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

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.