scholarly journals Surgical Reconstruction of Charcot Foot Neuroarthropathy, a Case Based Review

2014 ◽  
Vol 57 (3) ◽  
pp. 127-132 ◽  
Author(s):  
Tomáš Kučera ◽  
Pavel Šponer ◽  
Jaromír Šrot
Keyword(s):  
Limb Salvage ◽  
Imaging Techniques ◽  
Large Diameter ◽  
Operative Management ◽  
Plaster Cast ◽  
Surgical Reconstruction ◽  
Charcot Foot ◽  
Charcot Neuroarthropathy ◽  
Case Based

Our case-based review focuses on limb salvage through operative management of Charcot neuroarthropathy of the diabetic foot. We describe a case, when a below-knee amputation was considered in a patient with chronic Charcot foot with a rocker-bottom deformity and chronic plantar ulceration. Conservative treatment failed. Targeted antibiotic therapy and operative management (Tendo-Achilles lengthening, resectional arthrodesis of Lisfranc and midtarsal joints, fixation with large-diameter axial screws, and plaster cast) were performed. On the basis of this case, we discuss options and drawbacks of surgical management. Our approach led to healing of the ulcer and correction of the deformity. Two years after surgery, we observed a significant improvement in patient’s quality of life. Advanced diagnostic and imaging techniques, a better understanding of the biomechanics and biology of Charcot neuroarthropathy, and suitable osteosynthetic material enables diabetic limb salvage.

Two-stage reconstruction of infected Charcot foot using internal fixation

2021 ◽  
Vol 103-B (10) ◽  
pp. 1611-1618
Author(s):  
Venu Kavarthapu ◽  
Basil Budair
Keyword(s):  
Internal Fixation ◽  
Limb Salvage ◽  
Care Plan ◽  
Surgical Reconstruction ◽  
Charcot Foot ◽  
Foot Deformity ◽  
Two Stage ◽  
Infected Nonunion ◽  
Hardware Failure

Aims In our unit, we adopt a two-stage surgical reconstruction approach using internal fixation for the management of infected Charcot foot deformity. We evaluate our experience with this functional limb salvage method. Methods We conducted a retrospective analysis of prospectively collected data of all patients with infected Charcot foot deformity who underwent two-stage reconstruction with internal fixation between July 2011 and November 2019, with a minimum of 12 months’ follow-up. Results We identified 23 feet in 22 patients with a mean age of 56.7 years (33 to 70). The mean postoperative follow-up period was 44.7 months (14 to 99). Limb salvage was achieved in all patients. At one-year follow-up, all ulcers have healed and independent full weightbearing mobilization was achieved in all but one patient. Seven patients developed new mechanical skin breakdown; all went on to heal following further interventions. Fusion of the hindfoot was achieved in 15 of 18 feet (83.3%). Midfoot fusion was achieved in nine of 15 patients (60%) and six had stable and painless fibrous nonunion. Hardware failure occurred in five feet, all with broken dorsomedial locking plate. Six patients required further surgery, two underwent revision surgery for infected nonunion, two for removal of metalwork and exostectomy, and two for dynamization of the hindfoot nail. Conclusion Two-stage reconstruction of the infected and deformed Charcot foot using internal fixation and following the principle of ‘long-segment, rigid and durable internal fixation, with optimal bone opposition and local antibiotic elusion’ is a good form of treatment provided a multidisciplinary care plan is delivered. Cite this article: Bone Joint J 2021;103-B(10):1611–1618.

scholarly journals Influence of Patient Setting and Dedicated Limb Salvage Efforts on Outcomes in Charcot-Related Foot Ulcer

2019 ◽  
Vol 18 (4) ◽  
pp. 362-366 ◽  
Author(s):  
Brian M. Schmidt ◽  
Crystal M. Holmes
Keyword(s):  
Diabetes Mellitus ◽  
Limb Salvage ◽  
Patient Outcomes ◽  
Foot Ulcer ◽  
Outpatient Setting ◽  
Inpatient Setting ◽  
Charcot Foot ◽  
Specialist Care ◽  
Charcot Neuroarthropathy ◽  
Patients With Diabetes

