Chronic regional pain syndrome after subtalar arthrodesis is not prevented by early hyperbaric oxygen.
Subtalar arthrodesis was performed on a 48-year-old, non-insulin-dependent diabetic with a history of chronic ankle instability and lateral ankle pain. In the early post-operative period he presented as an emergency with an infection at the operative site. This was treated with 2 returns to the operating theatre for washout and debridement. His wounds were left open and at 3 weeks after emergency admission he was referred for adjunctive hyperbaric oxygen (HBO) therapy to aid healing by secondary intention. He received a total of 19 hyperbaric sessions, at a pressure of 2.2 ATA, one treatment per day for 5 days a week. Shortly after commencing HBO therapy his ankle became increasingly painful, despite the introduction of analgesia. By 7 weeks after emergency admission his wounds had virtually healed but hyperesthesia persisted over the dorsum of the foot. A computerized tomography scan at 5 1/2 months post-operatively showed satisfactory joint fusion and revealed no evidence of infection. Symptoms and signs at this time were compatible with a diagnosis of chronic regional pain syndrome (CRPS). There is published evidence to suggest that HBO therapy may be a useful modality in the treatment of established CRPS. Here, we seek to publicize a case in which early treatment with HBO for another indication did not prevent the simultaneous development of CRPS Type 1.
Diving Diseases Research Centre, Plymouth, UK. stbwilliams@hotmail.com
Simon T B
ST
Williams
Anthony
A
Davies
Phil
P
Bryson
D001174:Arthrodesis / Q000009:adverse effects*; D020918:Complex Regional Pain Syndromes / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D048909:Diabetes Complications / Q000503:physiopathology; D005528:Foot / Q000294:innervation / Q000503:physiopathology; D006801:Humans; D006931:Hyperbaric Oxygenation; D006941:Hyperesthesia / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D007593:Joint Instability / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D013380:Subtalar Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D013530:Surgical Wound Infection / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure; D014945:Wound Healing / Q000502:physiology