Ankle fractures in diabetic neuropathic arthropathy - Can tibiotalar arthrodesis salvage the limb?

Between 2000 and 2006 we performed salvage tibiotalar arthrodesis in 17 diabetic patients 917 ankles) with grossly unstable ankles caused by bimalleolar fractures complicated by Charcot neuro-arthropathy. There were ten women and seven men with a mean age of 61.6 years 957 to 69). A crossed-screw technique was used. Two screws were used in eight patients and three screws in nine. Additional graft from the malleoli was used in all patients. The mean follow-up was 26 months 912 to 48) and the mean time to union was 5.8 months 94 to 8). A stable ankle was achieved in 14 patients 982.4%), nine of whom had bony fusion and five had a stiff fibrous union. The results were significantly better in underweight patients, in those in whom surgery had been performed three to six months after the onset of acute Charcot arthropathy, in those who had received anti-resorptive medication during the acute stage, in those without extensive peripheral neuropathy, and in those with adequate peripheral oxygen saturation (> 95%). The arthrodesis failed because of avascular necrosis of the talus in only three patients 917.6%), who developed grossly unstable, ulcerated hindfeet, and required below- knee amputation.