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Midtarsal arthrodesis in the treatment of Charcot midfoot arthropathy. Surgical technique.
J Bone Joint Surg Am. 2010 Mar; 92 Suppl 1 Pt 1:1-19.JB

Abstract

BACKGROUND

Fracture-dislocation of the midfoot with collapse of the longitudinal arch is common in patients with neuropathic arthropathy of the foot. In this study, we describe a technique of midfoot arthrodesis with use of intramedullary axial screw fixation and review the results and complications following use of this technique.

METHODS

A retrospective study of twenty-two patients who had undergone surgical reconstruction and arthrodesis to treat Charcot midfoot deformity was performed. Bone resection and/or osteotomy were required to reduce deformity. Axially placed intramedullary screws, inserted either antegrade or retrograde across the arthrodesis sites, were used to restore the longitudinal arch. Radiographic measurements were recorded preoperatively, immediately postoperatively, and at the time of the last follow-up and were analyzed in order to assess the amount and maintenance of correction.

RESULTS

Patients were evaluated clinically and radiographically at an average of fifty-two months. Complete osseous union was achieved in sixteen of the twenty-two patients, at an average of 5.8 months. There were five partial unions in which a single joint did not unite in an otherwise stable foot. There was one nonunion, with recurrence of deformity. All patients returned to an independent functional ambulatory status within 9.5 months. Weight-bearing radiographs showed the talar-first metatarsal angle, the talar declination angle, and the calcaneal-fifth metatarsal angle to have improved significantly and to have been corrected to nearly normal values by the surgery. All measurements remained significantly improved, as compared with the preoperative values, at the time of final follow-up. There were no recurrent dislocations. Three patients had a recurrent plantar ulcer at the metatarsophalangeal joint that required additional surgery. There were eight cases of hardware failure.

CONCLUSIONS

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.

Authors+Show Affiliations

Cincinnati SportsMedicine and Orthopaedic Center, Cincinnati, OH 45242, USA. vjsammarco@csmoc.comNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20194340

Citation

Sammarco, V James, et al. "Midtarsal Arthrodesis in the Treatment of Charcot Midfoot Arthropathy. Surgical Technique." The Journal of Bone and Joint Surgery. American Volume, vol. 92 Suppl 1 Pt 1, 2010, pp. 1-19.
Sammarco VJ, Sammarco GJ, Walker EW, et al. Midtarsal arthrodesis in the treatment of Charcot midfoot arthropathy. Surgical technique. J Bone Joint Surg Am. 2010;92 Suppl 1 Pt 1:1-19.
Sammarco, V. J., Sammarco, G. J., Walker, E. W., & Guiao, R. P. (2010). Midtarsal arthrodesis in the treatment of Charcot midfoot arthropathy. Surgical technique. The Journal of Bone and Joint Surgery. American Volume, 92 Suppl 1 Pt 1, 1-19. https://doi.org/10.2106/JBJS.I.01289
Sammarco VJ, et al. Midtarsal Arthrodesis in the Treatment of Charcot Midfoot Arthropathy. Surgical Technique. J Bone Joint Surg Am. 2010;92 Suppl 1 Pt 1:1-19. PubMed PMID: 20194340.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Midtarsal arthrodesis in the treatment of Charcot midfoot arthropathy. Surgical technique. AU - Sammarco,V James, AU - Sammarco,G James, AU - Walker,Earl W,Jr AU - Guiao,Ronald P, PY - 2010/3/3/entrez PY - 2010/3/18/pubmed PY - 2010/4/2/medline SP - 1 EP - 19 JF - The Journal of bone and joint surgery. American volume JO - J Bone Joint Surg Am VL - 92 Suppl 1 Pt 1 N2 - BACKGROUND: Fracture-dislocation of the midfoot with collapse of the longitudinal arch is common in patients with neuropathic arthropathy of the foot. In this study, we describe a technique of midfoot arthrodesis with use of intramedullary axial screw fixation and review the results and complications following use of this technique. METHODS: A retrospective study of twenty-two patients who had undergone surgical reconstruction and arthrodesis to treat Charcot midfoot deformity was performed. Bone resection and/or osteotomy were required to reduce deformity. Axially placed intramedullary screws, inserted either antegrade or retrograde across the arthrodesis sites, were used to restore the longitudinal arch. Radiographic measurements were recorded preoperatively, immediately postoperatively, and at the time of the last follow-up and were analyzed in order to assess the amount and maintenance of correction. RESULTS: Patients were evaluated clinically and radiographically at an average of fifty-two months. Complete osseous union was achieved in sixteen of the twenty-two patients, at an average of 5.8 months. There were five partial unions in which a single joint did not unite in an otherwise stable foot. There was one nonunion, with recurrence of deformity. All patients returned to an independent functional ambulatory status within 9.5 months. Weight-bearing radiographs showed the talar-first metatarsal angle, the talar declination angle, and the calcaneal-fifth metatarsal angle to have improved significantly and to have been corrected to nearly normal values by the surgery. All measurements remained significantly improved, as compared with the preoperative values, at the time of final follow-up. There were no recurrent dislocations. Three patients had a recurrent plantar ulcer at the metatarsophalangeal joint that required additional surgery. There were eight cases of hardware failure. CONCLUSIONS: 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. SN - 1535-1386 UR - https://www.unboundmedicine.com/medline/citation/20194340/Midtarsal_arthrodesis_in_the_treatment_of_Charcot_midfoot_arthropathy__Surgical_technique_ L2 - https://doi.org/10.2106/JBJS.I.01289 DB - PRIME DP - Unbound Medicine ER -