Union occurs 4 months after screw fixation of hind and midfoot Charcot deformity

The surgeon reporting results called the open reduction reconstruction technique effective for correcting Charcot arthropathy.

Issue: November 2010

Ten of 12 patients with Eichenholtz stage 3b and 3c Charcot hind- and midfoot arthropathy who were treated with an internal method using cannulated screws achieved union. At about 7 months postoperatively all eventually ambulated, according to findings an investigator presented at the 2010 Summer Meeting of the American Orthopaedic Foot and Ankle Association.

“The limitation of the study is the small number of patients and its retrospective character, however it shows that our technique that uses screw fixation in the treatment of Charcot arthropathy achieves a good result concerning fusion rate and consolidation time,” Ute Waldecker, MD, said during her presentation.

Six patients with plantar ulcers of the foot and six patients without ulcerations were included in Waldecker’s small, retrospective study.

Assessing deformity, union

Preoperative MRIs were performed to any exclude osteomyelitis cases and intraoperatively all patients underwent bone grafting to supplement the screw-based reconstructions. Postoperatively patients wore a foot and ankle orthosis for 3 months, at which time a radiograph was taken of their feet to determine the extent of arthrodesis and whether immobilization should continue and/or if it needed to be modified.

“The average follow-up was 2.4 years and the average time to achieve the arthrodesis was 4.3 months,” Waldecker said.

Based on the abstract, radiographic measurements were made of each foot treated preoperatively, immediately postoperatively, at 3 months postoperatively and whenever the last follow-up evaluation occurred.

Comparable fusion rate

“Looking at our results and comparing them to the literature, we had a fusion rate of 83%. In the other studies dealing with screw fixation there are fusion rate ranges from 73% to 100%,” Waldecker said.

The literature reports concerning internal fusion, which is another surgical option for these cases, show somewhat lower rates of fusion at 36% to 96%, she noted. “However, in some studies the osseous union is not the desired outcome, so a stable nonunion in an acceptable result,” Waldecker noted, adding that her study’s consolidation times of 4.3 months to achieve union are in line with those reported with internal fixation techniques.

Two complications

Other screw fixation studies reported a 17% to 36% complication rate, however “we had a 16% complication rate,” she said.

There were two complications among the 12 patients; a postoperative infection in one patient and in the other a nonunion that caused the patient’s foot deformity to recur.

“It is a good surgical method for elective patients with Charcot arthropathy without osteomyelitis. In comparison to other fixation methods, screw fixation demonstrated acceptable results,” Waldecker said.

She discussed how treatment of Charcot arthropathy has evolved over the years from conservative care to surgical stabilization, with the surgeries gradually occurring earlier after onset of the condition to increase the chances of restoring function and better aligning the hind and midfoot, as well as to prevent progression of the deformity. – by Susan M. Rapp

Reference:

Waldecker U. Arthrodesis with screw fixation in the treatment of Charcot hind and midfoot arthopathy. Presented at the 2010 Summer Meeting of the American Orthopaedic Foot and Ankle Society. July 8-10. National Harbor, Md.

Ute Waldecker, MD, can be reached in the Orthopaedic Department, Hufeland Klinik, Taunus Allee 5, 56130 Bad Ems, Germany; 49-2603-92-1815; e-mail: ortho@hufeland-klinik.com.

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