Hindfoot Fusion Nail with Adjuvant Hybrid External Fixation used as Limb-Salvage Procedure after Failed Open Reduction Internal Fixation of Ankle Fracture in a Charcot Joint: A Case Report

Román G. Guerrero-Maestre, David Beaton-Comulada, Roberto Colón-Miranda, Pedro Reyes-Martinez


The failure of the internal fixation of an ankle fracture due to Charcot joint/ neuroarthropathy is rare; such occurred in the case of a 52-year-old woman with uncontrolled diabetes who sustained a right ankle fracture after falling from standing height. The patient was treated with the internal fixation of both malleoli, which procedure failed as the patient progressed, until she eventually was diagnosed with Charcot arthropathy. The post operative images were reviewed and showed a catastrophic fixation failure with a diagnosis of Charcot neuroarthropathy. At that point, we decided to treat the problem presented with salvage arthrodesis, combining hindfoot fusion nail with adjuvant external fixation. This treatment was selected to augment stability and achieve stable fixation. The post-operative visits showed wound healing without complications and painless weight bearing. The follow-up radiographs showed tibiotalar fusion with painless union of the subtalar joint at 48 weeks.


hindfoot nail; fusion nail; charcot joint; failed fixation; hybrid external fixation; tibiotalocalcaneal nail; diabetic foot; external fixation; limb-salvage

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