Yıl: 2020 Cilt: 54 Sayı: 3 Sayfa Aralığı: 256 - 261 Metin Dili: İngilizce DOI: 10.5152/j.aott.2020.03.334 İndeks Tarihi: 24-10-2020

Clinical evaluation of tibiocalcaneal arthrodesis with retrograde intramedullary nail fixation in diabetic patients

Öz:
Objective: The aim of this study was to evaluate clinical and functional outcomes in diabetic patients undergoing tibiocalcanealarthrodesis using a retrograde nail.Methods: A total of 12 diabetic patients [8 men and 4 women; mean age at intervention: 56.8 years (range: 27-76 years)]who underwent tibiocalcaneal arthrodesis by a retrograde nail were enrolled in this study. The indication for surgery wasmassive talar osteonecrosis in four patients, Charcot arthropathy in another four patients, and various severe ankle/hindfootderangements in four patients. All surgeries were performed by the same surgeon. All patients were evaluated by theirAmerican Orthopedic Foot and Ankle Score (AOFAS) score, and radiographic follow-up was performed.Results: The mean follow-up time was 59.5 months (range: 27-121 months). Ten patients (83.3%) healed and were able towalk with full weight bearing without crutches. Among them, nine patients (75%) achieved union with solid bone healing.The mean overall improvement in the AOFAS score was 72.5% (preoperatively: 40 points vs postoperatively: 69 points;p<0.001). We observe a complication in 50% of our patients. Minor complications included two cases of dehiscence of thesurgical wound, one case of soft tissue irritation owing to hardware protrusion, and one cause of lymphedema. Two patientshad deep infection and underwent surgical removal of hardware, debridement, and antibiotic treatment: one healed afterthe treatment but never recovered full weight bearing and the other one died from other complications. These two deepinfections occurred after 23 months of follow-up.Conclusion: Tibiocalcaneal arthrodesis using retrograde nails is a salvage technique extremely effective in ankle and hindfootdisorders in a diabetic patient. This procedure allows good functional outcomes and pain relief. When correctly indicated,it is a safe procedure with good clinical outcomes and low risk of below-knee amputation.
Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Bibliyografik
  • 1. AOFAS - American Orthopaedic Foot and Ankle Society. Available from: (http://www.aofas.org/footcaremd/conditions/ diabetic-foot)
  • 2. Muller LM, Gorter KJ, Hak E, et al. Increased risk of common infections in patients with type 1 and type 2 diabetes mellitus. Clin Infect Dis 2005; 41: 281-8. [Crossref]
  • 3. Thomas R, Daniels TR, Parker K., Gait analysis and functional outcomes following ankle arthrodesis for isolated ankle arthritis. J Bone Joints Surg Am 2006; 88: 526-35. [Crossref]
  • 4. Jehan S, Shakeel M, Bing AJ, Hill SO. The success of tibiotalocalcaneal arthrodesis with intramedullary nailing a systematic review of the literature. Acta Orthop Belg 2011; 77: 644-51.
  • 5. Dalla Paola L, Volpe A, Varotto D, et al. Use of a retrograde nail for ankle arthrodesis in Charcot neuroarthropathy: A limb salvage procedure. Foot Ankle Int 2007; 28: 967-70. [Crossref]
  • 6. Moeckel BH, Patterson BM, Inglis AE, Sculco TP. Ankle arthrodesis. A comparison of internal and external fixation. Clin Orthop Relat Res 1991; 268: 78-83.
  • 7. Millett PJ, O’Malley MJ, Tolo ET, Gallina J, Fealy S, Helfet DL. Tibiotalocalcaneal fusion with a retrograde intramedullary nail: clinical and functional outcomes. Am J Orthop (Belle Mead NJ) 2002; 31: 531-6.
  • 8. Klos K, Drechsel T, Gras F, et al. The use of a retrograde fixed-angle intramedullary nail for tibiocalcaneal arthrodesis after severe loss of the talus. Strategies Trauma Limb Reconstr 2009; 4: 95-102. [Crossref]
  • 9. Takenouchi K, Morishita M, Saitoh K, Wauke K, Takahashi H, Nagashima M. Long-term results of ankle arthrodesis using an intramedullary nail with fins in patients with rheumatoid arthritis hindfoot deformity. J Nippon Med Sch 2009; 76: 240-6. [Crossref]
  • 10. Caravaggi C, Cimmino M, Caruso S, Dalla Noce S. Intramedullary compressive nail fixation for the treatment of severe Charcot deformity of the ankle and rear foot. J Foot Ankle Surg 2006; 45: 20-4. [Crossref]
  • 11. Franceschi F, Franceschetti E, Torre G, et al. Tibiotalocalcaneal arthrodesis using an intramedullary nail: A systematic review. Knee Surg Sports Traumatol Arthrosc 2016; 24: 1316-25. [Crossref]
  • 12. Chraim M, Krenn S, Alrabai HM, Trnka HJ, Bock P. Mid-term follow-up of patients with hindfoot arthrodesis with retrograde compression intramedullary nail in Charcot neuroarthropathy of the hindfoot. Bone Joint J 2018; 100-B: 190-6. [Crossref]
  • 13. Oesmana I, Asdib ARB. Calcaneotalotibial arthrodesis by retrograde intramedullary nailing using expert tibia nail for charcot osteoneuropathy of the foot: A case series. Int J Surg Case Rep 2019; 57: 9-14. [Crossref]
  • 14. de Souza LJ. Charcot arthropathy and immobilization in a weight-bearing total contact cast. J Bone Joint Surg Am 2008; 90: 754-9. [Crossref]
  • 15. Bibbo C, Lin SS, Beam HA, Behrens FF. Complications of ankle fractures in diabetic patients. Orthop Clin North Am 2001; 32: 113-33. [Crossref]
  • 16. McCormack RG, Leith JM. Ankle fractures in diabetics. Complications of surgical management. J Bone Joint Surg Br 1998; 80: 689-92. [Crossref]
  • 17. White CB, Turner NS, Lee GC, Haidukewych GJ. Open ankle fractures in patients with diabetes mellitus. Clin Orthop Relat Res 2003; 414: 37-44. [Crossref]
  • 18. Wukich DK, Shen JY, Ramirez CP, Irrgang JJ. Retrograde ankle arthrodesis using an intramedullary nail: a comparison of patients with and without diabetes mellitus. J Foot Ankle Surg 2011; 50: 299-306. [Crossref]
  • 19. Hentges MJ, Richardson PE, Loveland JD, Lamm BM, Mendicino RW, Catanzariti AR. Internal Fixation Constructs for correction of Charcot Midfoot Deformity. Foot and Ankle Quarterly, Summer 2013, Vol. 24, No. 2.
