The Frame Over Nail or 'Frail' Technique, which was coined / invented by rockstar surgeon William Terrell MD, is the ultimate way to treat and fix Charcot Ankle and complex midfoot Charcot.
Deformity is corrected and respective joints are bone grafted (I usually use a combo of autograft from ipsilateral tibia, allograft, and bmac). The nail is then placed as a placeholder for the joints to fuse over.
All compression is then done externally with the struts of the ex fix. Additional limb deformity can be dialed in and corrected through the Orthofix TL-Hex Software. The nail is then perfect circled to lock in the correction when the frame is removed.
At this point I have probably performed this technique on ~15-20 ankles and have had near perfect results, and unreal fusion rates in this incredibly challenging population.
This particular patient had a plantar wound for 3 years, where every potential conservative wound care modality was tried. 2.5 months after surgery, her ankle is fused, her wound is 100% healed, and she is now able to ambulate at her sons upcoming wedding in a supportive shoe.
#exfix #charcot #anklefusion #ttc #tibiotalocalcaneal #arthrodesis #woundcare #diabetes #podiatry #orthopedics #footandanklesurgery