Case Study

Integra® External Fixation System

Charcot Reconstruction with External Fixation

Patient Profile/HistoryThis patient is a 53 year old type II diabetic who presented to the office with an acute Charcot flair to the left lower extremity. She reported a red and swollen foot for two months prior to presenting to the office which had been treated at multiple emergency departments for cellulitis. Her symptoms did not improve with oral antibiotics and had been weight bearing in sneaker. Upon initial office visit, patient had no open wounds. Her HgA1C was 11.0. Patient was made non-weight-bearing with serial casting for 9 weeks prior to progression to weight-bearing in boot walker. Five months from initial office visit, the patient was progressed to ankle foot orthotics. She did not tolerate bracing due to severe deformity through midfoot and bony medial prominence. Patient’s foot was deemed unbracable due to severe deformity. Charcot flair at point of surgical consent was chronic in nature. Patient was able to decrease HgA1C to 7.6 prior to surgery.

First ProcedurePatient underwent subtalar, talonavicular and midfoot fusion with medial plating and compression screws. An Integra 160mm ringed external fixator was applied to the operative limb for stabilization. The ring construct consisted of two 160 mm tibial rings fixated to the tibia with a combination of 5.0 half pins, smooth and olive wires. The external fixation foot plate was placed to allow weight-bearing.

Second Procedure8 weeks after initial surgery patient underwent CT assessment confirming bony fusion of both midfoot and rearfoot. Patient had external fixator removed and was casted for a total of 3 additional weeks prior to progression to weight bearing in boot walker.

Physician ConclusionThe patient achieved radiographic arthrodesis. Post-surgical CT showed near complete fusion of intended arthrodesis sites. Use of Integra external fixator allowed early weight bearing. Use of Integra external fixator synergistically, with internal fixation, aids in bone healing optimizing deformity correction. The ultimate outcome of charcot reconstruction is restitution of medial arch and bracable foot.

Physician ProfileElizabeth Hewitt, DPM, FACFAS

Foot and Ankle Physicians of Ohio

Board CertificationAmerican Board of Foot and Ankle Surgery -

Foot Surgery

American Board of Foot and Ankle Surgery - Reconstructive Rearfoot Ankle Surgery

Education and TrainingMedical School:

Kent State College of Podiatric MedicineCleveland, Ohio

Fellowship:Fellowship Instituto De Humanities

Milan, Italy

Integra®

External Fixation System

USA 800-654-2873 n 888-980-7742 faxInternational +1 609-936-5400 n +1 609-750-4259 faxintegralife.com

United States, Canada, Asia, Pacific, Latin America

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Figure 1. Radiographic pre-op Figure 2. Clinical presentation of immediate post-op

Figure 4. Immediate postoperative radiographs Figure 5. Radiographs at 8 weeks post-op

Figure 3. 8 weeks post-op photos

Figure 6. CT scans at 8 weeks post-op