Midtarsal Arthrodesis in the Treatment of Charcot Midfoot Arthropathy

• Published in: Journal of bone and joint surgery. American volume Vol. 91; no. 1; pp. 80 - 91
• Main Authors: Sammarco, V James, Sammarco, G James, Walker, Earl W, Guiao, Ronald P
• Format: Journal Article
• Language: English
• Published: Boston, MA Copyright by The Journal of Bone and Joint Surgery, Incorporated 01-01-2009; Journal of Bone and Joint Surgery Incorporated
• Subjects: Aged; Aged, 80 and over; Arthrodesis - methods; Arthropathy, Neurogenic - diagnostic imaging; Arthropathy, Neurogenic - surgery; Biological and medical sciences; Diseases of the osteoarticular system; Female; Humans; Male; Medical sciences; Middle Aged; Miscellaneous. Osteoarticular involvement in other diseases; Orthopedic surgery; Radiography; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Treatment Outcome; Arthropathy; Arthrodesis; Orthopedic surgery; Treatment; Diseases of the osteoarticular system
• ISSN: 0021-9355; 1535-1386
• DOI: 10.2106/JBJS.G.01629

BackgroundFracture-dislocation of the midfoot with collapse of the longitudinal arch is common in patients with neuropathic arthropathy of the foot. In this study, we describe a technique of midfoot arthrodesis with use of intramedullary axial screw fixation and review the results and complications following use of this technique.MethodsA retrospective study of twenty-two patients who had undergone surgical reconstruction and arthrodesis to treat Charcot midfoot deformity was performed. Bone resection and/or osteotomy were required to reduce deformity. Axially placed intramedullary screws, inserted either antegrade or retrograde across the arthrodesis sites, were used to restore the longitudinal arch. Radiographic measurements were recorded preoperatively, immediately postoperatively, and at the time of the last follow-up and were analyzed in order to assess the amount and maintenance of correction.ResultsPatients were evaluated clinically and radiographically at an average of fifty-two months. Complete osseous union was achieved in sixteen of the twenty-two patients, at an average of 5.8 months. There were five partial unions in which a single joint did not unite in an otherwise stable foot. There was one nonunion, with recurrence of deformity. All patients returned to an independent functional ambulatory status within 9.5 months. Weight-bearing radiographs showed the talar-first metatarsal angle, the talar declination angle, and the calcaneal-fifth metatarsal angle to have improved significantly and to have been corrected to nearly normal values by the surgery. All measurements remained significantly improved, as compared with the preoperative values, at the time of final follow-up. There were no recurrent dislocations. Three patients had a recurrent plantar ulcer at the metatarsophalangeal joint that required additional surgery. There were eight cases of hardware failure.ConclusionsOpen reduction and arthrodesis with use of multiple axially placed intramedullary screws for the surgical correction of neuropathic midfoot collapse provides a reliable stable construct to achieve and maintain correction of the deformity.Level of EvidenceTherapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.