{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T11:14:31Z","timestamp":1783509271096,"version":"3.55.0"},"reference-count":21,"publisher":"MDPI AG","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,5]]},"abstract":"<jats:p>Limb salvage for Charcot's neuroarthropathy has been shown to have high complication and failure rates. The aim of our report of two cases it to present a unique complication encountered with staged limb salvage for Charcot's neuroarthropathy. In two cases, patients developed delayed tibial shaft fracture associated with previous wire placement despite insertion of locked intramedullary nail fixation that spanned the delayed fracture. Both patients experienced fractures following advancement of weight after definitive fixation. In both patients, there was noted complication with the sites of the pins and revision of external fixation before fracture. In each case, the fracture was within the construct of the intramedullary fixation and successfully treated with an extended course of nonweightbearing. Complications of external fixation and intramedullary fixation are well reported within the literature; however, tibia fracture is rare. Based on these cases, it would seem prudent to recognize the risk of delayed pin-site complications and ensure adequate length of intramedullary fixation to span the potential areas of stress.<\/jats:p>","DOI":"10.7547\/19-005","type":"journal-article","created":{"date-parts":[[2020,7,30]],"date-time":"2020-07-30T20:59:43Z","timestamp":1596142783000},"source":"Crossref","is-referenced-by-count":2,"title":["Tibia Fracture in Staged Limb Salvage Using External Ring Fixation and Intramedullary Nailing: A Report of Two Cases"],"prefix":"10.3390","volume":"110","author":[{"given":"Nicholas S.","family":"Powers","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason M.","family":"St. John","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick R.","family":"Burns","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","reference":[{"key":"i8750-7315-110-3-Article_14-b01","series-title":"JAPMA","first-page":"390","article-title":"Charcot's arthropathy of the foot","volume":"92","author":"Armstrong","year":"2002","unstructured":"Armstrong\n              DG\n            \n            \n              Peters\n              EJ:\n            \n          \n          Charcot's arthropathy of the foot.\n\t\t\t\t\tJAPMA92: 390,\n\t\t\t\t\t2002."},{"key":"i8750-7315-110-3-Article_14-b02","series-title":"Am J Orthop","first-page":"492","article-title":"Health-related quality of life in patients with Charcot foot","volume":"32","author":"Pinzur","year":"2003","unstructured":"Pinzur\n              MS\n            \n            \n              Evans\n              A:\n            \n          \n          Health-related quality of life in patients with Charcot foot.\n\t\t\t\t\tAm J Orthop32: 492,\n\t\t\t\t\t2003.\n\t\t\t\t14620089"},{"key":"i8750-7315-110-3-Article_14-b03","series-title":"Foot Ankle Surg","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1016\/j.fas.2009.02.005","article-title":"Long-term outcome and quality of life in patients with Charcot foot","volume":"15","author":"Pakarinen","year":"2009","unstructured":"Pakarinen\n              TK\n            \n            \n              Lain\n              HJ\n            \n            \n              Maenpaa\n              H\n            \n            :\n\t\t\t\t\t\n          Long-term outcome and quality of life in patients with Charcot foot.\n\t\t\t\t\tFoot Ankle Surg15: 187,\n\t\t\t\t\t2009.\n\t\t\t\t1984075010.1016\/j.fas.2009.02.005"},{"key":"i8750-7315-110-3-Article_14-b04","series-title":"Foot Ankle Int","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1177\/1071100713517097","article-title":"Self-reported quality of life in patients with diabetes: a comparison of patients with and without Charcot neuroarthropathy","volume":"35","author":"Raspovic","year":"2014","unstructured":"Raspovic\n              KR\n            \n            \n              Wukich\n              DK:\n            \n          \n          Self-reported quality of life in patients with diabetes: a comparison of patients with and without Charcot neuroarthropathy.\n\t\t\t\t\tFoot Ankle Int35: 195,\n\t\t\t\t\t2014.