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Clinical Outcomes and Complications of Midfoot Charcot Reconstruction With Intramedullary Beaming.
Foot Ankle Int. 2019 Jan; 40(1):18-23.FA

Abstract

BACKGROUND:

The purpose of this study was to examine the clinical outcomes and complications of patients with midfoot Charcot managed with midfoot osteotomy, realignment arthrodesis, and stabilization using intramedullary beams.

METHODS:

Consecutive patients with midfoot Charcot treated at a tertiary-care foot and ankle center from January 2013 to July 2016 who underwent corrective osteotomy with internal beam fixation were identified; 25 patients were included in the final analysis. Patients with a minimum 1-year follow-up were evaluated with physical examination, weightbearing radiographs, and patient-reported outcome measures. The primary outcome measure was defined as restoration of a stable, plantigrade, ulcer-free foot. Median age was 58 years, median BMI was 32, and 80% were diabetic (75% insulin-dependent).

RESULTS:

An ulcer-free, stable, plantigrade foot was obtained in 84% of patients. The radiographic lateral and anteroposterior Meary angle medians improved 9° and 15°, respectively, from preoperative to final postoperative weightbearing measurements (P < .001 and P = .02). Overall, 46% of midfoot osteotomies were united on final radiographs at a median 18-month radiographic follow-up. Deep infection developed in 6 (24%) patients. The presence of a preoperative ulcer was found to be predictive of postoperative infection (P = .04); all 6 deep infections occurred in patients with preoperative ulceration. Four (16%) patients progressed to amputation at a mean 15 postoperative months, all for deep infection.

CONCLUSION:

Midfoot Charcot reconstruction with intramedullary beaming allowed for restoration of an ulcer-free, plantigrade foot in most patients, but the complication rates were high, especially in patients with preoperative ulceration.

LEVEL OF EVIDENCE:

Level IV, retrospective case series.

Authors+Show Affiliations

1 Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, NC, USA.2 OrthoCarolina Foot and Ankle Institute, Charlotte, NC, USA.2 OrthoCarolina Foot and Ankle Institute, Charlotte, NC, USA.2 OrthoCarolina Foot and Ankle Institute, Charlotte, NC, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30284492

Citation

Ford, Samuel E., et al. "Clinical Outcomes and Complications of Midfoot Charcot Reconstruction With Intramedullary Beaming." Foot & Ankle International, vol. 40, no. 1, 2019, pp. 18-23.
Ford SE, Cohen BE, Davis WH, et al. Clinical Outcomes and Complications of Midfoot Charcot Reconstruction With Intramedullary Beaming. Foot Ankle Int. 2019;40(1):18-23.
Ford, S. E., Cohen, B. E., Davis, W. H., & Jones, C. P. (2019). Clinical Outcomes and Complications of Midfoot Charcot Reconstruction With Intramedullary Beaming. Foot & Ankle International, 40(1), 18-23. https://doi.org/10.1177/1071100718799966
Ford SE, et al. Clinical Outcomes and Complications of Midfoot Charcot Reconstruction With Intramedullary Beaming. Foot Ankle Int. 2019;40(1):18-23. PubMed PMID: 30284492.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical Outcomes and Complications of Midfoot Charcot Reconstruction With Intramedullary Beaming. AU - Ford,Samuel E, AU - Cohen,Bruce E, AU - Davis,W Hodges, AU - Jones,Carroll P, Y1 - 2018/10/04/ PY - 2018/10/5/pubmed PY - 2020/1/15/medline PY - 2018/10/5/entrez KW - Charcot KW - deformity KW - diabetes KW - infection KW - internal fixation KW - intramedullary beam KW - intramedullary bolt KW - midfoot KW - osteoarthropathy SP - 18 EP - 23 JF - Foot & ankle international JO - Foot Ankle Int VL - 40 IS - 1 N2 - BACKGROUND:: The purpose of this study was to examine the clinical outcomes and complications of patients with midfoot Charcot managed with midfoot osteotomy, realignment arthrodesis, and stabilization using intramedullary beams. METHODS:: Consecutive patients with midfoot Charcot treated at a tertiary-care foot and ankle center from January 2013 to July 2016 who underwent corrective osteotomy with internal beam fixation were identified; 25 patients were included in the final analysis. Patients with a minimum 1-year follow-up were evaluated with physical examination, weightbearing radiographs, and patient-reported outcome measures. The primary outcome measure was defined as restoration of a stable, plantigrade, ulcer-free foot. Median age was 58 years, median BMI was 32, and 80% were diabetic (75% insulin-dependent). RESULTS:: An ulcer-free, stable, plantigrade foot was obtained in 84% of patients. The radiographic lateral and anteroposterior Meary angle medians improved 9° and 15°, respectively, from preoperative to final postoperative weightbearing measurements (P < .001 and P = .02). Overall, 46% of midfoot osteotomies were united on final radiographs at a median 18-month radiographic follow-up. Deep infection developed in 6 (24%) patients. The presence of a preoperative ulcer was found to be predictive of postoperative infection (P = .04); all 6 deep infections occurred in patients with preoperative ulceration. Four (16%) patients progressed to amputation at a mean 15 postoperative months, all for deep infection. CONCLUSION:: Midfoot Charcot reconstruction with intramedullary beaming allowed for restoration of an ulcer-free, plantigrade foot in most patients, but the complication rates were high, especially in patients with preoperative ulceration. LEVEL OF EVIDENCE:: Level IV, retrospective case series. SN - 1944-7876 UR - https://www.unboundmedicine.com/medline/citation/30284492/Clinical_Outcomes_and_Complications_of_Midfoot_Charcot_Reconstruction_With_Intramedullary_Beaming_ L2 - https://journals.sagepub.com/doi/10.1177/1071100718799966?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -