Comparison of 4 Different Fixation Strategies for Midfoot Arthrodesis: A Retrospective Comparative Study.

Foot & ankle specialist Pub Date : 2024-04-01 Epub Date: 2021-08-02 DOI:10.1177/19386400211032482
Wonyong Lee, Dan Prat, Keith L Wapner, Daniel C Farber, Wen Chao
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Abstract

Background: Midfoot arthrodesis is a common procedure performed both for arthritis and correction of deformity. The optimal fixation for midfoot arthrodesis has not been established, though numerous studies have been investigating the fixation techniques of midfoot arthrodesis. The purpose of this study was to compare the union rate of midfoot arthrodesis using 4 different fixation strategies and investigate risk factors of nonunion following midfoot arthrodesis.

Methods: A retrospective chart review was performed for patients who underwent midfoot joint arthrodesis between January 2014 and May 2019. The rates of nonunion and postoperative complication were compared among 4 different fixation constructs: staple fixation, compression plate fixation, compression plate with lag screw fixation, and compression screw fixation. Predictors of nonunion following midfoot arthrodesis were investigated through a multivariable logistic regression analysis. A total of 95 patients (99 feet), including 240 midfoot joints were included in this study. The mean follow-up period was 78.4 weeks.

Results: Overall, bony union was achieved in 86 out of 99 (86.9%) patients, which included 218 out of 240 (90.8%) midfoot joints. A significant difference in the nonunion rate according to the type of fixation construct was found (P = .011); the compression screw alone fixation construct was noted to have a significantly higher nonunion rate than other fixation constructs. Diabetes mellitus (odds ratio [OR] = 0.179 [95% CI: 0.059, 0.542]), the type of fixation construct (compression screw alone; OR =1.789 [95% CI: 1.071, 2.978]), lack of adjuvant bone graft (OR = 2.803 [95% CI: 1.081, 7.268], and postoperative nonanatomical alignment (OR = 3.937 [95% CI: 1.278, 12.126]) were identified as independent predictors of nonunion following midfoot arthrodesis.

Conclusion: The rate of nonunion following midfoot arthrodesis among 4 different commonly used fixation constructs was compared in this study. Risk factors of nonunion were investigated revealing that diabetes mellitus, compression screw fixation alone, lack of adjuvant bone graft, and postoperative nonanatomical alignment are independent predictors of nonunion following midfoot arthrodesis.

Levels of evidence: Level III: Comparative cohort study.

中足关节置换术中 4 种不同固定策略的比较:回顾性比较研究
背景:中足关节置换术是一种常见的手术,既可用于治疗关节炎,也可用于矫正畸形。尽管许多研究都在探讨中足关节置换术的固定技术,但中足关节置换术的最佳固定方式尚未确定。本研究的目的是比较采用四种不同固定策略的中足关节置换术的结合率,并调查中足关节置换术后不结合的风险因素:对2014年1月至2019年5月期间接受中足关节置换术的患者进行了回顾性病历审查。比较了4种不同固定结构的不愈合率和术后并发症发生率:订书钉固定、加压钢板固定、加压钢板加滞后螺钉固定和加压螺钉固定。通过多变量逻辑回归分析研究了中足关节置换术后不愈合的预测因素。本研究共纳入了 95 名患者(99 只脚),包括 240 个中足关节。平均随访时间为 78.4 周:总体而言,99 例患者中有 86 例(86.9%)实现了骨结合,其中包括 240 个中足关节中的 218 个(90.8%)。根据固定结构类型的不同,未愈合率也存在明显差异(P = .011);仅使用加压螺钉固定结构的未愈合率明显高于其他固定结构。糖尿病(几率比 [OR] = 0.179 [95% CI: 0.059, 0.542])、固定结构类型(单纯加压螺钉;OR = 1.789 [95% CI: 1.071, 2.978])、缺乏辅助植骨(OR = 2.803 [95% CI: 1.081, 7.268])、术后非解剖对位(OR = 3.937 [95% CI: 1.278, 12.126])被认为是中足关节置换术后不愈合的独立预测因素:结论:本研究比较了四种不同的常用固定结构在中足关节置换术后的不愈合率。研究发现,糖尿病、单纯加压螺钉固定、缺乏辅助植骨以及术后非解剖对位是中足关节置换术后发生骨不连的独立预测因素:三级:队列比较研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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