Fibular strut graft for primary ankle arthrodesis in diabetic charcot neuroarthropathy patients

INTRODUCTION: Arthrodesis is an expensive procedure that is less applicable in developing countries. In this case report we reported a case of diabetic charcot neuroartropathy (CN) with primary ankle arthrodesis technique with a fibular strut graft which is considered cheaper and has a higher union rate. CASE DESCRIPTION: A 47 years old female with complaints of pain in her right ankle after falling down the stairs with foot inverted one month before admission. The patient has uncontrolled diabetes mellitus with HbA1C 7.6 % and random blood sugar check >200 mg/dl. The patient's pain score using the visual analog score (VAS) showed a value of 8. While plain film X-ray revealed bony fragmentation in the Ankle joint. Arthrodesis surgery using fibular strut graft was performed. The postoperative X-ray examination revealed two plates attached to the anterior and medial distal tibia. A total of nine wires were attached to the patient. The patient used Ankle Foot Orthosis (AFO) and was able to walk normally 3-weeks post-surgery without pain and ulcer formation. DISCUSSION: Fibular strut graft has good cost-effectiveness, that is more suitable for use in developing countries. It also requires a simple implant that is easily applied by all orthopedists. Fibular strut graft has the advantage of having osteogenic, osteoinductive, and osteoconductive properties that can potentially improve union. CONCLUSION: The fibular strut graft technique can be an alternative in obtaining durable ankle fusion and functional salvaged limb with low complications.