  • 20. Galli M, Scavone G, Vitiello R, Flex A, Caputo S, Pitocco D. Surgical treatment for chronic Charcot neuroarthropathy. Foot (Edinb) 2018; 36: 59-66. [Crossref]
APA Vitiello R, Perna A, Peruzzi M, Pitocco D, Galli M (2020). Clinical evaluation of tibiocalcaneal arthrodesis with retrograde intramedullary nail fixation in diabetic patients. , 256 - 261. 10.5152/j.aott.2020.03.334
Chicago Vitiello Raffaele,Perna Andrea,Peruzzi Marco,Pitocco Dario,Galli Marco Clinical evaluation of tibiocalcaneal arthrodesis with retrograde intramedullary nail fixation in diabetic patients. (2020): 256 - 261. 10.5152/j.aott.2020.03.334
MLA Vitiello Raffaele,Perna Andrea,Peruzzi Marco,Pitocco Dario,Galli Marco Clinical evaluation of tibiocalcaneal arthrodesis with retrograde intramedullary nail fixation in diabetic patients. , 2020, ss.256 - 261. 10.5152/j.aott.2020.03.334
AMA Vitiello R,Perna A,Peruzzi M,Pitocco D,Galli M Clinical evaluation of tibiocalcaneal arthrodesis with retrograde intramedullary nail fixation in diabetic patients. . 2020; 256 - 261. 10.5152/j.aott.2020.03.334
Vancouver Vitiello R,Perna A,Peruzzi M,Pitocco D,Galli M Clinical evaluation of tibiocalcaneal arthrodesis with retrograde intramedullary nail fixation in diabetic patients. . 2020; 256 - 261. 10.5152/j.aott.2020.03.334
IEEE Vitiello R,Perna A,Peruzzi M,Pitocco D,Galli M "Clinical evaluation of tibiocalcaneal arthrodesis with retrograde intramedullary nail fixation in diabetic patients." , ss.256 - 261, 2020. 10.5152/j.aott.2020.03.334
ISNAD Vitiello, Raffaele vd. "Clinical evaluation of tibiocalcaneal arthrodesis with retrograde intramedullary nail fixation in diabetic patients". (2020), 256-261. https://doi.org/10.5152/j.aott.2020.03.334
APA Vitiello R, Perna A, Peruzzi M, Pitocco D, Galli M (2020). Clinical evaluation of tibiocalcaneal arthrodesis with retrograde intramedullary nail fixation in diabetic patients. Acta Orthopaedica et Traumatologica Turcica, 54(3), 256 - 261. 10.5152/j.aott.2020.03.334
Chicago Vitiello Raffaele,Perna Andrea,Peruzzi Marco,Pitocco Dario,Galli Marco Clinical evaluation of tibiocalcaneal arthrodesis with retrograde intramedullary nail fixation in diabetic patients. Acta Orthopaedica et Traumatologica Turcica 54, no.3 (2020): 256 - 261. 10.5152/j.aott.2020.03.334
MLA Vitiello Raffaele,Perna Andrea,Peruzzi Marco,Pitocco Dario,Galli Marco Clinical evaluation of tibiocalcaneal arthrodesis with retrograde intramedullary nail fixation in diabetic patients. Acta Orthopaedica et Traumatologica Turcica, vol.54, no.3, 2020, ss.256 - 261. 10.5152/j.aott.2020.03.334
AMA Vitiello R,Perna A,Peruzzi M,Pitocco D,Galli M Clinical evaluation of tibiocalcaneal arthrodesis with retrograde intramedullary nail fixation in diabetic patients. Acta Orthopaedica et Traumatologica Turcica. 2020; 54(3): 256 - 261. 10.5152/j.aott.2020.03.334
Vancouver Vitiello R,Perna A,Peruzzi M,Pitocco D,Galli M Clinical evaluation of tibiocalcaneal arthrodesis with retrograde intramedullary nail fixation in diabetic patients. Acta Orthopaedica et Traumatologica Turcica. 2020; 54(3): 256 - 261. 10.5152/j.aott.2020.03.334
IEEE Vitiello R,Perna A,Peruzzi M,Pitocco D,Galli M "Clinical evaluation of tibiocalcaneal arthrodesis with retrograde intramedullary nail fixation in diabetic patients." Acta Orthopaedica et Traumatologica Turcica, 54, ss.256 - 261, 2020. 10.5152/j.aott.2020.03.334
ISNAD Vitiello, Raffaele vd. "Clinical evaluation of tibiocalcaneal arthrodesis with retrograde intramedullary nail fixation in diabetic patients". Acta Orthopaedica et Traumatologica Turcica 54/3 (2020), 256-261. https://doi.org/10.5152/j.aott.2020.03.334