الفهرس 
Pathogenesis of charcot JointOnly 14 pages are availabe for public view
 |  | from | 151 |  |  |
| | | from | 151 | | |
Abstract
The management of CN patients of the foot and ankle is challenging. Education of patients about prevention, early recognition of arthropathy, and prompt institution of protective treatment are clearly the most effective means available to diminish the impact of this problem .
Occasionally, however, there are patients who, when they are first seen, have a disabling deformity or severe instability for which treatment with a brace or a plaster cast alone is destined to failure. For those patients, reconstruction of the foot and ankle is a valuable technique. The goals of operative treatment are to allow the patient to wear a shoe or a brace and to prevent amputation. Stability and appropriate alignment are more important than union for achieving a successful result.
Diabetic foot and ankle trauma and charcot reconstruction require a clear understanding of the pathogenesis of the disease process. The surgeon must consider patient factors, specifically peripheral neuropathy, and also factors specific to the injury or reconstruction. Appropriate preoperative planning is necessary for optimal outcome and to prevent postoperative complications. The surgeon should choose a fixation construct before embarking on a surgical procedure and understand its advantages and disadvantages for the selected procedure. The choice of fixation, whether internal, external, or a combination of the two, should be applied to provide osseous stability and account for anticipated problems commonly seen in this patient population. The surgeon should also consider the potential problems that may arise in these difficult cases.
Open reduction with internal fixation for charcot osteoarthropathy is associated with a high rate of complications and failure because of infection, bone softening, resorption, fragmentation and breakage of the implant . Complex reconstructive procedures with arthrodesis are more frequently reserved for realignment and stabilization of severely deformed feet and ankles in an effort to avoid amputation. The choice of internal or external fixation depends on the quality of the bone. Generally in charcot disease, the bone stock is poor and external fixation provides better compression with fewer fixation failures and soft tissue complications. Due to its ability to correct multiplanar deformities in osteopenic bone even in the presence of open wounds, the circular (Ilizarov) external fixation is preferred for most of charcot foot and ankle reconstructions .