The Journal of Bone and Joint Surgery, Vol 75, Issue 12 1765-1773, Copyright © 1993 by Journal of Bone and Joint Surgery, Inc
Deformity following fracture in diabetic neuropathic osteoarthropathy. Operative management of adults who have type-I diabetes
RC Thompson and DR Clohisy
Department of Orthopaedic Surgery, University of Minnesota, Minneapolis 55455.
We studied fifteen lower extremities that had a deformity following a
fracture in the region of the ankle or the tarsal bones, in fourteen adults
who had type-I diabetes and neuropathic osteoarthropathy. The skeletal
deformities associated with these fractures were either diagnosed late (two
limbs) or occurred in lower extremities that had been treated by means
other than non-weight-bearing and immobilization (thirteen limbs). All
deformities were severe and secondary to a non-union or malunion of the
fracture; all were ultimately treated with operative reconstruction. Before
the reconstruction, the limbs had had either persistent ulceration
associated with an uncorrectable skeletal deformity (four) or a severe
deformity that was difficult to contain with a custom-made orthosis
(eleven). The most recent result was considered a success when the
ulceration had healed, the involved foot was planti-grade, and the involved
limb was capable of bearing weight with use of a patellar tendon-bearing
orthosis. Following reconstruction, ten patients had a plantigrade foot
without ulceration, three had a plantigrade foot with a persistent draining
ulcer, and one had a foot that was not plantigrade. In the limbs that had
an ulcer at the time of the operation, there was one successful outcome and
three failures. In contrast, the outcome was successful for ten of the
limbs that had not had an ulcer and a failure for one. There were three
complications following sixteen operative reconstructive procedures in the
fourteen patients, including one infection and two instances of accelerated
bone resorption and collapse.(ABSTRACT TRUNCATED AT 250 WORDS)
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