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Wang C, Zhu Y, Pan D. Identifying the causal relationship between immune factors and osteonecrosis: a two-sample Mendelian randomization study. Sci Rep 2024; 14:9371. [PMID: 38654114 DOI: 10.1038/s41598-024-59810-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 04/15/2024] [Indexed: 04/25/2024] Open
Abstract
A wealth of evidence intimates a profound connection between the immune system and osteonecrosis, albeit the specific immune factors underlying this connection remain largely veiled. A bidirectional Mendelian randomization (MR) study was conducted based on genome-wide association study summary data to identify causal links between 731 immune factors and osteonecrosis including drug-induced osteonecrosis. Preliminary MR analysis was accomplished utilizing the inverse-variance weighted method under a multiplicative random effects model, and heterogeneity and potential horizontal pleiotropy were evaluated through Cochrane's Q-test, MR-Egger intercept test, MR-PRESSO global test, and leave-one-out analysis. Upon false discovery rate correction, the gene-predicted level of one immune factor (CD62L - monocyte %monocyte) exhibited a significant positive correlation with osteonecrosis, while eight immune traits associated with monocytes, dendritic cells, and NK cells demonstrated significant causal effects with drug-induced osteonecrosis. Reverse MR revealed no significant correlations. This MR research provides genetic evidence for the causal associations between a broad spectrum of immune factors and osteonecrosis. Such a study aids in unraveling the intricate interaction patterns between the immune and skeletal systems, elucidating the pathogenesis of osteonecrosis, and identifying potential novel therapeutic approaches.
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Affiliation(s)
- Chao Wang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Yong Zhu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China
| | - Ding Pan
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, 410008, Hunan, China.
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Hou R, Lei J, Xue D, Jing Y, Mi L, Guo Q, Xu K, Zhang L. The association of an elevated Th/Ts ratio and lupus anticoagulant with symptomatic osteonecrosis in systemic lupus erythematosus patients. Front Immunol 2024; 15:1288234. [PMID: 38384449 PMCID: PMC10879316 DOI: 10.3389/fimmu.2024.1288234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 01/22/2024] [Indexed: 02/23/2024] Open
Abstract
Objective This study aimed to assess the risk factors for symptomatic osteonecrosis (ON) in systemic lupus erythematosus (SLE) and identify clinical characteristics and laboratory markers for predicting symptomatic ON occurrence in SLE patients. Methods Seventy (6.0%) of 1175 SLE patients diagnosed with symptomatic ON were included in this study. An equal number of SLE patients without symptomatic ON, matched in terms of age and gender, were enrolled in the control group. Clinical symptoms, routine laboratory examinations, lymphocyte subsets, and treatments of these patients were retrospectively reviewed and compared between the two groups. Logistic regression analysis was employed to identify risk factors associated with symptomatic ON in SLE. Results Among the 70 cases in the symptomatic ON group, 62 (88.6%) patients experienced femoral head necrosis, with bilateral involvement observed in 58 patients. Bone pain was reported in 32 cases (51.6%), and 19 cases (30.6%) presented with multiple symptoms. Univariate analysis revealed significant differences between the two groups in various factors, including disease duration (months), cumulative steroid exposure time, history of thrombosis, neurological involvement, the number of affected organs, myalgia/myasthenia, and the use of medications such as glucocorticoids, immunosuppressants, aspirin, and statins (P<0.05). Moreover, lupus anticoagulant (LA) levels were significantly higher in the symptomatic ON group than in the control group (P<0.05). Furthermore, notable distinctions were observed in peripheral blood immune cells, including an elevated white blood cell count (WBC), a decreased percentage of Ts cells (CD3+CD8+), and an elevated Th/Ts ratio. Logistic regression analysis revealed that a history of thrombosis, LA positivity, and an elevated Th/Ts ratio remained positive factors associated with symptomatic ON (P<0.05). Conclusion Decreased Ts cells and changes in the T lymphocyte subset play an important regulatory role in the development of symptomatic ON. A history of thrombosis and LA are associated with an increased probability of symptomatic ON in SLE and may serve as potential predictors.
