Charcot Ankle Fractures

Indications

• Open reduction internal fixation is indicated for unstable neuropathic ankle fractures in patients with a suitable soft tissue envelope. Closed, neuropathic ankle fractures commonly present in three ways:

  • Acutely after a traumatic incident, these are often missed since the patient may be weight bearing on the fractured limb.

  • Subacutely, with a history of a minor injury and a longer period of sustained swelling, erythema, and possibly a history of treatment for cellulitis.

  • Chronically with progressive deformity and loss of ankle function.

• Charcot ankle fractures may also present as open fractures, in which case the ankle is first thoroughly irrigated, débrided, and stabilized with external fixation to allow the soft tissues to heal prior to reconstruction.

• It is important to understand that Charcot ankle fractures are uniquely different in that treatment requires more robust fixation and longer protected weight bearing than is typically required. The bone is softer due to increased resorption relative to new bone formation, and patients lack protective sensation allowing weight bearing on the fractured ankle ( Fig. 62.1 ). Failure to recognize these principles ( Fig. 62.2 ) risks failure due to loss of fixation ( Fig. 62.3 ), with subsequent revision ( Fig. 62.4 ), malunion and/or nonunion, and possibly amputation.

  
  
  
  

Examination/Imaging