\n\t\t\t\t2435165810.1177\/1071100713517097http:\/\/gateway.webofknowledge.com\/gateway\/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000339327900001&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f3"},{"key":"i8750-7315-110-3-Article_14-b05","series-title":"Foot Ankle Int","doi-asserted-by":"publisher","first-page":"705","DOI":"10.1177\/1071100717701233","article-title":"Functional impairment of patients undergoing surgical correction for Charcot foot arthroplasty","volume":"38","author":"Kroin","year":"2017","unstructured":"Kroin\n              E\n            \n            \n              Schiff\n              A\n            \n            \n              Pinzur\n              MS\n            \n            :\n\t\t\t\t\t\n          Functional impairment of patients undergoing surgical correction for Charcot foot arthroplasty.\n\t\t\t\t\tFoot Ankle Int38: 705,\n\t\t\t\t\t2017.\n\t\t\t\t10.1177\/1071100717701233"},{"key":"i8750-7315-110-3-Article_14-b06","series-title":"Clin Orthop Relat Res","first-page":"185","article-title":"How effective is intensive nonoperative initial treatment of patients with diabetes and Charcot arthropathy of the feet?","volume":"435","author":"Saltzman","year":"2005","unstructured":"Saltzman\n              CL\n            \n            \n              Hagy\n              ML\n            \n            \n              Zimmerman\n              B\n            \n            :\n\t\t\t\t\t\n          How effective is intensive nonoperative initial treatment of patients with diabetes and Charcot arthropathy of the feet?\n          Clin Orthop Relat Res\n          435\n          : \n          185,\n\t\t\t\t\t2005."},{"key":"i8750-7315-110-3-Article_14-b07","series-title":"Foot Ankle Int","doi-asserted-by":"publisher","first-page":"265","DOI":"10.1177\/1071100717742371","article-title":"Deformity and clinical outcomes following operative correction of Charcot foot: a new classification with implications for treatment","volume":"39","author":"Pinzur","year":"2018","unstructured":"Pinzur\n              MS\n            \n            \n              Schiff\n              AP:\n            \n          \n          Deformity and clinical outcomes following operative correction of Charcot foot: a new classification with implications for treatment.\n\t\t\t\t\tFoot Ankle Int39: 265,\n\t\t\t\t\t2018.\n\t\t\t\t2917275810.1177\/1071100717742371http:\/\/gateway.webofknowledge.com\/gateway\/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000429804400001&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f3"},{"key":"i8750-7315-110-3-Article_14-b08","series-title":"Tech Foot Ankle Surg","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1097\/01.btf.0000235411.21382.de","article-title":"Ankle arthrodesis using ring external fixation","volume":"5","author":"Easley","year":"2006","unstructured":"Easley\n              M\n            \n            \n              Looney\n              C\n            \n            \n              Wellman\n              S\n            \n            :\n\t\t\t\t\t\n          Ankle arthrodesis using ring external fixation.\n\t\t\t\t\tTech Foot Ankle Surg5: 150,\n\t\t\t\t\t2006.\n\t\t\t\t10.1097\/01.btf.0000235411.21382.de"},{"key":"i8750-7315-110-3-Article_14-b09","series-title":"Curr Surg","doi-asserted-by":"publisher","first-page":"618","DOI":"10.1016\/j.cursur.2005.03.016","article-title":"External fixation for Charcot foot reconstruction","volume":"62","author":"Sayner","year":"2005","unstructured":"Sayner\n              L\n            \n            \n              Rosenblum\n              B:\n            \n          \n          External fixation for Charcot foot reconstruction.\n\t\t\t\t\tCurr Surg62: 618,\n\t\t\t\t\t2005.\n\t\t\t\t10.1016\/j.cursur.2005.03.01616293497"},{"key":"i8750-7315-110-3-Article_14-b10","series-title":"Foot Ankle Int","doi-asserted-by":"publisher","first-page":"994","DOI":"10.3113\/FAI.2008.0994","article-title":"Complications encountered with circular ring fixation in persons with diabetes mellitus","volume":"29","author":"Wukich","year":"2008","unstructured":"Wukich\n              DK\n            \n            \n              Belczyk\n              RJ\n            \n            \n              Burns\n              PR\n            \n            :\n\t\t\t\t\t\n          Complications encountered with circular ring fixation in persons with diabetes mellitus.\n\t\t\t\t\tFoot Ankle Int29: 994,\n\t\t\t\t\t2008.