Yammine Kaissar, Samaha Camille, Assi Chahine
Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, School of Medicine, Beirut, Lebanon.
Diabetic Foot Clinic, Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon.
Foot Ankle Orthop. 2025 Feb 5;10(1):24730114251315672. doi: 10.1177/24730114251315672. eCollection 2025 Jan.
The tibiotalocalcaneal (TTC) arthrodesis using an intramedullary nail (IMN) is a common method used to treat advanced diabetic ankle/hindfoot Charcot deformity. The talus is usually resected when severe loss of its body is present and the medial malleolar cartilage excised. We report our initial results with talar retention and absence of medial ankle gutter cartilage debridement.
Four patients with type 2/3A Brodsky classification and stage 2/3 as Eichenholtz classification, presenting with a hindfoot varus deformity were treated with TTC using IMN. The talus was retained after excision of its proximal and distal cartilages while the medial malleolus cartilage was not touched. Bone union was the primary outcome. The minimum follow-up period was 12 months.
Bone union was achieved radiologically in all 4 cases within 6 months. No signs of postoperative infection was noted. The mean limb length difference between the pre- and postoperative values was 0.5 ± 0.2 cm. At the final follow-up, all patients were able to walk pain-free with full weightbearing. All 4 patients were very satisfied at 12 months with a mean American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score of 87 ± 3.1.
When performing TTC arthrodesis for diabetic Charcot, preserving the talus even when the body is severely damaged could add to the stability of the construct resulting in bone healing and some leg length preservation. Including the medial malleolus in the fusion surgery might not be necessary.
Level IV, case series.
使用髓内钉（IMN）进行胫距跟（TTC）关节融合术是治疗晚期糖尿病性踝/后足夏科氏畸形的常用方法。当距骨体严重缺失时通常会切除距骨，并切除内踝软骨。我们报告了保留距骨且不进行内踝沟软骨清创术的初步结果。
对4例2/3A Brodsky分级和2/3期Eichenholtz分级、表现为后足内翻畸形的患者采用IMN进行TTC治疗。切除距骨近端和远端软骨后保留距骨，同时不触及内踝软骨。骨愈合是主要观察指标。最短随访期为12个月。
所有4例患者均在6个月内实现影像学骨愈合。未观察到术后感染迹象。术前和术后肢体长度的平均差值为0.5±0.2厘米。在最后一次随访时，所有患者均能在完全负重的情况下无痛行走。所有4例患者在12个月时均非常满意，美国矫形足踝协会（AOFAS）踝后足平均评分为87±3.1。
在对糖尿病性夏科氏病进行TTC关节融合术时，即使距骨体严重受损仍保留距骨，可增加结构的稳定性，从而实现骨愈合并保留一定的下肢长度。融合手术中可能无需纳入内踝。
IV级，病例系列。
