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Involvement of the ankle joint in Charcot osteoarthropathy may be associated with severe instability and fracture or collapse of the talus. Recalcitrant ulceration may result over the lateral malleolus, increasing the risk of major amputation. This study evaluated ankle arthrodesis with a compressive intramedullary nail in 14 patients with diabetes affected by Charcot of the ankle. The mean patient age was 58 ± 12 years, and the mean duration of diabetes was 17 ± 5 years. Transcutaneous oxygen pressures were ≥ 50 mm Hg in all patients, indicating a good distal blood supply. A below-knee amputation had previously been suggested because of severe ankle joint instability. None of the patients were able to walk without a brace. Four patients had an ulceration that had healed before the index procedure. All procedures were performed in the quiescent phase of the disease. After a mean follow-up of 18 ± 4 months, 10 patients (71.4%) achieved a solid arthrodesis, returning to walking with protective shoes. Three patients (21.4%) developed breakage of the calcaneus screws, necessitating removal of the screws in 2 cases and removal of the entire nail in 2 cases. These 3 patients went on to fibrous union that allowed walking with a brace. One patient (7.2%) required a below-knee amputation because of postoperative osteomyelitis of the distal tibia. The data from our study demonstrate a high rate of limb salvage (92.8%), suggesting that this device is safe and effective in the treatment of Charcot arthropathy of the ankle. [Copyright &y& Elsevier]

Abstract: This study describes a GIS-based software tool for the qualitative assessment of desertification risk. The tool integrates results from several land degradation models into ArcGIS using the object-oriented programming language Visual Basic. The integration of GIS and models is based on different coupling approaches. The proposed methodology was developed and tested on Sardinia Island (Italy). Six driving factors of desertification (overgrazing, vegetation productivity, soil fertility, water erosion, wind erosion and seawater intrusion) were model-simulated over two time periods to investigate the spatio-temporal evolution pattern of desertification-prone areas. Model results were normalized, weighted and combined into an Integrated Desertification Index (IDI) ranging from 0 to 1 (representing the best and the worst conditions, respectively), and classified into five desertification risk levels. The implementation, performance of the methodology and benefits provided by the modelling approach to land management authorities for monitoring processes of land degradation are fully described in the paper. [Copyright &y& Elsevier]