A technique for difficult arthrodesis of the knee.
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Twenty knees, in which a total of 32 previous operations had been performed, were arthrodesed by the Charnley compression technique combined with intramedullary nailing. Patients with previous infection were excluded from the series, but three neuropathic knees were included. Bony union was evident after an average of six months in all but one patient who died three months after operation. One patient developed deep infection that resolved after removing the nail. The combined technique is simple and only limited bone resection is needed; it gives immediate stability and relief of pain with minimal morbidity. (+info)
Non-infective disease of the diabetic foot.
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Six different conditions of non-infective bone and joint pathology have been seen amongst 67 patients with diabetic neuropathy. The characteristics of each are described. Not all the conditions require treatment but they should be differentiated from osteomyelitis. Charcot osteoarthropathy is the most common condition seen but spontaneous fractures and dislocations generally present greater therapeutic problems. The aim of treatment should be to obtain a stable foot in which there is no undue pressure on the skin from a bony prominence. (+info)
Differentiation of infected from noninfected rapidly progressive neuropathic osteoarthropathy.
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Differentiation of infected from noninfected rapidly progressive neuropathic osteoarthropathy can be difficult in a combined bone/111In-leukocyte study. We present two cases: one infected and one not infected. By examining the distribution of the 111In leukocyte activity and the change in the lesion-to-background ratios from the 4-hr to the 24-hr image, it may be possible to determine if the rapidly progressive neuropathic osteoarthropathy is infected. (+info)
Below-knee amputation for Charcot joint developing 40 years after spinal cord injury. Case report.
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A Charcot joint developed following a spinal cord injury in a patient who had sustained a fracture-dislocation of the 12th thoracic vertebra and a spinal cord injury in a cave-in accident in a coal mine 40 years previously, and had since been assisted in walking with the aid of a short leg brace and a cane. Recently, the patient developed Charcot joints of the right knee and ankle, and the right ankle joint also became infected with a refractory open wound necessitating a below-knee amputation. (+info)
Development of a 'Charcot-like joint' in tophaceous gout.
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We report an unusually severe case of ulcerating tophaceous gout in which inflammation due to gout, infection and excessive alcohol intake resulted in complete destruction of an ankle joint. (+info)
Infrared dermal thermometry for the high-risk diabetic foot.
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BACKGROUND AND PURPOSE: The purpose of this study was to compare skin temperatures in patients with asymptomatic peripheral sensory neuropathy, patients with neuropathic ulcers, and patients with Charcot's arthropathy using the contralateral limb as a control. SUBJECTS: On a retrospective basis, patients with diabetes (N = 143) were divided into three groups: patients with asymptomatic sensory neuropathy (n = 78), patients with neuropathic foot ulcers (n = 44), and patients with neuropathic fractures (Charcot's arthropathy) (n = 21). METHODS: We evaluated the subjects' skin temperatures with a portable hand-held infrared skin temperature probe at the time pathology was initially identified and at subsequent clinical visits for an average of 22.1 months (SD = 6.4). Skin temperatures of the contralateral foot were measured as a control. RESULTS: There were differences in skin temperature between the affected foot and the contralateral (i.e., nonaffected) foot among the patients with Characot's arthropathy (8.3 degrees F) and the patients with neuropathic ulcers (5.6 degrees F), with no difference identified among the patients with asymptomatic sensory neuropathy. Five patients with neuropathic ulcers experienced reulceration a mean of 12.2 months (SD = 6.4) after initial healing, with a corresponding increase in skin temperature. (89.6 degrees +/- 1.2 degrees F versus 82.5 degrees +/- 2.9 degrees F) at the clinic visit immediately preceding reinjury. CONCLUSION AND DISCUSSION: The data suggest that monitoring of the corresponding contralateral foot site may provide clinical information before other clinical signs of injury can be identified. (+info)
Charcot arthropathy after acetabular fracture.
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Three middle-aged patients with diabetes sustained fractures of the acetabulum which were treated by open reduction and internal fixation. In each, rapid dissolution of the femoral head occurred with minimal discomfort, typical of a Charcot arthropathy. The patients had no other evidence of neuropathic arthropathy. Charcot changes may occur after high-energy trauma in patients with diabetes. (+info)
Wrist involvement in Hansen's disease.
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We performed a neurological and radiological study of the wrists of 58 patients with Hansen's disease and 60 age-matched healthy control subjects. Significant differences (p < 0.01) were found between the groups in the carpal glenoid sector, the radial physeal widening index, the carpal ulnar distance, the carpal index and in distal radio-ulnar discrepancy. Comparison of the results in three subgroups of leprous patients with sensory impairment (group A-1), motor deficit (A-2) and no neurological impairment (A-3), showed significant differences (p < 0.01) between group A-1 and the other two. This suggests that in these patients the changes in the carpus and radiocarpal joint may be caused by neuropathic arthropathy of the wrist. Our findings are of particular interest since there are few reports of neuropathic arthropathy in non-weight-bearing joints. (+info)