Triple Arthrodesis for Diabetic Peritalar Neuroarthropathy

From 1963 to 1990, the senior authors (R.E.M. and K.G.H.) performed eight triple arthrodeses in seven patients with diabetes mellitus with sensory loss in the lower extremities. By clinical and roentgenographic examination, all patients were diagnosed with peritalar neuroarthropathy before surgery. All patients underwent a two-incision triple arthrodesis with internal fixation. Patient follow-up averaged 44 months and included repeat physical examinations and radiographs. All patients went on to clinical union and were satisfied with the procedure. One patient had prolonged wound drainage that resolved with antibiotic therapy; another had a residual rocker-bottom deformity and plantar ulceration that resolved after modification of custom shoe wear. We believe comprehensive management of diabetic peritalar neuroarthropathy can include surgical arthrodesis of the involved joints. The disease process and surgical indications are discussed.

Roentgenographic Examination of the Wrist: A Systematic Study of the Normal, Lax and Injured Wrist

The standard and positional views of 53 normal wrists have been compared to views taken under stress. The stresses applied can be divided into normal and abnormal ones. All the injured wrists with pathological roentgenographic appearances were operated on and thus the findings confirmed. Roentgenographic examination of the wrist under stress appears to be a valuable and reliable diagnostic aid. Two types of laxity of the wrist and a radio-anatomical classification of wrist instabilities are defined.

Roentgenographic Examination of the Wrist: A Systematic Study of the Normal, Lax and Injured Wrist

The precise appearances and relationships of the carpal bones have been studied in 53 normal wrists, 15 lax wrists, and 80 injured wrists, using frontal and lateral projections with the wrist in neutral and in various other positions. The findings are discussed and analysed.