Orthopedic Disease

Lecture 3
Osteo Associated with
PVD
1. Bone involved
2. Bacteriology
3. Radiologic changes
4. Laboratory data
5. Treatment
Treatment

1. Conservative Therapy
2. Amputation
TREATMENT FAILURE

1. Too low dosage

2. Too short of time
 Osseous Pathology
Osteopenia
Stress fracture / reaction
Spontaneous dislocation
Resorptive neuroarthropathy
Osteolysis
Hypertrophic neuroarthropathy
Rheumatic syndromes
Osteomyelitis / septic arthritis
Charcot Joint Disease
Soft tissue changes
Resoptive / hypertrophic
Fracture / fragmentation
Detritic synovitis
Disorganization / subluxation
Dislocation
 Osteomyelitis
Serial radiographs
Needle biopsy / aspiriation
3 phase or 4 phase TC99m MDP
Ga67 citrate
I111 Leukocyte / CL
CAT
MRI
T1 image PD
T2 image
 Primary Amputaion
PRO CON

Single procedure Operative morbidity

Ideal if Rehabilitation costs
nonambulatory Deterioration of
“body image”
 Arterial Reconstruction

PRO CON

Maintain ambulation Marginal long term

Less costly if results
successful Often multiple
procedures
 Diabetic Infections:
Predisposing Factors
Vascular insufficiency
 Large and small vessels occlusion
Neuropathy
 Motor:intrinsic minus deformity(claw toes)
 Sensory:neurotrophic ulcer,osteopathy

 Autonomic:dry skin,fissured calluses

 Predisposing factors
Excessive/Repetitive trauma
 Ulceration
 Charcot,s joints

Leukocyte dysfunction
 Impaired chemotaxsis,phgocytosis(esp.
 S. Aureas. E. coli)
 Impaired glycolysis
 Diabetic Foot Ulcer
MILD
 Superficial
 No bone involvement
 No systemic toxicity
TREATMENT
 Rest, C&S
 Broad Antibiotic
 Careful Debridement
 Local dressings
 Podiatric appliances and
 Shoes,follow-up
SEVERE
 Deep ulcer
 ? Bone involvement
 Threatened limb loss
 Systemic toxicity
TREATMENT
 Immediate admission
 Control Blood Sugar
 IV Antibiotics
 Surgical debridment
 Possible Vascular
Bypass
 Later modification
 Surgical/conservative