OKOJ, Volume 5, No. 8

Charcot Foot Arthropathy

Charcot foot arthropathy is a progressive disease that creates significant deformity of the foot and ankle in patients with diabetic neuropathy. Some inciting event, often trauma, initiates the destructive process. Diagnosis is usually made on the basis of clinical manifestations consisting of a painful, warm, swollen, and insensate foot, and is supported by radiographs. Management of Charcot foot arthropathy includes both nonsurgical and surgical treatment options. Nonsurgical treatment consists of immobilization of the foot in a weight-bearing total contact cast during the acute active phase of the disease until the foot is sufficiently stable to be managed in therapeutic footwear. Surgery is advised when the foot is clinically nonplantigrade and unbraceable, and includes the removal of all infected bone, correction of the deformity with arthrodesis, and lengthening of the gastrocnemius-soleus complex. This article describes the use of ring external fixation to maintain the correction.

    • Keywords:
    • Charcot joint

    • diabetic foot

    • diabetic foot ulcer

    • peripheral neuropathy

    • hypertrophic osteoarthropathy

    • neuropathic osteoarthropathy

    • diabetic osteoarthropathy

    • diabetic neuroarthropathy

    • Charcot neuroarthropathy

    • Subspecialty:
    • Foot and Ankle

Fibrous Bony Lesions

In addition to fibrous dysplasia, there are several benign fibrous lesions that primarily affect bone, including osteofibrous dysplasia (OFD), nonossifying fibroma (NOF), and desmoplastic fibroma (DF). All three diseases have different presentations, imaging characteristics, and treatments. OFD is a rare, congenital, hamartomatous, osteofibrous lesion found primarily in the anterior cortex of the tibial midshaft of patients younger than 15 years. Excision of an OFD lesion should be avoided in skeletally immature patients because these lesions are prone to recurrence; instead, nonsurgical treatment should be used. NOF is a common, benign, fibrous, hamartomatous lesion usually found in the metaphyses of the lower extremity long bones of skeletally immature individuals. In most patients, NOF lesions remain asymptomatic and require no treatment. DF is a rare, benign, aggressive, bony lesion that most commonly affects the cancellous metaphyseal bone of the femur, tibia, and pelvis. DF can develop at any age, but the lesion is mostly found in individuals between 15 and 30 years of age. Wide excision, which can be challenging depending on the location of the lesion is the treatment of choice for DF lesions.

    • Keywords:
    • osteofibrous dysplasia

    • OD

    • ossifying fibroma

    • Campanaccis disease

    • congenital fibrous dysplasia

    • congenital fibrous defect of the tibia

    • intracortical fibrous dysplasia

    • nonossifying fibroma

    • NOF

    • fibrous cortical defect

    • fibroxanthoma

    • nonosteogenic fibroma

    • xanthogranuloma of bone

    • desmoplastic fibroma

    • Subspecialty:
    • Musculoskeletal Oncology

Vertebral Osteomyelitis/Diskitis

Pyogenic vertebral osteomyelitis is the most commonly encountered form of vertebral infection. It can develop from penetrating wounds, infections in adjacent structures, hematogenous dissemination of bacteria to a vertebra, or spine surgery. Left untreated, it can lead to neurologic deficits, spinal deformity, or death. The disease may occur at any age; however, it more frequently affects the elderly. Patients with acute infection will have fever, local spine pain, severe muscle spasm, and limited spine motion. Hamstring tightness, loss of lumbar lordosis, a positive straight leg raising test, reluctance to bear weight, and hip flexion contracture caused by psoas irritation may be observed in patients with lumbar involvement. In patients with cervical osteomyelitis, torticollis and fever may be the only presenting signs. Neurologic deficit is seen in about 17% of patients and may result from direct compression of the spinal cord or nerve roots by epidural pus, granulation tissue, or bone and disk from the development of spinal deformity and instability. Nonsurgical treatment consists of maximum dose parenteral antibiotic therapy for 6 weeks, followed by oral antibiotic therapy until resolution of the disease. Indications for surgical intervention include failure of needle biopsy to obtain necessary cultures, clinically significant abscess with systemic toxicity, failure of intravenous antibiotics alone to eradicate the infection, neurologic deficits, significant osseous involvement, and upper cervical osteomyelitis.

    • Keywords:
    • spine infection

    • pyogenic vertebral osteomyelitis

    • spinal osteomyelitis

    • vertebral infection

    • bacterial osteomyelitis

    • infectious osteomyelitis

    • pyogenic vertebral infection

    • discitis

    • diskitis

    • hematogenous osteomyelitis

    • direct inoculation osteomyelitis

    • Subspecialty:
    • Spine