Outcomes of Posterior Arthroscopic Subtalar Arthrodesis for Medial Facet Talocalcaneal Coalition

Background: Medial facet talocalcaneal coalition can be a painful condition. This study aimed to determine clinical and radiographic outcomes of posterior arthroscopic subtalar arthrodesis (PASTA) for adult patients presenting with symptomatic medial facet talocalcaneal coalition and normal hindfoot alignment, with a minimal follow-up of 18 months. Methods: Between June 2017 and July 2019, this procedure was performed on 8 feet (8 patients; mean age, 55 [42-70] years; mean BMI, 29.8 [24.4-45.0] kg/m2). Clinical assessment was performed using Visual Analog Scale for Pain (VAS-P), Foot and Ankle Outcome Score (FAOS) and the 36-Item Short-Form Health Survey (SF-36). Patient satisfaction was assessed at the last available follow-up as “very satisfied”, “satisfied” or “unsatisfied”. Radiographic analysis was performed using plain radiography, computed tomography (CT) scan and magnetic resonance imaging (MRI). The primary outcome was to determine both clinical and radiographic outcomes. Results: The mean follow-up was 25.1 (18.2-34.2) months. The authors found statistically significant improvement on all clinical scores (VASP-P, FAOS and SF-36). They registered 6 “very satisfied” patients, 2 “satisfied” patients and no “unsatisfied” patient. Fusion of the subtalar joint was observed in all patients by 12 weeks and in 5 of them as soon as 8 weeks postoperatively (mean, 9.5 [8-12] weeks). There were no cases of delayed fusion or nonunion of the subtalar joint, superficial or deep infection, neurovascular damage, thromboembolic event, screw breakage, need for hardware removal or revision surgery. Conclusion: This study found that PASTA is a safe and reliable technique for adult patients presenting with symptomatic medial facet talocalcaneal coalition and normal hindfoot alignment, demonstrating and maintaining clinical improvement at an average follow-up of 2 years. Level of Evidence: Level IV, case series.

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2020 IFFAS Award for Excellence Winner: Outcomes and Complications of Open versus Posterior Arthroscopic Subtalar Arthrodesis: A Prospective Randomized Controlled Multicenter Study

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00077 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0007

Author(s):

Chamnanni Rungprai ◽

Aekachai Jaroenarpornwatana ◽

Yantarat Sripanich ◽

Nusorn Chaiprom

Keyword(s):

Functional Outcomes ◽

Subtalar Joint ◽

T Test ◽

Return To Sports ◽

Subtalar Arthrodesis ◽

Sf 36 ◽

Significant Difference ◽

Subtalar Arthritis ◽

Joint Arthritis

Category: Hindfoot Introduction/Purpose: Open subtalar arthrodesis is a standard treatment for subtalar joint arthritis. Recently, posterior arthroscopic subtalar arthrodesis (PASTA) has been introduced and gained increasing popularity due to fasten recovery time and better cosmesis. However, there is limited current studies to report outcomes and complications between the two techniques. The purpose of this study is to compare outcomes and complications between open and PASTA techniques. Methods: A prospective, randomized collected data of 56 consecutive patients who were diagnosed with isolated subtalar arthritis and underwent either open (28 patients) or PASTA (28 patients) between 2016 and 2019 were enrolled in this study. The minimum follow-up time to be included in this study was 12 months. The primary outcome was union rate which was confirmed by post-operative CT scan. The secondary outcomes were union time, VAS, SF-36, FAAM, tourniquet times, and complications. A paired sample t-test was used to assess statistical differences between pre- and post-operative functional outcomes (VAS, SF-36, and FAAM) in the same group of both open and PASTA techniques while an independent t-test was used to compare functional outcomes (VAS, SF-36, and FAAM) between the two techniques. Results were significance at p < 0.05. Descriptive statistics were used for the demographic variables. Results: There were 56 patients (44 male and 12 female) with mean follow-up time was 17.7 months and 17.5 months for open and PASTA. The union time was significantly shorter in PASTA (9.4 vs 12.8 weeks, p<0.05). PASTA demonstrated significantly fasten recovery times (p<0.05 all) including time to return to ADL (8.4 vs 10.8 weeks), work (9.4 vs 12.8 weeks), and sports (9.4 vs 12.8 weeks). Both Open and PASTA techniques demonstrated significant improvement of all functional outcomes (FAAM, SF- 36, and VAS (p<0.01 all)); however, there was no significant difference between the two techniques. Other outcomes were not significant difference including tourniquet times (55.8 vs 67.2 minutes) and union rates (96.3 vs 100%) and complications. Conclusion: Both open and PASTA techniques demonstrated significant improvement of pain and function for treatment of patients with isolated subtalar joint arthritis. Although there was no significant difference of short-term of functional outcomes and complications, PASTA technique was better in term of shorten time to union and fasten time to return to sports.

