47: Neuropathic Bone Disease - Frush Flashcards Preview

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1

define charcot foot

Charcot foot is a progressive condition characterized by joint dislocation, pathological fractures, and severe destruction of the pedal architecture

2

6 Ds of charcot foot on xray

Destruction
Debris
Dislocation
Distention
Disorganization
Increased Density (subchondral sclerosis)

3

most common etiology

diabetes (anything that can cause neuropathy)

4

presence charcot in diabetics and in neuropathic pts

7.5% in Diabetic patients
29% in neuropathic patients
Mean age is 50.3 years

5

Neurotraumatic theory

Exaggerated overuse injury coupled with loss of protective sensation
Can be initiated by acute trauma or repetitive microtrauma
Lack of sensation allows continued tissue destruction resulting in fractures and dislocations

6

neurovascular theory

Vasomotor neuropathy in patients with intact blood flow
Arteriovenous shunting leads to excessive bone resorption and bone weakening
Contributes to fractures and dislocations with continued weightbearing

7

eichenholtz classification (stages)

0 - x ray normal, but high degree suspicion
I- acute red hot swollen, fragmentation on x ray
II- bony fragmentation becomes more solid
III - swelling gone, residual deformity

8

brodsky classification (location)

type 1: lisfranc's
2:choparts/subtalar
3A: ankle
3B: calcaneus
4: multiple regions
5: forefoot

9

s/s charcot

- red, hot, swollen foot
- temp difference (3-6 celsius)
- sensory neuropathy present
- pain doesnt match amount destruction
- bilateral 9-30% of the time

10

keys for diagnosis of charcot

- red, hot, edematous
- cortical fractures, periosteal reaction, joint debris, deformity, dislocation
- lack of break in skin

11

gold standard diagnosis osteomyelitis v. charcot

bone biopsy
- bone and cartilage debris embedded in synovium (charcot)

12

what test has highest sensitivity and specificity in detecting osteo in neuropathic foot

In111

best approach is to do a combined scan

13

+ Tec99
+ WBC scan

osteomyelitis

14

+ Tec 99
- WBC scan

charcot

15

- Tec 99
+ WBC scan

soft tissue infection

16

MRI for charcot

T1 - decreased
T2 - increased
STIR - high signal marrow edema

17

being able to probe to bone with metallic instrument is ____ positive for diagnosing osteomyelitis

89%

18

tx charcot based on stages

I - keep nwb in total contact cast or boot untiil ocnsolidationoccurs and/or temp stabilized
- may take months
II - increase protected weight bearing
III - custom orthotics or braces