Diabetic neuroarthropathy

This study was undertaken to assess the incidence of diabetic neuroarthropathy and its related morbidity. The medical records of 296 diabetic patients were analyzed retrospectively between June of 1998 and July of 1999. The patients with long standing, poorly controlled diabetes mellitus and associated peripheral neuropathy were evaluated clinically and radiographically for the presence of arthropathic changes in the feet. Clinically, neuropathy was considered if there was absence of ankle jerk or glove and stocking sensory loss, or both. Radiographically, the presence of stress fractures, dislocation/subluxation, lytic or arthritic lesions of the bone and joints were taken as indicative of the disease. They were treated conservatively by total contact casting or surgically in the form of ray excision, amputation and skin grafting. They were followed up for an average period of 13 months. Results were evaluated clinically and radiographically. The maximum incidence of diabetes mellitus was in the age group of 41-80 years. Diabetic neuropathy was present in 37 patients [12.5%]. Male to female ratio was 23:14 with an average age of 70.42 years. The mean duration of diabetes mellitus was 14.2 years. Seventeen feet in 11 patients [4%] were found to have diabetic neuroarthropathy. The joints involved were tarsometatarsal [76%], metatarsophalangeal [59%], subtalar [47%] and interphalangeal joints [41%]. Two patients underwent foot amputations. Patients treated with total contact casting resulted in satisfactory progress. Diabetic neuroarthropathy, a less recognized complication of diabetes mellitus needs greater attention in Saudi Arabia. High-risk feet should be subjected to routine radiographs or preferably a computerized tomography examination. The timely detection of this problem can save many patients from disastrous complications

Management of gunshot injuries to the limbs

To define the incidence and nature of gunshot fractures of the limbs and their management experience in the region of Najran, Saudi Arabia and adjoining areas of Yemen. Eighty nine patients with 101 long bone fractures following gunshot were managed between January 1996 to February 1998. The majority of people affected were Yemeni [78%], next were Saudi [16%] and 6% were others. Bulk of fractures fell in Gustilo grade two, three A and B injuries. Femur was the maximum involved bone ie. 58 out of 101, then tibia [20], humerus [12] and radius-ulna [11] in descending order. Management included initial resuscitation and thorough wound debridement followed by fracture stabilization. Implants used were Association of Osteosynthesis nails, interlocking nails. Dynamic Hip Screw, Dynamic Condylar Screw and plates, and flexible Intramedullary nailing with or without bone graft. Over all 66% of fractures had good results while 20% satisfactory and 14% poor results. Few limbs had to undergo amputation due to severe vascular injury. Results were superior in patients who had primary stable internal fixation, particularly locked nails. We recommend repeat and meticulous wound debridement and early stable internal fixation in grade one, two and three A fractures while external fixator and traction may be reserved for three-B and C injuries