Two-stage fixation in the treatment of diabetic arthropathy of the ankle

Aim — to improve the results of treatment of diabetic anklearthropathies by using the final method of fixation by semi-rigid systems after arthrodesis and the use of extrafocal ring fixators (RF). Materials and methods. The authors presented own experience of treatment of 12 patients with diabeticankle osteoarthropathy. After arthrodesis and fixation with RF, the alternating osteosynthesis was performed with Scotchcast/Softcast bandages. The use of extrafocal RF of the needle-rod type in the first stage with low trauma wasadvantageous, however the time of fixation before the appearance of the fusion between the tibia and talus was significant, which led to a decrease in the rigidity of the fixation of the bone-needle system and development of inflammation at the exit of the spokes. This required the transition to other means of fixation, which would provide the possibility of functional use of the limb. The authors used Scotchcast/Softcast functional bandages, applied circularly, with stiffeners on the lateral surfaces, which allowed to carry out the supporting function of the limb. Interventions (arthrodesis of the ankle joint) were performed under multimodal analgesia. Vascular disorders required hematopoietic therapy (use of a tourniquet and administration of tranexamic acid solution) and bemiparin administrationfor microthrombosisprevention. Treatment of diabetic neuropathy and metabolic disorders was carried out by prescribing vitamin B and C, drugs Ca and vitamin D3, antioxidants. Results. The dynamics of the most examined indicators of the coagulation — anticoagulation system did not differ significantly (activated partial thromboplastic time, prothrombin time, international normalized ratio, platelet quantity). There was a tendency to shift the indicators to the recommended safe zone and even a significant decrease in the level of soluble fibrin monomer complexes (R2= 0.9494). Conclusions. The use of Scotchcast/Softcast immobilizing bandages in patients with diabetic arthropathy was safe after arthrodesis and RF fixation.This strategy allowed to restore limb capacity in the early stages of treatment, which improved the social adaptation of patients.