23: Osteomyelitis and Charcot arthropathy - Bennett Flashcards Preview

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Flashcards in 23: Osteomyelitis and Charcot arthropathy - Bennett Deck (30):
1

look at slide in beginning of powerpoint

run the different pathologies

2

what leads to a charcot foot?

autonomic neuropathy --> autosympathectomy --> increased blood flow --> increased bone reabsorption --> joint collapse --> charcot foot

+ peripheral sensory neuropathy so you don't feel it

3

arterial occlusion typically involves the ____________ but spares the __________

tibial and peroneal

dorsalis pedis

4

sensory neuropathy:

- loss of protective sensation
- pain, pressure, temperature

5

motor neuropathy:

- atrophy of the intrinsic muscles
- flexion deformity
- pressure at met. heads and toes

6

autonomic neuropathy:

- dyshidrosis and dry skin
- AV shunting (increase in bone and shin perfusion)

7

beefy red v. whitish ulcer

beefy red: adequate circulation

whitish: fibrotic tissue

8

stages of wound healing

infalmmatory --> proliferative --> remodeling

9

inflammatory stage:

hemostasis
inflammation
cell migration

10

proliferative stage:

cell proliferation
ECM synthesis
granulation tissue
angiogenesis
re-epitheliazation

11

remodeling stage:

remodeling
wound closure
contraction

12

things that add to a stalled wound

- increased MMPs and decreased TIMPs
- deficiency GF receptors
- senescent fibroblasts
- loss of moisture control
- i

13

what is wagner's grading system?

0-5 scale

useful for expressing the severity of a diabetic foot ulcer or infection

14

wagners = ?
no evidence of ulcer or infection

grade 0

15

wagners =?
ulcers may simply be considered deeper lesions that have penetrated to bone or a fascial plane

grade 2

16

wagners = ?
feet have gangrene of the forefoot, frequently requiring debridement or amputation

grade 4

17

wagners = ?
implies gangrene of the entire foot that will likely require amputation

grade 5

18

what does the university of texas wound classification system tell you?

combines number indicating depth of ulcer with letter which indicates comorbidities

0-III
A-D
scale

19

UofT:
ischemic wound through tendon or capsule

grade II stage C

20

ishcemic and infected through bone or into joints

grade III stage D

21

wound through dermis and infected

grade I stage B

22

8 principles of ulcer management

1. vascular supply
2. debridement
3. infection
4. offloading
5. wound management
6. wound closure
7. management of medical comorbidities
8. nutrition status

23

complications from diabetes account for ______-% of LE amputations

45-70%

24

__% of diabetics will require an amputation at some time in their lives

5-15%

25

survival rates are _____ for the first 3 yrs and and _______ for the first 5 years after unilateral amputation

50%
40%

26

diabetics pts were __ times more likely to undergo a le amputation than nondiabetic person

15

27

acute osteomyelitis bone test results

Tc99m positive all phases

Ga67 scan - positive focal uptake

indium scan - positive

28

inactive chronic osteomyelitis bone test results

Tc99m all phases positive, phase one may be negative

Ga 67 scan negative

indium scan negative

29

acute cellulitis bone test results

tc99m scan all phases positive

ga 67 scan - positive diffuse uptake

indium scan - positive

30

charcot joint bone test results

tc 99m scan - all positive, phase I and II may be negative

Ga67 scan negative

indium scan negative