Retaining Severely Damaged Talar Body and Medial Malleolar Cartilage for Diabetic Ankle/Hindfoot Charcot Arthrodesis Using Intramedullary Nail: A Short Report
Background: The tibiotalocalcaneal (TTC) arthrodesis using an intramedullary nail (IMN) is a common method used to treat advanced diabetic ankle/hindfoot Charcot deformity. The talus is usually resected when severe loss of its body is present and the medial malleolar cartilage excised. We report our...
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SAGE Publishing
2025-02-01
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| Series: | Foot & Ankle Orthopaedics |
| Online Access: | https://doi.org/10.1177/24730114251315672 |
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| author | Kaissar Yammine MD, PhD Camille Samaha MD Chahine Assi MD, MSc |
| author_facet | Kaissar Yammine MD, PhD Camille Samaha MD Chahine Assi MD, MSc |
| author_sort | Kaissar Yammine MD, PhD |
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| description | Background: The tibiotalocalcaneal (TTC) arthrodesis using an intramedullary nail (IMN) is a common method used to treat advanced diabetic ankle/hindfoot Charcot deformity. The talus is usually resected when severe loss of its body is present and the medial malleolar cartilage excised. We report our initial results with talar retention and absence of medial ankle gutter cartilage debridement. Methods: Four patients with type 2/3A Brodsky classification and stage 2/3 as Eichenholtz classification, presenting with a hindfoot varus deformity were treated with TTC using IMN. The talus was retained after excision of its proximal and distal cartilages while the medial malleolus cartilage was not touched. Bone union was the primary outcome. The minimum follow-up period was 12 months. Results: Bone union was achieved radiologically in all 4 cases within 6 months. No signs of postoperative infection was noted. The mean limb length difference between the pre- and postoperative values was 0.5 ± 0.2 cm. At the final follow-up, all patients were able to walk pain-free with full weightbearing. All 4 patients were very satisfied at 12 months with a mean American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score of 87 ± 3.1. Conclusion: When performing TTC arthrodesis for diabetic Charcot, preserving the talus even when the body is severely damaged could add to the stability of the construct resulting in bone healing and some leg length preservation. Including the medial malleolus in the fusion surgery might not be necessary. Level of Evidence: Level IV, case series. |
| format | Article |
| id | doaj-art-dac8317201a344ef863e74f1d8d61546 |
| institution | Kabale University |
| issn | 2473-0114 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Foot & Ankle Orthopaedics |
| spelling | doaj-art-dac8317201a344ef863e74f1d8d615462025-02-06T07:03:24ZengSAGE PublishingFoot & Ankle Orthopaedics2473-01142025-02-011010.1177/24730114251315672Retaining Severely Damaged Talar Body and Medial Malleolar Cartilage for Diabetic Ankle/Hindfoot Charcot Arthrodesis Using Intramedullary Nail: A Short ReportKaissar Yammine MD, PhD0Camille Samaha MD1Chahine Assi MD, MSc2Center for Evidence-Based Anatomy, Sport & Orthopedics Research, Beirut, LebanonDepartment of Orthopedic Surgery, Lebanese American University Medical Center–Rizk Hospital, Lebanese American University, School of Medicine, Beirut, LebanonDepartment of Orthopedic Surgery, Lebanese American University Medical Center–Rizk Hospital, Lebanese American University, School of Medicine, Beirut, LebanonBackground: The tibiotalocalcaneal (TTC) arthrodesis using an intramedullary nail (IMN) is a common method used to treat advanced diabetic ankle/hindfoot Charcot deformity. The talus is usually resected when severe loss of its body is present and the medial malleolar cartilage excised. We report our initial results with talar retention and absence of medial ankle gutter cartilage debridement. Methods: Four patients with type 2/3A Brodsky classification and stage 2/3 as Eichenholtz classification, presenting with a hindfoot varus deformity were treated with TTC using IMN. The talus was retained after excision of its proximal and distal cartilages while the medial malleolus cartilage was not touched. Bone union was the primary outcome. The minimum follow-up period was 12 months. Results: Bone union was achieved radiologically in all 4 cases within 6 months. No signs of postoperative infection was noted. The mean limb length difference between the pre- and postoperative values was 0.5 ± 0.2 cm. At the final follow-up, all patients were able to walk pain-free with full weightbearing. All 4 patients were very satisfied at 12 months with a mean American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score of 87 ± 3.1. Conclusion: When performing TTC arthrodesis for diabetic Charcot, preserving the talus even when the body is severely damaged could add to the stability of the construct resulting in bone healing and some leg length preservation. Including the medial malleolus in the fusion surgery might not be necessary. Level of Evidence: Level IV, case series.https://doi.org/10.1177/24730114251315672 |
| spellingShingle | Kaissar Yammine MD, PhD Camille Samaha MD Chahine Assi MD, MSc Retaining Severely Damaged Talar Body and Medial Malleolar Cartilage for Diabetic Ankle/Hindfoot Charcot Arthrodesis Using Intramedullary Nail: A Short Report Foot & Ankle Orthopaedics |
| title | Retaining Severely Damaged Talar Body and Medial Malleolar Cartilage for Diabetic Ankle/Hindfoot Charcot Arthrodesis Using Intramedullary Nail: A Short Report |
| title_full | Retaining Severely Damaged Talar Body and Medial Malleolar Cartilage for Diabetic Ankle/Hindfoot Charcot Arthrodesis Using Intramedullary Nail: A Short Report |
| title_fullStr | Retaining Severely Damaged Talar Body and Medial Malleolar Cartilage for Diabetic Ankle/Hindfoot Charcot Arthrodesis Using Intramedullary Nail: A Short Report |
| title_full_unstemmed | Retaining Severely Damaged Talar Body and Medial Malleolar Cartilage for Diabetic Ankle/Hindfoot Charcot Arthrodesis Using Intramedullary Nail: A Short Report |
| title_short | Retaining Severely Damaged Talar Body and Medial Malleolar Cartilage for Diabetic Ankle/Hindfoot Charcot Arthrodesis Using Intramedullary Nail: A Short Report |
| title_sort | retaining severely damaged talar body and medial malleolar cartilage for diabetic ankle hindfoot charcot arthrodesis using intramedullary nail a short report |
| url | https://doi.org/10.1177/24730114251315672 |
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