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Elgoyoushi SM, Morrah AN, Kholeif AM, Elbadry AA. Outcomes of tibiotalocalcaneal (TTC) nailing in ankle fractures in diabetic patients with Charcot neuropathy. Trauma Case Rep 2025; 57:101158. [PMID: 40291406 PMCID: PMC12032318 DOI: 10.1016/j.tcr.2025.101158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2025] [Indexed: 04/30/2025] Open
Abstract
This study aimed to evaluate the clinical and radiographic outcomes of tibiotalocalcaneal (TTC) nailing in diabetic patients with Charcot neuropathy and ankle fractures. A total of 84 patients underwent TTC nailing between December 2022 and June 2024. Functional outcomes were assessed using the Foot and Ankle Outcome Score (FAOS). Significant improvement was observed, increasing from a preoperative mean of 19.9 ± 3.81 to 72.6 ± 11.66 at six months postoperatively (p < 0.001). Union was achieved in 75 % of patients, with delayed union in 17.9 % and nonunion in 7.1 %. Postoperative complications included superficial infections (7.1 %) and deep infections (3.6 %). No significant correlations were found between final FAOS scores and patient demographics or diabetes-related factors. TTC nailing is a reliable treatment option for this high-risk population. Clinical trial number: not applicable.
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Affiliation(s)
| | - Ahmed Nabawy Morrah
- Orthopedic Surgery Department, Faculty of Medicine, Kasr Alainy, Cairo University, Cairo, Egypt
| | - Ahmed Mahmoud Kholeif
- Orthopedic Surgery Department, Faculty of Medicine, Kasr Alainy, Cairo University, Cairo, Egypt
| | - Ahmad Amr Elbadry
- Orthopedic Surgery Department, Faculty of Medicine, Kasr Alainy, Cairo University, Cairo, Egypt
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Nsekpong TB, Amin AS, Ali SR, Beasley BJ, Panchbhavi V, Jupiter DC. Comparative Analysis of Secondary Outcomes in Treatment of Charcot Neuropathy: A Systematic Review. Foot Ankle Spec 2025; 18:144-150. [PMID: 35778875 DOI: 10.1177/19386400221106635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Charcot neuroarthropathy (CN) is commonly associated with diabetic neuropathy and can predispose patients to amputations. Management remains a challenge, with no definitive treatment. This study examines major postoperative complications associated with open reduction with internal (intramedullary) nails, fixation, external fixation, or combined internal and external fixation for correction of the deformity. METHODS We reviewed available literature using PubMed, OvidSP, Scopus, and Cochrane and searched bibliographies of the included studies to identify additional pertinent references. After review and agreement among 4 raters, a total of 15 studies were included in this analysis. RESULTS Hardware removal rates were 0.133 for intramedullary nails, 0.007 for external fixators, and 0.050 for combined fixation. Rates of hardware complication were 0.182 for intramedullary nails and 0.007 for external fixators. Wound dehiscence occurred at rates of 0.059 for intramedullary nails and 0.216 for combined fixation. The rate of deep infections was 0.031 for intramedullary nails, 0.032 for external fixators, and 0.113 for combined fixation. The rate of irrigation and debridement was 0.007 for external fixators. CONCLUSION Rates of hardware removal (13.3%) and complications (18.2%) were high with intramedullary nails. Dehiscence (21.6%) and deep infection (11.3%) were high in combined fixation. Other complications occurred relatively rarely. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
| | - Atish S Amin
- The University of Texas Medical Branch, Galveston, Texas
| | - Shahrukh R Ali
- The University of Texas Medical Branch, Galveston, Texas
| | | | - Vinod Panchbhavi
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, Texas
| | - Daniel C Jupiter
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, Texas
- Department of Preventive Medicine and Population Health, The University of Texas Medical Branch, Galveston, Texas
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Cossins C, George B, Talia AJ, Loizou C, Kendal A. The Outcomes of Isolated Tibiocalcaneal Arthrodesis: A Systematic Review. FOOT & ANKLE ORTHOPAEDICS 2024; 9:24730114241247547. [PMID: 38726323 PMCID: PMC11080734 DOI: 10.1177/24730114241247547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024] Open
Abstract
Background Tibiocalcaneal arthrodesis (TCA) can be achieved by internal fixation (intramedullary nail or plate), external fixation, or a combination. Evidence for the optimal approach is limited. This systematic review examines the outcomes of these different approaches to guide surgical management. Methods A MEDLINE and Oxford SOLO search was performed using "tibiocalcaneal," "ankle," "fusion OR arthrodesis." The primary outcome was union. Secondary outcomes included rates of postoperative complications, weightbearing status, rates of revision surgery, and PROMs. We included any studies with follow-up greater than 6 months that contained our primary outcome and at least 1 secondary outcome. Results The initial search yielded 164 articles, of which 9 studies totaling 53 cases met the criteria. The majority of articles were excluded because they were nonsurgical studies, or were not about isolated TCA but were for tibiotalocalcaneal arthrodesis, more complex reconstructions (eg, Charcot), case reports, and/or did not include the predetermined outcome measures.TCA union rate was 86.2% following external fixation, 82.4% for intramedullary nail fixation, and 83.3% for plate fixation. One patient underwent a hybrid of external and internal fixation, and the outcome was nonunion. The rate of complications following TCA was 69.8%. Conclusion There is limited evidence on the best operative approach for isolated tibiocalcaneal arthrodesis. Both external and internal fixation methods had comparable union rates. External fixation had frequent complications and a more challenging postoperative protocol. Novel techniques such as 3D-printed cages and talus replacement may become a promising alternative but require further investigation.