Charcot neuroarthropathy is a devastating consequence of diabetes mellitus and peripheral neuropathy. Because of its rarity, the condition is often misdiagnosed or poorly managed. When misadventure occurs, patients with Charcot neuroarthropathy can suffer ulceration, infection, amputation, and death. When patients have Charcot-related foot ulcers, the risks are amplified. Utilizing advanced electronic medical record analysis, a 30-month investigation was undertaken to determine if patients with diabetes mellitus and a concomitant diagnosis of Charcot-related foot ulcer were at greater risk of complications because of location setting of initial treatment for their condition. Charcot foot–related ulcers that are diagnosed in the outpatient setting had established foot specialist care. The outpatient management of the condition lead to a significant reduction in the amount of admissions to a higher acuity setting. However, patient outcomes did not vary once established and dedicated limb salvage efforts were employed. In this large contemporary population managed in a tertiary health system, patients with Charcot-related foot ulcer had negative outcomes when they were initially treated in an inpatient setting and had a significantly greater likelihood of readmission as compared with individuals who had established focused limb salvage care.

scholarly journals Improvement in Quality of Life Following Surgical Correction of Midtarsal Charcot Foot Deformity

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0038
Author(s):  
Michael Pinzur ◽  
Ellen Kroin
Keyword(s):  
Quality Of Life ◽  
Activity Index ◽  
Disease Process ◽  
Surgical Correction ◽  
Surgical Reconstruction ◽  
Charcot Foot ◽  
Modern Approach ◽  
Therapeutic Footwear ◽  
Patient Reported

Category: Diabetes Introduction/Purpose: Patients with Charcot Foot Arthropathy objectively report a poor quality of life following the development of deformity. It has recently been demonstrated that their quality of life is not improved with historic accommodative treatment. The recent interest in surgical reconstruction of the acquired deformity is directed at improving quality of life in addition to traditional goals of resolution of infection and limb retention. The Short Musculoskeletal Functional Assessment (SMFA) has been proven to be a valid tool for evaluating this complex patient population. Methods: Twenty-five consecutive patients undergoing surgical reconstruction for non-plantigrade midtarsal charcot foot arthropathy completed the SMFA patient reported outcomes instrument prior to surgery, with twenty-four completing it at one year following the surgery. One patient died during the year following surgery due to unrelated causes. Results: There was an 11.47 (95% CI: -19.70 to -3.23) point decrease in the standardized functional index. (p = .01) Similarly, there was a 12.38 (95% CI: -22.48 to -2.29) point de-crease in the standardized bother index. (p = .02) There was a 19.58 (95% CI: -30.53 to -8.63) point decrease in the standardized daily activity index. (p = .002), and there was an 14.68 (95% CI: -24.06 to - 5.31) point decrease in the standardized emotion index (p = .004). There was no meaningful change in the standardized arm/hand index. (p = .81) Conclusion: The results of this investigation demonstrate that successful surgical reconstruction of midtarsal Charcot Foot Arthropathy substantially improves quality of life. This supports the modern paradigm shift from immobilization during the active phase of the disease process followed by simple accommodation of the acquired deformity, to the modern approach of surgical correction to allow the use of commercially-available therapeutic footwear.

Surgical reconstruction for unilateral iliac artery lesions in patients younger than 50 years

VASA ◽  
2011 ◽  
Vol 40 (6) ◽  
pp. 474-481 ◽  
Author(s):  
Radak ◽  
Babic ◽  
Ilijevski ◽  
Jocic ◽  
Aleksic ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Limb Salvage ◽  
Iliac Artery ◽  
Graft Patency ◽  
Long Term Results ◽  
Surgical Reconstruction ◽  
Safe Procedure ◽  
Term Survival

