noce S (2006) Intramedullary compressive nail fixation for the treatment of severe Charcot deformity of the ankle and rear foot. J Foot Ankle Surg 45(1):20–24

    Article  PubMed  Google Scholar 

  21. Kane JM, Raikin SM (2014) Addressing hindfoot arthritis with concomitant tibial malunion or nonunion with retrograde tibiotalocalcaneal nailing: a novel treatment approach. J Bone Joint Surg Am 96(7):574–580

    Article  PubMed  Google Scholar 

  22. Rammelt S, Pyrc J, Agren PH et al (2013) Tibiotalocalcaneal fusion using the hindfoot arthrodesis nail: a multicenter study. Foot Ankle Int 34(9):1245–1255

    Article  PubMed  Google Scholar 

  23. Stone NC, Daniels TR (2000) Midfoot and hindfoot arthrodeses in diabetic Charcot arthropathy. Can J Surg 43(6):449–455

    PubMed Central  CAS  PubMed  Google Scholar 

  24. Herscovici D, Sammarco GJ, Sammarco VJ, Scaduto JM (2011) Pantalar arthrodesis for post-traumatic arthritis and diabetic neuroarthropathy of the ankle and hindfoot. Foot Ankle Int 32(6):581–588

    Article  PubMed  Google Scholar 

  25. Lowery NJ, Woods JB, Armstrong DG, Wukich DK (2012) Surgical management of Charcot neuroarthropathy of the foot and ankle: a systematic review. Foot Ankle Int 33(2):113–121

    Article  PubMed  Google Scholar 

Download references

Einhaltung ethischer Richtlinine

Interessenkonflikt. J. Recum ist Berater bei Depuy Synthes.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

Author information

Authors and Affiliations

  1. Sektion Knie-, Fuß- und Sprunggelenkchirurgie, BG-Unfallklinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland

    J. von Recum

Authors
  1. J. von Recum
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. von Recum.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

von Recum, J. Tibiotalokalkaneare Korrekturarthrodese bei Charcot-Arthropathie des oberen Sprunggelenks mit dem retrograden Nagel. Oper Orthop Traumatol 27, 114–128 (2015). https://doi.org/10.1007/s00064-014-0336-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00064-014-0336-x

Schlüsselwörter

Keywords

Search

Navigation