The Charcot knee is a progressive, degenerative disease of the joint that may represent a diagnostic challenge; at the moment, poorly controlled diabetes mellitus is the main cause of this condition. We describe here a case of a man presenting with an end stage joint arthropathy who was diagnosed with neurosyphilis. Tabetic arthropathy is currently a very rare disease, but in the past represented the main cause of joint arthropathy. Finally, we discussed the different surgical options of Charcot arthropathy, our choice of megaprosthesis implant and the failure of such procedure mainly due to patient\'s unreliability to care leading to infective complications and peri-prosthesis fracture.

The staged approach to below knee amputation has proven to be an effective method of achieving functionality after amputation and reducing risk for postamputation complications. Transtibial or \"guillotine\" amputations are often used as the first-stage amputation. Disarticulation at the ankle joint is an alternative method that can be used with favorable results and benefits. These include rapid infection decompression while minimizing the blood loss of traditional tibial osteotomy. Here we describe our operative technique, perioperative management, and indications for this surgical procedure.

Among the observations of patients suffering from abnormal movements, Jean-Gaspard Itard (1775-1838) published the case of Madame D. in 1825. It was republished in 1885 as the first clinical case characteristic of the disease described by Georges Gilles de la Tourette in the seminal article leading to his eponym, still in use today. However, the actual identity of Madame D., known throughout the 19th century as the Marquise de Dampierre, has remained a mystery, until now. The 17 July 1884 edition of the literary periodical Gil Blas provided an important lead by detailing the behavioural disturbances in society of the \"Countess Picot de Dampierre\". Information from diarists at that time make it possible to confirm that this patient, known for her involuntary verbal outbursts, typical of coprolalia, in salons frequented by the 19th-century Parisian aristocracy was in fact Ernestine Émilie Prondre de Guermantes, her maiden name. She was born on 22 August 1800, and her married name was Countess Picot de Dampierre. She died on 08 July 1884. This article examines the life of this woman, her disease, her identification and the connection with the Duchesse de Guermantes, heroine of LaRecherchedutempsperdu written by Marcel Proust.

Retrograde intramedullary nails are often used for tibiotalocalcaneal arthrodesis to correct severe hindfoot deformities in high-risk patient populations. The purposes of the current study are to report outcomes of patients undergoing staged management of infection after intramedullary nail fixation for tibiotalocalcaneal arthrodesis and to review the surgical approach to management of this limb-threatening complication. The authors reviewed patients who underwent hindfoot intramedullary nailing with subsequent revision for infection between January 2006 and December 2016. Staged protocol with antibiotic nail for the management of deep infection was used in 19 patients. The mean follow-up was 115.87 ± 92.80 (range 2.29 to 341.86) weeks. Twelve of the patients had diabetes, 10 had Charcot neuroarthropathy, and 7 had arthrodesis for equinovarus deformity. Sixteen had peripheral neuropathy and 13 had history of ulceration on the operated extremity. Limb salvage with the use of this protocol was achieved in 14 (73.68%) of 19 patients. Five (26.32%) patients had proximal amputation with 3 (15.79%) deaths within the follow-up period. Amputation was more likely in the nonsmoking (p = .01) and insulin-dependent (odds ratio = 22, p = .02) patient cohorts, whereas death was associated only with higher body mass index (p = .03). Time to revision was greater in patients with external bracing postoperatively as well (p = .004). Outcomes, including total number of procedures and retained antibiotic rods, were not associated with any of the preoperative variables or indications. In high-risk patient populations, the presented staged management of infected intramedullary hindfoot nails showed promising outcomes for limb preservation.

Nitinol has been shown to generate durable compression under loading via pseudoelastic shape memory. The purpose of this study was to evaluate the effectiveness of a hindfoot arthrodesis nail with an internal pseudoelastic nitinol compression element. Patients who had undergone tibiotalocalcaneal arthrodesis from 2013 to 2016 were identified at 2 tertiary referral centers (12-week follow-up minimum). Patients managed with a tibiotalocalcaneal nail with an internal nitinol compression element were identified for review. Sagittal computed tomographic scan reformats were reviewed to calculate a percentage of joint surface bony union. Intraoperative and postoperative radiographs were compared to calculate postoperative screw position change generated by the nitinol element, a surrogate for postoperative unloading of compressive forces. Thirty-three patients were included in analysis and 81% of patients had successful union of both tibiotalar and subtalar joints. Overall, 90% of all arthrodesis surfaces united. The union rate of arthrodesis surfaces among patients without Charcot osteoarthropathy was 94%. A history of Charcot was identified as a risk factor for subtalar nonunion (p = .04) and was associated with less complete computed tomography-based tibiotalar union: 94% versus 71% (p < .01). The posterior-to-anterior screw translated an average of 3.9 mm proximally relative to the rigid portion of the nail from intraoperative to initial postoperative radiographs (p < .0001). High rates of computed tomography-confirmed union were demonstrated in the face of challenging clinical scenarios. Shortening of the pseudoelastic nitinol element occurs early in the postoperative period, indicating continued unloading of the nitinol compression element through the arthrodesis sites after initial implantation.

