title: [The Midfoot Fusion Bolt: a new perspective?].
abstract: BACKGROUND
  There is no current guideline nor consensus regarding optimal surgical treatment of the midfoot Charcot. Due to the vast diversity of locations, it is difficult to make a general statement. Various different types of screws and plates are currently being used since they have been tested and declared to be most stable. The Midfoot Fusion Bolt is a new device which needs approval since long-term results are lacking. A short summary of currently published papers and results from our own institution are provided.
  
  
  OBJECTIVE
  The aim of this study was to investigate short-term results including complications and review published surveys.
  
  
  METHODS
  The Midfoot Fusion Bolt is a solid, intramedullary screw. An antegrade as well as a retrograde technique are postulated for insertion. A total of 16 patients/17 feet in two specialized foot and ankle centers were included. BMI, HbA1c, satisfaction rates, complication rates, and expert opinions were recorded.
  
  
  RESULTS
  The bolts were used an average of 21.17 months (range 3-55 months) in 16 patients/17 feet. Between 2009 and 2014, six bolts had to be removed. We encountered 4 cases of postoperative ulceration: 2 cases healed postoperatively, while the other 2 cases led to amputation. The average fusion rate was 92.35 %.
  
  
  CONCLUSIONS
  The Midfoot Fusion Bolt is no longer advised for single-device use only since there have been issues in terms of insufficient stability. However, stable conditions could be achieved with additional screws or plates, respectively. Prospective studies and biomechanical testing for general conclusions are still required to make a meaningful assessment.
authors.affiliation: Allgemeines Krankenhaus Wien, Universitätsklinik für Orthopädie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich, markus.wurm@meduniwien.ac.at.
authors.forename: M
authors.initials: M
authors.lastname: Wurm
authors.forename: R
authors.initials: R
authors.lastname: Schuh
authors.forename: A
authors.initials: A
authors.lastname: Wanivenhaus
authors.forename: R
authors.initials: R
authors.lastname: Windhager
authors.forename: H-J
authors.initials: HJ
authors.lastname: Trnka
mesh_terms: D001174:Arthrodesis / Q000295:instrumentation* / Q000379:methods*; D001177:Arthropathy, Neurogenic / Q000175:diagnosis / Q000601:surgery*; D001863:Bone Screws; D017719:Diabetic Foot / Q000175:diagnosis / Q000601:surgery*; D019544:Equipment Failure Analysis; D006801:Humans; D011474:Prosthesis Design; D016896:Treatment Outcome