Midfoot Charcot Neuroarthopathy- is there an ideal configuration of superconstruct?

M. Tiruveedhula, P. Poulios, A. Graham, M. Mulcahy

Aim: To describe an ideal combination of intramedullary and extramedullary stabilisation for Midfoot Charcot Neuroarthopaty (CN).  

Patients and methods: Consecutive group of patients who had internal stabilisation of Midfoot CN operated by a single surgeon from Mar 2018 and were followed with radiographs for a minimum of 12m were included in the analysis. Intramedullary beams in isolation or combination with extramedullary plates were used. When used in isolation, 4 intramedullary beams were used to stabilise the 3 column of the foot. In some patients, supplemental plates were used to stabilise the medial and lateral columns. Radiographic parameters of dorsal and lateral Meary’s angles and cubod height were calculated for each patient and progression of the deformity due to failure of metalwork was recorded.

Results: A total of 68 patients underwent stabilisation of midfoot CN since 2018, 48 patients were followed for a minimum of 12m (12-32m). Two patients died of unrelated causes and of the remaining, revision of metalwork was needed in 12 patients (26%). None in these group needed major limb amputation. Intramedullary beams when used in isolation provide adequate axial and rotational stability, however offered least stability in the coronal plane regardless of the length of the beams. The combination of intramedullary beam and medial plate provided the best construct for the medial and middle column which provided stability in all planes. When the intramedullary beam alone was used to stabilise the lateral column in combination with medial plate and beam, late failure in the coronal plane was noted. A lateral plate stabilised this column satisfactorily.    

Conclusion: Internal fixation based on the principles of Superconstruct with a combination of intramedullary beam and supplemental medial plate effectively stabilised the medial column; and a lateral plate the lateral column.