Surgical aspects of the diabetic foot

Robinson, A. H. N.; Pasapula, Chandra; Brodsky, James W.

doi:10.1302/0301-620x.91b1.21196

Cited by 46 publications

(51 citation statements)

References 54 publications

(52 reference statements)

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“…Early and aggressive operative stabilization has been recommended for displaced or unstable injuries in the diabetic elderly population. 330 Treating such injuries nonoperatively results in a high rate of progression to malunion or nonunion, 331 and patients may ultimately require surgical intervention in a delayed fashion. A meta-analysis of 140 diabetic ankle fractures showed an overall operative cohort complication rate of 30%, with an infection rate of 25%, a Charcot arthropathy rate of 7%, and a Charcot amputation rate of 5%.…”

Section: Special Considerations In Patients With Diabetes Mellitusmentioning

confidence: 99%

A Guide to Improving the Care of Patients with Fragility Fractures, Edition 2

Mears¹,

Kates²

2015

Geriatr Orthop Surg Rehabil

122

121

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Over the past 4 decades, much has been learned about the pathophysiology and treatment of osteoporosis, the prevention of fragility fractures, and the perioperative management of patients who have these debilitating injuries. However, the volume of published literature on this topic is staggering and far too voluminous for any clinician to review and synthesize by him or herself. This manuscript thoroughly summarizes the latest research on fragility fractures and provides the reader with valuable strategies to optimize the prevention and management of these devastating injuries. The information contained in this article will prove invaluable to any health care provider or health system administrator who is involved in the prevention and management of fragility hip fractures. As providers begin to gain a better understanding of the principles espoused in this article, it is our hope that they will be able to use this information to optimize the care they provide for elderly patients who are at risk of or who have osteoporotic fractures.

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Section: Special Considerations In Patients With Diabetes Mellitusmentioning

confidence: 99%

A Guide to Improving the Care of Patients with Fragility Fractures, Edition 2

Mears¹,

Kates²

2015

Geriatr Orthop Surg Rehabil

122

121

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“…Macrovascular disease causes calcification of the tunica media, which leads to the ''lead pipe'' appearance of the arteries in the distal limbs, thereby predisposing patients to peripheral vascular insufficiency. 1 Neuropathy is a common manifestation of diabetes mellitus, causing irreversible and progressive damage to the sensory, motor, and autonomic nervous systems. 1,3,4 Up to 40% of diabetic patients will be diagnosed with peripheral neuropathy within the first 10 years of their disease, and 80% of diabetics with foot ulcers suffer from neuropathy.…”

Section: Discussionmentioning

confidence: 99%

“…1 Neuropathy is a common manifestation of diabetes mellitus, causing irreversible and progressive damage to the sensory, motor, and autonomic nervous systems. 1,3,4 Up to 40% of diabetic patients will be diagnosed with peripheral neuropathy within the first 10 years of their disease, and 80% of diabetics with foot ulcers suffer from neuropathy. 5,6 Neuropathy results in decreased pain and pressure perception, leading to muscle imbalance and anatomic deformities, as well as impairment of the skin's integrity and dysfunction of the microcirculation.…”

Section: Discussionmentioning

confidence: 99%

“…Diabetes is currently the fourth leading cause of death worldwide, and, sadly, the number of people affected is rising and is expected to reach 366 million globally by 2030. 1 Diabetes is a systemic disease that affects most systems in the body, including the musculoskeletal system. Diabetics are at increased risk for bone disease, including fragility fractures, vasculopathy, and neuropathy, which can sometimes lead to neuropathic fractures.…”

