PubMed · 4197576
The source did not provide an abstract. Follow the original record for more information.
Explore connections, maps & timelines
D R Richard. 1973. Unreduced dislocations.. https://doi.org/10.1177/004947557300300308
Cite the original work for its findings. Save a collection to share your selection of sources.
KEEP EXPLORING
HISTORY AND CLINICAL FINDINGS: A 45-year-old patient with no significant past medical history was admitted 8 weeks after minor foot trauma with injury of the left ankle joint with massive destructive arthropathy. On admission the arch of both feet was flattened and both feet showed massive painless soft tissue swelling. Due to loss of muscle strength elevation of feet and toes was reduced and there was a "stocking-like" loss of sensation of the lower extremity. The gait was ataxic. No other abnormalities were detected besides hepatomegaly and hyperhidrosis. INVESTIGATIONS: Advanced polyneuropathy was confirmed by nerve conduction study. Laboratory tests revealed paraproteinaemia type IgG-lambda. Bone marrow biopsy, bone scan and skeletal survey did not provide additional information. Sonography confirmed hepatosplenomegaly, endocrinological work up showed impaired glucose tolerance and lowered testosterone levels. Based on these findings the diagnosis of POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, M-protein and skin changes) was established. TREATMENT AND COURSE: Plasma exchange was unsuccessful and due to worsening of the symptoms long term treatment with cyclophosphamide was started. Furthermore the patient received NSAIDs for symptomatic relief and orthopedic shoes. One year after initial presentation the patient continues to walk. CONCLUSION: Usually neurogenic arthropathy is associated with diabetes mellitus, syringomyelia or with infections. Our report illustrates that POEMS syndrome might present with Charcot arthritis.
The demand for minimally invasive techniques and more comfort for the patient is becoming higher and higher. In the region of the ankle joint, it is therefore ideal to use the arthroscope for pathology. Indications for ankle joint arthroscopy are: soft tissue impingement, ligament instability, impingement in the syndesmosis, osteochondral lesions, loose bodies, arthrosis, and loose os trigonum of the talus. In the subtalar joint the indications are rupture of the ligaments, loose bodies, and synovitis with soft tissue impingement. A new indication is arthroscopically assisted arthlodesis of the talar and subtalar joint. The reported high incidence of complications, especially in terms of neurovascular lesions, can be avoided by an exact knowledge of anatomy and use of non-invasive distraction of the joint.
Over an 18-month period findings of stress X-ray of the ankle and medical records of 112 cases were analyzed retrospectively as to indications, results and therapeutic consequences. The analysis showed that critical setting of indications can reduce the frequency of stress X-ray of the ankle and thus lower the total costs. The introduction of guidelines could be advantageous at medical training institutions.