Cases reported "Arthropathy, Neurogenic"

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21/28. Ankle and foot fractures in diabetics provoking neuropathic joint changes.

    Neuropathic joint changes, Charcot joints, in diabetics developing after ankle or foot fractures have received little attention in the literature. Three cases are presented here, one in a previously undiagnosed diabetic. The pathogenesis and the management are discussed, and the importance of adequate protection of these fractures is emphasized. Even fractures of the metatarsal bones should be immobilized and weight-bearing must be postponed until the bone is firmly united.
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22/28. The use of differential scintigraphy in the clinical diagnosis of osseous and soft tissue changes affecting the diabetic foot.

    Prompt recognition of cellulitis, osteomyelitis, diabetic osteolysis, Charcot neuroarthropathy, septic synovitis, and deep plantar abscesses in the diabetic foot is essential because the therapy is drastically different. Differential diagnosis has been greatly facilitated by recently developed scanning techniques.
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23/28. Subtalar and talonavicular joint dislocation as a presentation of diabetic neuropathic arthropathy with salvage by triple arthrodesis.

    Ligamentous laxity is a common component of diabetic neuropathic osteoarthropathy. In some cases soft tissue instability leads to spontaneous dislocations or subluxations without any bone destruction. This leads to marked instability in gait and chronic ulcerations. A case report is presented in which talonavicular and subtalar joint dislocation occurred with Charcot osteoarthropathy. The conservative and surgical management including salvage by triple arthrodesis is discussed with follow-up care.
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24/28. Management of neuropathic arthropathy with the Charcot Restraint Orthotic Walker.

    A recently designed Charcot Restraint Orthotic Walker (CROW) was used in the treatment of 18 patients with diabetic neuroarthropathy involving the foot and ankle. Eight of these patients had no surgery before the use of the CROW. In ten patients, the device was used for prolonged immobilization after surgery for complications of neuropathic joint disease. The CROW is a rigid, custom, full-foot enclosure ankle-foot orthosis. It was used after an initial period of cast immobilization. The CROW effectively controls limb edema, returns the patient to ambulatory activities, and prevents significant progression of deformity. All patients rated their satisfaction with the device as good or excellent. The CROW is an attractive alternative to currently used methods to provide the prolonged immobilization and protection necessary for healing in neuropathic arthropathy.
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25/28. Total knee arthroplasty in a patient with bilateral Charcot knees.

    Neuropathic arthropathy (Charcot joint) is a progressive and degenerative process resulting from underlying neurovascular and neurotraumatic deficits. diabetes mellitus is now the most common cause of Charcot joint. A marked predilection for the tarsometatarsal, tarsal, and ankle joints occurs. Involvement of large weight-bearing joints such as the knee is rare. When the knee is involved, and conservative treatment fails, standard surgical intervention often involves arthrodesis. arthroplasty is relatively contraindicated. The authors report a case of a 61-year-old, diabetic-woman with bilateral Charcot knees who successfully completed a rehabilitation program and achieved independence after left knee arthrodesis and right total knee arthroplasty.
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26/28. Poor vision as a contributory factor in diabetic neuro-arthropathy.

    Two patients with longstanding insulin-dependent diabetes mellitus (IDDM) complicated by neuropathy, nephropathy and retinopathy leading to poor vision each developed a swollen and relatively painless foot. The previous day, both had been walking over uneven ground. At initial presentation, no X-ray was taken of the foot in case one and no action was taken over an undisplaced navicular fracture in case two. A few weeks later, a midfoot Charcot had developed in both cases. Poor vision may increase the risk of injury to the feet and may be an important risk factor for Charcot neuro-arthropathy. Plain radiographs are an important investigation for the swollen insensitive foot, even in the absence of pain.
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27/28. Great toe neuroarthropathy: a report of two cases.

    Two cases of diabetic neuroarthropathy of the great toe are presented. The differential diagnosis is emphasized, and the literature regarding this unusual site for symptomatic disease is reviewed.
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28/28. ankle fractures in diabetics.

    ankle fractures are common and good results are expected. insulin dependent diabetes mellitus is also common, and long-standing disease is associated with peripheral neuropathy. A trauma unit will inevitably receive patients with both problems. We describe two salutary lessons and suggest how our experience with diabetic neuroarthropathy might be avoided.
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