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Affiliation(s)
- Ruihong Hou
- Department of Rheumatology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Tongji Medical College, Huazhong University of Science and Technology, Taiyuan, China
| | - Jiamin Lei
- Department of Rheumatology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Tongji Medical College, Huazhong University of Science and Technology, Taiyuan, China
| | - Dengfeng Xue
- Department of Galactophore Surgery, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Yukai Jing
- Department of Clinical Laboratory, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Tongji Medical College, Huazhong University of Science and Technology, Taiyuan, China
| | - Liangyu Mi
- Department of Rheumatology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Tongji Medical College, Huazhong University of Science and Technology, Taiyuan, China
| | - Qianyu Guo
- Department of Rheumatology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Tongji Medical College, Huazhong University of Science and Technology, Taiyuan, China
| | - Ke Xu
- Department of Rheumatology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Tongji Medical College, Huazhong University of Science and Technology, Taiyuan, China
| | - Liyun Zhang
- Department of Rheumatology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Tongji Medical College, Huazhong University of Science and Technology, Taiyuan, China
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Nozaki H, Honma M, Tanino H, Ishida-Yamamoto A. Characteristics of osteonecrosis of the femoral head complicated by psoriasis. J Dermatol 2024; 51:e42-e43. [PMID: 37698051 DOI: 10.1111/1346-8138.16959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/30/2023] [Accepted: 08/27/2023] [Indexed: 09/13/2023]
Affiliation(s)
- Hiroyoshi Nozaki
- Department of Dermatology, Asahikawa Medical University, Asahikawa, Japan
| | - Masaru Honma
- Center for promotion of International Exchange, Asahikawa Medical University, Asahikawa, Japan
| | - Hiromasa Tanino
- Department of Orthopedic Surgery, Asahikawa Medical University, Asahikawa, Japan
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Choi YH, Kwon TH, Choi JH, Lee DY, Lee KM. Natural course of talar avascular necrosis during short-term follow-up and factors associated with Disease progression. BMC Musculoskelet Disord 2024; 25:85. [PMID: 38254084 PMCID: PMC10801975 DOI: 10.1186/s12891-023-07136-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 12/19/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND This retrospective cohort study aimed to investigate the natural history of talar avascular necrosis (AVN) during short-term outpatient follow-up and to identify the risk factors for progression to collapse and arthritic changes. METHODS Thirty-four cases of talar AVN from 34 patients (15 males, 19 females) were included. The mean age of the patients was 48.9 years (SD 16.0 years) and the mean follow-up period was 39.5 months (SD 42.0 months). The patients were divided into two groups i.e., progression and non-progression groups. The progression group consisted of those who showed aggravation of the Ficat stage during the follow-up period or advanced arthritis of the ankle joint (Ficat stage 4) at presentation. Demographic data and information regarding BMI, medical comorbidities, trauma history, bilaterality, and location of the lesion (shoulder vs. non-shoulder lesions) were collected. Following the univariate analysis, a binary logistic regression analysis was performed. RESULTS The location of the talar AVN was the only significant factor (p = 0.047) associated with disease progression. A total of 14.3% (2 of 14) of the central (non-shoulder) talar AVN lesions showed progression, while 50% (10 of 20) of shoulder lesions aggravated during follow-up. Age, sex, bilaterality, medical comorbidities, and trauma history were not associated with progressive talar collapse or subsequent arthritic changes in talar AVN. CONCLUSIONS Conservative treatment should be considered for a central lesion of the talar AVN because it tends to remain stable without progression. A more comprehensive study with a larger study population is required to establish the surgical indications for talar AVN. LEVEL OF EVIDENCE Prognostic level III.
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Affiliation(s)
- Yoon Hyo Choi
- Department of Orthopedic Surgery, Seoul Nationl University Bundang Hospital, 300 Gumi-Dong, Bundang-Gu, Seongnam-Si, Gyeonggi, South Korea
| | - Tae Hun Kwon
- Department of Orthopedic Surgery, Seoul Nationl University Bundang Hospital, 300 Gumi-Dong, Bundang-Gu, Seongnam-Si, Gyeonggi, South Korea
| | - Ji Hye Choi
- Department of Orthopedic Surgery, Korea University Anam Hospital, Seoul, South Korea
| | - Dong Yeon Lee
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, South Korea
| | - Kyoung Min Lee
- Department of Orthopedic Surgery, Seoul Nationl University Bundang Hospital, 300 Gumi-Dong, Bundang-Gu, Seongnam-Si, Gyeonggi, South Korea.
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Ou Z, Feng Q, Peng L, Zhou M, Rai S, Tang X. Risk factors for osteonecrosis of the humeral head after internal fixation of proximal humeral fractures: a systematic review and meta-analysis. Arch Orthop Trauma Surg 2024; 144:31-40. [PMID: 37566131 DOI: 10.1007/s00402-023-05020-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 07/26/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Osteonecrosis of the humeral head (ONHH) is a severe complication after the internal fixation of proximal humeral fractures (IFPHF). The risk factors remain controversial though many studies have reported. In this research, meta-analysis was used to evaluate which surgeon-level factors can be modified to lower the risk and we hope to provide evidence-based support for preventing ONHH. METHODS Literature was retrieved from PubMed, Cochrane Library, Embase, Web of Science, and Scopus for eligible studies published up to January 2023. The pooled odds ratios (ORs) were calculated with their corresponding 95% confidence intervals (CIs) to evaluate. STATA 15.1 software was applied for data synthesis, sensitivity synthesis, and publication bias. RESULTS 45 articles were published between 2000 and 2022, and 2482 patients were finally included. All articles were observational research, with 7 case-control studies and 38 cohort studies, and the Newcastle Ottawa Scale (NOS) score ranged from 7 to 9. The pooled results suggested that age (OR 0.32, 95% CI 0.14-0.74, P = 0.01), reduction quality (OR 0.08, 95% CI 0.01-0.44, P = 0.00), fracture type (OR 0.44, 95% CI 0.25-0.78, P = 0.01), surgical approach (OR: 4.06, 95% CI 1.21-13.61, P = 0.02) and fixation implant (OR = 0.68, 95% CI = 0.34-1.33, P = 0.02) were risk factors for ONHH after IFPHF. According to sensitivity analysis, Begg (P = 0.42) and Egger (P = 0.68) tests, the results were stable and exhibited no publication bias. CONCLUSIONS The study showed that age, reduction quality, fracture type, surgical approach and fixation implant were risk factors for ONHH after IFPHF, while gender, varus or valgus, timely operation, injured side, and the existence of medial support have little influence on ONHH, as they could not be considered risk factors and still need further investigations.
