Charcot Ankle Treatment with Ilizarov versus Intramedullary Nail Systematic Review and Metaanalysis

Abstract

Abstract Background Charcot neuropathic osteoarthropathy or neuroarthropathy (CNO) of the foot and ankle constitutes a great clinical challenge for a poorly understood destructive process. The CNO is due to sensory and motor neuropathies which lead to a chronic and progressive destruction of the foot architecture involving bones, joints, and soft tissues. Secondary fractures and dislocations predispose to deformity and ulceration with a great decrease of the gait-related quality of life and an increasing potential for major amputation. Objective The aims of the arthrodesis reconstructive procedure are realignment and stabilization of the severely deformed ankle in order to avoid ulcers and amputation. Retrograde intramedullary nails (IMN) and ilizarov. are two of the most common fixation techniques used for arthrodesis in CNO. Materials and Methods This review seeks to collate evidence from comparative studies to look for significant differences in terms of fusion rate, salvage rate, and complications following ilizarov. and IMN techniques for tibiotalo-calcaneal arthrodesis. Recent clinical trials or cluster trials, prospective and retrospective comparative cohort studies. Search results will be uploaded to systematic review management software and manually screened for eligibility to be included. PRISMA flowchart will be introduced on the search results and the inclusion/exclusion criteria. Results As regard the American Academy of Orthopedic Surgeons Foot and Ankle score (AAOS- FAO), comparison between the two treatment groups was statistically insignificant preoperatively and postoperatively. Intergroup study, Ilizarov and IMN showed statistically highly significant difference between preoperative and postoperative scores (p < 0.01). Conclusion Charcot arthropathy of the foot and ankle is a difficult problem that significantly affects the diabetic population. Operative correction of Charcot deformity involving the ankle joint was associated with a high complication rate and risk for failure. The lessons learned from this highly comorbid patient population with complex deformities can be used as a benchmark for applying modern surgical techniques. Use of a retrograde intramedullary nail or ring fixator resulted in high rates of successful limb salvage when used for ankle arthrodesis in patients with Charcot arthropathy. In conclusion, retrograde IMN and the Ilizarov external fixator both yielded better union for tibiotalar arthrodesis in Charcot neuroarthropathy. Comparison between Ilizarov and IMN showed statistically non-significant difference regarding union. Also, Comparison showed that Ilizarov technique had higher rate of complications than IMN, However, the need for revision surgery was more frequent in the retrograde nail group compared to the ring fixator group. The added stability offered by external fixation may benefit patients who are at high risk for complications or require extended arthrodesis.