Until the advent of external ring fixation, success with techniques for reconstructing the acute Charcot foot was at best marginal. A great many of these patients have co-morbidities including obesity, motor neuropathy and weakness, which complicates their treatment.

Dr. Guy Pupp is among a handful of physicians who have dedicated themselves to the difficult task of salvaging the diabetic foot. Dr. Pupp states, "While not all amputations can be prevented, there are modalities, techniques and approaches that can give us better, more predictable results".

Dr. Pupp's presentation discusses these newer external fixation techniques which allow patients to partially weight bear and remain self sufficient while healing from procedures that classically required a difficult, lengthy, non weight bearing period. The goal of external fixation is the precise control of bone segments. This includes angulation, rotation, translation, lengthening and shortening.

Dr. Pupp warns us that the learning curve in reconstructing a Charcot foot is steep. Prepare yourself for pin tract infections, delayed unions, bone and soft tissue necrosis, and occasionally peripheral nerve damage. Patient education is extremely important. Uncooperative or mentally incompetent patients can make a nightmare of your valiant efforts.

Despite these trials and tribulations, Dr. Pupp feels great satisfaction knowing that he has helped his patients avoid the adverse physical, vocational and psychological complications and consequences of major limb loss. Watch his excellent lecture to get up to speed with using external ring fixation techniques to salvage the Charcot diabetic foot.