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Intramedullary fixation in severe Charcot osteo-neuroarthropathy with foot deformity results in adequate correction without loss of correction - Results from a multi-centre study.
Foot Ankle Surg. 2015 12; 21(4):269-76.FA

Abstract

BACKGROUND

Charcot osteo-neuroarthropathy (CN) of the foot can induce severe instability and deformity. Results of a consecutive clinical multi-centre study with Midfoot Fusion Bolt (MFB, Synthes GmbH, Oberdorf, Switzerland) are reported.

METHODS

All patients (aged 18 years and older) treated between 2009 and 2013 with surgical reconstruction of the midfoot with MFB for CN were included. Demographics, pre-surgical health status, details of foot pathology, details of surgery, postoperative treatment, treatment failure, and adverse events were registered. The following radiographic angles were measured on pre-op, post-op and last follow-up radiographs: talo-1st metatarsal (TMT) angle dorsoplantar and lateral view, and calcaneo-5th metatarsal angle.

RESULTS

Forty-seven patients (48 feet) were included in three centres. In 38 patients (80.1%) diabetes was diagnosed. Wound healing problems occurred in 21% of patients and recurrent ulceration in 13%. Revision surgery for loss of correction was performed in three cases (6%). Union rate at final follow-up was 98%. Major amputation for deep infection was performed in two patients (4%), minor amputation at the foot level in three cases (6%). Failure was more frequent when only one MFB (instead of 2 or 3) was used and no Gastrocnemius lengthening was performed. Radiographic alignment significantly improved pre- versus postoperatively and preoperatively versus follow-up.

CONCLUSIONS

Realignment and fixation with MFB in severe CN result in adequate correction with minimal loss of correction in the observed clinical course. The non-union rate was lower than previously reported. Stable fixation with MFB is a valuable treatment option for CN with minimal loss of correction and high union rates. The use of a minimum of two bolts is recommended to avoid recurrent deformity. Clinical Trials.gov: NCT01770639.

Authors+Show Affiliations

Department for Foot and Ankle Surgery, Sana Hospital Rummelsberg and Nuremberg, Germany. Electronic address: martinus.richter@sana.de.Department of Trauma, Hand and Reconstructive Surgery, Rostock University Medical Center, Germany.University Center for Orthopaedics and Traumatology, University Hospital Carl Gustav Carus, Dresden, Germany.Stockholms Fotkirurgklinik, Queen Sophia Hospital, Stockholm, Sweden.Department for Foot and Ankle Surgery, Sana Hospital Rummelsberg and Nuremberg, Germany.Department of Trauma, Hand and Reconstructive Surgery, Rostock University Medical Center, Germany.

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

26564730

Citation

Richter, Martinus, et al. "Intramedullary Fixation in Severe Charcot Osteo-neuroarthropathy With Foot Deformity Results in Adequate Correction Without Loss of Correction - Results From a Multi-centre Study." Foot and Ankle Surgery : Official Journal of the European Society of Foot and Ankle Surgeons, vol. 21, no. 4, 2015, pp. 269-76.
Richter M, Mittlmeier T, Rammelt S, et al. Intramedullary fixation in severe Charcot osteo-neuroarthropathy with foot deformity results in adequate correction without loss of correction - Results from a multi-centre study. Foot Ankle Surg. 2015;21(4):269-76.
Richter, M., Mittlmeier, T., Rammelt, S., Agren, P. H., Hahn, S., & Eschler, A. (2015). Intramedullary fixation in severe Charcot osteo-neuroarthropathy with foot deformity results in adequate correction without loss of correction - Results from a multi-centre study. Foot and Ankle Surgery : Official Journal of the European Society of Foot and Ankle Surgeons, 21(4), 269-76. https://doi.org/10.1016/j.fas.2015.02.003
Richter M, et al. Intramedullary Fixation in Severe Charcot Osteo-neuroarthropathy With Foot Deformity Results in Adequate Correction Without Loss of Correction - Results From a Multi-centre Study. Foot Ankle Surg. 2015;21(4):269-76. PubMed PMID: 26564730.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intramedullary fixation in severe Charcot osteo-neuroarthropathy with foot deformity results in adequate correction without loss of correction - Results from a multi-centre study. AU - Richter,Martinus, AU - Mittlmeier,Thomas, AU - Rammelt,Stefan, AU - Agren,Per-Henrik, AU - Hahn,Sarah, AU - Eschler,Anica, Y1 - 2015/03/09/ PY - 2014/10/31/received PY - 2015/02/02/revised PY - 2015/02/27/accepted PY - 2015/11/14/entrez PY - 2015/11/14/pubmed PY - 2016/8/10/medline KW - Charcot arthropathy KW - Correction KW - Deformity KW - Intramedullary fixation SP - 269 EP - 76 JF - Foot and ankle surgery : official journal of the European Society of Foot and Ankle Surgeons JO - Foot Ankle Surg VL - 21 IS - 4 N2 - BACKGROUND: Charcot osteo-neuroarthropathy (CN) of the foot can induce severe instability and deformity. Results of a consecutive clinical multi-centre study with Midfoot Fusion Bolt (MFB, Synthes GmbH, Oberdorf, Switzerland) are reported. METHODS: All patients (aged 18 years and older) treated between 2009 and 2013 with surgical reconstruction of the midfoot with MFB for CN were included. Demographics, pre-surgical health status, details of foot pathology, details of surgery, postoperative treatment, treatment failure, and adverse events were registered. The following radiographic angles were measured on pre-op, post-op and last follow-up radiographs: talo-1st metatarsal (TMT) angle dorsoplantar and lateral view, and calcaneo-5th metatarsal angle. RESULTS: Forty-seven patients (48 feet) were included in three centres. In 38 patients (80.1%) diabetes was diagnosed. Wound healing problems occurred in 21% of patients and recurrent ulceration in 13%. Revision surgery for loss of correction was performed in three cases (6%). Union rate at final follow-up was 98%. Major amputation for deep infection was performed in two patients (4%), minor amputation at the foot level in three cases (6%). Failure was more frequent when only one MFB (instead of 2 or 3) was used and no Gastrocnemius lengthening was performed. Radiographic alignment significantly improved pre- versus postoperatively and preoperatively versus follow-up. CONCLUSIONS: Realignment and fixation with MFB in severe CN result in adequate correction with minimal loss of correction in the observed clinical course. The non-union rate was lower than previously reported. Stable fixation with MFB is a valuable treatment option for CN with minimal loss of correction and high union rates. The use of a minimum of two bolts is recommended to avoid recurrent deformity. Clinical Trials.gov: NCT01770639. SN - 1460-9584 UR - https://www.unboundmedicine.com/medline/citation/26564730/Intramedullary_fixation_in_severe_Charcot_osteo_neuroarthropathy_with_foot_deformity_results_in_adequate_correction_without_loss_of_correction___Results_from_a_multi_centre_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1268-7731(15)00038-7 DB - PRIME DP - Unbound Medicine ER -