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Correction of foot malalignment after old talar neck fracture

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00509 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0050

Author(s):

Bibo Wang

Keyword(s):

Lateral Wall ◽

Clinical Problem ◽

Time Interval ◽

Hindfoot Alignment ◽

Vas Score ◽

Subtalar Arthrodesis ◽

Radiographic Outcomes ◽

Sf 36 ◽

Before And After ◽

Neck Fracture

Category: Hindfoot Introduction/Purpose: Posttraumatic talar neck mal-union often results in varus hindfoot and adducted forefoot. That leads to a deformed stiff foot and peri-talar osteoarthritis, causing pain, altered gait and dysfunctions. This study analyzed the adopted corrective methods and their clinical and radiographic outcomes. Methods: This study retrospectively reviewed 18 cases of symptomatic malaligned foot as a result of old talar neck fracture, who undertook corrective surgeries during the period from Sept.2009 to Oct. 2016. The average time interval between the injury and the corrective surgery was 23.8±33.5 months. Procedures including ORIF of talus, lateralizing calcaneal osteotomy, subtalar arthrodesis and opening osteotomy of medial talus were selected for the correction and reconstruction of foot deformity. The follow-up time after surgery was 29.5±18.5months. The angle of first metatarsal axis and talar axis (FMT) was measured on the A-P view of foot. The distance between the lowest point of calcaneus and the tibial axis (Moment Arm, MoA) and the angle between the lateral wall of calcaneus and tibial axis (hindfoot alignment angle, HAA) were measured on the hindfoot alignment view of foot. VAS score, AOFAS-AH score and SF-36 scores were compared before and after surgery. Results: The FMT angle increased from -6.8±5.7 degrees before surgery to +1.8±2.6 degrees after surgery (p<0.05); The MoA increased from -3.1±2.4 cm before surgery to +0.5±1.0 cm after surgery (p<0.05); The HAA increased from -19.6±8.3 degrees before surgery to -3.8±4.1 degrees after surgery (p<0.05) 。 The VAS score decreased from 6.5±2.3 before surgery to 1.0±1.2 after surgery (p<0.05). The AOFAS-AH score increased from 54.5±16.2 before surgery to 88.6±12.3 after surgery (p<0.05). The SF-36 score increased from 48.7±10.5 before surgery to 85.4±9.2 after surgery (p<0.05). The osteotomy and arthrodesis sites were healing well judging from the X-ray and CT images. Conclusion: The correction and reconstruction of deformed foot resulted from old mal-united talar fracture poses a difficult clinical problem. The major principle is to correct the varus hindfoot and adducted forefoot. Selected Combined procedures including ORIF of talus, calcaneal lateralizing osteotomy, subtalar arthrodesis and medial talar opening osteotomy are recommended to restore normal alignments and functions.

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Syndesmotic Fixation Utilizing a Novel Metal Screw: A Retrospective Case Series Reporting Early Clinical and Radiographic Outcomes

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00410 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0041

Author(s):

Derek S. Stenquist ◽

Brian Velasco ◽

Patrick K. Cronin ◽

Jorge Briceno ◽

Christopher Miller ◽

...

Keyword(s):