Background: To evaluate safety, short and long-term graft patency, clinical success rates, and factors associated with patency, limb salvage and mortality after surgical reconstruction in patients younger than 50 years of age who had undergone unilateral iliac artery bypass surgery. Patients and methods: From January 2000 to January 2010, 65 consecutive reconstructive vascular operations were performed in 22 women and 43 men of age < 50 years with unilateral iliac atherosclerotic lesions and claudication or chronic limb ischemia. All patients were followed at 1, 3, 6, and 12 months after surgery and every 6 months thereafter. Results: There was in-hospital vascular graft thrombosis in four (6.1 %) patients. No in-hospital deaths occurred. Median follow-up was 49.6 ± 33 months. Primary patency rates at 1-, 3-, 5-, and 10-year were 92.2 %, 85.6 %, 73.6 %, and 56.5 %, respectively. Seven patients passed away during follow-up of which four patients due to coronary artery disease, two patients due to cerebrovascular disease and one patient due to malignancy. Limb salvage rate after 1-, 3-, 5-, and 10-year follow-up was 100 %, 100 %, 96.3 %, and 91.2 %, respectively. Cox regression analysis including age, sex, risk factors for vascular disease, indication for treatment, preoperative ABI, lesion length, graft diameter and type of pre-procedural lesion (stenosis/occlusion), showed that only age (beta - 0.281, expected beta 0.755, p = 0.007) and presence of diabetes mellitus during index surgery (beta - 1.292, expected beta 0.275, p = 0.026) were found to be significant predictors of diminishing graft patency during the follow-up. Presence of diabetes mellitus during index surgery (beta - 1.246, expected beta 0.291, p = 0.034) was the only variable predicting mortality. Conclusions: Surgical treatment for unilateral iliac lesions in patients with premature atherosclerosis is a safe procedure with a low operative risk and acceptable long-term results. Diabetes mellitus and age at index surgery are predictive for low graft patency. Presence of diabetes is associated with decreased long-term survival.

Limb Salvage in Charcot Foot and Ankle Osteomyelitis: Combined Use Single Stage/Double Stage of Arthrodesis and External Fixation

2009 ◽  
Vol 30 (11) ◽  
pp. 1065-1070 ◽  
Author(s):  
Luca Dalla Paola ◽  
Tanja Ceccacci ◽  
Sasa Ninkovic ◽  
Sara Sorgentone ◽  
Maria Grazia Marinescu
Keyword(s):  
External Fixation ◽  
Limb Salvage ◽  
Single Stage ◽  
Foot And Ankle ◽  
Charcot Foot ◽  
Combined Use

scholarly journals The Role of Bone Scintigraphy with SPECT/CT in the Characterization and Early Diagnosis of Stage 0 Charcot Neuroarthropathy

2020 ◽  
Vol 9 (12) ◽  
pp. 4123
Author(s):  
Raju Ahluwalia ◽  
Ahmad Bilal ◽  
Nina Petrova ◽  
Krishna Boddhu ◽  
Chris Manu ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Early Diagnosis ◽  
Bone Scintigraphy ◽  
Photon Emission ◽  
Emission Computed Tomography ◽  
Charcot Foot ◽  
Bone Pathology ◽  
Charcot Neuroarthropathy ◽  
Focal Uptake ◽  
Stage 1

We describe the use of Single Photon Emission Computed Tomography/Computed Tomography (SPECT/CT) in the investigation and diagnosis of Charcot neuroarthropathy (CN) in patients with a hot swollen foot but normal radiographs and clinical suspicion of CN, usually termed Stage 0. This was a retrospective cohort review of 46 diabetes patients who underwent 3 phase bone scintigraphy with “High Resolution” SPECT/CT. The imaging demonstrated that Stage 0 Charcot foot has a distinct bone pathology, which can be classified into three groups: (1) fractures on Computed Tomography (CT) with accompanying focal uptake of tracer on SPECT, (2) bony abnormalities apart from fracture on CT with focal uptake of tracer on SPECT, and (3) normal CT but focal bony uptake of tracer on SPECT. The CT component of SPECT/CT detected bony fractures in 59% of patients. Early treatment with below knee cast and follow-up for 24 months showed only 4 patients who developed Stage 1 Eichenholtz Charcot foot. Our findings support the use of 3 phase bone scintigraphy with SPECT/CT in the characterization and early diagnosis of CN. Stage 0 Charcot foot has a distinct bone pathology which requires urgent treatment to prevent progression to Stage 1 Eichenholtz Charcot foot. If SPECT/CT is unavailable, CT alone will detect bone fracture in 59% patients.