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Affiliation(s)
- ZiXuan Ou
- Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - QiYuan Feng
- Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - LianQi Peng
- Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - MinQi Zhou
- Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Saroj Rai
- Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Orthopaedics, Al Ahalia Hospital, Abu Dhabi, United Arab Emirates
| | - Xin Tang
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Alley MC, Vallier HA, Tornetta P. Identifying Risk Factors for Osteonecrosis After Talar Fracture. J Orthop Trauma 2024; 38:25-30. [PMID: 37735752 DOI: 10.1097/bot.0000000000002706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVE To identify patient, injury, and treatment factors associated with the development of avascular necrosis (AVN) after talar fractures, with particular interest in modifiable factors. METHODS DESIGN Retrospective chart review. SETTING 21 US trauma centers and 1 UK trauma center. PATIENT SELECTION CRITERIA Patients with talar neck and/or body fractures from 2008 through 2018 were retrospectively reviewed. Only patients who were at least 18 years of age with fractures of the talar neck or body and minimum 12 months follow-up or earlier diagnosis of AVN were included. Further exclusion criteria included non-operatively treated fractures, pathologic fractures, pantalar dislocations, and fractures treated with primary arthrodesis or primary amputation. OUTCOME MEASUREMENTS AND COMPARISONS The primary outcome measure was development of AVN. Infection, nonunion, and arthritis were secondary outcomes. RESULTS In total, 798 patients (409 men; 389 women; age 18-81 years, average 38.6 years) with 798 (532 right; 264 left) fractures were included and were classified as Hawkins I (51), IIA (71), IIB (113), III (158), IV (40), neck plus body (177), and body (188). In total, 336 of 798 developed AVN (42%), more commonly after any neck fracture (47.0%) versus isolated body fracture (26.1%, P < 0.001). More severe Hawkins classification, combined neck and body fractures, body mass index, tobacco smoking, right-sided fractures, open fracture, dual anteromedial and anterolateral surgical approaches, and associated medial malleolus fracture were associated with AVN ( P < 0.05). After multivariate regression, fracture type, tobacco smoking, open fractures, dual approaches, age, and body mass index remained significant ( P < 0.05). Excluding late cases (>7 days), time to joint reduction for Hawkins type IIB-IV neck injuries was no different for those who developed AVN or not. AVN rates for reduction of dislocations within 6 hours of injury versus >6 hours were 48.8% and 57.5%, respectively. Complications included 60 (7.5%) infections and 70 (8.8%) nonunions. CONCLUSIONS Forty-two percent of all talar fracture patients developed AVN, with talar neck fractures, more displaced fractures, and open injuries having higher rates. Injury-related factors are most prognostic of AVN risk. Surgical technique to emphasize anatomic reduction, without iatrogenic damage to remaining blood supply appears to be prudent. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Jin Z, Chen L, Wang D, Ye Y, Fu J, Yang Z, He B. A prediction model for osteonecrosis of femoral head after internal fixation with multiple cannulated compression screws for adult femoral neck fractures. Jt Dis Relat Surg 2024; 35:20-26. [PMID: 38108162 PMCID: PMC10746905 DOI: 10.52312/jdrs.2024.975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 08/10/2023] [Indexed: 12/19/2023] Open
Abstract
OBJECTIVES This study aims to investigate the high-risk factors for osteonecrosis of the femoral head (ONFH) after internal fixation with multiple cannulated compression screws for adult femoral neck fractures and to construct a prediction model. PATIENTS AND METHODS Between from January 2012 and December 2020, a total of 268 patients (138 males, 130 females; mean age: 53±10 years; range, 23 to 70 years) with ONFH who had complete follow-up data were included. Closed reduction in combination with open reduction were performed. All patients received internal fixation with multiple cannulated compression screws and were assigned to ONFH and non-ONFH groups. Logistic regression model was utilized to identify independent risk factors for postoperative ONFH, followed by constructing a nomogram prediction model. The predictive ability of the model was evaluated by receiver operating characteristic curve, Hosmer-Lemeshow test, and calibration curve. RESULTS Multivariate analysis revealed that older age (odds ratio [OR]: 2.307, 95% confidence interval [CI]: 1.295-4.108], Charlson Comorbidity Index (CCI) ≥2 (OR: 2.214, 95% CI: 1.035-4.739), fracture displacement (OR: 2.426, 95% CI: 1.122-5.247), unsatisfactory reduction (OR: 2.629, 95% CI: 1.275-5.423), postoperative removal of internal fixation implant (OR: 2.200, 95% CI: 1.051-4.604) were independent risk factors for postoperative ONFH (p<0.05). The nomogram prediction model constructed based on these clinical characteristics showed high predictive value (AUC=0.807) and consistency (p>0.05). CONCLUSION Age, comorbidity index, fracture type, reduction quality and postoperative removal of internal fixation implant are of utmost importance for postoperative ONFH in patients with femoral neck fractures. The established nomogram prediction model can accurately predict the occurrence of postoperative ONFH.
