الفهرس 
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Abstract
Charcot neuropathic osteoarthropathy or neuroarthropathy (CNO) of the foot and ankle constitutes a great clinical challenge for a poorly understood destructive process. The CNO is due to sensory and motor neuropathies which lead to a chronic and progressive destruction of the foot architecture involving bones, joints, and soft tissues.
Secondary fractures and dislocations predispose to deformity and ulceration with a great decrease of the gait-related quality of life and an increasing potential for major amputation.
Charcot restraint orthotic walker devices, and bracing are usually used in the initial treatment of CNO. Contrary to the foot charcot neuroarthropathy, involvement of the ankle is most likely to lead to progressive deformity poorly responding to non operative management.
The aims of the arthrodesis reconstructive procedure are realignment and stabilization of the severely deformed ankle in order to avoid ulcers and amputation. Retrograde intramedullary nails (IMN) and ilizarov. are two of the most common fixation techniques used for arthrodesis in CNO.
As no cast is usually required following ring fixator, swelling and ulcer recurrence could be monitored. Advocates of retrograde nails cite the high incidence of pin tract infections, risk of tibia fracture, and the need for a second surgery for EF removal as reasons to choose a nail over external fixation.
This review seeks to collate evidence from comparative studies to look for significant differences in terms of fusion rate, salvage rate, and complications following ilizarov. and IMN techniques for tibiotalo-calcaneal arthrodesis.
Criteria for considering studies for this review
Types of studies :
Recent clinical trials or cluster trials, prospective and retrospective comparative cohort studies. Search results will be uploaded to systematic review management software and manually screened for eligibility to be included. PRISMA flowchart will be introduced on the search results and the inclusion/exclusion criteria.
Types of participants:
This review will consider all studies that involve Ankle charcot neuroarthropathy and the two methods used for ankle fusion: retrograde intramedullary nail (IMN) and ilizarov.
Types of interventions:
● Interventions of interest included those related to clinical outcomes of retrograde intramedullary nail (IMN) and ilizarov.
● Types of outcome measures
● The primary outcome was set as the radiological fusion healing rate. Secondary outcomes were defined as time to heal, revision surgery, hardware infection, wound infection, and amputation rate. It is anticipated that not all cases of nonunion were revised; in the case of revision due to symptomatic nonunion, such outcome has been reported separately.
Selection criteria for studies
Inclusion criteria
● Prospective and retrospective studies discussing the results of various techniques as surgical management of charcot ankle in diabetic patients
● Reporting functional outcomes following each technique
● Studies conducted in English.
● In period of 2000-2019
The lessons learned from this highly comorbid patient population with complex deformities can be used as a benchmark for applying modern surgical techniques. Use of a retrograde intramedullary rod or ring fixator resulted in high rates of successful limb salvage when used for tibiotalocalcaneal arthrodesis in patients with charcot arthropathy. However, the need for revision surgery was more frequent in the retrograde nail group compared to the ring fixator group. The added stability offered by external fixation may benefit patients who are at high risk for complications or require extended arthrodesis, but this was unable to be demonstrated statistically in this study. Patients with this difficult pathology can be successfully salvaged, However, Comparison showed that Ilizarov technique had higher rate of complications than IMN. In conclusion, retrograde IMN and Ilizarov external fixator both yielded better union with statistically non-significant difference for tibiotalar arthrodesis in charcot neuroarthropathy.