Clinical comparison of internal fixation constructs in midfoot charcot arthropathy

Charcot neuroarthropathy affects 0.4-13% of diabetic patients and can be limb threatening, often requiring surgical stabilization. Traditionally, intramedullary fixation ("beaming") has been utilized, but more recently intramedullary compression nails ("IM nails") have been introduced.

This study compared radiographic union, hardware failure, and major reoperations between IM nails and traditional beaming for Charcot midfoot reconstruction.

Patient outcomes following Charcot midfoot reconstruction were retrospectively analyzed at a single center from 2016 to 2021.

We identified patients with midfoot Charcot treated with extended intramedullary fixation and ≥9 months follow-up. Patients with ulceration, ankle Charcot, or external fixation were excluded. Demographics, construct type, and radiographic outcomes were evaluated. Union was assessed by two fellowship-trained surgeons. Multivariable logistic regression controlled for construct type and subtalar arthrodesis.

Forty-two feet (mean age 56.6 ± 9.2 years) were included: 18 beaming and 24 IM nail constructs. Mean follow-up was 2.2 ± 1.2 years (clinical) and 12.8 ± 7.1 months (radiographic). Demographics were similar between groups. Secondary surgery was required in 19 feet (45.2%) with no significant difference between groups (p = 0.07). IM nail constructs had significantly higher union rates (91.7% vs 50.0%, p = 0.004) and lower hardware failure rates (12.5% vs 66.7%, p < 0.001). Regression analysis showed this association was independent of concomitant subtalar arthrodesis status.

Intramedullary compression nails demonstrated superior union and hardware failure rates than traditional beaming constructs in midfoot Charcot reconstruction, benefits that persisted independent of concomitant subtalar arthrodesis. Further investigation is needed to determine whether this is primarily attributable to implant design or additive effects of hindfoot stabilization.