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Affiliation(s)
| | | | | | | | | | | | - Baoqiang He
- Department of Acupuncture, Yangxian People's Hospital, Hanzhong 723300, Shaanxi Province, China.
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Alice Letizia A, Sara T, Stefano B, Mori F, Giulio M. A chimeric medial femoral condyle chondro-osseus flap with two thin periosteal flaps to reconstruct partial necrosis of talar body: A case report. Microsurgery 2024; 44:e31127. [PMID: 37937805 DOI: 10.1002/micr.31127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 09/20/2023] [Accepted: 10/07/2023] [Indexed: 11/09/2023]
Abstract
Total talar extrusion is a rare complication of high-energy traumas. A consequence of this injury can be avascular necrosis (AVN) of the talus. Patients are confronted with pain, limited range of motion and post-traumatic arthritis. As AVN progresses the talus is gradually destroyed. This report presents the use of a chimeric medial femoral condyle chondro-osseus flap with two thin periosteal flaps to increase vascular supply to the traumatized area, accelerate bone formation, flap integration, and restore articular surfaces in a patient with partial necrosis of talar body. The patient was a 26-year-old female with open left lateral talar extrusion after a motor-vehicle accident that developed a partial avascular necrosis, at the level of the subtalar and ankle joint with altered talar dome surface with partial depression of 2 cm. The patient was in pain and not able to walk. The medial femoral condyle chondro-osseus portion was placed in the talar dome depression to restore the subtalar joint, the periosteal flaps were placed on top to reconstruct the ankle joint restoring the articular surfaces and the correct weight-bearing distribution. No complications or morbidity of donor site were observed. One year after the operation, the patient walks free, without pain. Post-operatory x-ray performed, evidenced progressive bone healing and reduction of the AVN. In the intent of performing a joint-saving procedure, the presented chimeric flap might be effective in the short-term with excellent clinical and radiographic outcomes.
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Affiliation(s)
- Andreoli Alice Letizia
- Department of Plastic Reconstructive and Microsurgery, AOU Careggi, Florence, Italy
- University of Florence, Florence, Italy
| | - Tamburello Sara
- Department of Plastic Reconstructive and Microsurgery, AOU Careggi, Florence, Italy
- University of Florence, Florence, Italy
| | - Bianco Stefano
- Department of Orthopedics and Traumatology, AOU Careggi, Florence, Italy
| | - Francesco Mori
- Department of orthoplasty, IRCCS hospital Rizzoli, Bologna, Italy
| | - Menichini Giulio
- Department of Plastic Reconstructive and Microsurgery, AOU Careggi, Florence, Italy
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Wen C, Zhang Y, Zhang Y. Comment on Na et al.: Outcomes and complications after arthroplasty in patients with osteonecrosis of humeral head- systematic review. J Orthop Sci 2024; 29:468. [PMID: 38042730 DOI: 10.1016/j.jos.2023.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 10/25/2023] [Indexed: 12/04/2023]
Affiliation(s)
- Caining Wen
- Department of Joint Surgery and Sports Medicine, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, China
| | - Yuanmin Zhang
- Department of Joint Surgery and Sports Medicine, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, China
| | - Yuge Zhang
- Department of Joint Surgery and Sports Medicine, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, China.
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May CC, Abzug JM. Transphyseal Fracture of the Distal Humerus. Instr Course Lect 2024; 73:427-434. [PMID: 38090914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Transphyseal fractures of the distal humerus often occur in children younger than 4 years as a result of birth trauma, nonaccidental trauma, or falls from a low height. It is important to identify and treat these injuries in a timely manner to ensure successful management. Most transphyseal fractures of the distal humerus are treated with closed reduction and percutaneous pinning with the aid of an elbow arthrogram. The most common complication following a fracture is cubitus varus caused by growth arrest, malunion, or osteonecrosis of the medial condyle. Normal carrying angles may be restored through corrective lateral closing wedge osteotomy.
