Midtarsal Arthrodesis in the Treatment of Charcot Midfoot Arthropathy

Vj, Sammarco; Gj, Sammarco; Ew, Walker; Rp, Guiao

doi:10.2106/jbjs.i.01289

Cited by 41 publications

(32 citation statements)

References 5 publications

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“…All of these ulcers in our study healed uneventfully following corrective arthrodesis. In contrast, a number of authors advocate postponing surgery until a concomitant ulcer has definitely healed [8,30,31] or rely on alternative techniques of fixation as external fixators [24]. Despite the fact that an open wound may increase the risk for complications [4], we observed no major infectious complications.…”

Section: Discussioncontrasting

confidence: 62%

“…Nonoperative measures such as total contact casting are regarded as treatment of choice for a majority of patients if the treatment is likely to provide a plantigrade foot without major bony destruction and deformities [6,7,31]. According to some series, however, 40% to 50% of these patients may have secondary surgery due to recurrent ulcers or residual deformity [3,5,12,23,29].…”

Section: Discussionmentioning

confidence: 99%

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Should One Consider Primary Surgical Reconstruction in Charcot Arthropathy of the Feet?

Mittlmeier

Klaue

Haar

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Charcot neuroosteoarthropathy of the feet can induce severe instability and deformity with subsequent plantar ulceration leading to substantial disability or even amputation. Traditionally, nonoperative treatment is regarded as the primary option of treatment while surgery is restricted to treating complications or failure of nonoperative treatment. Failed nonoperative treatment essentially prolongs treatment period. We retrospectively reviewed 22 patients (26 feet) with midfoot (n = 9) or hindfoot (n = 17) neuropathy who underwent primary surgical reconstruction and reorientation arthrodesis due to manifest instability, nonplantigrade foot position, and deformity with overt (n = 8) or what we judged was impending ulceration (n = 9). The minimum followup was 0.5 years (mean, 2.7 years; range 0.5-7 years). All eight ulcers healed without recurrence of ulceration or manifestation of new ulcers during the followup period. We observed complications leading to further surgery in nine patients: five with perioperative hematoma and four with instability.

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Section: Discussioncontrasting

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Should One Consider Primary Surgical Reconstruction in Charcot Arthropathy of the Feet?

Mittlmeier

Klaue

Haar

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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“…Cannulated screws have been shown to have a high rate of failure, 5,6,16,22,23 and supplementation with plates can lead to increased bulk and cause soft tissue complications. 4 Plantar plating has been shown to be mechanically stronger but is associated with considerable soft-tissue stripping to achieve optimal fixation.…”

Section: Discussionmentioning

confidence: 99%

The medial column Synthes Midfoot Fusion Bolt is associated with unacceptable rates of failure in corrective fusion for Charcot deformity

Butt

Hester

Bilal

et al. 2015

The Bone & Joint Journal

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Charcot neuro-osteoarthropathy (CN) of the midfoot presents a major reconstructive challenge for the foot and ankle surgeon. The Synthes 6 mm Midfoot Fusion Bolt is both designed and recommended for patients who have a deformity of the medial column of the foot due to CN. We present the results from the first nine patients (ten feet) on which we attempted to perform fusion of the medial column using this bolt. Six feet had concurrent hindfoot fusion using a retrograde nail. Satisfactory correction of deformity of the medial column was achieved in all patients. The mean correction of calcaneal pitch was from 6° (-15° to +18°) pre-operatively to 16° (7° to 23°) post-operatively; the mean Meary angle from 26° (3° to 46°) to 1° (1° to 2°); and the mean talometatarsal angle on dorsoplantar radiographs from 27° (1° to 48°) to 1° (1° to 3°). However, in all but two feet, at least one joint failed to fuse. The bolt migrated in six feet, all of which showed progressive radiographic osteolysis, which was considered to indicate loosening. Four of these feet have undergone a revision procedure, with good radiological evidence of fusion. The medial column bolt provided satisfactory correction of the deformity but failed to provide adequate fixation for fusion in CN deformities in the foot. In its present form, we cannot recommend the routine use of this bolt.

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“…Standard small fragment orthopaedic hardware is likely to fail in this group of patients because of the poor‐quality bone, the difficulty in achieving rigid internal fixation and the high propensity to develop non‐union. Sammarco has popularized the concept of a mechanical ‘super construct’ to achieve rigid internal fixation .…”

Section: Correction Of Deformity With Internal Fixationmentioning

confidence: 99%

“…These patients have severe localized osteoporosis and have a high mechanical complication rate with traditional methods of internal fixation. Because of their multiple medical diabetic co‐morbidities, these patients are at high risk for complication when subjected to extensive soft tissue dissection or placement of large foreign body implants .…”

Section: Correction Of Deformity With External Fixationmentioning

confidence: 99%

Surgical treatment of the Charcot foot

Pinzur

2016

Diabetes Metabolism Res

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With the increased number of diabetics worldwide and the increased incidence of morbid obesity in more prosperous cultures, there has become an increased awareness of Charcot arthropathy of the foot and ankle. Outcome studies would suggest that patients with deformity associated with Charcot Foot arthropathy have impaired health related quality of life. This awareness has led reconstructive-minded foot and ankle surgeons to develop surgical strategies to treat these acquired deformities. This article outlines the current clinical approach to this disabling medical condition.

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Midtarsal Arthrodesis in the Treatment of Charcot Midfoot Arthropathy

Abstract: Open reduction and arthrodesis with use of multiple axially placed intramedullary screws for the surgical correction of neuropathic midfoot collapse provides a reliable stable construct to achieve and maintain correction of the deformity.

Cited by 41 publications

References 5 publications

Should One Consider Primary Surgical Reconstruction in Charcot Arthropathy of the Feet?

Should One Consider Primary Surgical Reconstruction in Charcot Arthropathy of the Feet?

The medial column Synthes Midfoot Fusion Bolt is associated with unacceptable rates of failure in corrective fusion for Charcot deformity

Surgical treatment of the Charcot foot

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