\n\t\t\t\t10.3113\/FAI.2008.0994http:\/\/gateway.webofknowledge.com\/gateway\/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000259719800005&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f318851815"},{"key":"i8750-7315-110-3-Article_14-b11","series-title":"J Foot Ankle Surg","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1053\/j.jfas.2004.11.004","article-title":"The use of circular wire external fixation in the treatment of salvage ankle arthrodesis","volume":"44","author":"Zarutsky","year":"2005","unstructured":"Zarutsky\n              E\n            \n            \n              Rush\n              S\n            \n            \n              Schuberth\n              J:\n            \n          \n          The use of circular wire external fixation in the treatment of salvage ankle arthrodesis.\n\t\t\t\t\tJ Foot Ankle Surg44: 22,\n\t\t\t\t\t2005.\n\t\t\t\t1570407910.1053\/j.jfas.2004.11.004"},{"key":"i8750-7315-110-3-Article_14-b12","series-title":"J Foot Ankle Surg","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1053\/j.jfas.2005.10.003","article-title":"Intramedullary compressive nail fixation for the treatment of severe Charcot deformity of the ankle and rearfoot","volume":"45","author":"Caravaggi","year":"2006","unstructured":"Caravaggi\n              C\n            \n            \n              Cimmino\n              M\n            \n            \n              Caruso\n              S\n            \n            :\n\t\t\t\t\t\n          Intramedullary compressive nail fixation for the treatment of severe Charcot deformity of the ankle and rearfoot.\n\t\t\t\t\tJ Foot Ankle Surg45: 20,\n\t\t\t\t\t2006.\n\t\t\t\t10.1053\/j.jfas.2005.10.003"},{"key":"i8750-7315-110-3-Article_14-b13","series-title":"Foot Ankle Int","first-page":"971","article-title":"Use of retrograde nail for ankle arthrodesis in Charcot neuroarthopathy: a limb salvage procedure","volume":"28","author":"Dalla Paola","year":"2007","unstructured":"Dalla Paola\n              L\n            \n            \n              Volpe\n              A\n            \n            \n              Varotto\n              D\n            \n            :\n\t\t\t\t\t\n          Use of retrograde nail for ankle arthrodesis in Charcot neuroarthopathy: a limb salvage procedure.\n\t\t\t\t\tFoot Ankle Int28: 971,\n\t\t\t\t\t2007."},{"key":"i8750-7315-110-3-Article_14-b14","series-title":"J Foot Ankle Surg","first-page":"83","article-title":"Tibiotalocalcaneal arthrodesis with retrograde intramedullary nailing","volume":"43","author":"Mendicino","year":"2004","unstructured":"Mendicino\n              RW\n            \n            \n              Catanzariti\n              AR\n            \n            \n              Saltrick\n              KR\n            \n            :\n\t\t\t\t\t\n          Tibiotalocalcaneal arthrodesis with retrograde intramedullary nailing.\n\t\t\t\t\tJ Foot Ankle Surg43: 83,\n\t\t\t\t\t2004."},{"key":"i8750-7315-110-3-Article_14-b15","series-title":"J Foot Ankle Surg","doi-asserted-by":"publisher","first-page":"876","DOI":"10.1053\/j.jfas.2015.02.019","article-title":"Tibiotalocalcaneal arthrodesis using retrograde intramedullary nail fixation: comparison of patients with and without diabetes mellitus","volume":"54","author":"Wukich","year":"2015","unstructured":"Wukich\n              DK\n            \n            \n              Mallory\n              BR\n            \n            \n              Suder\n              NC\n            \n            :\n\t\t\t\t\t\n          Tibiotalocalcaneal arthrodesis using retrograde intramedullary nail fixation: comparison of patients with and without diabetes mellitus.\n\t\t\t\t\tJ Foot Ankle Surg54: 876,\n\t\t\t\t\t2015.\n\t\t\t\thttp:\/\/gateway.webofknowledge.com\/gateway\/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000360373600022&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f32601530510.1053\/j.jfas.2015.02.019"},{"key":"i8750-7315-110-3-Article_14-b16","series-title":"J Foot Ankle Surg","doi-asserted-by":"publisher","first-page":"309","DOI":"10.1053\/j.jfas.2016.10.014","article-title":"Ilizarov external fixator versus retrograde intramedullary nailing for ankle joint arthrodesis in diabetic Charcot neuroarthropathy","volume":"56","author":"ElAlfy","year":"2017","unstructured":"ElAlfy\n              B\n            \n            \n              Ali\n              AM\n            \n            \n              Fawzy\n              SI:\n            \n          \n          Ilizarov external fixator versus retrograde intramedullary nailing for ankle joint arthrodesis in diabetic Charcot neuroarthropathy.\n\t\t\t\t\tJ Foot Ankle Surg56: 309,\n\t\t\t\t\t2017.