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Salman LA, Hantouly AT, Khatkar H, Al-Ani A, Abudalou A, Al-Juboori M, Ahmed G. The outcomes of total hip replacement in osteonecrosis versus osteoarthritis: a systematic review and meta-analysis. Int Orthop 2023; 47:3043-3052. [PMID: 36905418 PMCID: PMC10673986 DOI: 10.1007/s00264-023-05761-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/02/2023] [Indexed: 03/12/2023]
Abstract
PURPOSE This systematic review and meta-analysis aimed to compare the outcomes of THA in patients with osteonecrosis (ON) and those with osteoarthritis (OA). METHODS Four databases were searched from inception till December 2022 for original studies that compared the outcomes of THA in ON and OA. The primary outcome was the revision rate; the secondary outcomes were dislocation and Harris hip score. This review was conducted in line with PRISMA guidelines, and the risk of bias was assessed using the Newcastle-Ottawa scale. RESULTS A total of 14 observational studies with 2,111,102 hips were included, with a mean age of 50.83 ± 9.32 and 55.51 ± 8.95 for ON and OA groups, respectively. The average follow-up was 7.25 ± 4.6 years. There was a statistically significant difference in revision rate between ON and OA patients in favour of OA (OR: 1.576; 95%CI: 1.24-2.00; p-value: 0.0015). However, dislocation rate (OR: 1.5004; 95%CI: 0.92-2.43; p-value: 0.0916) and Haris hip score (HHS) (SMD: - 0.0486; 95%CI: - 0.35-0.25; p-value: 0.6987) were comparable across both groups. Further sub-analysis adjusting for registry data also showed similar results between both groups. CONCLUSION A higher revision rate, periprosthetic fracture and periprosthetic joint infection following total hip arthroplasty were associated with osteonecrosis of the femoral head compared with osteoarthritis. However, both groups had similar dislocation rates and functional outcome measures. This finding should be applied in context due to potential confounding factors, including patient's age and activity level.
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Affiliation(s)
- Loay A Salman
- Orthopedics Department, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK
| | - Ashraf T Hantouly
- Orthopedics Department, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Harman Khatkar
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK
- Royal London Hospital, Whitechapel, London, UK
| | - Abdallah Al-Ani
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan
| | - Abedallah Abudalou
- Orthopedics Department, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Mohammed Al-Juboori
- Orthopedics Department, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Ghalib Ahmed
- Orthopedics Department, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar.
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Muñoz García A, Jiménez Martín F, Hernández Herrero D. Knee Osteonecrosis After SARS-CoV-2 Virus Infection. Am J Phys Med Rehabil 2023; 102:e162-e164. [PMID: 37669074 DOI: 10.1097/phm.0000000000002334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
ABSTRACT Osteonecrosis after COVID-19 infection is a complex pathology with multifactorial origin. Factors such as infection itself with associated coagulopathy, as well as genetic mechanisms, and medications used for its treatment such as corticosteroids, may also be involved. The variability in the presentation makes diagnosis difficult, which, if done soon, can help delay progression and reduce morbidity and the need for surgery.This report presents a case of knee osteonecrosis in a female patient who did not have previous knee pathology on imaging tests. She was diagnosed by magnetic resonance imaging months after hospital admission for SARS-CoV-2 pneumonia, which required high-dose corticosteroid treatment.
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Rachunek-Medved K, Illg C, Einzmann A, Kolbenschlag J, Daigeler A, Medved F. Postoperative scaphoid alignment, smoking, and avascular necrosis mostly influence union rate after scaphoid reconstruction: Results from a retrospective single center study involving 370 patients. J Plast Reconstr Aesthet Surg 2023; 87:430-439. [PMID: 37944453 DOI: 10.1016/j.bjps.2023.10.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 10/11/2023] [Accepted: 10/15/2023] [Indexed: 11/12/2023]
Abstract
Current literature does not definitely demonstrate the superiority of any particular scaphoid reconstruction method. The primary goal of this retrospective single center study was to evaluate the influence of reconstruction techniques and other factors on the union rate after reconstruction of scaphoid nonunions. In the study, 370 patients with nonunions classified as stable (Mayo 1) or unstable (Mayo 2) depending on carpal alignment were included. Minimal radiological follow-up was 3 months. Bone healing after scaphoid reconstruction was evaluated using computer tomography scans in 294 and radiograms in 76 patients. Univariate and multivariate logistic regressions were applied in the analysis. Eight statistically significant factors that influenced the union rate were fixation method, type of previous operations, number of all operations, number of reconstructions, smoking, postoperative pathological lateral intrascaphoid angle (LISA>45°), avascular necrosis (AVN), and stability of nonunion. Smoking and postoperative LISA>45° significantly reduced the probability of bone fusion by approximately 4.4 and 9.5 times, respectively. Patients with reduced vascularity in the nonunion site had a 5.2 times lower chance of bone fusion. Our multivariate logistic regression model can explain 32% of failures after scaphoid reconstruction, including postoperative LISA>45°, patients' present record of smoking, and reduced vascularity in the nonunion site. However, bone graft type does not impact the union rate in general; however, in case of AVN, the tendency toward higher union rates was observed for medial femoral condyle free flaps when compared to other types of graft (non-vascularized and pedicled bone grafts considered as one group, p = 0.09).
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Affiliation(s)
- K Rachunek-Medved
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Trauma Center, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076 Tuebingen, Germany.
| | - C Illg
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Trauma Center, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076 Tuebingen, Germany.
| | - A Einzmann
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Trauma Center, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076 Tuebingen, Germany.
| | - J Kolbenschlag
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Trauma Center, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076 Tuebingen, Germany.
| | - A Daigeler
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Trauma Center, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076 Tuebingen, Germany.
| | - F Medved
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Trauma Center, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076 Tuebingen, Germany.
