Dergiler / Acta Orthopaedica et Traumatologica Turcica / 2020 / Cilt: 54 - Sayı: 3
Clinical evaluation of tibiocalcaneal arthrodesis with retrograde intramedullary nail fixation in diabetic patients
- Sayfa
- 256–261
- DOI
- —
Özet
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.