Arthrodesen mit ausschließlicher Schraubenosteosynthese in der Behandlung der diabetischen Charcot-Arthropathie des Rück- und Mittelfußes

Abstract

Surgical reconstruction of Charcot arthropathy in diabetes is characterised by long consolidation periods and extensive osteosynthesis procedures. The different methods of osteosynthesis are difficult to compare. Studies differ in many aspects such as favourable outcome, timing of surgery, clinical features, severity and stage of the disease. Therefore uniformity and comparability of the studies is not given. An evidence-based therapy algorithm for the surgical reconstruction of Charcot feet does not exist. A retrospective study of twelve patients with 13 affected feet who had undergone arthrodesis of the foot to treat Charcot deformity was performed. All surgical procedures were performed at Eichenholtz stage 3. Six patients showed an ulcer of the foot at the time of surgery, six patients were without pedal ulceration. Screw fixation was used for reconstruction and bone grafting was performed in all patients. Radiographic measurements were recorded preoperatively, immediately postoperatively, 3 months postoperatively and at the time of the last follow-up. Patients were evaluated clinically and radiographically at an average of 2.4 years. Complete osseous union was achieved in ten patients at an average of 4.3 months. There was one patient with a postoperative infection and an internal amputation, one patient with an unstable non-union, with recurrence of deformity. All pedal ulcers healed during the period of the osseous consolidation. All patients returned to an ambulatory status within 7 months. Open reduction and arthrodesis with the use of screw fixation alone for the surgical correction of Charcot arthropathy provide a good result compared to other fixation methods.