Bone Defect Replacement in Diabetic Neuropathic Osteoarthropathy (Charcot Foot): Review

Background. The number of patients with diabetes mellitus, including those with its severe complications such as Charcot neuropathic osteoarthropathy, is increasing worldwide. Restoration of weight bearing ability and creation of conditions for ulcer healing is challenging for trauma and orthopedic surgeons, especially because of the need to restore bone tissue defects. Aim of the review — to compare modern methods of replacement of large bone tissue defects of the distal segment of the lower limb in patients with Charcot neuropathic osteoarthropathy. Methods. The articles were searched in PubMed/MEDLINE, Google Scholar, Scopus, eLIBRARY, CyberLeninka databases. The search was performed using the following keywords and word combinations: Charcot foot, diabetic neuropathic osteoarthropathy and bone grafting. Full-text articles in Russian and English were selected. The search was carried out without chronological limitations due to the small number of published studies and specific subject of research. Results. The possibilities of bone defect replacement in Charcot foot are poorly described in the world literature. The narrow specificity and relative infrequency of this pathology is the probable reason for the small number of publications and the lack of studies with a high level of evidence. Conclusion. Bone autografting for lesions of the medial or lateral midfoot column and Ilizarov tibial lengthening to compensate for limb shortening after reconstructive surgeries at the level of the hindfoot and ankle joint are the most commonly used methods of bone defect replacement in patients with Charcot foot. Free bone autografting (possibly with demineralized bone matrix) is the method of choice for small defects of the lateral or medial column of the midfoot

Indications for various options of foot deformities orthopedic correction in diabetic neuroosteoarthropathy

Diabetic osteoarthropathy is one of the most difficult complication of diabetes mellitus, requiring the cooperation of a many of specialitys, including traumatologists - orthopedists. However, there is no single approach to the choice of orthopedic treatment tactics for this group of patients. From 2015 to 2018 inclusive, there were 35 patients with diabetic osteoarthropathy that received conservative or surgical orthopedic treatment. 11 patients received conservative orthopedic treatment; 24 patients received surgical treatment. A total of 26 surgical interventions were performed. Two types of surgical interventions were performed: 1) resection of the protruding fragment of one or another bone of the tarsus - 12 operations 2) reconstructive surgery aimed at correcting gross deformation of the middle and / or hindfoot - 14 operations. Along with general clinical examination, all patients underwent orthopedic examination, determining the degree of blood supply disturbance. A differentiated approach to choosing the method of orthopedic treatment of the presented group of patients allowed to restore limb supportability, ensure stability in the ankle joint and joints of the middle foot, create conditions for healing and prevention of relapse of the ulcer. The experience gained allowed us to offer indications for a particular method of orthopedic treatment of foot deformities in diabetic osteoarthropathy, depending on the stage of the pathological process, its location, the severity of the deformation, and the clinical course of this pathology