title: Complication assessment and prevention strategies using midfoot fusion bolt for medial column stabilization in Charcot's osteoarthropathy.
abstract: In Charcot's osteoarthropathy stabilization of the medial column of the foot was introduced in order to establish a stable foot and reduce the risk for amputation. This study was performed to analyze postoperative complications, define risk factors for those and develop strategies for prevention. Since bolt dislocation takes place frequently, it was aimed to predict an appropriate time point for bolt removal under the condition that osseous healing has occurred. Fourteen consecutive patients with neuroosteoarthropathy of the foot and arch collapse were treated with open reduction and stabilization using midfoot fusion bolt and lateral lag screws. Age, gender, presence of preoperative osteomyelitis or ulcer, number of complications and operative revisions, Hba1c value, consolidation of arthrodesis, presence of a load-bearing foot and period to bolt dislocation was assessed. The mean follow-up was 21.4±14.6 (mean±SDM) months, 64% of patients suffered from diabetes with a preoperative Hba1c of 8.5±2.4. The mean number of revisions per foot was 3.6±4.1. Bolt dislocation was seen in 57% of the patients following 11.3±8.5 months; in 75% of these patients bony healing occurred before dislocation. There was a significant association between preoperative increased Hba1c value, presence of preoperative ulcer and wound infection. Healing of arthrodesis was demonstrated in 57% and a permanent weight-bearing foot without recurrent ulcer was achieved in 79%. The early and late postoperative complications could be controlled in general. A fully load-bearing and stable foot was obtained, despite osseous consolidation was not detected in all of these cases. Once a stable foot has established early removal of fusion bolt should be considered. To decrease the risk of infection Hba1c should be adjusted and ulcers should be treated before the operation.
authors.affiliation: Department of Orthopedic and Trauma Surgery, University Medical Center, Hugstetterstrasse 55, Germany; Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Hugstetterstrasse 55, 79106 Freiburg, Germany; Center of Foot and Ankle Surgery, Schön Klinik München Harlaching, Harlachingerstraße 51, 81547 Munich, Germany. Electronic address: amehlhorn@schoen-kliniken.com.
authors.forename: Alexander T
authors.initials: AT
authors.lastname: Mehlhorn
authors.affiliation: Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Hugstetterstrasse 55, 79106 Freiburg, Germany; Center of Foot and Ankle Surgery, Schön Klinik München Harlaching, Harlachingerstraße 51, 81547 Munich, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Walther
authors.affiliation: Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Hugstetterstrasse 55, 79106 Freiburg, Germany; Center of Foot and Ankle Surgery, Schön Klinik München Harlaching, Harlachingerstraße 51, 81547 Munich, Germany.
authors.forename: Niklas
authors.initials: N
authors.lastname: Iblher
authors.affiliation: Department of Orthopedic and Trauma Surgery, University Medical Center, Hugstetterstrasse 55, Germany.
authors.forename: Norbert P
authors.initials: NP
authors.lastname: Südkamp
authors.affiliation: Department of Orthopedic and Trauma Surgery, University Medical Center, Hugstetterstrasse 55, Germany; Department of Orthopedics and Traumatology, Odense University Hospital and Department of Clinical Research, University of Southern Denmark, Sdr. Boulevard 29, 500 Odense C, Denmark.
authors.forename: Hagen
authors.initials: H
authors.lastname: Schmal
mesh_terms: D001174:Arthrodesis / Q000009:adverse effects* / Q000379:methods; D001177:Arthropathy, Neurogenic / Q000209:etiology / Q000601:surgery*; D001863:Bone Screws; D020878:Device Removal; D003920:Diabetes Mellitus; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010523:Peripheral Nervous System Diseases / Q000150:complications; D011183:Postoperative Complications; D012086:Reoperation; D013530:Surgical Wound Infection / Q000209:etiology; D013640:Tarsal Joints / Q000601:surgery*
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: Charcot’s osteoarthropathy; Diabetes mellitus; Foot; Infection