External Rotation ◽

Case Series ◽

Break Point ◽

The Novel ◽

Suture Button ◽

Radiographic Outcomes ◽

Clear Space ◽

Anatomic Reduction ◽

Screw Breakage

Category: Ankle Introduction/Purpose: Syndesmotic disruption occurs in nearly 1 in 5 ankle fractures and requires anatomic reduction and internal stabilization to maximize functional outcomes. There is growing evidence to support retaining syndesmotic hardware from both a functional and economic standpoint. However, although broken screws are typically of little consequence, the location of screw breakage can be unpredictable and cause painful bony erosion and difficulty with extraction. The purpose of this investigation is to report early clinical and radiographic outcomes of patients who underwent syndesmotic fixation using a novel metal screw with a more predictable break point and design features to allow for easier extraction. Methods: We performed a retrospective review of all consecutive patients who underwent syndesmotic fixation utilizing the novel syndesmotic screw over a one year period. Demographic data were obtained such as age, gender, fracture classification and relevant comorbidities. Screw specific data were obtained such as number of screws utilized and length. Screw loosening or breakage was documented. Postoperative radiographs were reviewed and tibiofibular overlap, tibiofibular clear space and medial clear space were measured. Results: 18 patients met inclusion criteria. Mean length of clinical follow-up was 4.67 months (range 0.5 to 8.5 months). Per the Lauge Hansen classification, 14 injuries were supination external rotation type, two were pronation abduction and two pronation external rotation type. Three screws (12.5%) fractured at the break point with no screws fracturing at a different location. 21 screws did not fracture with 10 (42%) of the screws demonstrated to be loose. There was no evidence of syndesmotic diastasis or mortise malalignment on final follow up of the cohort. No screws required removal during the study period. There were no other complications of any type (Table 1). Conclusion: Early reporting of outcomes is essential to maximize both safety and value in healthcare technology innovation. This study provides the first clinical data on a novel alternative to traditional screws and suture button devices for fixation of syndesmotic injuries. At short-term follow up, there were no complications and the novel screw provided adequate fixation to allow healing and prevent diastasis. While initial results are favorable, longer term follow-up is required to determine whether this novel implant can reduce rates of symptomatic hardware requiring removal, which could ultimately make them more cost- effective than suture-button fixation.

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Syndesmotic Fixation Utilizing a Novel Screw: A Retrospective Case Series Reporting Early Clinical and Radiographic Outcomes

Foot & Ankle Specialist ◽

10.1177/1938640019866322 ◽

2019 ◽

Vol 13 (5) ◽

pp. 397-403 ◽

Cited By ~ 2

Author(s):

Derek Stenquist ◽

Brian T. Velasco ◽

Patrick K. Cronin ◽

Jorge Briceño ◽

Christopher P. Miller ◽

...

Keyword(s):

Weight Bearing ◽

Case Series ◽

Break Point ◽

Retrospective Case ◽

Level Of Evidence ◽

Radiographic Outcomes ◽

Retrospective Case Series ◽

Screw Breakage ◽

Tissue Stabilization

Background. Syndesmotic disruption occurs in 20% of ankle fractures and requires anatomical reduction and stabilization to maximize outcomes. Although screw breakage is often asymptomatic, the breakage location can be unpredictable and result in painful bony erosion. The purpose of this investigation is to report early clinical and radiographic outcomes of patients who underwent syndesmotic fixation using a novel metal screw designed with a controlled break point. Methods. We performed a retrospective review of all patients who underwent syndesmotic fixation utilizing the R3lease Tissue Stabilization System (Paragon 28, Denver, CO) over a 12-month period. Demographic and screw-specific data were obtained. Postoperative radiographs were reviewed, and radiographic parameters were measured. Screw loosening or breakage was documented. Results. 18 patients (24 screws) met inclusion criteria. The mean follow-up was 11.7 months (range = 6.0-14.7 months). 5/24 screws (21%) fractured at the break point. No screw fractured at another location, nor did any fracture prior to resumption of weight bearing; 19 screws did not fracture, with 8/19 intact screws (42.1%) demonstrating loosening. There was no evidence of syndesmotic diastasis or mortise malalignment on final follow-up. No screws required removal during the study period. Conclusion. This study provides the first clinical data on a novel screw introduced specifically for syndesmotic fixation. At short-term follow up, there were no complications and the R3lease screw provided adequate fixation to allow healing and prevent diastasis. Although initial results are favorable, longer-term follow-up with data on cost comparisons and rates of hardware removal are needed to determine cost-effectiveness relative to similar implants. Level of Evidence: Level IV: Retrospective case series

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Ilizarov Technique Combined with Additional Procedures for the Correction of Equinocavovarus Foot Deformity in Adults

10.21203/rs.3.rs-34937/v1 ◽

2020 ◽

Author(s):

Longbin Bai ◽

Peiting Liu ◽

Sihe Qin ◽

Zengtao Wang

Keyword(s):

