Background: The treatment of multiple foot and ankle fractures in Charcot neuroarthropathy is challenging and often leads to amputation. Early diagnosis and proper treatment is necessary to prevent complications. Delay in diagnosis is often seen and this delay often results in further complications including amputation. The objective of this study was to evaluate clinical and radiographic healing times in patients with multiple fractures associated with Charcot neuroarthropathy.
Method: A total of 10 patients were analyzed in this study, all were diagnosed with Charcot neuroarthropathy. Nine fractures involved the Lisfranc joint and one fracture involved the proximal phalanx of the hallux. Five patients were treated with teriparitide (1-34) 20 micograms daily and five patients elected to be treated without teriparitide. All patients were initially treated with Jones compression casting and strict non-weight bearing. Patients were evaluated on 2-week intervals. Clinical evaluations and radiographs were obtained on each visit. Parameters evaluate included: 1) edema control, 2) temperature stabilization of the involved limb, 3) radiographic evidence of bone consolidation, 4) time to begin weight bearing. Period from initial injury to diagnosis and treatment ranged from one day to four weeks (average 3 weeks).
Results: Patients who received teriparitide (1-34) 20 micograms daily achieved quicker edema control and temperature stabilization (average 5 weeks) versus the non-teriparitide group (average 9 weeks). The teriparitide group achieved more bone fractures consolidation (average 9 weeks) vs. the non-teriparitide group (average 14 weeks). Weight bearing was initiated (average 9 weeks) in the teriparitide group vs. (14 weeks) in the non-teriparitide group.
Conclusion: Treatment of multiple fractures in patients with Charcot neuroarthopathy with teriparitide (1-34) 20 micograms daily decreased clinical symptoms with a subsequent increase in bone consolidation. Teriparitide treatment enhanced fracture strength that ultimately led to quicker return to weight bearing status. Future investigation with routine CT scanning may be helpful in evaluating bone fracture healing associated with teriparitide (1-34) on fractures in lower extremity.
Disclosure Information:
Faculty Member's Name: Thomas Brosky, DPM
I have no relationships to disclose.
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