DIABETIC OSTEOARTHROPATHY

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Abstract
The clinical and roentgenographic findings in 90 cases of diabetic osteoarthropathy are described with emphasis on 2 case reports resembling avascular necrosis, and pathologic correlation in 3 cases, 1 of which is consistent with avascular necrosis. The roentgenographic manifestations are: swelling of the joint; subluxation; fracture fragmentation; a zone of subchondral osteoporosis; and sclerosis in the adjacent bone. The bone may heal and retain its normal architecture at this stage. If the disease progresses, the articular surface is completely destroyed with resorption and dissolution of the subchondral bone. Healing, if it occurs, is by bone fusion with loss of the joint. The "sucked candy" or "sharpened pencil" deformity of the metatarsal head most likely results from a combination of neuropathy with repeated episodes of trauma manifested by a series of fractures with attempt at healing without success. There may be superimposed episodes of avascular necrosis. The end result is concentric resorption. Infection may play a minor role.

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