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Assi C, Boulos K, Yammine K. Outcomes of three cannulated screws in a modified triangular transverse configuration for fixation of intra-capsular femoral neck fractures. Musculoskelet Surg 2023; 107:423-430. [PMID: 37221315 DOI: 10.1007/s12306-023-00788-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 05/11/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND Intra-capsular femoral neck fractures (FNF) are commonly encountered in trauma settings and are associated with high rates of morbidity and mortality. One of the most used methods of FNF treatment is the use of multiple cannulated screws. Many different screw constructs are reported in the literature, with no evidence of superiority of one construct over others. We present a series of patients treated by one senior surgeon with three cannulated screws positioned in a specific configuration. MATERIALS AND METHODS We conducted a retrospective monocentric analysis. All charts of patients hospitalized between January 2004 and June 2022 for an intra-capsular femoral neck fracture treated by three cannulated screws by the same senior surgeon were retrieved and analyzed. The clinical and radiological evaluations were performed by two independent researchers. Functional status of patients was assessed using the modified Harris Hip score (mHHS). Complications such as secondary displacement, non-union, avascular necrosis (AVN) and femoral neck shortening were all recorded. RESULTS A total of 38 patients met the inclusion criteria. There were 17 males and 21 females with an average age of 66.3 ± 13.6 years and a follow-up period of 16 ± 20 months. Bone union was observed in 34 (89.5%) patients. Mild shortening was observed in two patients (5.2%) with no functional limitation. Four patients (10.5%) underwent reoperations, three due to another fall and one due to AVN four years post-fracture fixation. CONCLUSION In our series, we demonstrate that the use of three cannulated screws in a triangular transverse configuration for fixation of intra-capsular femoral neck fractures provides excellent results with low rates of femoral neck shortening, AVN or non-union.
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Affiliation(s)
- C Assi
- Department of Orthopedic Surgery, School of Medicine, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, Beirut, Lebanon
| | - K Boulos
- Department of Orthopedic Surgery, School of Medicine, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, Beirut, Lebanon
| | - K Yammine
- Department of Orthopedic Surgery, School of Medicine, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, Beirut, Lebanon.
- Center for Evidence-Based Anatomy, Sport and Orthopedics Research, Jdeideh, Lebanon.
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15
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Okewunmi JO, Duey AH, Zubizarreta N, Kodali H, Poeran J, Hayden BL, Moucha CS, Chen DD. Did the COVID-19 Pandemic Coincide With an Increase in Osteonecrosis as Indication for Total Hip Arthroplasty in Older Patients? J Arthroplasty 2023; 38:2634-2637. [PMID: 37315633 PMCID: PMC10260267 DOI: 10.1016/j.arth.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 05/31/2023] [Accepted: 06/03/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Osteonecrosis of the femoral head is a common indication for total hip arthroplasty (THA). It is unclear to what extent the COVID-19 pandemic has impacted its incidence. Theoretically, the combination of microvascular thromboses and corticosteroid use in patients who have COVID-19 may increase the risk of osteonecrosis. We aimed to (1) assess recent osteonecrosis trends and (2) investigate if a history of COVID-19 diagnosis is associated with osteonecrosis. METHODS This retrospective cohort study utilized a large national database between 2016 and 2021. Osteonecrosis incidence in 2016 to 2019 was compared to 2020 to 2021. Secondly, utilizing a cohort from April 2020 through December 2021, we investigated whether a prior COVID-19 diagnosis was associated with osteonecrosis. For both comparisons, Chi-square tests were applied. RESULTS Among 1,127,796 THAs performed between 2016 and 2021, we found an osteonecrosis incidence of 1.6% (n = 5,812) in 2020 to 2021 compared to 1.4% (n = 10,974) in 2016 to 2019; P < .0001. Furthermore, using April 2020 to December 2021 data from 248,183 THAs, we found that osteonecrosis was more common among those who had a history of COVID-19 (3.9%; 130 of 3,313) compared to patients who had no COVID-19 history (3.0%; 7,266 of 244,870); P = .001). CONCLUSION Osteonecrosis incidence was higher in 2020 to 2021 compared to previous years and a previous COVID-19 diagnosis was associated with a greater likelihood of osteonecrosis. These findings suggest a role of the COVID-19 pandemic on an increased osteonecrosis incidence. Continued monitoring is necessary to fully understand the impact of the COVID-19 pandemic on THA care and outcomes.
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Affiliation(s)
- Jeffrey O Okewunmi
- Department of Orthopaedic Surgery, Brown University, Providence, Rhode Island; Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Akiro H Duey
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Nicole Zubizarreta
- Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Hanish Kodali
- Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jashvant Poeran
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Brett L Hayden
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Calin S Moucha
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Darwin D Chen
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
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16
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Martin S, Trenque T, Bergeret A, Tralongo F, Azzouz B. Osteonecrosis of the jaw with axitinib: A case report. Therapie 2023; 78:764-766. [PMID: 36878838 DOI: 10.1016/j.therap.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/13/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Salomé Martin
- Regional Centre of Pharmacovigilance and Pharmacoepidemiology, Reims University Hospital, 51100 Reims, France
| | - Thierry Trenque
- Regional Centre of Pharmacovigilance and Pharmacoepidemiology, Reims University Hospital, 51100 Reims, France
| | - Angélique Bergeret
- Pharmacy Department, Groupe Hospitalier Sud Ardennes, 08300 Rethel, France
| | - Federica Tralongo
- Regional Centre of Pharmacovigilance and Pharmacoepidemiology, Reims University Hospital, 51100 Reims, France
| | - Brahim Azzouz
- Regional Centre of Pharmacovigilance and Pharmacoepidemiology, Reims University Hospital, 51100 Reims, France.
