Zacharia Facaros

An overview of conservative treatment options for diabetic Charcot foot neuroarthropathy.

Conservative management of Charcot foot neuroarthropathy remains efficacious for certain clinical scenarios. Treatment of the patient should take into account the stage of the Charcot neuroarthopathy, site(s) of involvement, presence or absence of ulceration, presence or absence of infection, overall medical status, and level of compliance. The authors present an overview of evidence-based non-operative treatment for diabetic Charcot neuroarthropathy with an emphasis on the most recent developments in therapy.

External Fixation for Surgical Off-Loading of Diabetic Soft Tissue Reconstruction

Early and aggressive treatment of diabetic foot wounds is imperative for the reduction of amputation risk. Whereas sound local wound care is important for successful management; chronic wounds often reach a stagnant point in healing because of diabetic vasculopathy, immunopathy, or neuropathy. The type, size, shape, and location of wound may not always allow primary closure or grafting. In patients with adequate perfusion and in the absence of infection, local advancement flaps are suitable for durable closure. A review and case report demonstrating the use of these flaps with external fixation as an adjunctive therapy for surgical off-loading is presented.

Combined Circular External Fixation and Open Reduction Internal Fixation with Pro-syndesmotic Screws for Repair of a Diabetic Ankle Fracture.

The surgical management of ankle fractures among the diabetic population is associated with higher complication rates compared to the general population. Efforts toward development of better methods in prevention and treatment are continuously evolving for these injuries. The presence of peripheral neuropathy and the possible development of Charcot neuroarthropathy in this high risk patient population have stimulated much surgical interest to create more stable osseous constructs when open reduction of an ankle fracture/dislocation is required. The utilization of multiple syndesmotic screws (pro-syndesmotic screws) to further stabilize the ankle mortise has been reported by many foot and ankle surgeons. In addition, transarticular Steinmann pins have been described as an adjunct to traditional open reduction with internal fixation (ORIF) of the ankle to better stabilize the talus, thus minimizing risk of further displacement, malunion, and Charcot neuroarthropathy. The authors present a unique technique of ORIF with pro-syndesmotic screws and the application of a multi-plane circular external fixator for management of a neglected diabetic ankle fracture that prevented further deformity while allowing a weight-bearing status. This techniqu may be utilized for the management of complex diabetic ankle fractures that are prone to future complications and possible limb loss.

An overview of bone grafting techniques for the diabetic Charcot foot and ankle.

Surgical options for diabetic Charcot neuroarthropathy of the foot and ankle must take into consideration the challenging environment for bone healing that accompanies these complex pathologic conditions. Bone grafting has established an important role in reconstructive surgery to promote bone formation, replacement, and repair. This article provides an overview of available bone grafting methods in conjunction with a review of the literature on these techniques as they pertain to diabetic Charcot foot and ankle reconstruction.

Primary Subtalar Joint Arthrodesis with Internal and External Fixation for the Repair of a Diabetic Comminuted Calcaneal Fracture

Comminuted, intra-articular calcaneal fractures can cause severe lower extremity impairment and have devastating effects on a patients well being. Diabetes is a multisystem process that may cause neuropathy and loss of protective sensation further complicating the prognosis. Not all calcaneal fractures are created equal and when considering the patients overall presentation and extent of injury, the combined approach of internal and external fixation for fracture reduction may be beneficial for restoration of anatomic alignment and function.

Abductor hallucis muscle flap with circular external fixation for Charcot foot osteomyelitis: A case report

Complicated soft tissue defects of the diabetic foot often call for alternative methods to traditional primary closure. Despite the popularity of microvascular free flaps, local muscle flaps can offer reliable reconstruction for these challenging wounds with shorter surgical times and reduced complication rates. In this article, the authors describe the successful use of the abductor hallucis muscle flap and external fixation for soft tissue reconstruction of a chronic Charcot foot wound and osteomyelitis in a diabetic patient.