Successful treatment of nonunion with an Ilizarov ring fixator after ankle fracture for Charcot arthropathy: a case report

BMC Research Notes

Ikuko Wakabayashi²  Tsutomu Sakuraba²  Takeshi Kashiwagura²  Shin Yamada¹  Yoshiaki Kimura²  Yoichi Shimada¹  Koji Nozaka¹ 

[1] Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan;Department of Orthopedic Surgery, Akita City Hospital, 4-30 kawamoto matsuokacho, Akita 010-0933, Japan

关键词: Diabetes;    Nonunion;    Charcot arthropathy;    Ankle fracture;    Ilizarov ring fixator;   

Others  :  1131701
DOI  :  10.1186/1756-0500-7-503

 received in 2014-05-12, accepted in 2014-07-29,  发布年份 2014

【 摘 要 】

Background

Ankle fractures in patients with diabetes mellitus have long been recognized as a challenge to orthopedic surgeons. Nonunion and lengthy wound healing in high-risk patients with diabetes, particularly patients with peripheral arterial disease and renal failure, occur secondary to several clinical conditions and are often fraught with complications. Whether diabetic ankle fractures are best treated noninvasively or surgically is controversial.

Case presentation

A 53-year-old Japanese man fractured his right ankle. The fractured ankle was treated nonsurgically with a plaster cast. Although he remained non-weight-bearing for 3 months, radiography at 3 months showed nonunion. The nonunion was treated by Ilizarov external fixation of the ankle. The external fixator was removed 99 days postoperatively, at which time the patient exhibited anatomical and functional recovery and was able to walk without severe complications.

Conclusion

In patients with diabetes mellitus, severe nonunion of ankle fractures with Charcot arthropathy in which the fracture fragment diameter is very small and the use of internal fixation is difficult is a clinical challenge. Ilizarov external fixation allows suitable fixation to be achieved using multiple Ilizarov wires.

【 授权许可】

   
2014 Nozaka et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

【 参考文献 】

• [1]Ayoub MA: Ankle fractures in diabetic neuropathic arthropathy: can tibiotalar arthrodesis salvage the limb? J Bone Joint Surg Br 2008, 90(7):906-914.
• [2]Chaudhary SB, Liporace FA, Gandhi A, Donley BG, Pinzur MS, Lin SS: Complications of ankle fracture in patients with diabetes. J Am Acad Orthop Surg 2008, 16(3):159-170.
• [3]Wukich DK, Joseph A, Ryan M, Ramirez C, Irrgang JJ: Outcomes of ankle fractures in patients with uncomplicated versus complicated diabetes. Foot Ankle Int 2011, 32(2):120-130.
• [4]Matsushita T, Watanabe Y: Chipping and lengthening technique for delayed unions and nonunions with shortening or bone loss. J Orthop Trauma 2007, 21(6):404-406.
• [5]Holmes GB Jr, Hill N: Fractures and dislocations of the foot and ankle in diabetics associated with Charcot joint changes. Foot Ankle Int 1994, 15(4):182-185.
• [6]McCormack RG, Leith JM: Ankle fractures in diabetics: Complications of surgical management. J Bone Joint Surg Br 1998, 80(4):689-692.
• [7]Crist BD, Khazzam M, Murtha YM, Della Rocca GJ: Pilon fractures: advances in surgical management. J Am Acad Orthop Surg 2011, 19(10):612-622.
• [8]Calleja-Agius J, Muscat-Baron Y, Brincat MP: Skin ageing. Menopause Int 2007, 13(2):60-64.
• [9]Bacon S, Smith WR, Morgan SJ, Hasenboehler E, Philips G, Williams A, Ziran BH, Stahel PF: A retrospective analysis of comminuted intra-articular fractures of the tibial plafond: Open reduction and internal fixation versus external Ilizarov fixation. Injury 2011, 39(2):196-202.
• [10]Gordon JE, Kelly-Hahn J, Carpenter CJ, Schoenecker PL: Pin site care during external fixation in children: results of a nihilistic approach. J Pediatr Orthop 2000, 20(2):163-165.
• [11]Lovisetti G, Agus MA, Pace F, Capitani D, Sala F: Management of distal tibial intra-articular fractures with circular external fixation. Strategies Trauma Limb Reconstr 2009, 4(1):1-6.
• [12]Wyrsch B, McFerran MA, McAndrew M, Limbird TJ, Harper MC, Johnson KD, Schwartz HS: Operative treatment of fractures of the tibial plafond. A randomized prospective study. J Bone Joint Surg Am 1996, 78(11):1646-1657.
• [13]Tornetta P 3rd, Weinwer L, Bergman M, Watnik N, Steuer J, Kelley M, Yang E: Pilon fractures: treatment with combined internal and external fixation. J Orthop Trauma 1993, 7(6):489-496.
• [14]El-Sayed M, Atef A: Management of simple (types A and B) closed tibial shaft fractures using percutaneous lag-screw fixation and Ilizarov external fixation in adults. Int Orthop 2012, 36(10):2133-2138.