Management of neuropathic arthropathy with the Charcot Restraint Orthotic Walker.

A recently designed Charcot Restraint Orthotic Walker (CROW) was used in the treatment of 18 patients with diabetic neuroarthropathy involving the foot and ankle. Eight of these patients had no surgery before the use of the CROW. In ten patients, the device was used for prolonged immobilization after surgery for complications of neuropathic joint disease. The CROW is a rigid, custom, full-foot enclosure ankle-foot orthosis. It was used after an initial period of cast immobilization. The CROW effectively controls limb edema, returns the patient to ambulatory activities, and prevents significant progression of deformity. All patients rated their satisfaction with the device as good or excellent. The CROW is an attractive alternative to currently used methods to provide the prolonged immobilization and protection necessary for healing in neuropathic arthropathy.

Neuropathic calcaneal tuberosity avulsion fractures.

Avulsion of a calcaneal tuberosity can be the initial presentation of a neuropathic fracture. Neuropathic fracture should be investigated in patients who appear without a history of significant indirect or direct trauma. Neuropathic fractures should always be considered in patients with diabetes mellitus. The diagnosis of neuropathic calcaneal tuberosity avulsion fracture alters the prognosis and treatment of this injury. Two cases of bilateral fracture avulsions are reported to emphasize problems in diagnosis and treatment.

The safety of the Esmarch tourniquet.

The use of an Esmarch bandage as a tourniquet in surgery has been criticized. Many authors claim that the pressures under the Esmarch are inconsistent and may be extremely high. We have seen few, if any, problems from the use of an Esmarch in surgery of the foot and ankle. The purpose of this study was to evaluate the pressures generated under the Esmarch tourniquet in a situation that mimics its clinical application, and to determine whether pressures of appropriate magnitude and consistency are obtained in order to recommend its continued use in surgery. Ten volunteers performed numerous applications of the Esmarch. The number of wraps and the width of the Esmarch bandage used were varied. The Esmarch was applied as it would be for a surgical case. Pressures directly beneath the Esmarch were recorded 8 cm proximal to the distal tip of the medial malleolus. Considering all volunteers and all pressures generated, a 3-in Esmarch applied with three wraps gave a mean pressure (+/- SD) of 225 +/- 46 mm Hg. A 3-in Esmarch applied with four wraps gave a mean pressure of 291 +/- 53 mm Hg. A 4-in Esmarch applied with three wraps gave a mean pressure of 233 +/- 35 mm Hg, and a 4-in Esmarch with four wraps gave a mean pressure of 284 +/- 42 mm Hg. The maximum pressures generated by any individual were as follows: 3-in three wraps, 321 mm Hg; 3-in four wraps, 413 mm Hg; 4-in three wraps, 328 mm Hg; and 4-in four wraps, 380 mm Hg.(ABSTRACT TRUNCATED AT 250 WORDS)