Abstract
Lateral column deterioration and subsequent loss of function poses a challenge for
limb preservation in patients with Charcot neuroarthropathy (CN). Application of “superconstructs”
provides stability and clinical improvement to an often-ulcerated lateral foot. This
study examines radiodensity in Hounsfield units (HU) to compare bone quality of lateral
column fixation targets using computed tomography (CT) scans between patients with
and without midfoot CN. A retrospective chart review identified control (nondiabetic,
non-CN; n = 29) and midfoot CN (n = 21) groups. Patient demographics and medical history
were collected. Two reviewers measured the mean HU of circular regions of interest
centered on the fourth and fifth metatarsal heads as well as the anterior, middle,
and posterior thirds of the calcaneus. Radiodensity was compared between groups, among
calcaneal locations, Eichenholtz stages and Brodsky types. A p value ≤.05 was considered statistically significant. Age and body mass index were
not significantly different between groups. The CN group exhibited greater HU than
the control group at the metatarsal head and calcaneus (p < .001). The anterior calcaneus exhibited greater HU than the posterior calcaneus
in the CN group (p = .02). The difference in HU was not statistically significant between Stages 0-1
and Stages 2-3 or midfoot Brodsky Types. Indirect bone density analysis revealed an
increased density in CN compared to control patients with no significant difference
between midfoot CN stages or types. The anterior calcaneus was the densest rearfoot
bone among the CN patients, a result that may have implications in surgical fixation.
Level of Clinical Evidence
Keywords
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Article info
Publication history
Published online: October 03, 2022
Footnotes
Financial Disclosure: This study received no internal or external funding.
Conflict of Interest: Dr. Hyer is a consultant for Wright Medical Technology, Integra, Ossio, Artelon, and In2Bones. He maintains IP rights with Wright Medical Technology, Zimmer Biomet, Integra, and Stryker. Dr. Blum is a consultant for Wright Medical Technology and NovaStep.
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