4th annual international external fixation symposium...

Charles M Zelen, DPM FACFAS FACFAOMClinical Assistant Professor Department of Medicine; University of Virginia

Podiatry Section Chief; Department of Orthopedics, Lewis Gale HospitalPodiatry Section Chief; Department of Surgery, Roanoke Memorial

President; Virginia Podiatric Medical Association

4th Annual International External Fixation Symposium

December 11-14, 2008

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Literature ReviewLiterature ReviewRisks of Charcot SurgeryRisks of Charcot Surgery

2 of 5 ankle fusions successful (40%)2 of 5 ankle fusions successful (40%)2 of 5 ankle fusions successful (40%). 2 of 5 ankle fusions successful (40%). –– Samilson, R., Sankaras, B., Bersani, F., & Smith, A. Samilson, R., Sankaras, B., Bersani, F., & Smith, A.

Orthopedic management of neuropathic joints. Arch. Orthopedic management of neuropathic joints. Arch. Surg., 78:115, 1959.Surg., 78:115, 1959.

38% of patients with neuropathic arthropathy 38% of patients with neuropathic arthropathy received a satisfactory ankle fusion. received a satisfactory ankle fusion. yy–– Stuart, M., and Morey, B. Clin. Ortho., 253:209Stuart, M., and Morey, B. Clin. Ortho., 253:209--211, 211,

1990.1990.



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Literature ReviewLiterature ReviewRisks of Charcot SurgeryRisks of Charcot Surgery

Ni d th i 29 ti t fNi d th i 29 ti t fNine pseudoarthroses in 29 patients for Nine pseudoarthroses in 29 patients for arthrodesis of Charcot (31% Non Union Rate)arthrodesis of Charcot (31% Non Union Rate)–– Papa, J., Myerson, M., & Girard, Pierre. Salvage, with Papa, J., Myerson, M., & Girard, Pierre. Salvage, with

Arthrodesis, in Intractable Diabetic Neuropathic Arthrodesis, in Intractable Diabetic Neuropathic Arthropathy of the Foot and Ankle. J. Bone and Joint Arthropathy of the Foot and Ankle. J. Bone and Joint Surgery. Vol 75Surgery. Vol 75--A, No.7, July 1993.A, No.7, July 1993.



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Charcot’s ArthropathyCharcot’s Arthropathy



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ComplicationsComplicationsofof

Diabetic/NeuropathicDiabetic/NeuropathicReconstructionsReconstructions

NonNon--Union / MalunionUnion / Malunion–– AVNAVN–– Failure of Internal Failure of Internal –– External FixationExternal Fixation

InfectionInfection–– Soft TissueSoft TissueSo t ssueSo t ssue–– OsteomyelitisOsteomyelitis

Wound ComplicationsWound Complications



Wound Complications Wound Complications –– TreatmentTreatment–– Use of the reconstructive Step LadderUse of the reconstructive Step Ladder

1) Local Wound Care1) Local Wound Care2) Negative Pressure Wound Management2) Negative Pressure Wound Management3) Skin Grafting3) Skin Grafting4) Local / Random Flaps4) Local / Random Flaps4) Local / Random Flaps4) Local / Random Flaps5) Intrinsic Muscle Pedicle Flaps5) Intrinsic Muscle Pedicle Flaps



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1) Local Wound Care1) Local Wound Care




2) Negative Pressure Wound Management2) Negative Pressure Wound Management



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3) Skin Grafting3) Skin Grafting




4) Local / Random Flaps4) Local / Random Flaps



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5) Intrinsic Muscle Pedicle Flaps5) Intrinsic Muscle Pedicle Flaps



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FailureFailureOfOfOfOf

Charcot Charcot PlantarPlantarPlantar Plantar PlaningPlaning



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CharcotCharcotFailureFailureFailureFailure

Of Internal Of Internal FixationFixationFixationFixation



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CMT CMT -- NeuropathyNeuropathyF ilF ilFailureFailure

Of Ankle ImplantOf Ankle Implant



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ConclusionsConclusions

ConclusionsConclusions



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4th annual international external fixation symposium...

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