23: Osteomyelitis and Charcot arthropathy - Bennett

Question 1

look at slide in beginning of powerpoint

Answer 1

run the different pathologies

Question 2

what leads to a charcot foot?

Answer 2

autonomic neuropathy –> autosympathectomy –> increased blood flow –> increased bone reabsorption –> joint collapse –> charcot foot

+ peripheral sensory neuropathy so you don’t feel it

Question 3

arterial occlusion typically involves the ____________ but spares the __________

Answer 3

tibial and peroneal

dorsalis pedis

Question 4

sensory neuropathy:

Answer 4

• loss of protective sensation

- pain, pressure, temperature

Question 5

motor neuropathy:

Answer 5

• atrophy of the intrinsic muscles
• flexion deformity
• pressure at met. heads and toes

Question 6

autonomic neuropathy:

Answer 6

• dyshidrosis and dry skin

- AV shunting (increase in bone and shin perfusion)

Question 7

beefy red v. whitish ulcer

Answer 7

beefy red: adequate circulation

whitish: fibrotic tissue

Question 8

stages of wound healing

Answer 8

infalmmatory –> proliferative –> remodeling

Question 9

inflammatory stage:

Answer 9

hemostasis
inflammation
cell migration

Question 10

proliferative stage:

Answer 10

cell proliferation
ECM synthesis
granulation tissue
angiogenesis
re-epitheliazation

Question 11

remodeling stage:

Answer 11

remodeling
wound closure
contraction

Question 12

things that add to a stalled wound

Answer 12

• increased MMPs and decreased TIMPs
• deficiency GF receptors
• senescent fibroblasts
• loss of moisture control
• i

Question 13

what is wagner’s grading system?

Answer 13

0-5 scale

useful for expressing the severity of a diabetic foot ulcer or infection

Question 14

wagners = ?

no evidence of ulcer or infection

Answer 14

grade 0

Question 15

wagners =?

ulcers may simply be considered deeper lesions that have penetrated to bone or a fascial plane

Answer 15

grade 2

Question 16

wagners = ?

feet have gangrene of the forefoot, frequently requiring debridement or amputation

Answer 16

grade 4

Question 17

wagners = ?

implies gangrene of the entire foot that will likely require amputation

Answer 17

grade 5

Question 18

what does the university of texas wound classification system tell you?

Answer 18

combines number indicating depth of ulcer with letter which indicates comorbidities

0-III
A-D
scale

Question 19

UofT:

ischemic wound through tendon or capsule

Answer 19

grade II stage C

Question 20

ishcemic and infected through bone or into joints

Answer 20

grade III stage D

Question 21

wound through dermis and infected

Answer 21

grade I stage B

Question 22

8 principles of ulcer management

Answer 22

1. vascular supply
2. debridement
3. infection
4. offloading
5. wound management
6. wound closure
7. management of medical comorbidities
8. nutrition status

Question 23

complications from diabetes account for ______-% of LE amputations

Answer 23

45-70%

Question 24

__% of diabetics will require an amputation at some time in their lives

Answer 24

5-15%

Question 25

survival rates are _____ for the first 3 yrs and and _______ for the first 5 years after unilateral amputation

Answer 25

50%

40%

Question 26

diabetics pts were __ times more likely to undergo a le amputation than nondiabetic person

Answer 26

15

Question 27

acute osteomyelitis bone test results

Answer 27

Tc99m positive all phases

Ga67 scan - positive focal uptake

indium scan - positive

Question 28

inactive chronic osteomyelitis bone test results

Answer 28

Tc99m all phases positive, phase one may be negative

Ga 67 scan negative

indium scan negative

Question 29

acute cellulitis bone test results

Answer 29

tc99m scan all phases positive

ga 67 scan - positive diffuse uptake

indium scan - positive

Question 30

charcot joint bone test results

Answer 30

tc 99m scan - all positive, phase I and II may be negative

Ga67 scan negative

indium scan negative