Case Report: Tibial plateau fracture in Charcot neuroarthropathy: a report of two cases with contrasting outcomes.

Charcot neuroarthropathy (CNA) is a debilitating complication of diabetes mellitus that often poses diagnostic challenges, particularly when associated with fractures around the knee joint. This case series describes two contrasting cases of CNA manifesting as tibial plateau fractures in patients with type 2 diabetes. In the first case, a 55-year-old woman with poorly controlled diabetes sustained a tibial plateau fracture following a minor sprain. The fracture was misdiagnosed as an old comminuted tibial plateau fracture, and the patient underwent open reduction and internal fixation (ORIF) with iliac bone grafting. Intraoperative findings revealed severe bone fragmentation, osteolysis, and osteoporosis-features suggestive of underlying CNA, which were not recognized at the time. The surgery ultimately failed because of implant displacement and osteochondral collapse. In the second case, a 65-year-old man with well-controlled diabetes presented with acute knee pain and swelling after minimal trauma. Early diagnosis of CNA (modified Eichenholtz stage I) was established, and following a period of conservative management, the patient underwent total knee arthroplasty with stemmed components. At 9-year follow-up, the patient remained free of complications with satisfactory joint function. These cases highlight the critical importance of maintaining a high index of suspicion for CNA in diabetic patients presenting with fractures that are disproportionate to the mechanism of injury. Early recognition is essential to avoid inappropriate surgical interventions, and when joint destruction is advanced, total knee arthroplasty can yield durable long-term outcomes.