CME OnDemand: 2022 AOFAS Annual Meeting-Intramedullary Beaming Superconstructs for the Treatment of Midfoot Deformity in Patients with Charcot Arthropathy

Intramedullary Beaming Superconstructs for the Treatment of Midfoot Deformity in Patients with Charcot Arthropathy

Pdf Summary

This study evaluated the use of intramedullary beaming superconstructs for the treatment of Charcot midfoot deformity. The study included 36 patients who underwent midfoot arthrodesis with an intramedullary beaming superconstruct between January 2017 and January 2021. The results showed a limb salvage rate of 97%, a successful arthrodesis rate of 83%, and a return to ambulation rate of 92%. In 89% of patients, a plantigrade, ulcer-free foot was achieved.<br /><br />Supplemental plate fixation, especially lateral column or both medial and lateral column plating, significantly improved the fusion rate (100% vs 76%) and reduced complications (26% vs 59%). Nonunion was associated with increased repeat surgery (50% vs 13%) and postoperative ulceration (33% vs 3%). Additional subtalar arthrodesis did not affect fusion rates, repeat surgery, infection rates, or postoperative complications. However, additional tibiotalarcalcaneal arthrodesis was associated with an increase in repeat surgery (60% vs 13%).<br /><br />The study also provided patient characteristics, including a mean age of 60.7 years and a mean BMI of 36.2. The majority of patients did not use tobacco (67%), had diabetes mellitus (94%), and had deformity classified as Brodsky-Trepman Classification 4 (42%). Eight patients had ulceration.<br /><br />Overall, this study supports the use of intramedullary beaming as a treatment option for Charcot midfoot deformity. The findings suggest that supplemental plate fixation can enhance fusion rates and reduce complications. Creating "superconstructs" with fusion of joints outside of the fragmentation zone and using strong implants are important considerations in treating these patients. Charcot arthropathy is a serious condition that often requires surgical intervention due to progressive deformity resulting from midfoot collapse.

Asset Subtitle

Doug Haase, MD, Steven Clary, Morgan Hadley, Erik Mersereau, Jake S. Enos, Greg A. Horton, MD

Keywords

intramedullary beaming superconstructs

Charcot midfoot deformity

midfoot arthrodesis

limb salvage rate

supplemental plate fixation

fusion rate

complications

nonunion

repeat surgery

Charcot arthropathy