Early Results using a Locking Intramedullary Nail for Charcot Reconstruction

Abstract

Category: Other; Basic Sciences/Biologics; Diabetes; Hindfoot; Trauma Introduction/Purpose: The goal for this review was to show the early results from a novel locking intramedullary nail within the medial column for use in the reconstruction of Charcot arthropathy. We hypothesized that the utilization of the locking intramedullary nail would lead to successful fusion and stabilization. Our primary aim was to assess the rate of fusion, with secondary aims of an acceptable reduction between pre- and postoperative Meary's angle, time to return to function, and safety. Methods: This case series was designed and implemented by JL and AM. Informed consent was obtained from all patients to allow their clinical data and images to be used for research. The authors examined all patients, collected all data for the study, and performed all surgical procedures at their respective sites. Additional patients were included from Carroll Jones, MD and W. Hodges Davis, MD. All chart and radiographic reviews were also performed by JL and AM. The Advarra Institutional Review Board (IRB; Columbia, MD) determined that this research was exempt from IRB oversight. This study was conducted in compliance with the ethical principles from the 1964 Declaration of Helsinki and the International Conference on Harmonisation guidelines for Good Clinical Practice, along with the latest Health Insurance Portability and Accountability Act (HIPAA) regulations. Results: With respect to safety, there were no intraoperative complications. Additionally, there were no instances of recurrent ulceration in those patients who had ulcerations preoperatively. There were no instances of hardware failure or limb loss in the case series. There were 3 adverse events (21.43%), all of which are to be considered major events that required operative intervention for resolution. There were 2 instances of wound dehiscence (14.29%) that required operative debridement and 1 instance of a stable partial nonunion along the medial column (7.14%) which was a braceable deformity (Table 3). Conclusion: Overall, this case series review of the use of a locking intramedullary nail in Charcot neuroarthropathy patients showed efficacy by rate fusion and time to weightbearing and safety by the low number of adverse events. The data show that the utilization of the locking intramedullary nail can lead to successful fusion and stabilization, even in these high-risk patients.