Neuropathic ankle fractures

CJEM
Allison Tucker, N Craig Stone

Abstract

A 65-year-old diabetic female presented with a 3-week history of a left swollen foot after a minor inversion injury and was found to have a minimally displaced fibular fracture. Despite casting and strict instructions to remain non-weight bearing, the patient continued to bear weight and later developed a significantly more displaced fracture with a draining ulcer. This injury eventually required a tibiotalocalcaneal arthrodesis using a retrograde hindfoot nail. Neuropathy and neuropathic fractures can be devastating complications of diabetes and thus require early diagnosis and intervention because they may result in significant morbidity for the patient. Thorough assessment involving imaging, a complete history and physical examination, and tools such as a 129 Hz tuning fork and the 10 g Semmes-Weinstein monofilament are paramount to establishing an accurate initial diagnosis. These tactics aid in future follow-up of the patient's injury and can be employed in both the clinic and the emergency department. Although management remains controversial for neuropathic ankle fractures because both conservative and surgical treatment regimens have high complication rates, open reduction and internal fixation continues to be the treat...Continue Reading

References

Jan 23, 1999·The Journal of the American Academy of Orthopaedic Surgeons·M S Myerson, W H Edwards
May 16, 2000·Foot & Ankle International·J M FlynnP A Pizá
Jan 30, 2007·Foot & Ankle International·William CostiganUjjwal K Debnath
Mar 5, 2008·The Journal of the American Academy of Orthopaedic Surgeons·Saad B ChaudharySheldon S Lin
Jul 3, 2008·The Journal of Bone and Joint Surgery. American Volume·Dane K Wukich, Alex J Kline
Nov 5, 2011·Foot & Ankle International·Yak-Nam WangWilliam R Ledoux

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