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17
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García-González LA, Aguilar-Sierra FJ, Gómez-Cadavid D, Rodriguez-Ricardo MC, Gomez-Eslava B. Clinical outcomes in patients with scaphoid non-union treated with the vascularized medial femoral condyle technique a case series. Injury 2023; 54 Suppl 6:110727. [PMID: 38143150 DOI: 10.1016/j.injury.2023.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 04/07/2023] [Accepted: 04/12/2023] [Indexed: 12/26/2023]
Abstract
INTRODUCTION Non-union is a prevalent complication of scaphoid fractures. Late diagnosis is common and has a clinical impact due to functional limitations for the patient. Multiple treatments have been proposed to manage this complication, ranging from conservative (i.e., orthopedic) to surgical treatment. The vascularized medial femoral condyle technique has shown satisfactory clinical and paraclinical results, mainly in presence of avascular necrosis of the proximal pole but data regarding functional outcomes and patient satisfaction is scarce. This case series aims to describe the clinical and patient-reported outcomes in a consecutive series of patients with non-union of the proximal third of the scaphoid treated with vascularized medial femoral condyle technique. METHODS Case series reporting results for a consecutive - initial cohort of patients who presented with a non united fracture of the proximal pole of the scaphoid, avascular necrosis of the proximal pole was documented by CT od MRI imaging preoperatively in all patients. Measurement instruments include the q-DASH and PRWE questionnaires, radiographic images, goniometry, and assessment of grip strength. RESULTS Twelve consecutive patients are included and they represent the initial cases for all surgeons involved; bone union was obtained in 10 patients (83%) after a mean follow-up time of 31 months (6-72), successful improvement in the range of motion and grip strength was documented. A high rate of satisfaction expressed by the patient was obtained, with an average score in Q-DASH of 17.3 and 20.1 in PRWE. CONCLUSIONS The vascularized medial condyle technique in cases of nonunion of scaphoid fracture is a reproducible treatment in clinical terms, both in imaging and functional terms, and in patient satisfaction. The learning curve is flat for a dedicated multi surgeon team.
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Affiliation(s)
- Luis Alejandro García-González
- Service of hand surgery, Department of Orthopedic Surgery, San Ignacio University Hospital, Pontificia Universidad Javeriana, Bogotá, Colombia.
| | - Francisco Javier Aguilar-Sierra
- Service of hand surgery, Department of Orthopedic Surgery, San Ignacio University Hospital, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Daniel Gómez-Cadavid
- Service of hand surgery, Department of Orthopedic Surgery, San Ignacio University Hospital, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - María Cristina Rodriguez-Ricardo
- Service of hand surgery, Department of Orthopedic Surgery, San Ignacio University Hospital, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Barbara Gomez-Eslava
- Service of hand surgery, Department of Orthopedic Surgery, San Ignacio University Hospital, Pontificia Universidad Javeriana, Bogotá, Colombia
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Reddy GB, Tremblay JO, Yakkanti RR, Hernandez VH, D'Apuzzo MR. Increased Risk of In-Hospital Complications and Costs After Total Hip Arthroplasty for Primary and Secondary Osteonecrosis. J Arthroplasty 2023; 38:2398-2403. [PMID: 37271238 DOI: 10.1016/j.arth.2023.05.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/15/2023] [Accepted: 05/20/2023] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND An increasing proportion of patients are undergoing total hip arthroplasty (THA) for osteonecrosis (ON). Comorbid conditions and surgical risk factors are known to be greater in ON patients compared with patients who have osteoarthritis (OA) alone. The purpose of our study was to quantify the specific in-hospital complications and resource utilization associated with patients undergoing THA for ON versus OA. METHODS A large national database was queried to identify patients undergoing primary THA from January 1, 2016 to December 31, 2019. A total of 1,383,880 OA, 21,080 primary ON, and 54,335 secondary ON patients were identified. Demographics, in-hospital complications, costs, lengths of stay, and discharge dispositions for primary and secondary ON cohorts were compared to OA only. Age, race, ethnicity, comorbidities, Medicaid, and income status were controlled with binary logistic regression analyses. RESULTS The ON patients were often younger, African American or Hispanic, and had more comorbidities. Those undergoing THA for primary and secondary ON had a significantly higher risk of perioperative complications, including myocardial infarction, postoperative blood transfusion, and intraoperative bleeding. Total hospital costs and lengths of stay were significantly higher for both primary ON and secondary ON and both cohorts were less likely to be discharged home. CONCLUSION While rates of most complications have decreased over recent decades in ON patients undergoing THA, the ON patients still have worse outcomes even when controlling for comorbidity differences. Bundled payment systems and perioperative management strategies for these different patient cohorts should be considered separately.
