title: Intramedullary fixation in severe Charcot osteo-neuroarthropathy with foot deformity results in adequate correction without loss of correction - Results from a multi-centre study.
abstract: Charcot osteo-neuroarthropathy (CN) of the foot can induce severe instability and deformity. Results of a consecutive clinical multi-centre study with Midfoot Fusion Bolt (MFB, Synthes GmbH, Oberdorf, Switzerland) are reported.
  
  
  
  All patients (aged 18 years and older) treated between 2009 and 2013 with surgical reconstruction of the midfoot with MFB for CN were included. Demographics, pre-surgical health status, details of foot pathology, details of surgery, postoperative treatment, treatment failure, and adverse events were registered. The following radiographic angles were measured on pre-op, post-op and last follow-up radiographs: talo-1st metatarsal (TMT) angle dorsoplantar and lateral view, and calcaneo-5th metatarsal angle.
  
  
  
  Forty-seven patients (48 feet) were included in three centres. In 38 patients (80.1%) diabetes was diagnosed. Wound healing problems occurred in 21% of patients and recurrent ulceration in 13%. Revision surgery for loss of correction was performed in three cases (6%). Union rate at final follow-up was 98%. Major amputation for deep infection was performed in two patients (4%), minor amputation at the foot level in three cases (6%). Failure was more frequent when only one MFB (instead of 2 or 3) was used and no Gastrocnemius lengthening was performed. Radiographic alignment significantly improved pre- versus postoperatively and preoperatively versus follow-up.
  
  
  
  Realignment and fixation with MFB in severe CN result in adequate correction with minimal loss of correction in the observed clinical course. The non-union rate was lower than previously reported. Stable fixation with MFB is a valuable treatment option for CN with minimal loss of correction and high union rates. The use of a minimum of two bolts is recommended to avoid recurrent deformity. Clinical Trials.gov: NCT01770639.
authors.affiliation: Department for Foot and Ankle Surgery, Sana Hospital Rummelsberg and Nuremberg, Germany. Electronic address: martinus.richter@sana.de.
authors.forename: Martinus
authors.initials: M
authors.lastname: Richter
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, Rostock University Medical Center, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Mittlmeier
authors.affiliation: University Center for Orthopaedics and Traumatology, University Hospital Carl Gustav Carus, Dresden, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Rammelt
authors.affiliation: Stockholms Fotkirurgklinik, Queen Sophia Hospital, Stockholm, Sweden.
authors.forename: Per-Henrik
authors.initials: PH
authors.lastname: Agren
authors.affiliation: Department for Foot and Ankle Surgery, Sana Hospital Rummelsberg and Nuremberg, Germany.
authors.forename: Sarah
authors.initials: S
authors.lastname: Hahn
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, Rostock University Medical Center, Germany.
authors.forename: Anica
authors.initials: A
authors.lastname: Eschler
mesh_terms: D000328:Adult; D000368:Aged; D001177:Arthropathy, Neurogenic / Q000601:surgery*; D048909:Diabetes Complications / Q000150:complications; D005260:Female; D005530:Foot Deformities / Q000601:surgery*; D005594:Fracture Fixation, Intramedullary; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
keywords: Charcot arthropathy; Correction; Deformity; Intramedullary fixation