Advertisement

Posterior Approach for Medial Column Beam Screw in Midfoot Charcot Reconstruction: Technique and Structures at Risk

Published:November 11, 2014DOI:https://doi.org/10.1053/j.jfas.2014.10.006

      Abstract

      Charcot neuroarthropathy is frequently recognized as a major cause of morbidity in patients with neuropathic diabetes mellitus. Recently, intramedullary beam screw fixation has been used for midfoot Charcot reconstructions. Ten below-the-knee cadaveric specimens were used to demonstrate an antegrade, posterior approach for placement of a medial column beam screw, with specific attention to the proximity of the anatomic structures at risk. Six structures at risk were identified, including the sural nerve, ankle joint, flexor hallucis longus tendon, Achilles tendon, neurovascular bundle, and peroneal tendon sheath. The sural nerve was the most commonly injured structure, injured in 50% of the limbs. The Achilles and flexor hallucis longus tendons were injured in 20% and the ankle joint in 10% of the limbs. The neurovascular bundle and peroneal tendon sheath were located over 1 cm from the reference guidewire and were considered safe structures in this approach. Our results have demonstrated an alternative posterior approach to the delivery of an intramedullary medial column beam screw, instead of a retrograde technique beginning in the metatarsal heads. Our results have also made clear the need to be aware of the potential for damage to the sural nerve, Achilles tendon, flexor hallucis longus tendon, and ankle joint.

      Level of Clinical Evidence

      Keywords

      To read this article in full you will need to make a payment

      References

        • Myerson M.S.
        • Henderson M.R.
        • Saxby T.
        • Short K.W.
        Management of midfoot diabetic neuroarthropathy.
        Foot Ankle Int. 1994; 15: 233-241
        • de Souza L.J.
        Charcot arthropathy and immobilization in a weight-bearing total contact cast.
        J Bone Joint Surg Am. 2008; 90: 754-759
        • Pinzur M.S.
        • Lio T.
        • Posner M.
        Treatment of Eichenholtz stage I Charcot foot arthropathy with a weightbearing total contact cast.
        Foot Ankle Int. 2006; 27: 324-329
        • Lesko P.
        • Maurer R.C.
        Talonavicular dislocations and midfoot arthropathy in neuropathic diabetic feet: natural course and principles of treatment.
        Clin Orthop Relat Res. 1989; 240: 226-231
        • Early J.S.
        • Hansen S.T.
        Surgical reconstruction of the diabetic foot: a salvage approach for midfoot collapse.
        Foot Ankle Int. 1996; 17: 325-330
        • Sammarco G.J.
        • Conti S.F.
        Surgical treatment of neuroarthropathic foot deformity.
        Foot Ankle Int. 1998; 19: 102-109
        • Brodsky J.W.
        • Rouse A.M.
        Exostectomy for symptomatic bony prominences in diabetic Charcot feet.
        Clin Orthop Relat Res. 1993; 296: 21-26
        • Catanzariti A.R.
        • Mendicino R.
        • Haverstock B.
        Ostectomy for diabetic neuroarthropathy involving the midfoot.
        J Foot Ankle Surg. 2000; 39: 291-300
        • Papa J.
        • Myerson M.
        • Girard P.
        Salvage, with arthrodesis, in intractable diabetic neuropathic arthropathy of the foot and ankle.
        J Bone Joint Surg Am. 1993; 75: 1056-1066
        • Sammarco V.J.
        • Sammarco G.J.
        • Walker Jr., E.W.
        • Guiao R.P.
        Midtarsal arthrodesis in the treatment of Charcot midfoot arthropathy.
        J Bone Joint Surg Am. 2009; 91: 80-91
        • Bono J.V.
        • Roger D.J.
        • Jacobs R.L.
        Surgical arthrodesis of the neuropathic foot: a salvage procedure.
        Clin Orthop Relat Res. 1993; 296: 14-20
        • Cooper P.S.
        Application of external fixators for management of Charcot deformities of the foot and ankle.
        Foot Ankle Clin. 2002; 7: 207-254
        • Schon L.C.
        • Easley M.E.
        • Weinfeld S.B.
        Charcot neuroarthropathy of the foot and ankle.
        Clin Orthop Relat Res. 1998; 349: 116-131
        • Sammarco V.J.
        Superconstructs in the treatment of Charcot foot deformity: plantar plating, locked plating, and axial screw fixation.
        Foot Ankle Clin. 2009; 14: 393-407
        • Grant W.P.
        • Garcia-Lavin S.
        • Sabo R.
        Beaming the columns for Charcot diabetic foot reconstruction: a retrospective analysis.
        J Foot Ankle Surg. 2011; 50: 182-189
        • Lamm B.M.
        • Siddiqui N.A.
        • Nair A.K.
        • LaPorta G.
        Intramedullary foot fixation for midfoot Charcot neuroarthropathy.
        J Foot Ankle Surg. 2012; 51: 531-536
        • Assal M.
        • Stern R.
        Realignment and extended fusion with use of a medial column screw for midfoot deformities secondary to diabetic neuropathy.
        J Bone Joint Surg Am. 2009; 91: 812-820
        • Grant W.P.
        Biomechanics of the Charcot foot collapse and roding the medial column of the foot as a beam to salvage the Charcot foot.
        in: Annual American College of Foot and Ankle Surgeons Scientific Seminar, Orlando, FL. 1997
        • Lamm B.M.
        • Paley D.
        Charcot Neuroarthropathy of the foot and ankle.
        in: Rozbruch S.R. Ilizarov S. Limb Lengthening and Reconstructive Surgery. Informa Healthcare, New York2007: 221-231