Rekonstruktive Fu�chirurgie bei diabetisch-neuropathischer Osteoarthropathie

Koller, A.; Hafkemeyer, U.; Fiedler, R.; Wetz, H. H.

doi:10.1007/s00132-004-0700-x

Cited by 11 publications

(8 citation statements)

References 13 publications

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“…Acute foot trauma in the cases was defined as elective minor operation on the foot skeleton (17), that is, removal or implantation of hardware ( n =5), bone resection ( n =3), or arthrodesis ( n =4), requiring skin incision and suturing. Most feet were affected by chronic or acute osteomyelitis.…”

Section: Definitionsmentioning

confidence: 99%

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Effect of painless diabetic neuropathy on pressure pain hypersensitivity (hyperalgesia) after acute foot trauma

Wienemann

Chantelau

Koller

2014

Diabetic Foot & Ankle

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Introduction and objectiveAcute injury transiently lowers local mechanical pain thresholds at a limb. To elucidate the impact of painless (diabetic) neuropathy on this post-traumatic hyperalgesia, pressure pain perception thresholds after a skeletal foot trauma were studied in consecutive persons without and with neuropathy (i.e. history of foot ulcer or Charcot arthropathy).Design and methodsA case–control study was done on 25 unselected clinical routine patients with acute unilateral foot trauma (cases: elective bone surgery; controls: sprain, toe fracture). Cases were 12 patients (11 diabetic subjects) with severe painless neuropathy and chronic foot pathology. Controls were 13 non-neuropathic persons. Over 1 week after the trauma, cutaneous pressure pain perception threshold (CPPPT) and deep pressure pain perception threshold (DPPPT) were measured repeatedly, adjacent to the injury and at the opposite foot (pinprick stimulators, Algometer II®).ResultsIn the control group, post-traumatic DPPPT (but not CPPPT) at the injured foot was reduced by about 15–25%. In the case group, pre- and post-operative CPPPT and DPPPT were supranormal. Although DPPPT fell post-operatively by about 15–20%, it remained always higher than the post-traumatic DPPPT in the control group: over musculus abductor hallucis 615 kPa (kilopascal) versus 422 kPa, and over metatarsophalangeal joint 518 kPa versus 375 kPa (medians; case vs. control group); CPPPT did not decrease post-operatively.ConclusionPhysiological nociception and post-traumatic hyperalgesia to pressure are diminished at the foot with severe painless (diabetic) neuropathy. A degree of post-traumatic hypersensitivity required to ‘pull away’ from any one, even innocuous, mechanical impact in order to avoid additional damage is, therefore, lacking.

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Section: Definitionsmentioning

confidence: 99%

“…The subjects were studied in supine position in a quiet room at a temperature of 18° C. Measurements were performed at the feet and the hands, after completion of the diagnostic workup and prior to treatment (13–17). Vibration perception thresholds were measured first, followed by CPPPTs, and finally DPPPTs.…”

Section: Perception Threshold Measurementsmentioning

confidence: 99%

Effect of painless diabetic neuropathy on pressure pain hypersensitivity (hyperalgesia) after acute foot trauma

Wienemann

Chantelau

Koller

2014

Diabetic Foot & Ankle

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“…Auch ist das Risiko einer Verletzung des medial laufenden Gefäßnervenbündels, insbesondere des N. plantaris medialis, bei Verwendung eines gekrümmten Nagels geringer (37). Von anderen Arbeitsgruppen wird die Kompressionsarthrodese im Ringfixateur mit Erfolg eingesetzt (27,33,46). Die Vorteile dieses Verfahrens liegen in der geringen Menge an eingebrachtem Osteosynthesematerial, dem Verzicht auf eine Aufbohrung der Markhöhle mit potenzieller Keimverschleppung sowie der Möglichkeit einer schrittweisen Korrektur bzw.…”

