Western Health Orthopaedic Registrar presentation
Dr Daniel Sydenham
Epidemiology
- Usually develops in weight bearing joints
- Usually secondary to DM in lower extremity & syringomyelia in shoulder
- Associated with peripheral neuropathy
Pathology
Pathogenesis
- Usually develops in weight bearing joints
- Usually secondary to
- diabetes mellitus in lower extremity
- syringomyelia in shoulder
- Associated with peripheral neuropathy
Histology
- osteochondral fragments embedded within synovium
- Related to destruction of afferent proprioceptive fibres & subsequent unrecognized trauma to joint
Classification
Staging (Eichenholtz)
| Stage | Description | |
| 0 | diabetic patient with peripheral neuropathy & acute ankle sprain or Fracture | |
| 1 | Fragmentation | acute inflammatory process characterised by oedema, hyperaemia & erythema & bony fragmentation on X-rays |
| 2 | Coalescence | swelling, redness & warmth with coalescing new bone at site of fracture or dislocation on X-rays |
| 3 | Resolution | resolution of clinical inflammation & bony consolidation on X-ray (usu 9-12 mos after onset) |
Treatment
| Stage | Treatment | |
| 0 | always treat acute ankle fractures immediately ORIF has ↑ complications including wound necrosis & amputation if casting, must remain NWB > 6 weeks treat ankle sprains aggressively with NWB & foam walker boot | |
| 1 | Fragmentation | high rate of complications following surgery NWB in total contact casts or foam walker boot for prolonged periods of time (up to 9-12 mos) until reparative stage reached |
| 2 | Coalescence | as above |
| 3 | Resolution | can intervene surgically at this stage but still has ↑ risk of complications usually performing reconstructive fusions to prevent pressure points & recurrent ulceration |
Preoperative Evaluation
- internal medicine consult
- control of diabetes
- assessment of end organ dysfunction
- vascular consult
- assess vascular supply to foot
- document neuropathy
- vibration sense & filament tests
Indications for Surgery
- R ecurrent ulceration
- I nfection
- P ain
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.