Novosti
Khirurgii

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Year 2017 Vol. 25 No 5

EXCHANGE OF EXPERIENCE

А.А. DMITRIENKO 1, V.V.ANICHKIN 2, А.А. TRETYAKOV 2, M.F.KUREK 2, А.Y. MAKANIN 1

SURGICAL CORRECTION OF FOOT DEFORMITY IN CHARCOT OSTEOARTHROPATHY

SME “Gomel City Clinical Hospital №3” 1,
EE “Gomel State Medical University” 2, Gomel
THE Republic of Belarus

Objectives. To analyze the first experience of the reconstructive surgery in patients with Charcot joint.
Methods. Treatment results of 4 patients with Charcot joint (diabetic neurogenic arthropathy) who were performed the reconstructive surgery aimed to correct osteoarticular foot deformities. Charcot joint diagnostics was based on the results of clinical and radiological studies (direct radiography, computed tomography). In the treatment of patients, the technique of arthrodesis of the destructed foot joints was used with the stabilization of by the external fixators or using the techniques of focal (osteal and transosseous) osteosynthesis (internal fracture fixation).
Results. It is established that when the destruction is located in the ankle joint area, the method of choice of the surgical correction of the foot deformation in the acute phase of diabetic neurogenic arthropathy is arthrodesis of the joint with the external fixation with the compression-distraction apparatus; in the chronic phase of neurogenic arthropathy – arthrodesis of the joint using internal fracture fixation with a metal plate with angular stability of screws. When the destruction zone is located in the middle part of the foot in the chronic phase of the disease, the method of choice of the surgical correction is arthrodesis of the tarsal joints with the internal fixation with the metal wires. In all 4 patients, the performed surgical interventions resulted in the improvement of the anatomical and functional characteristics of the foot and there was no need to use complex orthopedic footwear while resting on the limb and walking, and one managed to avoid recurrences of trophic ulcers on the foot during the entire period of the postoperative follow-up.
Conclusions. The issue of using various methods of orthopedic correction of the foot deformity is relevant in the surgery of the diabetic foot syndrome (DFS) and should be considered individually, taking into account such factors as: the stage of the disease, localization and prevalence of the bone-joint destruction zone, the severity of foot deformity, the presence of foci of purulent inflammation and trophic ulcers as well as the patient’s somatic status.

Keywords: diabetic foot syndrome, Charcot joint, neurogenic arthropathy, foot deformity, arthrodesis of the joints, foot trophic ulcer
p. 535-542 of the original issue
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Address for correspondence:
246013, Republic of Belarus,
Gomel, Ilicha str., 286,
SME “Gomel City Clinical Hospital №3”,
Surgical Unit №3,
tel. 375 44 780-19-50,
e-mail: dmitrienko-83@mail.ru,
Anatoly A. Dmitrienko
Information about the authors:
Dmitrienko A.A. Deputy Chief Physician on Medical Affairs, SME ‘’Gomel City Clinical Hospital N3’’.
Anichkin V.V. MD, Professor of Department of Surgical Diseases N3, EE ‘’Gomel State Medical University’’.
Tretyakov A.A. Assistant of Department of Traumatology, Orthopedics, Military Field Surgery, EE ‘’Gomel State Medical University’’.
Kurek M.F. PhD, Ass. Professor of Department of Surgical Diseases N1, EE ‘’Gomel State Medical University’’.
Makanin A.Y. Head of Surgical Unit N3, SME ‘’Gomel City Clinical Hospital N3’’.
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