Abstract
Internal and total condylar depression of the proximal end of the tibia was found in an insulin dependent diabetic (IDDM) patient and a non-insulin dependent diabetic (NIDDM) patient, respectively. The patients had advanced somatic and autonomic neuropathy with long-standing poorly controlled diabetes. The IDDM patient suffered severe gastroenteropathy with nausea and vomiting, whereas the NIDDM patient had diabetic amyotrophy. The patients' daily activity was markedly diminished long before the fractures. Diabetic sensory disturbance, muscle weakness, and decreased physical strength were pointed out as causal factors of the fractures. Amenorrhea was also found in the IDDM patient, whose hypogonadism may have exacerbated osteoporosis.
The fractures were triggered by minor events such as ordinary walking. Therefore, when slight pain in the joints or feet diabetic patients experience, early diagnosis by X-ray and MRI of the bone followed by appropriate treatment, such as non-weight-bearing by the lesions is mandatory to prevent progression to Charcot's joint or severe diabetic osteoarthropathy.
