A retrospective comparative analysis of Charcot ankle stabilization using an intramedullary rod with or without application of circular external fixator--utilization of the Retrograde Arthrodesis Intramedullary Nail database.

Brodsky type 3a Charcot destruction of the ankle is devastating to patients. The authors have surgically stabilized this deformity with the use of an intramedullary arthrodesis nail, and explore the usefulness of adjunctive application of a circular external fixator. Fifty-two patients were treated with retrograde intramedullary nail with and without circular external fixation. A comprehensive chart and radiographic review were pulled from the Retrograde Arthrodesis Intramedullary Nail database. Of these, 45 patients were treated with a nail alone (Nail group), and 7 were treated with a nail and circular external fixation augmentation (ExFix group). The primary end point was major amputation or braceable limb. The average age was 59.4 and 51.6 years in the Nail and ExFix groups, respectively (p = .0068). Chronic steroid use was statistically significantly different and was found in 3 (6.7%) and 4 (57.1%) patients in the Nail and ExFix groups, respectively (p = .0039). The rate of major amputation was 10/45 (22.2%) and 2/7 (28.6%) in the Nail and ExFix groups, respectively (p = .656), with an overall salvage rate of 40/52 limbs (75.6%). The addition of circular external fixation does not affect the overall salvage or complication rate. The authors feel that the added stability offered by external fixation may benefit patients who are at high risk for complications or require extended arthrodesis, but this was unable to be demonstrated statistically in this study. Patients with this difficult pathology can be successfully salvaged, but there is a high risk of complications.