Neglected infected Charcot neuroarthropathy of the ankle: limb salvage using a one-stage reconstruction by distraction histogenesis principles.

INTRODUCTION: Neglected Infected Charcot neuroarthropathy (CN) of the ankle remains one of the most challenging problems in orthopaedic surgery. Traditionally, below-knee amputation (BKA) has been regarded as a common approach for these complex cases, reflecting the morbidity associated with prolonged and often unsuccessful reconstruction. However, advances in the principles of distraction histogenesis and circular external fixation offer a feasible option for limb salvage. PATIENTS AND METHODS: We report our experience with a specialized management protocol characterized by a one-stage procedure, the "corticotomy-first" technique, and non-radical debridement, applied in a series of 55 patients with Eichenholtz stage III Charcot neuroarthropathy of the ankle. Osteomyelitis was suspected clinically and radiographically in all patients, with active infection present in 45.5% of cases at the time of reconstruction and the remainder demonstrating chronic quiescent osteomyelitis. RESULTS: By leveraging the angiogenic potential of distraction histogenesis principles, functional weight-bearing and limb preservation were achieved in the large majority of patients, including those with chronic ulceration, wheelchair dependency, and multi-drug resistant infection. Limb salvage was achieved in 52 of 55 patients (94.5%), radiographic union in 48 patients (87.3%), and independent ambulation in 50 patients (90.9%). CONCLUSION: We present our clinical rationale together with representative cases that illustrate this technique as an alternative reconstructive strategy for limb salvage in Neglected Infected Charcot neuroarthropathy of the ankle.