Superconstructs in reconstruction surgery of Charcot foot Brodsky 1: A case report

Abstract

Introduction Charcot neuropathic osteoarthropathy (CN) is a chronic, progressive condition of joints, soft tissues, and bones. CN causes considerable high mortality and morbidity. A common issue is early diagnosis and appropriate treatment. Thus, the operative treatment is indicated when patients have progressive deformities, infection and ulceration. The superconstructs method for Charcot foot (CF) is considered giving better clinical outcome than other methods. Presentation of case A 61-year-old male admitted to an outpatient clinic with chief complaint of swelling and pain on a left foot with history of diabetes mellitus type 2. From the physical examination, left foot revealed a swelling with rocker bottom deformity and limited range of motion. The radiological examination showed sclerotic appearance of bone deformity metatarsal joint of midfoot of toe. The patients were diagnosed with left Charcot foot Brodsky Type 1, Eichenholtz grade III with diabetes mellitus type 2. Discussion We made superconstructs rather than standard fixation which is frequently inadequate due to changes accompanying the Charcot process. Thus, we performed an adequate reduction of deformity, reduce soft tissue tension, fixation extension beyond a zone of injury, then use of strongest fixation devices that are applied to maximize mechanical function. Conclusion This study showed that superconstructs provide satisfactory clinical and outcomes. This method is useful for achieving construct and stable fixation especially for Charcot foot.

Presurgical Perspective and Postsurgical Evaluation of the Diabetic Foot

“…So-called superconstruct techniques have been introduced to improve fixation in patients with Charcot's foot. 59 A superconstruct is defined by four factors: (1) fusion is extended beyond the zone of injury to include joints unaffected to improve fixation, (2) bone resection is performed to shorten the extremity to allow for adequate reduction of deformity without undue tension on the soft tissue envelope, (3) the strongest device is used that can be tolerated by the soft tissue envelope, and (4) the devices are applied in a novel position that maximizes mechanical stability ( Fig. 9 ).…”