The bone and joint journal (2018) published: "mid-term follow-up of patients with hindfoot arthrodesis with retrograde compression intramedullary nail in charcot neuropathy of the hindfoot".The purpose of this study is to evaluate the mid-term outcome of hindfoot reconstruction in terms of union, function, alignment, and complication rate in patients with deformity of the ankle secondary to charcot arthropathy presenting with or without ulcers, with the major endpoint being the rate of limb salvage.A total of 18 patients (19 feet) with an advanced degree of ankle and subtalar joint instability and/or deformity were operated on during the study period (january 2011 to june 2013).In three limbs, amputation had to be performed due to persisting infection and osteomyelitis resistant to parenteral antibiotic therapy and repeated debridement.All amputees were initially poor hosts in terms of general health and immunity status.All of them had preoperatively presented with infected sole ulceration.Two of them were diabetic patients and one was a heavy smoker with established peripheral vascular disease.Additional information was requested to the author, the following was received: patient: (b)(6) male, fusion level: left hindfoot, procedure date: (b)(6) 2015, follow-up: 9 months.Based on additional information received, integra, panta nail, was implanted in 2 of the 3 amputations.A competitor implant was used in the third amputation case.The other report for amputation for integra panta nail is the mfg report number 9615741-2018-00062.
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Integra has completed their internal investigation: as no product id and no manufacturing lot number was provided, no dhr, design specification or design change record will be performed.No failure analysis was performed, product was not returned.The root cause is not determined but, physical condition, preoperative risk factors and etiologies of the patient might be reason of amputation.Indeed, as mentioned in clinical evidence report, comorbidities such as diabetes and charcot arthropathy as well as preoperative ulcers pose a higher risk of amputation.
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