Short Form ◽

Weight Bearing ◽

Case Series ◽

Foot Deformities ◽

Ilizarov Technique ◽

Foot Deformity ◽

Hindfoot Alignment ◽

Sf 36 ◽

Hind Foot

Abstract Background: The Ilizarov technique has been used to treat equinocavovarus foot deformity and has shown good results. However, these results were mostly observed in pediatric patients, and few reports involving only adult case series exist. The aim of this study was to evaluate the outcome of the Ilizarov technique combined with additional procedures for equinocavovarus deformities in adults. Methods: Total 28 adult patients (33 feet) who underwent equinocavovarus foot deformities correction using the Ilizarov technique combined with additional procedures between February 2013 and December 2017 were included. Clinical outcomes were assessed preoperatively and at final follow-up using the Visual Analog Scale (VAS), the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot score, the Foot Ankle Ability Measure (FAAM) score, and the Short Form-36 (SF-36) questionnaire. The radiographic outcomes were measured using weight-bearing ankle and foot radiographs taken preoperatively and at the last follow-up visit.Results: The mean VAS, AOFAS ankle-hind foot scores, FAAM scores were significantly improved (P < 0.0001 for each) at a mean follow-up of 37.30 ±10.94 months. SF-36 scores increased postoperatively in terms of physical function, role-physical, body pain, general health, vitality, social function, role-emotional, mental health, and health transition (P < 0.0001 for each). Early complications were found in 19 feet (57.6%) and late complications were found in 7 feet (21.2%). Radiographs showed that the tibio-talar angle (p < 0.0001), tibial-sole angle (p < 0.0001), talus-first metatarsal angle (p = 0.0004), talo-calcaneal angle (p = 0.0002), and hindfoot alignment view angle (p < 0.0001) were significantly improved. Twenty-seven (97%) patients were satisfied with their outcomes and reported that they would undergo the same procedure if they had the same preoperative deformities.Conclusion: The combination of the Ilizarov technique and additional procedures provides an effective and reliable means of correcting equinocavovarus foot deformity, yielding high levels of patient satisfaction and a low incidence of recurrence. Studies with more cases are needed to assess the results because there are many different etiological mechanisms.

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Operative treatment of calcaneal fractures: improved outcomes and low complications rates with a strict management protocol

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2016.0259 ◽

2017 ◽

Vol 99 (4) ◽

pp. 275-279 ◽

Cited By ~ 1

Author(s):

N Vasukutty ◽

V Kumar ◽

M Diab ◽

W Moussa

Keyword(s):

Subtalar Joint ◽

Postoperative Management ◽

Long Term Results ◽

Foot And Ankle ◽

Calcaneal Fractures ◽

Wound Breakdown ◽

Management Protocol ◽

Sf 36 ◽

The Mean

This is a retrospective review of 80 intra-articular calcaneal fractures treated with open reduction and internal fixation by a specialist team under supervision of a single surgeon in a tertiary centre between 2005 and 2014. The fractures were evaluated with plain radiography and computed tomography, and graded using the Eastwood–Atkins classification. A lateral approach was used and all fractures were fixed with calcaneal plates. All patients had clinical and radiological follow-up. Clinical assessment included foot and ankle disability index, SF-36® and Kerr–Atkins scores. The mean follow-up duration was 72 months (range: 12–130 months). The mean age of patients was 49 years (range: 17–73 years). There were three open fractures and eight patients had other injuries. The mean Bohler’s angle improved from 6° preoperatively to 26° postoperatively. The mean foot and ankle disability index score was 78.62, the mean SF-36® scores were 45.5 (physical component) and 52.6 (mental component), and the mean Kerr–Atkins score was 72 (range: 36–100). Early complications included one case of screw protrusion in the subtalar joint (which warranted a repeat procedure), one sural nerve injury and one wound breakdown, which healed with non-operative measures. Twelve patients had symptomatic subtalar joint osteoarthritis. Four of these had subtalar fusion. We believe that our strict protocols of patient selection, intraoperative and postoperative management produced long-term results comparable with those in the peer reviewed literature.

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Clinical and Radiographic Results of Ankle Joint Preservation Surgery in Posterior Ankle Arthritis

Foot & Ankle International ◽

10.1177/10711007211011182 ◽

2021 ◽

pp. 107110072110111

Author(s):

Jaeyoung Kim ◽

Ji-Beom Kim ◽

Woo-Chun Lee

Keyword(s):

