Purpose: Diabetic Charcot arthropathy represents a major serious complication of diabetes, frequently culminating in nonunion and limb amputation. This study aimed to identify the risk factors of nonunion in patients with diabetic Charcot arthropathy. Materials and Methods: A retrospective analysis was conducted on 23 patients who received treatment for Charcot arthropathy of the Lisfranc joint at a single specialized medical center from January 2000 through September 2024. Eight patients underwent fusion surgery, and 15 underwent conservative treatment using a total contact cast. Follow-up observations were performed for at least 1 year, and joint fusion was evaluated. The primary risk factor examined was proper anatomical alignment assessed by Meary’s angle. The study also examined the treatment methods and various patient characteristics, including age, body weight index, blood sugar control (HbA1c), kidney function (eGFR), blood flow measurements (ABI and TBI), nerve function tests, smoking habits, hemodialysis treatment, and insulin use. Statistical analyses were performed using an independent t-test or Mann-Whitney U-test for the continuous variables and Fisher’s exact test for categorical variables. Results: Proper anatomical alignment showed a strong correlation with successful fusion and emerged as the most powerful predictor of treatment success (p=0.018). Statistical significance was also observed when Meary’s angle was analyzed as a continuous variable, which showed that a greater degree of malalignment was associated with a higher likelihood of nonunion (p=0.003). Other factors, including treatment method, patient age, body weight, blood sugar control, kidney function, blood flow measurements, nerve function tests, smoking habits, insulin use, and dialysis treatment, showed no meaningful relationship with fusion success. Conclusion For patients with Charcot arthropathy, proper anatomical alignment represents the most crucial factor determining successful bone fusion regardless of the treatment method. Therefore, establishing and preserving correct alignment greatly improves the joint fusion probability.

Vertebral artery injury is common in cervical trauma, and can lead to infarction in some patients with potentially fatal outcomes. The authors encountered a patient with posterior inferior cerebellar artery infarction resulting from preoperative vertebral artery injury after anterior cervical discectomy and fusion and posterior decompression and fusion in a 44-year-old male after unilateral cervical facet joint fracture (compression-extension type injury). This paper reports these imaging findings and relevant clinical studies for this case.