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Arthrodesis with retrograde compression nail  in Charcot neuroarthropathy of the hindfoot

Published in N°009 - Juanary / February 2021
Article viewed 172 times

Arthrodesis with retrograde compression nail in Charcot neuroarthropathy of the hindfoot

By Michel Chraim (1), Peter Bock (1), Sabine Krenn (1), Heinrich Franner (1), Hans-Jörg Trnka (2), Simon Recheis (1), Hamza M. Alrabai (3) in category SURGICAL TECHNIQUE
(1) Service d’orthopédie pédiatrique, Chirurgie de la cheville et du pied chez l’adulte Hôpital orthopédique de Speising, Vienne, Autriche - (2) Fusszentrum Wein, Vienne, Autriche - (3) Service d’orthopédie, Université de King Saud, Riyad, Arabie Saoudite

The treatment of charcot neuroarthropathy of the hindfoot often leads to amputation after unsuccessful attempts of conservative and surgical treatment. Despite highly advanced exoprothetics after amputation, when compared to successfully fused hindfoot, looks less functionally efficient in terms of ambulation and energy expenditure, resulting in excessive cardiac strain.

Introduction

The treatment of charcot neuroarthropathy of the hindfoot often leads to amputation after unsuccessful attempts of conservative and surgical treatment.1,6,7 Despite highly advanced exoprothetics after amputation, when compared to successfully fused hindfoot, looks less functionally efficient in terms of ambulation and energy expenditure, resulting in excessive cardiac strain.8  Hindfoot fusion using a tibiotalocalcaneal nail can be a valid option before considering amputation. Therefore, the amputation and exoprothetics should exclusively be reserved for the non-reconstructable foot. For charcot arthropathy there are numerous different arthrodesis techniques with screws, plate osteosynthesis and external fixators described in the literature.1,6  The correction of bony deformity, a stable intraosseous fixation, the locking function as well as the ability of compression are the perquisites for the bony union in hindfoot arthrodesis.1

Retrograde tibiotalocalcaneal compression nail often provides a robust hindfoot capable of pain- free full weightbearing avoiding secondary dislocation and implant failure. Hindfoot fusion with a retrograde tibiotalocalcaneal nail is of great value in advanced stage of chracot neuroarthropathy and is therefore an effective operative...

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