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Charcot Midfoot Reconstruction: Does Subtalar Arthrodesis or Medial Column Fixation Improve Outcomes?
J Foot Ankle Surg. 2020 Nov - Dec; 59(6):1219-1223.JF

Abstract

Charcot neuroarthropathy is a complication of neuropathy often secondary to diabetes mellitus and most commonly affects the midfoot. In these patients, reconstruction of the foot may be required for limb salvage. A superconstruct technique has previously been described using intramedullary beaming fixation of the midfoot and hindfoot to span the zone of injury. Inclusion of the subtalar joint in the arthrodesis construct is not consistently performed among different surgeons. The aim of this study was to describe midfoot beaming constructs and postoperative complications after midfoot reconstruction with and without subtalar arthrodesis. We reviewed medical records of patients who underwent midfoot Charcot reconstruction with an intramedullary beaming superconstruct. Patients included in the study had at least 3 months of follow-up and had Sanders-Frykberg II/III classification of Charcot neuroarthropathy. Postoperative radiographs were evaluated for evidence of hardware failure at the latest follow-up evaluation. The main variables of interest were: hardware failure or nonunion requiring revision operation, deep infection, and unplanned reoperation. Thirty patients who underwent midfoot reconstruction were included. The mean follow-up was 67.4 ± 25.9 weeks. Twenty-two (73.3%) patients had concomitant subtalar arthrodesis and midfoot beaming. Overall complications were lower in patients with subtalar arthrodesis (40.9%) than those without subtalar arthrodesis (75%) resulting in an odds ratio of 0.271 (0.042-1.338, p = .146). Furthermore, increased number of screws used in the midfoot construct was negatively correlated with complications (r = -0.44, p = .01). An intramedullary midfoot beaming superconstruct with subtalar arthrodesis has previously been proposed to provide better fixation after midfoot beaming Charcot neuroarthropathy reconstruction. Our results suggest including the subtalar joint as part of a superconstruct for the reconstruction of Sanders-Frykberg II/III Charcot results in an 80% lower complication rate than intramedullary beaming alone. We also found an increased number of screws used in the midfoot results in a lower complication rate.

Authors+Show Affiliations

Resident, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.Resident, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.Medical Student, University of Texas Southwestern Medical School, Dallas, TX.Associate Professor, Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX.Associate Professor, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.Associate Professor, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.Associate Professor, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.Professor and Chair, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.Assistant Professor, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX. Electronic address: Trapper_Lalli@med.unc.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32950368

Citation

Manchanda, Kshitij, et al. "Charcot Midfoot Reconstruction: Does Subtalar Arthrodesis or Medial Column Fixation Improve Outcomes?" The Journal of Foot and Ankle Surgery : Official Publication of the American College of Foot and Ankle Surgeons, vol. 59, no. 6, 2020, pp. 1219-1223.
Manchanda K, Wallace SB, Ahn J, et al. Charcot Midfoot Reconstruction: Does Subtalar Arthrodesis or Medial Column Fixation Improve Outcomes? J Foot Ankle Surg. 2020;59(6):1219-1223.
Manchanda, K., Wallace, S. B., Ahn, J., Nakonezny, P., Liu, G. T., Raspovic, K. M., VanPelt, M., Wukich, D. K., & Lalli, T. (2020). Charcot Midfoot Reconstruction: Does Subtalar Arthrodesis or Medial Column Fixation Improve Outcomes? The Journal of Foot and Ankle Surgery : Official Publication of the American College of Foot and Ankle Surgeons, 59(6), 1219-1223. https://doi.org/10.1053/j.jfas.2020.07.001
Manchanda K, et al. Charcot Midfoot Reconstruction: Does Subtalar Arthrodesis or Medial Column Fixation Improve Outcomes. J Foot Ankle Surg. 2020 Nov - Dec;59(6):1219-1223. PubMed PMID: 32950368.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Charcot Midfoot Reconstruction: Does Subtalar Arthrodesis or Medial Column Fixation Improve Outcomes? AU - Manchanda,Kshitij, AU - Wallace,S Blake, AU - Ahn,Junho, AU - Nakonezny,Paul, AU - Liu,George T, AU - Raspovic,Katherine M, AU - VanPelt,Michael, AU - Wukich,Dane K, AU - Lalli,Trapper, Y1 - 2020/07/18/ PY - 2020/06/10/received PY - 2020/07/14/accepted PY - 2020/9/21/pubmed PY - 2021/6/25/medline PY - 2020/9/20/entrez KW - Charcot neuroarthropathy KW - diabetes mellitus KW - intramedullary beaming KW - midfoot KW - subtalar joint KW - superconstruct SP - 1219 EP - 1223 JF - The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons JO - J Foot Ankle Surg VL - 59 IS - 6 N2 - Charcot neuroarthropathy is a complication of neuropathy often secondary to diabetes mellitus and most commonly affects the midfoot. In these patients, reconstruction of the foot may be required for limb salvage. A superconstruct technique has previously been described using intramedullary beaming fixation of the midfoot and hindfoot to span the zone of injury. Inclusion of the subtalar joint in the arthrodesis construct is not consistently performed among different surgeons. The aim of this study was to describe midfoot beaming constructs and postoperative complications after midfoot reconstruction with and without subtalar arthrodesis. We reviewed medical records of patients who underwent midfoot Charcot reconstruction with an intramedullary beaming superconstruct. Patients included in the study had at least 3 months of follow-up and had Sanders-Frykberg II/III classification of Charcot neuroarthropathy. Postoperative radiographs were evaluated for evidence of hardware failure at the latest follow-up evaluation. The main variables of interest were: hardware failure or nonunion requiring revision operation, deep infection, and unplanned reoperation. Thirty patients who underwent midfoot reconstruction were included. The mean follow-up was 67.4 ± 25.9 weeks. Twenty-two (73.3%) patients had concomitant subtalar arthrodesis and midfoot beaming. Overall complications were lower in patients with subtalar arthrodesis (40.9%) than those without subtalar arthrodesis (75%) resulting in an odds ratio of 0.271 (0.042-1.338, p = .146). Furthermore, increased number of screws used in the midfoot construct was negatively correlated with complications (r = -0.44, p = .01). An intramedullary midfoot beaming superconstruct with subtalar arthrodesis has previously been proposed to provide better fixation after midfoot beaming Charcot neuroarthropathy reconstruction. Our results suggest including the subtalar joint as part of a superconstruct for the reconstruction of Sanders-Frykberg II/III Charcot results in an 80% lower complication rate than intramedullary beaming alone. We also found an increased number of screws used in the midfoot results in a lower complication rate. SN - 1542-2224 UR - https://www.unboundmedicine.com/medline/citation/32950368/Charcot_Midfoot_Reconstruction:_Does_Subtalar_Arthrodesis_or_Medial_Column_Fixation_Improve_Outcomes L2 - https://linkinghub.elsevier.com/retrieve/pii/S1067-2516(20)30255-6 DB - PRIME DP - Unbound Medicine ER -