Neuropathic Fractures and Joint Injuries

Abstract

Current concepts of the treatment of neuropathic joints are reviewed and a number of questions are raised. Selected cases are reviewed which illustrate the role of fractures, the varied clinical picture, and the natural course of the condition. The mode of onset is discussed with reference to obvious and occult trauma, stress fractures, and ligament damage. The local pathological changes are briefly reviewed with emphasis on their variety and their relationship to the stage of development of the process. The various stages and clinical course of the condition are described and the interrelationship of different clinical stages is shown. Animal experiments showed no demonstrable intrinsic weakness of denervated bones and joints, and the subsequent Charcot-like fractures and joint injuries were felt to be purely traumatic. A rational form of treatment is described based on an understanding of the pathogenesis of the condition. Emphasis is placed on preventive therapy.