Section: Abstract: Ankle Diabetes Fracture Neuropathicmentioning

confidence: 99%

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Neuropathic ankle fractures

Tucker

Stone

2012

CJEM

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A 65-year-old diabetic female presented with a 3-week history of a left swollen foot after a minor inversion injury and was found to have a minimally displaced fibular fracture. Despite casting and strict instructions to remain non-weight bearing, the patient continued to bear weight and later developed a significantly more displaced fracture with a draining ulcer. This injury eventually required a tibiotalocalcaneal arthrodesis using a retrograde hindfoot nail. Neuropathy and neuropathic fractures can be devastating complications of diabetes and thus require early diagnosis and intervention because they may result in significant morbidity for the patient. Thorough assessment involving imaging, a complete history and physical examination, and tools such as a 129 Hz tuning fork and the 10 g SemmesWeinstein monofilament are paramount to establishing an accurate initial diagnosis. These tactics aid in future followup of the patient's injury and can be employed in both the clinic and the emergency department. Although management remains controversial for neuropathic ankle fractures because both conservative and surgical treatment regimens have high complication rates, open reduction and internal fixation continues to be the treatment of choice once closed reduction has been attempted and fails. Education is essential because diabetic patients have compromised pain and pressure sensation, which can lead to injuries and subsequent complications of which they are simply unaware. Physicians must be diligent when evaluating the diabetic foot and be explicit when providing instructions to these patients because preventing these injuries and their complications is the best patient care available. RÉ SUMÉUne femme diabé tique de 65 ans pré sentait un historique de 3 semaines d'enflure du pied gauche aprè s une inversion mineure. Une fracture du pé roné minimalement dé placé e lui a é té diagnostiqué e. Malgré un plâ tre et la recommandation formelle de ne pas s'appuyer sur son pied, la patiente a continué de mettre du poids sur son pied et a par la suite dé veloppé une fracture significativement plus dé placé e, avec ulcè re suintant. Cette blessure a fini par exiger une arthrodè se tibiotalocalcané enne avec utilisation d'un clou de maniè re ré trograde dans l'arriè re-pied. Les neuropathies et les fractures neuropathiques peuvent constituer de graves complications du diabète et né cessitent donc un diagnostic et une intervention pré coces, puisqu'elles peuvent entraîner une morbidité significative pour le patient. Une é valuation approfondie incluant de l'imagerie, un historique et un examen physique complets, ainsi que des outils tels qu'un diapason de 129 Hz et le monofilament Semmes-Weinstein 10 g sont cruciaux dans l'é tablissement d'un diagnostic pré coce exact. Ces tactiques favorisent le suivi futur de la blessure du patient et peuvent ê tre utilisé es à la clinique comme au service des urgences. Mê me si la gestion des fractures neuropathiques de la cheville demeure controversé e à cause du taux é levé de ...

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“…12–14 ARMD occurs secondary to metal ion release from edge loading and wear, which depends on implant type, size and position. 15,16 Women in particular have been shown to have high failure rates, as has the use of the ASR™ prosthesis (DePuy, Warsaw, IN, USA) 17 . These concerns have led to a withdrawal of this particular HRA from the market.…”

mentioning

confidence: 99%

Hip resurfacing arthroplasty at a non-specialist centre

Patel

Wright

Sabharwal

et al. 2014

annals

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INTRODUCTIONFew studies have reported the outcome of hip resurfacing arthroplasty (HRA) with respect to implant characteristics from non-specialist centres. We report the survival, clinical and radiological outcomes of a single surgeon series of HRA with an average follow-up duration of five years.METHODSAll consecutive HRAs performed by a single surgeon between 2003 and 2011 at a district general hospital were retrospectively examined clinically and radiologically.RESULTSA total of 85 patients underwent 109 HRAs (58 male [53.2%] and 51 female patients [46.8%]) with a mean follow-up period of 62 months (range: 12–102 months). The median age was 57 years (range: 25–75 years). The mean acetabular and femoral head component sizes were 54mm (range: 48–64mm) and 48mm (range: 42–58mm) respectively with a mean acetabular inclination angle of 42.9º (range: 20–75º).The survival rate was 95% with five revisions due to aseptic loosening (n=3) and fracture (n=2): these were predominantly for female patients (n=4), with significantly smaller mean acetabular (51mm, p=0.04) and femoral (44mm, p=0.02) implant sizes. Furthermore, they had a higher mean acetabular inclination angle of 48.1º (p=0.74). The mean Oxford hip score was 43.8 (range: 25–48) and the mean University of California Los Angeles (UCLA) activity score was 6.8 (range: 3–10). Radiological findings included heterotopic ossification in 13 (11.9%), radiolucent lines in 6 (5.5%), femoral neck thinning in 2 (1.8%) and femoral neck notching in 5 patients (4.6%).CONCLUSIONSWe have shown that HRA at a non-specialist centre has short to medium-term outcomes comparable with those at specialist centres. HRA therefore remains a viable option although vigilance is required in case selection and follow-up according to national guidance.

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Surgical aspects of the diabetic foot

Abstract: A comprehensive review of the literature relating to the pathology and management of the diabetic foot is presented. This should provide a guide for the treatment of ulcers, Charcot neuro-arthropathy and fractures involving the foot and ankle in diabetic patients.

Cited by 46 publications

References 54 publications

A Guide to Improving the Care of Patients with Fragility Fractures, Edition 2

A Guide to Improving the Care of Patients with Fragility Fractures, Edition 2

Neuropathic ankle fractures

Hip resurfacing arthroplasty at a non-specialist centre

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