Diabetic Neuropathy

Diabetes mellitus is becoming increasingly common worldwide. As this occurs, there will be an increase in the prevalence of known comorbidities from this disorder of glucose metabolism. One of the most disabling adverse comorbidities is diabetic neuropathy. The most common neuropathic manifestation is distal symmetric polyneuropathy, which can lead to sensory disturbances, including diminished protective sense, making patients prone to foot injuries. However, focal, multifocal, and autonomic neuropathies are also common. Diabetic nerve pain and Charcot osteoarthropathy are advanced neuropathic conditions that portend a severe deterioration in quality of life. To combat these symptoms, along with glycemic control and establishment of health care systems to educate and support patients with the complexities of diabetes, there are pharmacologic remedies to ameliorate the neurologic symptoms. Several guidelines and review boards generally recommend the use of tricyclic antidepressants, serotonin/norepinephrine-reuptake inhibitors, α-2-delta ligands, and anticonvulsants as medications to improve painful diabetic neuropathy and quality of life.

Advanced Engineering in Orthopedic Surgery Applications

The paper reports the use of advanced engineering tools, techniques and manufacturing process for the preoperative planning, visualization and simulation of complex osteotomy of a diabetic foot (Charcot osteoarthropathy). Two case studies focused on the same clinical data are illustrating the use of medical modeling techniques, reverse engineering and Additive Manufacturing technology in the development of 3D printed anatomical model and customized surgical cutting guides, as well as the use of Augmented Reality (AR) tools for enhancing the communication and information exchange between surgeons, and between surgeons and engineers. A good and accurate communication surgeon-engineer in identifying and selecting anatomical landmarks and supporting surfaces, in establishing the resections trajectories and K-wires positions proved mandatory for the guides’ design process. The importance of using both 3D virtual models, AR models and physical models as collaboration tools is also discussed.

Bilateral neuropathic osteoarthropathy of the shoulder due to syringomyelia

Neuropathic osteoarthropathy, which is known as Charcot osteoarthropathy, is a degenerative arthritis that develops as a result of proprioceptive and sensory innervation loss. A 47-year-old man was admitted to the emergency department of the hospital with left shoulder pain, which was ongoing and exacerbating for 5 days. Examination of the cervical region takes a crucial part in determining shoulder pathology. Palliative therapy is the prior treatment of choice as surgical therapy has potential risks in Charcot osteoarthropathy.