[The Midfoot Fusion Bolt: a new perspective?].

Area of Science:

• Orthopedic surgery
• Foot and ankle reconstruction
• Diabetic foot complications

Background:

• Optimal surgical treatment for midfoot Charcot remains undefined due to anatomical diversity.
• Current fixation methods include screws and plates, with a new intramedullary device, the Midfoot Fusion Bolt, under investigation.
• Limited long-term data exists for the Midfoot Fusion Bolt, necessitating evaluation of its short-term outcomes.

Purpose of the Study:

• To assess the short-term results and complication rates of the Midfoot Fusion Bolt in midfoot Charcot reconstruction.
• To review existing literature on surgical interventions for midfoot Charcot.
• To evaluate patient satisfaction and expert opinions regarding the device.

Main Methods:

• The Midfoot Fusion Bolt, a solid intramedullary screw, was implanted using antegrade or retrograde techniques in 16 patients (17 feet).
• Data collected included body mass index (BMI), glycosylated hemoglobin (HbA1c), patient satisfaction, and complication rates.
• Follow-up averaged 21.17 months, with analysis of fusion rates and need for secondary interventions.

Main Results:

• An average fusion rate of 92.35% was achieved.
• Four cases of postoperative ulceration occurred, leading to two amputations.
• Six bolts required removal between 2009 and 2014 due to instability or complications.

Conclusions:

• The Midfoot Fusion Bolt alone may provide insufficient stability for midfoot Charcot reconstruction.
• Adjunctive fixation with additional screws or plates can achieve stable outcomes.
• Further prospective studies and biomechanical testing are essential for definitive conclusions on the device's utility.