title: Late corrective arthrodesis in nonplantigrade diabetic charcot midfoot disease is associated with high complication and reoperation rates.
abstract: BACKGROUND
  Charcot arthropathy may lead to a loss of osteoligamentous foot architecture and consequently loss of the plantigrade alignment. In this series of patients a technique of internal corrective arthrodesis with maximum fixation strength was provided in order to lower complication rates.
  
  
  METHODS
  21 feet with severe nonplantigrade diabetic Charcot deformity Eichenholtz stages II/III (Sanders/Frykberg II/III/IV) and reconstructive arthrodesis with medial and additional lateral column support were retrospectively enrolled. Follow-up averaged 4.0 years and included a clinical (AOFAS score/PSS), radiological, and complication analysis.
  
  
  RESULTS
  A mean of 2.4 complications/foot occurred, of which 1.5/foot had to be solved surgically. 76% of feet suffered from soft tissue complications; 43% suffered hardware-associated complications. Feet with only 2 out of 5 high risk criteria according to Pinzur showed significantly lower complication counts. Radiographs revealed a correct restoration of all foot axes postoperatively with superior fixation strength medially.
  
  
  CONCLUSIONS
  Late corrective arthrodesis with medial and lateral column stabilization in the nonplantigrade stages of neuroosteoarthropathy can provide reasonable reconstruction of the foot alignment. Nonetheless, overall complication/reoperation rates were high. With separation into low/high risk criteria a helpful guide in treatment choice is provided. This trial is registered with German Clinical Trials Register (DRKS) under number DRKS00007537.
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, University of Rostock Medical Center, Schillingallee 35, 18057 Rostock, Germany.
authors.forename: Anica
authors.identifier: 0000-0002-3189-0849
authors.initials: A
authors.lastname: Eschler
authors.affiliation: Department of Trauma, Orthopedic and Reconstructive Surgery, Munich Municipal Hospital Group, Harlaching Clinic, Sanatoriumsplatz 2, 81545 Munich, Germany.
authors.forename: Georg
authors.identifier: 0000-0002-6780-472X
authors.initials: G
authors.lastname: Gradl
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, University of Rostock Medical Center, Schillingallee 35, 18057 Rostock, Germany.
authors.forename: Annekatrin
authors.initials: A
authors.lastname: Wussow
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, University of Rostock Medical Center, Schillingallee 35, 18057 Rostock, Germany.
authors.forename: Thomas
authors.identifier: 0000-0002-0536-8045
authors.initials: T
authors.lastname: Mittlmeier
mesh_terms: D000328:Adult; D000368:Aged; D001174:Arthrodesis / Q000009:adverse effects*; D001177:Arthropathy, Neurogenic / Q000601:surgery*; D003922:Diabetes Mellitus, Type 1 / Q000601:surgery; D003924:Diabetes Mellitus, Type 2 / Q000601:surgery; D017719:Diabetic Foot / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D012086:Reoperation; D016896:Treatment Outcome