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  1. 1. ANNUAL INTERNATIONAL EXTERNAL FIXATION5th SYMPOSIUM December 2009, SAN ANTONIO, TX EUROPEAN INSIGHTS IN NEUROPATHIC FOOT AND ANKLE INJURIES Tahir Ögüt, MD Istanbul University Cerrahpasa Medical Faculty Department of Orthopaedics & TraumatologyTahir OGUT Istanbul, TURKEY
  2. 2. SOME FACTS ABOUT DIABETIC FRACTURES •Diabetes impairs bone healing •Time to union in diabetic pts is 163% that of nondiabetics •Neuropathic fx requires at least 3 additional months than controls Loder RT, Clin Orthop 1988. Boddenberg U. Zentralbl Chir 2004.Tahir OGUT Istanbul, TURKEY
  3. 3. All diabetic foot & ankle fracture patients need to be informed of potential increased complications: •Wound healing problems •Deep infection •Delayed/nonunion Charcot neuroarthropathy and peripheral vascular disease play distinct roles in increasing these complication rates.Tahir OGUT Istanbul, TURKEY
  4. 4. NONOPERATIVE TREATMENT Immobilization and non-weight bearing are done for durations of two to three times that of nondiabetic patients in an effort to avoid malunion and Charcot arthropathy. Charcot arthropathy can develop as a posttraumatic eventTahir OGUT Istanbul, TURKEY
  5. 5. NONOPERATIVE TREATMENT Closed treatment does not bar a patient from the risk of infection •Noncompliance with diabetes treatment Increases the •Peripheral vascular disease risk •Peripheral neuropathy for infection •Swelling in the •Ecchymosis diabetic populationTahir OGUT Istanbul, TURKEY
  6. 6. OPERATIVE FIXATION In a review of 67 pts with ankle fractures (21 with diabetes), the complication rate among the diabetics was 43% compared with 15.5% in the nondiabetic group. Complications in the diabetics included: •5 deep infections •3 losses of fixation •2 below knee amputations Blotter et al. Foot Ankle Int, 1999.Tahir OGUT Istanbul, TURKEY
  7. 7. OPERATIVE FIXATION Another review of 26 diabetic and 26 nondiabetic patients with ankle fractures had 42% versus 0% complication rates, respectively. McCormack & Leith. J Bone Joint Surg Br, 1998.Tahir OGUT Istanbul, TURKEY
  8. 8. Respect for soft tissue management and attention to stable, rigid fixation with prolonged immobilization and prolonged restricted weight bearing are essential for successful treatmentTahir OGUT Istanbul, TURKEY
  9. 9. Case Y.K., 50y, M 4 months old fractureTahir OGUT Istanbul, TURKEY
  10. 10. Postop 3. monthTahir OGUT Istanbul, TURKEY
  11. 11. CASE N.D.,78y, F 6 months after the first cast applicationTahir OGUT Istanbul, TURKEY
  12. 12. 10 days after removal of the first castTahir OGUT Istanbul, TURKEY
  13. 13. Second cast application at the same centerTahir OGUT Istanbul, TURKEY
  14. 14. She has been operated by us 3 months postoperativelyTahir OGUT Istanbul, TURKEY
  15. 15. Postop 1. monthTahir OGUT Istanbul, TURKEY
  16. 16. Postop 9. monthTahir OGUT Istanbul, TURKEY
  17. 17. Tahir OGUT Istanbul, TURKEY
  18. 18. CASE H.G., 26y, FTahir OGUT Istanbul, TURKEY
  19. 19. Tahir OGUT Istanbul, TURKEY
  20. 20. Postop 3. monthTahir OGUT Istanbul, TURKEY
  21. 21. Postop 6. monthTahir OGUT Istanbul, TURKEY
  22. 22. THANK YOU drtahirogut@gmail.comTahir OGUT Istanbul, TURKEY