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Affiliation(s)
| | - Ben George
- Nuffield Orthopaedic Centre, Oxford, United Kingdom
| | - Adrian J. Talia
- Nuffield Orthopaedic Centre, Oxford, United Kingdom
- Department of Orthopaedic Surgery, Western Health, Footscray Hospital, Footscray, Australia
| | | | - Adrian Kendal
- Nuffield Orthopaedic Centre, Oxford, United Kingdom
- The Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, United Kingdom
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Sell R, Meinert M, Herrmann E, Gramlich Y, Klug A, Neun O, Hoffmann R, Fischer S. Preservation of the Subtalar Joint Determines Outcomes in a 10-Year Evaluation of Ankle Arthrodesis. J Clin Med 2023; 12:jcm12093123. [PMID: 37176564 PMCID: PMC10179703 DOI: 10.3390/jcm12093123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 04/13/2023] [Accepted: 04/23/2023] [Indexed: 05/15/2023] Open
Abstract
Posttraumatic osteoarthritis may lead to surgical fusion of the ankle joint if non-surgical therapy fails. The indication for a fusion of the joint is based on the pain and disability of the patient, radiographic imaging, and surgeon experience, with no strict guidelines. We aimed to compare outcomes after tibiotalocalcaneal arthrodesis (TTCA) and tibiotalar arthrodesis (TTA) to highlight the functional importance of the subtalar joint. In total, 432 patients with ankle arthrodesis were retrospectively enrolled. Group A (n = 216) underwent TTCA; group B (n = 216) underwent TTA. Demographics, Olerud & Molander Ankle Score (OMAS), Foot Function Index (FFI-D), and Short Form-12 Questionnaire (SF-12) were recorded at a mean follow-up of 6.2 years. The mean OMAS was 50.7; the mean FFI-D was 68.9; the mean SF-12 physical component summary was 39.1. These scores differed significantly between the groups (p < 0.001). The overall revision rate was 18%, primarily for revision of non-union and infection (p < 0.001). Approximately 16% of group A and 26% of group B were able to return to previous work (p < 0.001). Based on significantly worse clinical scores of TTCA compared to TTA and the prolonged downtime and permanent incapacity, the indication for a generous subtalar joint arthrodesis with planned ankle arthrodesis should always be critically examined.
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Affiliation(s)
- Rebecca Sell
- Department of Foot and Ankle Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, 60389 Frankfurt am Main, Germany
| | - Magalie Meinert
- Department for Trauma and Orthopaedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, 60389 Frankfurt am Main, Germany
| | - Eva Herrmann
- Institut für Biostatistik und Mathematische Modellierung, Goethe-Universität Frankfurt am Main, Theodor-Stern-Kai 7, 60596 Frankfurt am Main, Germany
| | - Yves Gramlich
- Department for Trauma and Orthopaedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, 60389 Frankfurt am Main, Germany
| | - Alexander Klug
- Department for Trauma and Orthopaedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, 60389 Frankfurt am Main, Germany
| | - Oliver Neun
- Department of Foot and Ankle Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, 60389 Frankfurt am Main, Germany
| | - Reinhard Hoffmann
- Department for Trauma and Orthopaedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, 60389 Frankfurt am Main, Germany
| | - Sebastian Fischer
- Department of Foot and Ankle Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, 60389 Frankfurt am Main, Germany
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Fernández AN, Gómez-Carrión A, Zaragoza-García I, Sebastián CM, Wozniak PS, Lara AG, Saura-Sempere A, Sánchez-Gómez R. Management of post-surgical infection of onychocryptosis with topical application of hyaluronic acid versus antibacterial ointments. Heliyon 2022; 8:e10099. [PMID: 35992002 PMCID: PMC9389182 DOI: 10.1016/j.heliyon.2022.e10099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/03/2022] [Accepted: 07/25/2022] [Indexed: 10/27/2022] Open
Abstract
Introduction The prevention and cure of postoperative infections has been a source of study over the years and is currently being studied. In this bibliographic review, a comparison between the different products used for the prevention and treatment of postsurgical infections has been procured, likewise, being able to determine which would be the best option for the treatment of post-surgical infections. In this bibliographic review we focus on Onychocryptosis because it is an emerging problem today. Many surgeries are performed to fix this condition, which increases the risk of infections. Material databases, including PubMed and Cochrane Library, as well as websites of international organizations, were searched up to January 2021. The search included studies and trials in humans on the use of hyaluronic acid and antibacterial ointments in various conditions or diseases. Results 18 articles were analyzed individually, which included randomized studies of Hyaluronic Acid, various antibiotics and honey, and variables used topically. 3 articles were also selected to explain onychocryptosis and postoperative infections. Conclusion Despite being able to determine which antibiotic would be the best, and whether hyaluronic acid can be used for the prevention and/or cure of post-surgical infections, this review emphasizes that there is still a need for more specific studies on its use of these variables, both in post-surgical infections in general and in post-surgical onychocryptosis infections.
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Affiliation(s)
- Almudena Núñez Fernández
- Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040, Spain
| | - Alvaro Gómez-Carrión
- Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040, Spain
| | - Ignacio Zaragoza-García
- Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040, Spain
| | - Carlos Martínez Sebastián
- Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040, Spain
| | - Paola Sanz Wozniak
- Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040, Spain
| | - Arturo Gómez Lara
- Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040, Spain
| | - Arturo Saura-Sempere
- Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040, Spain
| | - Rubén Sánchez-Gómez
- Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, 28040, Spain
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