Tags

Type your tag names separated by a space and hit enter

[Corrective arthrodesis of midfoot Charcot neuroosteoarthropathy with internal fixation].
Oper Orthop Traumatol. 2015 Apr; 27(2):139-53.OO

Abstract

OBJECTIVE

The goal of treatment is a plantigrade, stable, ulcer-free foot which can be addressed with diabetes-adapted insoles and/or DNOAP shoes.

INDICATIONS

Charcot foot of the midfoot with/without infection-free ulcers.

CONTRAINDICATIONS

Inacceptable anesthesiological risk in polymorbidity. Severe anesthesiological risks in multimorbid patients; symptomatic peripheral arterial occlusive disease not suitable for reconstruction; infections PEDIS/IWGDF grade 3 or 4, nonreconstructable osseous defects.

SURGICAL TECHNIQUE

Corrective arthrodesis with segmental resection or bone grafting of the midfoot to achieve a plantigrade foot position. Plantar plate application or intramedullary (e.g., midfoot fusion bolt) and extramedullary (preferably: angular stable locking plates) implant combinations to create the highest possible degree of primary stability of the medial and/or lateral foot columns (superconstruct). In case of higher degrees of instability, the hindfoot should also be included into the arthrodesis.

POSTOPERATIVE MANAGEMENT

Partial weight-bearing (20 kg) with forearm crutches for 3-5 months postoperatively in special orthosis or total contact cast. Therapeutic shoes with diabetes-adapted insoles with full weight-bearing.

RESULTS

Using any of these stabilization variants, a plantigrade, stable, and long-lasting ulcer-free foot may be obtained that is suitable for custom-made footwear. The outcome does not depend on definite osseous healing of the arthrodesis and allows for the patient to have a self-determined lifestyle. The consecutive rate of amputation is low.

COMPLICATIONS

High rate of surgical complications (e.g., infection, implant failure, non-union, loss of correction, reulceration), in particular, in cases of inadequate indication or insufficient primary stability.

Authors+Show Affiliations

Chirurgische Klinik und Poliklinik, Abt. für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsmedizin Rostock, Schillingallee 35, 18055, Rostock, Deutschland, thomas.mittlmeier@med.uni-rostock.de.No affiliation info available

Pub Type(s)

Clinical Trial
Journal Article

Language

ger

PubMed ID

25862129

Citation

Mittlmeier, T, and A Eschler. "[Corrective Arthrodesis of Midfoot Charcot Neuroosteoarthropathy With Internal Fixation]." Operative Orthopadie Und Traumatologie, vol. 27, no. 2, 2015, pp. 139-53.
Mittlmeier T, Eschler A. [Corrective arthrodesis of midfoot Charcot neuroosteoarthropathy with internal fixation]. Oper Orthop Traumatol. 2015;27(2):139-53.
Mittlmeier, T., & Eschler, A. (2015). [Corrective arthrodesis of midfoot Charcot neuroosteoarthropathy with internal fixation]. Operative Orthopadie Und Traumatologie, 27(2), 139-53. https://doi.org/10.1007/s00064-014-0338-8
Mittlmeier T, Eschler A. [Corrective Arthrodesis of Midfoot Charcot Neuroosteoarthropathy With Internal Fixation]. Oper Orthop Traumatol. 2015;27(2):139-53. PubMed PMID: 25862129.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Corrective arthrodesis of midfoot Charcot neuroosteoarthropathy with internal fixation]. AU - Mittlmeier,T, AU - Eschler,A, Y1 - 2015/04/10/ PY - 2014/12/19/received PY - 2015/02/22/accepted PY - 2015/02/09/revised PY - 2015/4/12/entrez PY - 2015/4/12/pubmed PY - 2016/11/9/medline SP - 139 EP - 53 JF - Operative Orthopadie und Traumatologie JO - Oper Orthop Traumatol VL - 27 IS - 2 N2 - OBJECTIVE: The goal of treatment is a plantigrade, stable, ulcer-free foot which can be addressed with diabetes-adapted insoles and/or DNOAP shoes. INDICATIONS: Charcot foot of the midfoot with/without infection-free ulcers. CONTRAINDICATIONS: Inacceptable anesthesiological risk in polymorbidity. Severe anesthesiological risks in multimorbid patients; symptomatic peripheral arterial occlusive disease not suitable for reconstruction; infections PEDIS/IWGDF grade 3 or 4, nonreconstructable osseous defects. SURGICAL TECHNIQUE: Corrective arthrodesis with segmental resection or bone grafting of the midfoot to achieve a plantigrade foot position. Plantar plate application or intramedullary (e.g., midfoot fusion bolt) and extramedullary (preferably: angular stable locking plates) implant combinations to create the highest possible degree of primary stability of the medial and/or lateral foot columns (superconstruct). In case of higher degrees of instability, the hindfoot should also be included into the arthrodesis. POSTOPERATIVE MANAGEMENT: Partial weight-bearing (20 kg) with forearm crutches for 3-5 months postoperatively in special orthosis or total contact cast. Therapeutic shoes with diabetes-adapted insoles with full weight-bearing. RESULTS: Using any of these stabilization variants, a plantigrade, stable, and long-lasting ulcer-free foot may be obtained that is suitable for custom-made footwear. The outcome does not depend on definite osseous healing of the arthrodesis and allows for the patient to have a self-determined lifestyle. The consecutive rate of amputation is low. COMPLICATIONS: High rate of surgical complications (e.g., infection, implant failure, non-union, loss of correction, reulceration), in particular, in cases of inadequate indication or insufficient primary stability. SN - 1439-0981 UR - https://www.unboundmedicine.com/medline/citation/25862129/[Corrective_arthrodesis_of_midfoot_Charcot_neuroosteoarthropathy_with_internal_fixation]_ L2 - https://doi.org/10.1007/s00064-014-0338-8 DB - PRIME DP - Unbound Medicine ER -