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Surgical treatment of midfoot charcot neuroarthropathy review of literature and our results after superconstruct reconstruction of midfoot charcot neuroarthropathy.
J Clin Orthop Trauma. 2021 Jun; 17:59-64.JC

Abstract

BACKGROUND

Charcot neuroarthropathy (CN) of the midfoot was traditionally treated non-operatively with off-loading in a total contact cast (TCC). After introduction of the super construct concept, promising results were reported, however there is a need for further studies on this concept. Analysis of non-operative versus operative treatment is presented as well as our results from a consecutive series of 20 patients operated with the superconstruct concept.

METHODS

Twenty patients were operated from July 2017 until June 2020. Mean age was 58 years (50-80), mean weight was 116 kg (68-156), giving a BMI of 31 (26-45). Preoperative patients off-loaded in a TCC until decreased swelling and skin temperature measurement or ulcer had healed, mean 16 weeks immobilization. Surgery was without tourniquet, using a standard medial and lateral incision. Mean follow up is 24 (5-40) months.

RESULTS

Mean operation time was 227 (150-315) minutes. Medial column fusion was mandatory, in five cases as an isolated procedure, in 12 cases in combination with lateral column fusion and in three cases with a talocalcaneal fusion. Preoperative lateral Meary angle decreased from 23.5 to 9.6°, antero-posterior Meary angle decreased from 16.0 to 4.7°. Eight patients had postoperative incisional wound problems. Four patients had partial implant removal. All healed with a good clinical result. Two patients had an acute Charcot attack in the ankle joint during postoperative mobilization. One had a severe collapse of the talus resulting in a below knee amputation, giving an amputation rate of 5%. Radiographic examination at follow up, showed bone union of all patients. Nineteen patients are ambulated in orthopedic shoes at latest follow up, giving a 95% satisfactory result.

CONCLUSION

Superconstruct reconstruction of CN midfoot collapse is a safe procedure. There are incisional wound problems, recognition and fast treatment of these complications is important to achieve good results. There is a risk for overloading the ankle, initiating a new acute Charcot attack. Attention must be on this problem. The surgical technique is demanding and should be performed by experienced foot and ankle surgeons in a multidisciplinary team set up.

Authors+Show Affiliations

University Center for Wound Healing, Odense University Hospital, J.B. Winsløws Vej 4, 5000, Odense, Denmark.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

33680840

Citation

Frøkjær, Johnny. "Surgical Treatment of Midfoot Charcot Neuroarthropathy Review of Literature and Our Results After Superconstruct Reconstruction of Midfoot Charcot Neuroarthropathy." Journal of Clinical Orthopaedics and Trauma, vol. 17, 2021, pp. 59-64.
Frøkjær J. Surgical treatment of midfoot charcot neuroarthropathy review of literature and our results after superconstruct reconstruction of midfoot charcot neuroarthropathy. J Clin Orthop Trauma. 2021;17:59-64.
Frøkjær, J. (2021). Surgical treatment of midfoot charcot neuroarthropathy review of literature and our results after superconstruct reconstruction of midfoot charcot neuroarthropathy. Journal of Clinical Orthopaedics and Trauma, 17, 59-64. https://doi.org/10.1016/j.jcot.2021.02.003
Frøkjær J. Surgical Treatment of Midfoot Charcot Neuroarthropathy Review of Literature and Our Results After Superconstruct Reconstruction of Midfoot Charcot Neuroarthropathy. J Clin Orthop Trauma. 2021;17:59-64. PubMed PMID: 33680840.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Surgical treatment of midfoot charcot neuroarthropathy review of literature and our results after superconstruct reconstruction of midfoot charcot neuroarthropathy. A1 - Frøkjær,Johnny, Y1 - 2021/02/11/ PY - 2020/12/28/received PY - 2021/02/02/revised PY - 2021/02/07/accepted PY - 2021/3/8/entrez PY - 2021/3/9/pubmed PY - 2021/3/9/medline KW - Charcot KW - Charcot reconstruction KW - Medullary beaming KW - Midfoot KW - Neuroarthropathy KW - Superconstruct SP - 59 EP - 64 JF - Journal of clinical orthopaedics and trauma JO - J Clin Orthop Trauma VL - 17 N2 - BACKGROUND: Charcot neuroarthropathy (CN) of the midfoot was traditionally treated non-operatively with off-loading in a total contact cast (TCC). After introduction of the super construct concept, promising results were reported, however there is a need for further studies on this concept. Analysis of non-operative versus operative treatment is presented as well as our results from a consecutive series of 20 patients operated with the superconstruct concept. METHODS: Twenty patients were operated from July 2017 until June 2020. Mean age was 58 years (50-80), mean weight was 116 kg (68-156), giving a BMI of 31 (26-45). Preoperative patients off-loaded in a TCC until decreased swelling and skin temperature measurement or ulcer had healed, mean 16 weeks immobilization. Surgery was without tourniquet, using a standard medial and lateral incision. Mean follow up is 24 (5-40) months. RESULTS: Mean operation time was 227 (150-315) minutes. Medial column fusion was mandatory, in five cases as an isolated procedure, in 12 cases in combination with lateral column fusion and in three cases with a talocalcaneal fusion. Preoperative lateral Meary angle decreased from 23.5 to 9.6°, antero-posterior Meary angle decreased from 16.0 to 4.7°. Eight patients had postoperative incisional wound problems. Four patients had partial implant removal. All healed with a good clinical result. Two patients had an acute Charcot attack in the ankle joint during postoperative mobilization. One had a severe collapse of the talus resulting in a below knee amputation, giving an amputation rate of 5%. Radiographic examination at follow up, showed bone union of all patients. Nineteen patients are ambulated in orthopedic shoes at latest follow up, giving a 95% satisfactory result. CONCLUSION: Superconstruct reconstruction of CN midfoot collapse is a safe procedure. There are incisional wound problems, recognition and fast treatment of these complications is important to achieve good results. There is a risk for overloading the ankle, initiating a new acute Charcot attack. Attention must be on this problem. The surgical technique is demanding and should be performed by experienced foot and ankle surgeons in a multidisciplinary team set up. SN - 0976-5662 UR - https://www.unboundmedicine.com/medline/citation/33680840/Surgical_treatment_of_midfoot_charcot_neuroarthropathy_review_of_literature_and_our_results_after_superconstruct_reconstruction_of_midfoot_charcot_neuroarthropathy_ L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/33680840/ DB - PRIME DP - Unbound Medicine ER -
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