A high-profile thread with grit-blasted and acid-etched surface reduces loosening of medial column fusion bolt in instable Charcot foot

被引:4
作者
Mehlhorn, Alexander T. [1 ,2 ]
Ugland, Karl, I [3 ]
Hoerterer, Hubert [1 ]
Gottschalk, Oliver [1 ]
Suedkamp, Norbert [2 ]
Walther, Markus [1 ]
机构
[1] Schon Klin Munchen Harlaching, Ctr Foot & Ankle Surg, Harlachingerstr 55, D-81549 Munich, Germany
[2] Albert Ludwigs Univ Freiburg, Med Ctr, Dept Orthoped & Trauma Surg, Freiburg, Germany
[3] Univ Oslo, Dept Biosci, PB 1066 Blindern, N-0316 Oslo, Norway
关键词
Charcot foot; Fusion bolt; Diabetes mellitus; ASA CLASSIFICATION; FIXATION; ARTHRODESIS; SCREW;
D O I
10.1016/j.fas.2019.08.004
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Background: Intramedullary fusion bolts (FB) were introduced to stabilize the medial column of the instable Charcot foot (ICF), but complications as bolt loosening or breakage are frequent. We compared the use of a standard FB and a high-profile threaded FB with a grit-blasted surface. We hypothesized that implant related complications occurred less often and osseous consolidation of fusion sites was more distinctive using the latter type of FB. Methods: Consecutive patients suffering from an ICF were stabilized with a high-profile threaded and surface-modified FB (HTFB) (n = 20) or with a standard FB (n = 20) which was placed into the first ray. Additional bolts and dorsal low-profile plates were applied in every patient. In a retrospective assessment osseous consolidation of the fusion sites was analyzed at 3 month and quantified by CT scan. At 3 and 12 month longitudinal foot arch collapse and rate of bolt loosening were assessed. Results: Compared to the control group, the HTFB group reached significant higher consolidation after 3 month. No dislocation and a single bolt breakage was observed in the HTFB group after the fourth month, while the control group included 3 patients with bolt dislocation at 3 +/- 1 month and 5 patients with bolt breakage at 6 +/- 1.8 month. Compared to preoperative values, the improvement of Meary's angle after one-year was significant higher in the HTFB group (23.4 degrees +/- 14) than in controls (11.7 degrees +/- 13). Conclusions: Modificationofboltdesignimprovesthestabilityof themedial column: Ahigherrateofosseous consolidation of the medial column leads to lower rate of bolt dislocation/breakage and finally to permanently erected longitudinal foot arch. Initially disappointing results following medial column stabilization with fusion bolts can be rejected by modifications of bolt design and its technical application. (c) 2019 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.
引用
收藏
页码:637 / 643
页数:7
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