This report documents an unusual case of distal symmetrical peripheral neuropathy (DSPN) in an otherwise healthy patient without diabetes mellitus (DM) presenting to a podiatric wound care clinic. The development of gas gangrene coupled with Charcot neuroarthropathic changes ultimately resulted in a potentially life-saving transmetatarsal (TMT) amputation. Causation of, or at least a contributor to, the DSPN was likely phenytoin usage for epileptic seizures. Long-term use of phenytoin can lead to axonal shrinkage and random clusters of nerve demyelination [1]. Clinical standards for DM-induced DSPN indicate that annual comprehensive neurological assessment to detect nerve function deterioration is warranted [2]. This can aid in identifying patients at high risk of diabetic foot ulceration. However, oftentimes, patients exhibiting medication-induced neuropathy are not assessed to determine severity of the neuropathy nor are they educated about ulcer prevention in the same manner as patients with DM. This report advocates for a standardized threshold of diagnostic and preventative investigation for neuropathy of all aetiologies; diabetic, traumatic, viral, medication-induced and idiopathic.

Dengue is the most common and widespread arthropod borne arboviral infection in the world today. Recent observations indicate that the clinical profile of dengue fever is changing with neurological manifestations being reported more frequently. A 50-year-old male patient was admitted with fever and thrombocytopenia. He was diagnosed as dengue fever with positive IgM dengue serology. Patient was managed medically in the ward for seven days and observed for any complications. Fever subsided since third day of admission and platelet count started to improve; he had no complication of dengue fever and was discharged in stable condition. However, patient again came back to emergency with two episodes of generalized tonic clonic seizures followed by altered sensorium. Emergency NCCT head and later MRI brain revealed bilateral subdural effusion. Patient was managed with antiepileptic drugs and anti-oedema measures were taken. Patient showed improvement in sensorium after 48 hours of admission. Later after six weeks NCCT and MRI brain revealed complete resolution of subdural effusion.

Diabetic Charcot neuroarthropathy is a complex, limb-threatening disease process with major lifestyle-altering repercussions for patients. When Charcot neuroarthropathy leads to unstable deformity, ulceration, and potential infection despite conservative therapies, foot and ankle surgeons often consider reconstructive limb salvage procedures to restore function. The purpose of the present study was to evaluate the clinical and radiographic outcomes of diabetic Charcot reconstruction using combined internal and external fixation. A total of 22 patients were reviewed; 16 (72.73%) midfoot and 6 (27.27%) tibiotalocalcaneal arthrodesis procedures were consecutively performed from March 2009 to May 2013. All surgical procedures were performed in nonacute phases of the Charcot process in patients with diagnosed diabetes mellitus and documented peripheral neuropathy. Patients were excluded from the study if they were not diabetic despite having undergone Charcot reconstruction, regardless of the fixation method, or if they did not complete radiographic imaging. During a mean follow-up period of 58.60 ± 42.37 (range 16 to 164) weeks, limb salvage was achieved in 20 patients (90.91%), and 2 (9.09%) required below-the-knee amputation at a mean of 42 ± 14.14 weeks. Wound dehiscence occurred in 8 (36.36%), pin tract infection in 10 (45.45%), and superficial wound infection in 9 (40.91%) and peaked in bimodal fashion at 4 and 8 weeks postoperatively. Radiographic analysis of the pre- versus postoperative alignment showed statistically significant changes in the lateral talo-first metatarsal angle (p = .02) and lateral talar declination angle (p = .01). The limb salvage rates with diabetic Charcot reconstruction are improving in part because of the continued development of increasingly superior modalities for both internal and external fixation.

暂无摘要。

Charcot neuro-osteoarthropathy (CN) of the midfoot presents a major reconstructive challenge for the foot and ankle surgeon. The Synthes 6 mm Midfoot Fusion Bolt is both designed and recommended for patients who have a deformity of the medial column of the foot due to CN. We present the results from the first nine patients (ten feet) on which we attempted to perform fusion of the medial column using this bolt. Six feet had concurrent hindfoot fusion using a retrograde nail. Satisfactory correction of deformity of the medial column was achieved in all patients. The mean correction of calcaneal pitch was from 6° (-15° to +18°) pre-operatively to 16° (7° to 23°) post-operatively; the mean Meary angle from 26° (3° to 46°) to 1° (1° to 2°); and the mean talometatarsal angle on dorsoplantar radiographs from 27° (1° to 48°) to 1° (1° to 3°). However, in all but two feet, at least one joint failed to fuse. The bolt migrated in six feet, all of which showed progressive radiographic osteolysis, which was considered to indicate loosening. Four of these feet have undergone a revision procedure, with good radiological evidence of fusion. The medial column bolt provided satisfactory correction of the deformity but failed to provide adequate fixation for fusion in CN deformities in the foot. In its present form, we cannot recommend the routine use of this bolt.