Sagittal Plane ◽

Case Series ◽

Radiographic Evaluation ◽

Ankle Arthritis ◽

Hindfoot Alignment ◽

Tibiotalar Joint ◽

Joint Preservation ◽

Subtalar Arthrodesis ◽

Study Results

Background: Little information is available about how to manage ankles with eccentric arthritis in the sagittal plane. This study aimed to report clinical and radiographic outcomes following joint preservation surgery for ankles with eccentric arthritis at the posterior tibiotalar joint and a plantarflexed talus in the sagittal plane, which we named posterior ankle arthritis. Methods: Ten ankles with posterior ankle arthritis were treated with realignment surgery between 2017 and 2018. Posterior ankle arthritis was defined as having both (1) eccentric narrowing of the joint space at the posterior aspect of the tibiotalar joint on weightbearing lateral radiographs and (2) coronal talar tilt angle less than 4 degrees on weightbearing anteroposterior radiographs. Flatfoot reconstruction with a hindfoot arthrodesis procedure was performed in all patients (subtalar arthrodesis, n = 9; triple arthrodesis, n = 1), and a supramalleolar osteotomy was added in patients with varus distal tibial alignment (n = 6). Pain, functional outcome (foot function index [FFI]), radiographic arthritis stage (stage I to IV), and 9 radiographic parameters, including lateral talar center migration (LTCM), were evaluated on pre- and postoperative weightbearing radiographs. All patients completed a minimum 2-year follow-up. Results: Preoperative radiographic evaluation demonstrated that ankles with posterior arthritis had a lower medial longitudinal arch, forefoot abduction, and valgus hindfoot alignment. Postoperatively, sagittal tibiotalar alignment was restored, as evidenced by an improved median LTCM from −3.3 to −0.3 mm ( P < .001). The radiographic arthritis stage improved in 7 (70%) patients, whereas 3 (30%) remain unchanged in the same stage. The median score for pain (visual analog scale) decreased significantly from 8 to 2, and the median FFI improved significantly from 67.8 to 23.4 ( P < .001). None of the patients underwent conversion to joint-sacrificing procedures at the latest follow-up. Conclusion: The study results suggest a possible relationship between posterior ankle arthritis and the plantarflexion of the talus, which can be seen in the setting of a flatfoot deformity. Reconstruction of the flatfoot deformity using subtalar arthrodesis restored the tibiotalar relationship in the sagittal plane and resulted in clinical improvements at an average 2.3-year follow-up in this 10-ankle case series. Level of Evidence: Level IV, case series.

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Outcomes and Complications of Open vs Posterior Arthroscopic Subtalar Arthrodesis: A Prospective Randomized Controlled Multicenter Study

Foot & Ankle International ◽

10.1177/10711007211047239 ◽

2021 ◽

pp. 107110072110472

Author(s):

Chamnanni Rungprai ◽

Aekachai Jaroenarpornwatana ◽

Nusorn Chaiprom ◽

Phinit Phisitkul ◽

Yantarat Sripanich

Keyword(s):

Functional Outcomes ◽

Recovery Time ◽

Subtalar Joint ◽

Complication Rates ◽

Union Rate ◽

Tourniquet Time ◽

Randomized Controlled ◽

Subtalar Arthrodesis ◽

Sf 36 ◽

Joint Arthritis

Background: Open subtalar arthrodesis is the standard treatment for subtalar arthritis. Posterior arthroscopic subtalar arthrodesis (PASTA) has recently gained increasing popularity due to a shorter recovery time and better cosmesis. However, studies comparing outcomes and complications between these 2 techniques are limited. Methods: In total, 56 patients with subtalar joint arthritis were prospectively randomized to 2 parallel groups to receive either PASTA (n = 28 patients) or open subtalar arthrodesis (n = 28 patients). The minimum follow-up period was 12 months. Primary outcome was union rate confirmed on postoperative computed tomography (CT) scan. Secondary outcomes were union time; visual analog scale (VAS), Short Form–36 (SF-36), and Foot and Ankle Ability Measure (FAAM) scores; tourniquet time; and complications. Results: Union time (9.4 vs 12.8 weeks) and recovery time (time to return to activities of daily living [8.4 vs 10.8 weeks], work [10.6 vs 12.9 weeks], and sports [24.9 vs 32.7 weeks]) were significantly shorter with PASTA than with the open technique ( P < .05 all). Both techniques led to significant improvements in all functional outcomes (FAAM, SF-36, and VAS scores; P < .01 all); however, there was no significant difference between the techniques in these outcomes ( P > .05 all). Other outcomes, including tourniquet time (55.8 vs 67.2 min), union rate (96.3% vs 100%), and complication rate, were not significantly different between the techniques. Conclusion: Both open and PASTA techniques led to significant improvements in pain and function in patients with isolated subtalar joint arthritis. Although short-term functional outcomes and complication rates were not significantly different between the techniques, the PASTA technique was better at shortening the union and recovery times. Level of Evidence: Level I, prospective multicenter randomized controlled trial.

