Cement Arthroplasty for Ankle Joint Destruction

Introduction: Charcot arthropathy can lead to joint destruction and often causes ulcers at sites of bony prominences. In the ankle, it causes instability that limits gait and makes it difficult for patients to wear shoes or orthoses. This was a retrospective study describing cases of Charcot arthropathy of the ankle treated at our institution from 1997 to 2017. Methods: Over the study period, we treated 252 patients with Charcot arthropathy. Of these patients, 27 presented the disease exclusively in the ankle. The selected cases were unilateral; 17 of the patients were men, and the mean age was 55 years. Nine patients were treated conservatively, and 18 were treated surgically to stabilize the ankle (including the hindfoot, if necessary). During surgery, different fixation methods were used depending on the presence or absence of ulcer at the time of the intervention. At the end of the treatment, we assessed the patient’s ability to wear shoes or orthoses for walking, the stability of the ankle joint and, in surgical cases, union. We considered a good outcome when the patient was able to walk wearing shoes or orthoses, and the limb was stable; an acceptable outcome when the limb was unstable, but the patient adapted to orthoses; and a poor outcome when the patient was unable to walk, and the ankle was unstable or amputated. Results: Nine patients underwent conservative treatment using total contact casting at the initial phase of the disease, followed by orthosis after union. Of these patients, the outcome was poor for 5, good for 3 and acceptable for 1. Eighteen patients underwent reconstructive surgery; 12 patients had a good outcome; 2 patients underwent amputation, and 4 patients had unsuccessful surgeries. Conclusion: Charcot arthropathy of the ankle causes considerable instability. Conservative treatment of the disease fails to provide good outcomes, and the patients who underwent reconstructive surgery had the best functional and clinical evaluations.

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Unilateral lytic changes over the weight-bearing joint causing severe destruction of ankle joint (atypical Charcot joint) in a girl with congenital insensitivity to pain without anhidrosis (hereditary sensory and autonomic neuropathy type V): Case report and literature review

Pediatric Traumatology Orthopaedics and Reconstructive Surgery ◽

10.17816/ptors7181-86 ◽

2019 ◽

Vol 7 (1) ◽

pp. 81-86

Author(s):

Ali Al Kaissi ◽

Franz Grill ◽

Rudolf Ganger

Keyword(s):

Ankle Joint ◽

Autonomic Neuropathy ◽

Treatment Plan ◽

Joint Destruction ◽

Autonomic Nerve ◽

Congenital Insensitivity ◽

Joint Dislocations ◽

Tarsal Bones ◽

Congenital Insensitivity To Pain ◽

Insensitivity To Pain

Background. The presence of Charcot arthropathies, joint dislocations, infections and fractures in a child without evidence of neurological abnormality should give rise to a suspicion of congenital insensitivity to pain (hereditary sensory and autonomic neuropathy). Hereditary sensory and autonomic neuropathy (HSAN) is a rare syndrome characterized by congenital insensitivity to pain, temperature changes and by autonomic nerve formation disorders. HSAN is classified into five types: sensory radicular neuropathy (HSAN I), congenital sensory neuropathy (HSAN II), familial dysautonomia or Riley Day Syndrome (HSAN III), congenital insensitivity to pain with anhidrosis (HSAN IV) and congenital indifference to pain (HSAN V). Case presentation. A 13-year old girl first product of a non-consanguineous marriage, presented with malunion of successive fractures or Charcots ankle joint destruction on top of significant lytic changes/osteonecrosis. The patient had sustained many painless injuries resulting in fractures with subsequent disfiguremnt of her ankle joint. Arthropathy of the knees, ankles, tarsal bones and feet without pain associated with obvious changes in the shape of the ankle joint were present. Despite a normal sense of touch in our patient the indifference to pain made her extremely susceptible to breakdown of the skin over the ankle osseous prominences. Conclusion. Generally speaking, the orthopaedic management of such patients is extremely difficult since these patients do not restrict the movements of the involved extremity as they lack the inhibitory pain reflex. Interestingly, our attempts for surgical stabilisation of the ankle joints were succsessfull and eventually the girl became able to walk. It is important to anticipate patient and parent education in joint protection and surveillance for injury as the most important component of the treatment plan for these children. We might postulate that the degree of osteolysis of the ankle joint in our present child might be a form of secondary osteolysis.