Section: Typ IV (Oberes Sprunggelenk Und Subtalar-gelenk)unclassified

Behandlungsstrategien bei Charcot-Osteoarthropathie

Rammelt¹,

Zwipp²,

Schneiders³

2014

Osteologie

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ZusammenfassungDie neuropathische Osteoarthropathie („Charcot-Fuß”) ist eine schwere pathologische Alteration von Knochen, Gelenken und Weichteilen an Fuß und Sprunggelenk. Die Genese der Erkrankung ist multifaktoriell und noch nicht vollständig aufgeklärt. Ein entscheidender pathogenetischer Faktor ist der Verlust der Schutzsensibilität des Fußes; auslösend ist ein vom Patienten nicht immer wahrgenommenes, mitunter repetitives Trauma. Die frühe Phase der Erkrankung ist von einer entzündlichen Veränderung gekennzeichnet, die über proinflammatorische Zytokine vermittelt wird und von einer akuten Infektion beim diabetischen Fußsyndrom abgegrenzt werden muss. Der Diabetes mellitus ist die weitaus häufigste Ursache neuropathischer Veränderungen am Fuß, jedoch kann das Vollbild eines Charcot-Fußes bei Neuropathien jeder Genese und auch idiopathisch auftreten. Das Behandlungsziel beim Charcot- Fuß ist ein plantigrader, stabiler, infektfreier Fuß ohne Ulzeration und mit sicherer Gehfähigkeit in entsprechend angepasstem Schuhwerk. Aufgrund der unterschiedlichen Genese, des vielgestaltigen Krankheitsbildes und fehlender vergleichender oder gar randomisierter Studien gibt es keine höhergradige Evidenz zur Therapie. In vielen Fällen ist die konsequente Entlastung im Kontaktcast die Therapie der Wahl, um eine Konsolidierung der Knochen und Weichteile zu erzielen. Die Indikation zur operativen Stabilisierung ist gegeben bei hochgradiger Instabilität und Deformität, drohender Hautperforation durch knöcherne Prominenzen, therapierefraktären Ulzerationen und der Unmöglichkeit der orthopädischen Schuhversorgung. Zur Anwendung kommen stabile Arthrodeseverfahren, während konventionelle Osteosynthesen zwangsläufig zum Implantatversagen führen. Aufgrund des häufigen Versagens der konservativen Therapie insbesondere bei Befall des oberen Sprunggelenks wird die Indikation zur frühzeitigen Stabilisierung zunehmend großzügiger gestellt, um den Krankheits verlauf abzukürzen. Prolongierte Verläufe mit schwerwiegenden Komplikationen resultieren nach wie vor aus einer mangelnden Kenntnis des Krankheitsbildes mit verzögerter Diagnosestellung und inadäquater Therapie.

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“…Reconstruction arthrodesis techniques vary from external fixation techniques using ring fixators to internal techniques with intra- and extramedullary implants such as plates, screws, or bolts or combinations of these [ 1 , 4 – 7 ]. Postoperatively, prolonged healing periods due to diabetes-associated comorbidities such as peripheral artery disease can result in severe complications such as infections, nonunion or malunion, stress fractures, fixation failure, metal-induced soft-tissue irritations, implant breakage or loosening, and hence concomitant high reoperation rates [ 1 , 6 , 8 – 15 ]. Currently, general evidence-based treatment algorithms are lacking and the literature is inconsistent regarding both the ideal treatment type and timing of treatment.…”

Section: Introductionmentioning

confidence: 99%

Late Corrective Arthrodesis in Nonplantigrade Diabetic Charcot Midfoot Disease Is Associated with High Complication and Reoperation Rates

Eschler

Gradl

Wussow

et al. 2015

Journal of Diabetes Research

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Introduction. Charcot arthropathy may lead to a loss of osteoligamentous foot architecture and consequently loss of the plantigrade alignment. In this series of patients a technique of internal corrective arthrodesis with maximum fixation strength was provided in order to lower complication rates. Materials/Methods. 21 feet with severe nonplantigrade diabetic Charcot deformity Eichenholtz stages II/III (Sanders/Frykberg II/III/IV) and reconstructive arthrodesis with medial and additional lateral column support were retrospectively enrolled. Follow-up averaged 4.0 years and included a clinical (AOFAS score/PSS), radiological, and complication analysis. Results. A mean of 2.4 complications/foot occurred, of which 1.5/foot had to be solved surgically. 76% of feet suffered from soft tissue complications; 43% suffered hardware-associated complications. Feet with only 2 out of 5 high risk criteria according to Pinzur showed significantly lower complication counts. Radiographs revealed a correct restoration of all foot axes postoperatively with superior fixation strength medially. Conclusion. Late corrective arthrodesis with medial and lateral column stabilization in the nonplantigrade stages of neuroosteoarthropathy can provide reasonable reconstruction of the foot alignment. Nonetheless, overall complication/reoperation rates were high. With separation into low/high risk criteria a helpful guide in treatment choice is provided. This trial is registered with German Clinical Trials Register (DRKS) under number DRKS00007537.

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Rekonstruktive Fu�chirurgie bei diabetisch-neuropathischer Osteoarthropathie

Cited by 11 publications

References 13 publications

Effect of painless diabetic neuropathy on pressure pain hypersensitivity (hyperalgesia) after acute foot trauma

Effect of painless diabetic neuropathy on pressure pain hypersensitivity (hyperalgesia) after acute foot trauma

Behandlungsstrategien bei Charcot-Osteoarthropathie

Late Corrective Arthrodesis in Nonplantigrade Diabetic Charcot Midfoot Disease Is Associated with High Complication and Reoperation Rates

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