OKOJ, Volume 5, No. 7

Charcot arthropathy is a destructive disease process that creates significant deformity of the foot and ankle. It is most commonly found in patients who have long-standing diabetes (10+ years) and the comorbidity of peripheral neuropathy. The peripheral neuropathy associated with diabetes is just one of the multiple pathological organ system expressions associated with the disease process. Nerve dysfunction, as much of diabetes-specific organ dysfunction, appears to be a consequence of glycosylated hemoglobin acting at the arteriolar basement membrane of nerve fibers. This complex interaction gives rise to a progressive loss of function first appreciated in the smallest nerve fibers. With time, patients develop conduction defects in the sensory, motor, and autonomic components of peripheral nerves. There is virtually no role for nonsurgical treatment of even nondisplaced ankle fractures or Charcot ankle arthropathy in diabetic patient. A displaced ankle fracture in a diabetic patient with peripheral neuropathy is a potentially life-threatening event; rigid internal fixation is required. In this patient population, ankle fusion with retrograde locked intramedullary nail is generally performed through an anterior or transmalleolar approach.

Minimally invasive surgical (MIS) approaches have been developed to limit the morbidity of traditional open exposures to the spine and hasten patient recovery. These approaches generally involve smaller incisions and produce less damage to the paraspinous soft tissues. In addition, a number of studies suggest that reduced intraoperative blood loss, less postoperative pain, a shorter period of hospitalization, and quicker return to normal activities can be achieved with the use of an MIS approach. A variety of lumbar spinal conditions can now be treated with an MIS approach. This article describes MIS procedures used in the treatment of symptomatic radiculopathy caused by disk herniation or lateral recess stenosis, as well as minimally invasive lumbar fusion for patients with symptomatic instability of the lumbar spine, or for those with destabilizing trauma, infection, or tumors of the spine.

Distal biceps tendon rupture is a rare injury that usually occurs as the result of sudden application of an extension force against a concentrically flexed biceps. Typically, the tendon avulses from its insertion on the radial tuberosity; however, the tendon can also rupture in its midsubstance. Classically, this injury is seen in the dominant extremity of men between the ages of 40 and 60 years. The common symptom of distal biceps tendon rupture is a sharp, tearing pain followed by discomfort in the region of the antecubital fossa. Proximal migration of the tendon, when present, allows the diagnosis to be readily made. Management of distal biceps tendon rupture includes both nonsurgical and surgical treatment options. Nonsurgical treatment consists of local and systemic measures for comfort in addition to physical therapy, with return to activities as tolerated. Surgical intervention involves reattachment of the tendon to the radial tuberosity. This article describes repair of the distal biceps tendon through one-incision and two-incision techniques.