The Medial Column Fusion Bolt

Abstract

Category: Diabetes Introduction/Purpose: Charcot neuroarthropathy (CN) of the foot can cause severe bone and joint destruction. The aim of reconstruction is to correct the deformity and achieve bone fusion, in order to provide a plantigrade foot to ambulate with using accommodative footwear. Column beaming using the Medial Column Fusion Bolt (MCB) is a new technique described to stabilize - medial and/or lateral columns. We performed a meta-analysis to assess the outcome of the use of column beaming in treatment of CN. Methods: We performed a search of the English literature for the following search terms: ‘Charcot’, ‘arthropathy’, ‘column bolt’, ‘superconstruct’, ‘intramedullary’, ‘beaming’, ‘rodding’, ‘midfoot fusion’, ‘midfoot arthrodesis and ‘fusion bolt’. We included all the studies published until 2015. Only 10 studies met the inclusion criteria, and were identified for evaluation. Results: There were a total of 197 feet in 191 patients 47; average age 58.1 years (29-81 years). Diabetes mellitus was the most common cause of CN (81.8%). The average follow-up duration post-operatively was approximately 30 months (range 3-137 months). Several classification systems were used to grade deformity, implants were commonly combined with other fixation based on the location and severity of the deformity, presence or absence of ulcers and surgeon’s preference. All studies reported improvement in correction of deformities both clinically & radiologically with an associated-loss of correction over the follow-up period. Overall, we observed 49.8% of patients experienced a complication, including screw breakage or migration (33), infection (42), wound dehiscence (20) and peri-prosthetic fractures (4). Resulting in revision and lower than expected fusion rates and recurrent ulceration. Conclusion: The MCB provides excellent correction of deformity, with high-failure-rate. This is especially true if a single-rod is used, as it may not provide enough stability to achieve osseous-fusion, due its inability to provide enough compression, reduce shear stress at bone interfaces when used in isolation. Thus additional-implants in neutralising rotational-instability to achieve a stable ‘‘superconstruct’’ may-avoid implant-failure, recurrent-deformity & high-complication-rates. Further assessment & stratification of CN deformity and implant use must be ascertained prior to definitive conclusions being reached regarding the use of the MCB. Whilst there is significant heterogeneity, current evidence suggests surgeons should use this device with caution.