Artroscopia y ortopedia: Discusión entre pares / 55 male DM Deformed painful foot Hx trivial trauma 2 yrs ago

Indian-Orthopaedic Research-Group

Rimon Lazar Sliwa

29 de mayo a la(s) 9:45

55 male DM Deformed painful foot
Hx trivial trauma 2 yrs ago

Alberto Padilla D old Lisfrank dislocation?

29 de mayo a la(s) 9:52 · Me gusta
Mohamed Abo Elghet Any neurovascular prpblem

29 de mayo a la(s) 10:01 · Me gusta
Mohamed El Morsy Ashour Charchot foot

29 de mayo a la(s) 10:02 · Me gusta · 4
Rimon Lazar Sliwa No N/V problem
Yea i agree with u dr ashout but how can we help him

29 de mayo a la(s) 10:08 · Editado · Me gusta
Shashank Hore Does having active infn

29 de mayo a la(s) 10:08 · Me gusta
Rimon Lazar Sliwa No infection

29 de mayo a la(s) 10:08 · Me gusta
Sadique Ahmed Khan Since injury was he able to walk? How did he go for this 2 yrs.

29 de mayo a la(s) 10:22 · Me gusta
Hossam Helmy Charcot brace

29 de mayo a la(s) 10:22 · Me gusta
Santosh Rawat This is a diabetic foot, impending neuropathic joint.... Charcot 's joint. Has to be handled extremely carefully. If ulceration starts may land up in amputation. At present he needs immobilisation in a well padded and well moulded cast for several months and good glycemic control

29 de mayo a la(s) 10:29 · Me gusta · 1
Mohamed El Morsy Ashour Thanks Rimon Lazar Sliwa, l have no experience in such cases.l saw a Belgum ankle and foot surgeon doing conventional plate and screws fixation planterly, some others had trials of ilizarov with compression , the results were not promising

29 de mayo a la(s) 10:29 · Me gusta · 2
DrDilawar Khan Mahsud Charcot joints

29 de mayo a la(s) 10:41 · Me gusta · 1
Swetabh Verma Atrophic charcots foot....wil need meticulous ulcer management(if any) and padded immobilization..not to forget diabetic management

29 de mayo a la(s) 11:07 · Me gusta
Amanj Gardi Charcot

29 de mayo a la(s) 11:50 · Me gusta
Naresh Chodha why not below knee amputation?for early mobilisation

29 de mayo a la(s) 12:02 · Me gusta
Alok Jain Its a classical Charcot's Neuropathic foot...
I feel, its now stable..
If not much oedema/swelling...
U will have to arthodese the lisfrank joint...
If active, go for serial total contact casting, even up to three months..
Than a Charcot's walker orthosis..
Followed by arthodesis...

29 de mayo a la(s) 13:03 · Me gusta
Rebar Khaffaf Stage 4 charcot joint he need plate fixation

29 de mayo a la(s) 13:53 · Me gusta
Amine Benhima Without diabet... i ll think syphilis !!!!!

29 de mayo a la(s) 15:44 · Me gusta
Amine Benhima Neuro syphilis... be carefull

29 de mayo a la(s) 15:45 · Me gusta
Abhay Mohite Charcots

29 de mayo a la(s) 22:13 · Me gusta
Shyamlal Mukhi Diabetic foot

Ayer a las 2:12 · Me gusta
Anuj Agrawal Charcot's midfoot. Correcting and fusing it will be extremely difficult.
If the patient's pain is not sufficiently relieved in an orthosis, go for a primary Syme's amputation.

Ayer a las 4:41 · Me gusta · 1
Navin Singh Symes amputation in diabetics often creates problems. Usually they have little pain , but in this case pain would be due to instability/ deformity

Ayer a las 5:06 · Editado · Me gusta · 1
Anuj Agrawal Navin Singh Syme's is the most commonly performed major foot amputation in diabetics, and is largely successful, if the patient selection is correct. Each diabetic foot is different, and the level of amputation has to be carefully decided.
Making a generalisation that Syme's is not successful in diabetics is not correct.

Ayer a las 8:07 · Me gusta · 2
Navin Singh But how many of midfoot charcot's need amputation. And what percentage truly need surgery? At least two thirds of them can be managed conservatively, each one of them with a plantigrade foot can be treated by custom made foot orthosis, some needing periods of total contact plaster. Only those without plantigrade foot need corrective osteotomy with or without attempted fusion (as it may not fuse). A very small minority end up in amputation . In this case apart from X ray, a thorough inspection including gait examination, wt bearing X rays would be needed. And I would like to know If he is really in pain

Ayer a las 10:29 · Editado · Me gusta · 1
Navin Singh Secondly, why do one needs proper patient selection for Syme's in diabetics? like palbable PT and ABI above .7 , no infection beyond midfoot? because results are poorer in diabetics as compared to trauma.

Ayer a las 10:32 · Editado · Me gusta
Navin Singh Now why do you need syme's here. Pt may not need surgery. even of he does he may not need amputation. even if heeds amputation he may not need symes as a lesfranc's may do much better. or choparts.

Ayer a las 10:34 · Me gusta · 1
Anuj Agrawal I think you have mistaken my comments. I have advised an amputation, only if conservative management fails. An attempt to fuse might be difficult, if not impossible.
A midfoot amputation like Lisfranc's is not possible in this case. And, Syme's does better than other hindfoot amputations like Chopart's.

hace 22 horas · Me gusta · 2
Navin Singh Attempt to fuse may be unnecessary too. Choparts gives good result if Achilles tendon is lengthened, TA transfered and T/C fusion done. A Pirogoff amputation gives equal leg length and better prosthetic fitting than Syme's if needed. Having said this most Charcot's can be managed and are managed conservatively, orthos not seeing them regularly should remember this as the grotesque X rays may make them jump the gun.

Ayer a las 13:12 · Me gusta
Anuj Agrawal Modified Chopart's and Pirogoff's amputations are increasingly becoming obsolete, as they preserve greater leg lengths, which may be advantageous to people opting not to wear prostheses, but gives little room to fit a prosthesis if one is required. The...Ver más

6 horas · Me gusta
Navin Singh This patient will in every possibility need none of them.