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World J Orthop. Apr 18, 2026; 17(4): 114757
Published online Apr 18, 2026. doi: 10.5312/wjo.v17.i4.114757
Published online Apr 18, 2026. doi: 10.5312/wjo.v17.i4.114757
Transmalleolar tibiotalocalcaneal fusion with biologic augmentation and fibular preservation for chronic Charcot ankle arthropathy: A retrospective cohort study
Mohamed M Elalfy, Mohamed Abdelrazek, Department of Orthopedic Surgery, Mansoura University Hospitals, Dakahlia 35516, Mansoura, Egypt
Mohamed M Elalfy, Department of Orthopedic Surgery, Andalusia Hospital, Jeddah 22341, Makkah al Mukarramah, Saudi Arabia
Osama M Embaby, Department of Orthopedic Surgery, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham B66 2QT, United Kingdom
Osama M Embaby, Department of Orthopedic Surgery, Damietta University, Damietta 34517, Egypt
Orjwan A Abulaban, Department of Orthopedic Surgery, King Abdulaziz University Hospital, Jeddah 22252, Makkah al Mukarramah, Saudi Arabia
Ahmed N Aladl, Department of Orthopedic Surgery, Sana Klinikum Coburg, Ketschendorfer 96450, Germany
Khaled Youssef, Department of Orthopedic Surgery, Southampton General Hospital, Southa
Mohammed H Abushal, Department of Orthopedic Surgery, University of Tabuk, Tabuk 71491, Saudi Arabia
Farid Kassab, Department of Orthopedic Surgery, International Medical Center Hospital, Jeddah 23214, Saudi Arabia
Author contributions: Elalfy MM designed the research and performed the surgeries and clinical work; Embaby OM curated and analyzed the data and wrote the original draft; Elalfy MM, Embaby OM, Abulaban OA, Aladl AN, Abdelrazek M, Youssef K, Abushal MH, and Kassab F contributed to the interpretation of data and critical revision of the manuscript for important intellectual content; Kassab F supervised the study; All authors read and approved the final manuscript and agreed to be accountable for all aspects of the work.
Institutional review board statement: The requirement for formal ethical approval was waived by the Institutional Review Board of Red Crescent Hospital as this was a retrospective case series of anonymized data. The study was conducted in accordance with the principles of the Declaration of Helsinki.
Informed consent statement: Informed consent was waived by the Research Ethics Committee because the study was retrospective in nature and all patient data were fully anonymized with no identifiable information included.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: Data supporting the findings of this study are available from the corresponding author upon reasonable request.
Corresponding author: Mohamed M Elalfy, MD, Foot and Ankle Surgery Consultant, Depart
Received: September 28, 2025
Revised: November 17, 2025
Accepted: January 12, 2026
Published online: April 18, 2026
Processing time: 195 Days and 5.3 Hours
Revised: November 17, 2025
Accepted: January 12, 2026
Published online: April 18, 2026
Processing time: 195 Days and 5.3 Hours
Core Tip
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.