Neuropathic Joint – Chronic

Neuropathic Joint – Chronic

July 24, 2010Musculoskeletal

55 years old MaleFindings, summary, final Dx?

Answers:

Neuropathic Joint – Chronic:

• The first image (above, left) showed evidence of a longstanding lisfranc fracture-dislocation with extensive eburnation and fragmentation around the metatarsal joints
• Remaining images showed similar changes in the spine and knee
• All these findings are consistent with a Neuropathic (Charcot) joint in the late-stage
• The Neuropathic Joint has been called “Osteoarthritis with a Vengeance” – nothing else causes as severe destruction

• D’s of the late-stage Neuropathic Joint (De3nse subchondral bone, Destruction of articular cortex, Deformity, Debris (loose bodies), and Dislocation)
• Diabetes is the most common cause, even though it occurs in only 5 to 10 % of diabetics
• Again, Remember the causes: “DS6” (Diabetes, Syphilis, Steroids, Spinal Cord Injury, Spina Bifida, Syringomyelia, Scleroderma)

• In the case an examiner asks: a Lifranc fracture-dislocation is a Tarsometatarsal dislocation (as shown above)
• A Chopart fracture-dislocation involves the hindfoot-midfoot joint, i.e., tarsonavicular and calcaneocuboid joints