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EVALUATION OF OUTCOME OF SUBTALAR ARTHRITIS TREATED WITH SUBTALAR ARTHRODESIS

10.36106/paripex/9302482 ◽

2020 ◽

pp. 1-2

Author(s):

Mayur Kalariya ◽

Jyotish Patel ◽

Ankit Patel

Keyword(s):

Subtalar Joint ◽

Functional Result ◽

Fusion Rate ◽

Reliable Technique ◽

Subtalar Arthrodesis ◽

Lag Screw ◽

Study Results ◽

Subtalar Arthritis ◽

Lost To Follow Up

Involvement of the subtalar joint in fracture calcaneus intraarticular malunion may give rise to chronic pain and functional impairment. In this study evaluate the effectiveness of a technique using double lag screw from the calcaneus to the talus and the functional result of subtalar joint fusion. Materials and Methods: In between May ‘18 and feb ‘20, we performed 20 isolated subtalar arthrodesis by double lag screw technique from calcaneus to talus. we included 13 males and 7 females in study. Results:18 out of 20 joints were fused except one who developed infection and one lost to follow up,resulting in an overall fusion rate of above 90%. The average time for fusion was 5 months (ranging from 3 to 6 months).Conclusion: Using the double lag screws of 6.5 mm across the posterior facet of the subtalar joint resulted in fusion of joints in 90% of patients. The relief from pain was obtained in 100% of cases. This is a simple and reliable technique for achieving fusion of the subtalar joint.

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Comparison of Beaming Screw Outcomes with and without Subtalar Arthrodesis in Midfoot Charcot Reconstruction

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00088 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0008

Author(s):

Junho Ahn ◽

Dane K. Wukich ◽

George T. Liu ◽

Katherine M. Raspovic ◽

Michael D. VanPelt ◽

...

Keyword(s):

Outcome Variable ◽

Rigid Fixation ◽

Charcot Neuroarthropathy ◽

Subtalar Arthrodesis ◽

Subtalar Fusion ◽

Current Series ◽

Initial Surgery ◽

Screw Breakage ◽

Hardware Failures

Category: Diabetes, Midfoot/Forefoot Introduction/Purpose: Charcot neuroarthropathy (CN) is a complication of neuropathy secondary to diabetes mellitus (DM) and may involve multiple joints of the foot, in particular the midfoot. Patients with CN deformity associated with infection, ulceration or pre-ulceration are at risk of losing their limb. In these patients, reconstruction of the foot structure through beaming arthrodesis screws for stabilization is often required. In addition to midfoot beaming, previous reports have advocated for subtalar arthrodesis. Fixation of the subtalar joint restricts motion of the hindfoot. This rigid fixation has been hypothesized to offer greater stability and fewer hardware failures. The aim of this study was to describe failure of midfoot beaming screws after midfoot reconstruction of CN with and without subtalar arthrodesis. Methods: We retrospectively reviewed patients with DM diagnosed with CN. Patient radiographs were evaluated for type of midfoot Charcot reconstruction and hardware failure. Patients included in the study had follow up of 3 months or more. The main outcome variable of interest was hardware breakage. Results: Eighteen patients who underwent midfoot reconstruction for CN were included. The average age was 52.7 years (±8.4 years), 10 (55.6%) were male, and the average body-mass index (BMI) was 35.8 kg/m2 (±10.3 kg/m2). The average follow-up time was 6.5 months (±3.7 months). In the current series, thirteen out of 18 (72.2%) patients underwent subtalar fusion along with midfoot fusion. Screw breakage occurred in two patients, one at the 1st tarsometarsal joint and 2nd-4th tarsometarsal screws in another patient at 9 and 6 months respectively. Both patients with screw breakage had subtalar fusion. A third patient who had subtalar fusion subsequently developed collapse of their talus leading to subtalar screw removal 3 months after initial surgery. Patients without subtalar fusion did not experience screw breakage. Conclusion: An extended medial column fixation with subtalar arthrodesis has been previously proposed to provide better fixation after midfoot CN reconstruction with beaming screws as it restricts motion of the hindfoot. However, little to no evidence has been reported in favor of this technique. Our findings suggest that subtalar arthrodesis may result in fixation that is too rigid, which may place the beaming screws at higher risk of breakage. However, the number of observations is a limitation of our study, and further investigation comparing these techniques is needed to fully evaluate the effect of subtalar arthrodesis on midfoot beaming outcomes.

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