\n\t\t\t\t2823196410.1053\/j.jfas.2016.10.014http:\/\/gateway.webofknowledge.com\/gateway\/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000395498900023&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=b7bc2757938ac7a7a821505f8243d9f3"},{"key":"i8750-7315-110-3-Article_14-b17","series-title":"Foot Ankle Int","doi-asserted-by":"publisher","first-page":"639","DOI":"10.1177\/107110079701801007","article-title":"A biomechanical comparison of intramedullary nail and crossed lag screw fixation for tibiotalocalcaneal arthrodesis","volume":"18","author":"Berend","year":"1997","unstructured":"Berend\n              ME\n            \n            \n              Glisson\n              RR\n            \n            \n              Nunley\n              JA:\n            \n          \n          A biomechanical comparison of intramedullary nail and crossed lag screw fixation for tibiotalocalcaneal arthrodesis.\n\t\t\t\t\tFoot Ankle Int18: 639,\n\t\t\t\t\t1997.\n\t\t\t\t10.1177\/1071100797018010079347301"},{"key":"i8750-7315-110-3-Article_14-b18","series-title":"J South Orthop Assoc","first-page":"19","article-title":"Biomechanical analysis of hindfoot fixation using an intramedullary rod","volume":"7","author":"Fleming","year":"1998","unstructured":"Fleming\n              SS\n            \n            \n              Moore\n              TJ\n            \n            \n              Hutton\n              WC:\n            \n          \n          Biomechanical analysis of hindfoot fixation using an intramedullary rod.\n\t\t\t\t\tJ South Orthop Assoc7: 19,\n\t\t\t\t\t1998.\n\t\t\t\t9570728"},{"key":"i8750-7315-110-3-Article_14-b19","series-title":"J Bone Joint Surg Am","doi-asserted-by":"publisher","first-page":"558","DOI":"10.2106\/00004623-199704000-00012","article-title":"Stress fracture of the tibia after arthrodesis of the ankle of the hindfoot","volume":"79","author":"Lidor","year":"1997","unstructured":"Lidor\n              C\n            \n            \n              Ferris\n              LR\n            \n            \n              Hall\n              R\n            \n            :\n\t\t\t\t\t\n          Stress fracture of the tibia after arthrodesis of the ankle of the hindfoot.\n\t\t\t\t\tJ Bone Joint Surg Am79: 558,\n\t\t\t\t\t1997.\n\t\t\t\t911140110.2106\/00004623-199704000-00012"},{"key":"i8750-7315-110-3-Article_14-b20","series-title":"Foot Ankle Int","doi-asserted-by":"publisher","first-page":"497","DOI":"10.1177\/107110079902000806","article-title":"Stress fractures and tibial cortical hypertrophy and tibiotalocalcaneal arthrodesis with an intramedullary nail","volume":"20","author":"Thordarson","year":"1999","unstructured":"Thordarson\n              DB\n            \n            \n              Chang\n              D:\n            \n          \n          Stress fractures and tibial cortical hypertrophy and tibiotalocalcaneal arthrodesis with an intramedullary nail.\n\t\t\t\t\tFoot Ankle Int20: 497,\n\t\t\t\t\t1999.\n\t\t\t\t10.1177\/10711007990200080610473060"},{"key":"i8750-7315-110-3-Article_14-b21","series-title":"Foot Ankle Int","doi-asserted-by":"publisher","first-page":"572","DOI":"10.1177\/1071100714531229","article-title":"Tibial stress fracture secondary to half-pins in circular ring external fixation for Charcot foot","volume":"35","author":"Jones","year":"2014","unstructured":"Jones\n              CP\n            \n            \n              Youngblood\n              SA\n            \n            \n              Waldrop\n              N\n            \n            :\n\t\t\t\t\t\n          Tibial stress fracture secondary to half-pins in circular ring external fixation for Charcot foot.\n\t\t\t\t\tFoot Ankle Int35: 572,\n\t\t\t\t\t2014.\n\t\t\t\t2470974210.1177\/1071100714531229"}],"container-title":["Journal of the American Podiatric Medical Association"],"original-title":[],"link":[{"URL":"https:\/\/japmaonline.org\/view\/journals\/apms\/110\/3\/i8750-7315-110-3-article_14.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/meridian.allenpress.com\/japma\/article-pdf\/doi\/10.7547\/19-005\/2558782\/i8750-7315-110-3-article_14.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/japmaonline.org\/downloadpdf\/journals\/apms\/110\/3\/i8750-7315-110-3-article_14.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/japmaonline.org\/downloadpdf\/journals\/apms\/110\/3\/i8750-7315-110-3-article_14.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T10:17:55Z","timestamp":1783505875000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1930-8264\/110\/3\/19005"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,5]]},"references-count":21,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.7547\/19-005","relation":{},"ISSN":["8750-7315"],"issn-type":[{"value":"8750-7315","type":"print"}],"subject":[],"published":{"date-parts":[[2020,5]]}}}