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Hemosiderin deposition evaluation in hemophilic ankle joints: association between US finding and gradient-recalled echo MR imaging sequence

Insights into Imaging ◽

10.1186/s13244-021-01050-1 ◽

2021 ◽

Vol 12 (1) ◽

Author(s):

Marcel Prasetyo ◽

Ariel Elisa Mongan ◽

Novie Amelia Chozie ◽

Joedo Prihartono ◽

Stefanus Imanuel Setiawan

Keyword(s):

Mr Imaging ◽

Ankle Joint ◽

Predictive Value ◽

Joint Destruction ◽

Weak Association ◽

Hemophilic Arthropathy ◽

Array Transducer ◽

Imaging Sequence ◽

Hemosiderin Deposition ◽

Ankle Joints

Abstract Background Repeated bleeding in hemophilic arthropathy (HA) may result in severe degenerative changes and joint destruction. The gradient-recalled echo (GRE) sequence MR is proved to be the best method to detect hemosiderin deposition. However, MR is not widely available in developing countries, including Indonesia. Some studies have proposed ultrasonography (US) as an alternative tool in evaluating hemophilic joint. However, there is still some disagreement on the ability of US to detect hemosiderin deposition. Objective To evaluate the association between US and GRE-sequence MR imaging in detecting hemosiderin deposition in hemophilic ankle joint. Material and methods A total of 102 sites from 17 ankle joints of 11 boys with severe hemophilia A underwent US examination using a high-frequency linear array transducer. GRE-sequence MR examination was performed in sagittal view consistent with the sites scanned by US. Both examinations were performed on the same day, but MR interpretation was performed blindly at different times. The association between US and GRE-sequences in detecting hemosiderin deposition was analyzed using McNemar’s test. Results Statistical analysis showed a significant association (p value < 0.001) between US and GRE MR in detecting hemosiderin deposition, but the association is weak (R = 0.26). Sensitivity and specificity of US for detecting hemosiderin deposition were 46.84% (95%CI: 35.51–58.40) and 95.65% (95%CI: 78.05–99.89), respectively, with positive predictive value 97.37% (95%CI: 84.29–99.61), negative predictive value 34.38% (95%CI: 29.50–39.60) and accuracy 57.84% (95%CI: 47.66–67.56). Conclusion There was a weak association between US and GRE-sequences in detecting hemosiderin deposition of hemophilic ankle joint.

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Single Hemicerclage for Lateral Type B Malleolar Fracture - A Novel, Minimal and Reliable Osteosynthesis

Swiss Surgery ◽

10.1024/1023-9332.9.6.283 ◽

2003 ◽

Vol 9 (6) ◽

pp. 283-288

Author(s):

Maurer ◽

Stamenic ◽

Stouthandel ◽

Ackermann ◽

Gonzenbach

Keyword(s):

Ankle Joint ◽

Weight Bearing ◽

Fracture Type ◽

Type B ◽

Malleolar Fracture ◽

Metallic Wire ◽

Long Term Outcome ◽

X Ray ◽

Upper Ankle Joint ◽

Upper Ankle

Aim of study: To investigate the short- and long-term outcome of patients with isolated lateral malleolar fracture type B treated with a single hemicerclage out of metallic wire or PDS cord. Methods: Over an 8-year period 97 patients were treated with a single hemicerclage for lateral malleolar fracture type B and 89 were amenable to a follow-up after mean 39 months, including interview, clinical examination and X-ray controls. Results: The median operation time was 35 minutes (range 15-85 min). X-ray controls within the first two postoperative days revealed an anatomical restoration of the upper ankle joint in all but one patient. The complication rate was 8%: hematoma (2 patients), wound infection (2), Sudeck's dystrophy (2) and deep vein thrombosis (1). Full weight-bearing was tolerated at median 6.0 weeks (range 2-26 weeks). No secondary displacement, delayed union or consecutive arthrosis of the upper ankle joint was observed. All but one patient had restored symmetric joint mobility. Ninety-seven percent of patients were satisfied or very satisfied with the outcome. Following bone healing, hemicerclage removal was necessary in 19% of osteosyntheses with metallic wire and in none with PDS cord. Conclusion: The single hemicerclage is a novel, simple and reliable osteosynthesis technique for isolated lateral type B malleolar fractures and may be considered as an alternative to the osteosynthesis procedures currently in use.

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