Managing complications in Charcot neuroarthropathy: A case report on hindfoot nailing and peri-implant fractures

Abstract Charcot neuroarthropathy (CN) is a serious complication of diabetes, causing foot bone and joint damage. Hindfoot nail surgery is a common procedure for hindfoot Charcot arthropathy. However, postsurgical complications can occur due to inadequate planning. This case report discusses one such postsurgical uncommon complication in the management of a hind foot CN with a hind foot nail. A 50-year-old patient with severe diabetes presented with hindfoot issues, leading to a CN (diagnosis). A two-stage surgical approach, involving an external fixator and later a tibiotalocalcaneal nail, was initially pursued. However, a peri-implant fracture occurred, prompting a revision surgery with a longer nail insertion, ultimately resulting in successful postoperative healing and hindfoot fusion. The management of hind foot CN in diabetic patients can be complex. This case report highlights a postsurgical complication, a peri-implant fracture, which required revision surgery with a longer nail for successful healing. Meticulous planning, vigilant postoperative monitoring, and longer nails that cross the pin tract site can help to avoid such complications.