Criteria for Return to Play After Hip Arthroscopy in the Treatment of Femoroacetabular Impingement: A Systematic Review

2021 ◽  
pp. 036354652110389
Author(s):  
Martin S. Davey ◽  
Eoghan T. Hurley ◽  
Matthew G. Davey ◽  
Jordan W. Fried ◽  
Andrew J. Hughes ◽  
...  
Keyword(s):  
Systematic Review ◽  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Operative Management ◽  
Return To Play ◽  
Return To Sports ◽  
Level Of Evidence ◽  
The Mean

Background: Femoroacetabular impingement (FAI) is a common pathology in athletes that often requires operative management in the form of hip arthroscopy. Purpose: To systematically review the rates and level of return to play (RTP) and the criteria used for RTP after hip arthroscopy for FAI in athletes. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review of the literature, based on the PRISMA guidelines, was performed using PubMed, Embase, and Scopus databases. Studies reporting outcomes after the use of hip arthroscopy for FAI were included. Outcomes analyzed were RTP rate, RTP level, and criteria used for RTP. Statistical analysis was performed using SPSS software. Results: Our review found 130 studies, which included 14,069 patients (14,517 hips) and had a mean methodological quality of evidence (MQOE) of 40.4 (range, 5-67). The majority of patients were female (53.7%), the mean patient age was 30.4 years (range, 15-47 years), and the mean follow-up was 29.7 months (range, 6-75 months). A total of 81 studies reported RTP rates, with an overall RTP rate of 85.4% over a mean period of 6.6 months. Additionally, 49 studies reported the rate of RTP at preinjury level as 72.6%. Specific RTP criteria were reported in 97 studies (77.2%), with time being the most commonly reported item, which was reported in 80 studies (69.2%). A total of 45 studies (57.9%) advised RTP at 3 to 6 months after hip arthroscopy. Conclusion: The overall rate of reported RTP was high after hip arthroscopy for FAI. However, more than one-fourth of athletes who returned to sports did not return at their preinjury level. Development of validated rehabilitation criteria for safe return to sports after hip arthroscopy for FAI could potentially improve clinical outcomes while also increasing rates of RTP at preinjury levels.

What Does Imaging Add to the Management of Alzheimer's Disease?

CNS Spectrums ◽  
2004 ◽  
Vol 9 (S5) ◽  
pp. 20-23 ◽  
Author(s):  
Gary W. Small
Keyword(s):  
Quality Of Life ◽  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Cognitive Impairment ◽  
Imaging Techniques ◽  
Screening Tools ◽  
Surrogate Markers ◽  
Genetic Disposition ◽  
Number Of Patients

AbstractThe prevalence of Alzheimer's disease (AD) and dementia continues to rise. However, a significant number of patients are undiagnosed or untreated. Given the complexities of detecting cognitive impairment and the early signs of AD, this review discusses how advances in brain imaging can help assist in improving overall management. Imaging techniques and surrogate markers may provide unique opportunities to diagnose accurately AD in presymptomatic stages with practical consequences for patients, caregivers, and physicians. The possible outcomes for using imaging and surrogate markers as adjuncts to clinical examination and as screening tools for AD, as well as tangible and intangible advantages to early diagnosis and treatment, will be discussed. The specific value of using advanced serial imaging in patients with a genetic disposition to AD will be evaluated. If neurons can be protected from neurodegenerative damage in early stages, this may preserve patient cognition, function, and quality of life, and may confer considerable societal healthcare benefits.

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