23: Osteomyelitis and Charcot arthropathy - Bennett Flashcards
look at slide in beginning of powerpoint
run the different pathologies
what leads to a charcot foot?
autonomic neuropathy –> autosympathectomy –> increased blood flow –> increased bone reabsorption –> joint collapse –> charcot foot
+ peripheral sensory neuropathy so you don’t feel it
arterial occlusion typically involves the ____________ but spares the __________
tibial and peroneal
dorsalis pedis
sensory neuropathy:
- loss of protective sensation
- pain, pressure, temperature
motor neuropathy:
- atrophy of the intrinsic muscles
- flexion deformity
- pressure at met. heads and toes
autonomic neuropathy:
- dyshidrosis and dry skin
- AV shunting (increase in bone and shin perfusion)
beefy red v. whitish ulcer
beefy red: adequate circulation
whitish: fibrotic tissue
stages of wound healing
infalmmatory –> proliferative –> remodeling
inflammatory stage:
hemostasis
inflammation
cell migration
proliferative stage:
cell proliferation ECM synthesis granulation tissue angiogenesis re-epitheliazation
remodeling stage:
remodeling
wound closure
contraction
things that add to a stalled wound
- increased MMPs and decreased TIMPs
- deficiency GF receptors
- senescent fibroblasts
- loss of moisture control
- i
what is wagner’s grading system?
0-5 scale
useful for expressing the severity of a diabetic foot ulcer or infection
wagners = ?
no evidence of ulcer or infection
grade 0
wagners =?
ulcers may simply be considered deeper lesions that have penetrated to bone or a fascial plane
grade 2
wagners = ?
feet have gangrene of the forefoot, frequently requiring debridement or amputation
grade 4
wagners = ?
implies gangrene of the entire foot that will likely require amputation
grade 5
what does the university of texas wound classification system tell you?
combines number indicating depth of ulcer with letter which indicates comorbidities
0-III
A-D
scale
UofT:
ischemic wound through tendon or capsule
grade II stage C
ishcemic and infected through bone or into joints
grade III stage D
wound through dermis and infected
grade I stage B
8 principles of ulcer management
- vascular supply
- debridement
- infection
- offloading
- wound management
- wound closure
- management of medical comorbidities
- nutrition status
complications from diabetes account for ______-% of LE amputations
45-70%
__% of diabetics will require an amputation at some time in their lives
5-15%
survival rates are _____ for the first 3 yrs and and _______ for the first 5 years after unilateral amputation
50%
40%
diabetics pts were __ times more likely to undergo a le amputation than nondiabetic person
15
acute osteomyelitis bone test results
Tc99m positive all phases
Ga67 scan - positive focal uptake
indium scan - positive
inactive chronic osteomyelitis bone test results
Tc99m all phases positive, phase one may be negative
Ga 67 scan negative
indium scan negative
acute cellulitis bone test results
tc99m scan all phases positive
ga 67 scan - positive diffuse uptake
indium scan - positive
charcot joint bone test results
tc 99m scan - all positive, phase I and II may be negative
Ga67 scan negative
indium scan negative
