Published online Apr 18, 2026. doi: 10.5312/wjo.v17.i4.114757
Revised: November 17, 2025
Accepted: January 12, 2026
Published online: April 18, 2026
Processing time: 195 Days and 5.3 Hours
Charcot neuroarthropathy of the ankle presents significant surgical challenges with conventional tibiotalocalcaneal (TTC) fusion techniques often prioritizing mechanical stability while neglecting biological deficiencies, resulting in high non-union rates. This study evaluated a refined surgical approach integrating biological augmentation with fibular preservation.
To evaluate trans-malleolar TTC fusion with bone marrow aspirate (BMA)-soaked allograft and fibular preservation for chronic Charcot ankle arthropathy.
We conducted a retrospective case series of 24 adult patients with chronic ankle Charcot arthropathy who underwent TTC fusion with biologic augmentation between 2023 and 2024 at a tertiary care trauma center. The technique involved a transmalleolar approach with fibular preservation, comprehensive joint preparation, and biologic augmentation using BMA-soaked allograft. Outcomes were assessed using the validated American Orthopedic Foot and Ankle Society hindfoot scale and Short Form-36 health survey with comprehensive radio
At a mean follow-up of 1.5 years, 100% (24/24) of patients achieved successful TTC fusion confirmed by robust bony bridging. Mean American Orthopedic Foot and Ankle Society scores demonstrated significant improvement from 31.2 ± 9.1 preoperatively to 76.8 ± 14.2 at the final follow-up (P < 0.001), exceeding the minimal clinically important difference. Short Form-36 scores showed significant improvements across all domains with physical function scores improving from 29.4 ± 10.8 to 72.1 ± 15.3 (P < 0.001). Complications included breakage of both fibular fixation screws managed conservatively without compromising stability, nail protrusion requiring a minor removal procedure, and a periprosthetic tibial fracture treated conservatively with walker boot immobilization. No major infections, wound complications, or amputations were observed.
Trans-malleolar TTC fusion with BMA-soaked allograft and fibular preservation achieved high union and improved outcomes in chronic Charcot ankle arthropathy.
Core Tip: This retrospective case series evaluated a transmalleolar tibiotalocalcaneal fusion with biologic augmentation while preserving the fibula for chronic Charcot neuroarthropathy of the ankle. The technique aims to enhance stability, promote fusion, and reduce wound morbidity by avoiding fibular osteotomy and supplementing fixation with orthobiologics. We reported limb salvage, fusion, alignment, and complication outcomes, demonstrating consistent union and acceptable risks in a high-risk cohort. Transmalleolar tibiotalocalcaneal fusion with fibular preservation is a pragmatic, tissue-sparing option for complex Charcot neuroarthropathy ankles.