Internal Versus External Fixation of Charcot Midfoot Deformity Realignment

Area of Science:

• Orthopedic surgery
• Podiatric medicine
• Diabetic foot complications

Background:

• Charcot midfoot deformity requires surgical reconstruction, with no consensus on optimal fixation methods.
• Internal and external fixation are surgical options for realignment and arthrodesis.

Purpose of the Study:

• To systematically compare clinical outcomes of internal versus external fixation for Charcot midfoot deformity surgery.
• To evaluate effects on ambulation, ulcer occurrence, nonunion, amputation, infection, and complications.

Main Methods:

• Systematic review of studies published between 1990 and 2014.
• Logistic regression analysis to assess outcomes associated with fixation type.

Main Results:

• Internal fixation showed higher odds of return to functional ambulation (OR, 1.259) and reduced ulcer occurrence (OR, 0.578).
• External fixation had 8x higher odds of nonunion (OR, 8.2).
• Internal fixation increased odds of amputation (OR, 1.488), deep infection (OR, 2.068), wound healing issues (OR, 3.405), and overall complications (OR, 1.525).

Conclusions:

• Internal fixation may enhance ambulation and decrease nonunion risk for Charcot midfoot deformity.
• However, internal fixation is associated with significantly higher rates of overall complications compared to external fixation.