title: Charcot Collapse: Does Collapse Pattern Dictate Osseous Metabolism?
abstract: Charcot fracture pattern (FP) and Charcot dislocation pattern (DP) are 2 distinct collapse patterns identified in Charcot neuroarthropathy of the foot and ankle. These patterns are believed to demonstrate relative differences in central bone mineral density (BMD), which has been theoretically extrapolated to describe local BMD. To assess variation in local bone composition of FP and DP patients, 10 patients, 5 DP and 5 FP were recruited. The patient's age, body mass index (BMI), radiographs, central BMD, local BMD, sRANKL (soluble receptor activator nuclear factor kappa-beta ligand), sRAGE (soluble receptors of advanced glycated end-products), and osteocalcin were measured to determined bone metabolic status and density. Central BMD was determined using DEXA (dual-energy X-ray absorptiometry) scans of the hip. peripheral BMD was determined using scans at the level of the ankle mortise and Chopart's joint, depending on the location of collapse. These scans were then compared with controls. Central and peripheral DEXA scans were significantly reduced in the FP ( P = .002 and P < .0001) when compared with healthy controls. Additionally, FP patients demonstrated statistically significant elevations in sRANKL ( P = .05) and sRAGE ( P = .002) when compared with DP. No significant difference was seen in osteocalcin ( P = 0.22); however, elevated values compared with normal reference ranges suggest increase bone production. These elevations combined with an osteoporotic profile may indicate difficulty of FP patients in repairing micro fracture. Results from this study emphasize the increased risk of nonunion during FP reconstruction, and highlight the variation in bone composition in these 2 Charcot subtypes.
  
  
  METHODS
  Level III.
authors.affiliation: Western Pennsylvania Hospital Department of Foot and Ankle Surgery, Pittsburgh, Pennsylvania (LG).|College of Podiatric Medicine and Surgery, Des Moines University, Des Moines, Iowa (RY).|Grant Medical Center Department of Foot and Ankle Surgery, Columbus, Ohio (CH).|Tidewater Foot and Ankle Clinic, Virginia Beach, Virginia, (WG).
authors.forename: Lisa
authors.initials: L
authors.lastname: Grant
authors.affiliation: Western Pennsylvania Hospital Department of Foot and Ankle Surgery, Pittsburgh, Pennsylvania (LG).|College of Podiatric Medicine and Surgery, Des Moines University, Des Moines, Iowa (RY).|Grant Medical Center Department of Foot and Ankle Surgery, Columbus, Ohio (CH).|Tidewater Foot and Ankle Clinic, Virginia Beach, Virginia, (WG).
authors.forename: Robert
authors.initials: R
authors.lastname: Yoho
authors.affiliation: Western Pennsylvania Hospital Department of Foot and Ankle Surgery, Pittsburgh, Pennsylvania (LG).|College of Podiatric Medicine and Surgery, Des Moines University, Des Moines, Iowa (RY).|Grant Medical Center Department of Foot and Ankle Surgery, Columbus, Ohio (CH).|Tidewater Foot and Ankle Clinic, Virginia Beach, Virginia, (WG).
authors.forename: Chandana
authors.initials: C
authors.lastname: Halaharvi
authors.affiliation: Western Pennsylvania Hospital Department of Foot and Ankle Surgery, Pittsburgh, Pennsylvania (LG).|College of Podiatric Medicine and Surgery, Des Moines University, Des Moines, Iowa (RY).|Grant Medical Center Department of Foot and Ankle Surgery, Columbus, Ohio (CH).|Tidewater Foot and Ankle Clinic, Virginia Beach, Virginia, (WG).
authors.forename: William
authors.initials: W
authors.lastname: Grant
mesh_terms: D015502:Absorptiometry, Photon / Q000379:methods; D000368:Aged; D001177:Arthropathy, Neurogenic / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D015519:Bone Density / Q000502:physiology; D003430:Cross-Sectional Studies; D005593:Fracture Fixation, Internal / Q000379:methods; D017102:Fracture Healing / Q000502:physiology*; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D006801:Humans; D004204:Joint Dislocations / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012016:Reference Values; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: Charcot neuroarthropathy; bone; dislocation; fracture; metabolism; pattern