Background. Treatment of patients with Charcot neuroosteoarthropathy remains an unsolved problem at present. The current state of the problem motivated us to develop a new original method for reconstructing the rear part of the foot to form a tibiocalcaneal bone block with the maximum possible preservation of limb length in patients with Charcot neuroosteoarthropathy. The aim of this study is to demonstrate a new method of one-stage tibiocalcaneal arthrodesis with maximum possible preservation of limb length. The surgical procedure on the preoperative stage includes measuring the angle adjacent to the Gissan angle and its bisector on radiographs. After accessing the ankle joint according to Kocher with resection of the lateral malleolus and osteonecrectomy, the distal metaepiphysis of the tibia is sawn in an oblique-horizontal plane at the bisector angle, open posteriorly and equal to the preoperatively measured value. The resulting triangular bone fragment is rotated 180º and the bone fragments are adapted in the external fixation apparatus. The treatment results of patients with a total talus defect due to Charcot diabetic neuroosteoarthropathy (n = 11) in 2021-2023 were analyzed. The average duration of fixation in the external fixation apparatus in these patients was 6.4 ± 0.2 (5.5-7) months. The observation period after completion of treatment is more than 1 year. No suppurations, non-unions, or spoke osteomyelitis were detected during the observation period. Discussion. In Charcot neuroosteoarthropathy with damage to the hindfoot and total destruction of the talus, talectomy with tibiocalcaneal arthrodesis in an external fixation device is a good way to stabilize and restore the support of the limb, but this shortens the limb not only due to the height of the resected talus, but also due to the height of the resection of the tibia and calcaneus to impart congruence to the surfaces. The surgical intervention method proposed by us for total destruction of the talus in patients with Charcot osteoarthropathy is more convenient and simple for adapting the discrepant surfaces of the calcaneus and tibia to each other and allows to reduce the shortening of the lower limb during tibiocalcaneal arthrodesis. Further studies on a larger sample of patients are needed to establish an evidence base for the use of the proposed method. Conclusion. The proposed method of tibiocalcaneal arthrodesis has a number of advantages and can be used in the treatment of patients with Charcot osteoarthropathy.
Read full abstract