The Journal of Bone and Joint Surgery, Vol 70, Issue 8 1192-1200, Copyright © 1988 by Journal of Bone and Joint Surgery, Inc
Fractures associated with neuropathic arthropathy in adults who have juvenile-onset diabetes
DR Clohisy and RC Thompson
Department of Orthopaedic Surgery, University of Minnesota, Minneapolis 55455.
Eighteen patients, twenty-five to fifty-two years old, who had
juvenile-onset diabetes, had neuropathic arthropathy and fractures at the
ankle or tarsus, most of which were bilateral. After a minimum follow-up of
one year, four patients could not walk and fourteen were dependent on
orthoses. In nine patients, the lesions produced fixed skeletal deformities
that caused severe malum perforans, which in three patients was so severe
that a below-the-knee amputation had to be done. In patients who had
bilateral lesions, when the extremity that was initially involved was
prevented from bearing weight, involvement of the contralateral limb became
evident after an average of 4.5 months, compared with an average of twelve
months in the patients who were allowed weight-bearing on the extremity
that was initially involved. Our current treatment protocol is
non-weight-bearing immobilization of the involved extremity, and we
recommend prophylactic immobilization of the contralateral extremity with a
protective cast or orthosis. All of the patients who had this treatment
regimen could walk; in contrast, of the eleven patients who were not so
treated, four could not walk.
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