Name: Charcot Arthroplasty Using the Medial Column Fusion Plate
Uploaded: 2015-10-15T00:00:00Z
Channel: Arthrex

Foot and Ankle

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VID1-00587-EN | A | Charcot Arthroplasty Using the Medial Column Fusion Plate

Nicholas Abidi

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Charcot Arthroplasty Using the Medial Column Fusion Plate

Okay. So we're going to talk about Charcot Arthropathy a little bit and go through the staging and classification, and also talk about some of the plates that we've developed for Arthrex and why we've developed them. These shortcut plates are part of the Arthrex comprehensive modular foot system. And so they should be pretty familiar to Arthrex users. They go along with some of the mid foot plates and the Lapidis plate system and the Lisfranc system as well. And they're not meant to be that strange or different than what you're used to using already, including some of the same drill bits, the 2.8mm drill bit, and the same type of locking sleeves that are on the ankle fracture system, as well as on the mid foot trays. So in terms of the plates that we've developed, we've developed both left and right and small, medium and large. We're using a lot of small and medium and large is for some size 13 and 15ft. So we're using mostly the smalls and the mediums. The Charcot fracture system is meant to think about the deformity, including type one, type two, type three, but not type four. Type fours, ankle arthritis, or ankle charcot. The other types are more of a midfoot and a forefoot type. Charcot. Now this can go along with collapse even without Charcot, but just mid foot rock or bottom deformity due to a Gastroc contracture. Autoimmune inflammatory disease as well. This plate and screw construct is designed to be put on after most of the deformity has been corrected. It doesn't go on in situ. This is allow you to hold a reconstructed foot. So this is a normal foot. We can't really recreate a good Charcot model, but the Charcot, typically a type one Charcot, would have a tarsometatarsal or a navicular cuneiform type Charcot, in which you would have a rock or bottom foot. It's important in two planes, both the axial and the sagittal type planes and coronal planes, to three planes to recreate the arch so that it's close to normal, with the second cuneiform being the apex of the Roman arch. And so that involves sometimes resecting doing a primary arthrodesis, not just fixing and bringing back together ligamentous taxes. So making, for instance, three incisions, perhaps one medially, one dorsally, and maybe even one laterally. Sometimes you can work through a medial and lateral incision and wind up just cutting through and through and realigning things. And I always start by pinning the second tarsometatarsal joint to get my landmarks, my bearings, and then bring it together a large tenaculum on the outside to get the Roman arch reconstructed. So it's not excessively supinated or pronated, so you don't get bumps in new places. So the idea is to avoid developing calcaneocuboid joint ulcerations or talonavicular or navicular type ulcerations or medial cuneiform ulcerations, which are pretty typical in Charcot or rocker bottom foot deformity. So the indications for plating isn't just when there's a bump, but more so when there's an unstable midfoot. So you know, when the foot is moving back and forth, but through the foot itself and it's unstable. The plating is indicated for that. If you simply have a bump and the whole foot moves as a unit, you don't need to plate it necessarily. So when someone has a quiescent Charcot, stage three, when it's resolved and it's not no longer actively inflamed, these plates are indicated for unstable midfoot. And the plates come in as we talked about small medium and large. And what they allow you to do is go from the navicular to the fourth to the first metatarsal, and then actually put the screws all the way the way across the foot. There are long screws in these trays which let you set up initially with a lag or a compression type screw from medial to non-locking screw, go all the way across the arch, and then once you're happy with your correction, you can put some tacks, usually two tacks, one distally, one proximally to prevent it from windshield washer, and then start to fill in with eccentric compression and holes and another eccentric compression hole to compress the arthrodesis and then lock it in place with the locking screws. So this can be considered almost the backbone of the plate. It's like a rail system, but the philosophy behind the plate altogether was I felt that putting a planter plate on was very difficult. It created damage underneath the foot with exposure that had a lot of morbidity, and trying to fit drill holes and put drills in from the bottom of the foot is very challenging, and you can actually bend these things to kind of make the whole thing more rigid construct. The idea is to make this a rigid construct and allow the medial column to support through a raft of screws through the whole body, similar to a lisfranc construct a midfoot arthrodesis. Now, after that's completed on the medial side, making sure again you're not in supination and pronation, you can put can put another plate laterally, or simply fix this with small tarsometatarsal plates or lapidis type plates, whatever you feel. We actually have tarsometatarsal plates in the CFS set as well, which go along the entire metatarsal, so the Charcot plates will go from the medial aspect of the foot, from the navicular, across the cuneiform and the tarsometatarsal joint. So typically a Charcot will affect all three of these joints. And again this is meant to create a locking construct and reduce the and the deformity of a rock or bottom foot and prevent it from progressing to the point where it's not where it becomes stable. So this is for mid foot Charcot tarsometatarsal and navicular cuneiform arthrodesis. This plate can be cut along here and as well as distally if it's too long. And simply leaving it along these tabs where you may not need to use it. You also don't have to fill all the holes, but if you're worried about getting prominent or loose, you can actually cut each one of these tabs off if you feel like you don't need it.

Charcot Arthroplasty Using the Medial Column Fusion Plate

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