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Affiliation(s)
- Gireesh B Reddy
- Department of Orthopaedics and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida
| | - Julien O Tremblay
- Department of Orthopaedics and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida
| | - Ramakanth R Yakkanti
- Department of Orthopaedics and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida
| | - Victor H Hernandez
- Department of Orthopaedics and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida
| | - Michele R D'Apuzzo
- Department of Orthopaedics and Rehabilitation, University of Miami Miller School of Medicine, Miami, Florida
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19
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Alshurafa A, Soliman AT, De Sanctis V, Ismail O, Abu-Tineh M, Hemadneh MKE, Rashid FR, Yassin K, Qasim H, Nashwan AJ, Yassin MA. Clinical and epidemiological features and therapeutic options of avascular necrosis in patients with sickle cell disease (SCD): a cross-sectional study. Acta Biomed 2023; 94:e2023198. [PMID: 37850770 PMCID: PMC10644931 DOI: 10.23750/abm.v94i5.14603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 06/07/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Avascular necrosis (AVN) is a debilitating complication in sickle cell disease (SCD) patients, and its management is usually challenging. This study aims to evaluate the clinical and epidemiological features and therapeutic options of AVN in sickle cell patients in Qatar. PATIENTS AND METHODS A cross-sectional study was conducted on a 49 SCD patients who were diagnosed with AVN and attended the hematology clinic at the National Center for Cancer care & research, Hamad Medical Corporation, Qatar between Jan-2011 to Jan2021. Results: Forty-nine adult patients with SCD who were diagnosed with AVN were studied. The median age of the study population is 32 years, and the median age at the first AVN diagnosis was 26 years (range: 11-44 yr.). 37 (75.5%) patients suffered from multiple joints AVN while 12(24.5%) had single joint involvement. 31 (63.3%) patients had bilateral hip AVN and 18 (36.7%) had shoulder involvement. 30 patients (61%) were on Hydroxyurea treatment. Based on FICAT and Alert classification of AVN, 57 % of patients had stage III and above at first diagnosis. 20 (40.8%) were managed with a conservative approach, 11 (22.4%) received hyperbaric oxygen with good response, 6(12.2%) underwent hip core decompression and 12(24.5%) underwent hip replacement surgery. CONCLUSION In SCD patients, AVN occurred more during the 3rd and 4th decades of life. The majority of AVN represented with advanced stage and had multiple joint involvements. We recommend adopting a low threshold of joint imaging for early detection and prevention of further complications.
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20
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Bhowmick K, Dey S, Roy D, Jain H, Haldar S, Mondal S, Sircar G. Multifocal osteonecrosis in systemic lupus erythematosus. Int J Rheum Dis 2023; 26:2093-2094. [PMID: 37309589 DOI: 10.1111/1756-185x.14759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/14/2023] [Accepted: 05/19/2023] [Indexed: 06/14/2023]
Affiliation(s)
- Kaustav Bhowmick
- Department of Clinical Immunology and Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Sonali Dey
- Department of Clinical Immunology and Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Debaditya Roy
- Department of Clinical Immunology and Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Harsh Jain
- Department of Clinical Immunology and Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Subhankar Haldar
- Department of Clinical Immunology and Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Sumantro Mondal
- Department of Clinical Immunology and Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata, India
| | - Geetabali Sircar
- Department of Clinical Immunology and Rheumatology, Institute of Post Graduate Medical Education and Research, Kolkata, India
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21
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Za P, Tecame A, Papalia GF, Rizzello G, Adravanti P, Papalia R. Time to reconsider post arthroscopic osteonecrosis of the knee: a systematic review. Musculoskelet Surg 2023; 107:269-277. [PMID: 37014550 DOI: 10.1007/s12306-023-00783-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 03/26/2023] [Indexed: 04/05/2023]
Abstract
The etiology of post-arthroscopic osteonecrosis of the knee (PAONK) is still unknown. The aims of this systematic review were to analyze the main characteristics of patients who developed osteonecrosis after arthroscopy. We considered for inclusion in the review case reports, case series, retrospective and prospective clinical trial, that involved patients who developed osteonecrosis of the knee within 1 year of arthroscopy for meniscal lesion or anterior cruciate ligament rupture with or without chondropathy. In all cases, there was a pre-operative magnetic resonance imaging that excluded the presence of osteonecrosis. We used the MINORS criteria to estimate the risk of bias. A total of 13 studies that involved 125 patients were included in the review. Only 14 out of 55 patients performed the pre-operative MRI after the "window period", which we considered 6 weeks between the onset of symptoms and positive MRI findings. A diagnosis of PAONK was made for 55 patients within 1 year of surgery. Of these, 29% was treated conservatively, while 71% repeated surgery. Osteonecrosis after knee arthroscopy is a reality and surgeon shouldn't underestimate the persistence or re-emergence of symptoms after arthroscopy. It may be due to subchondral insufficiency fractures in osteopenic bone, without evidence of necrosis. However, there are not elements enough to differentiate clinical and radiological characteristics of PAONK from SPONK. Terminology should be simplified, distinguishing subchondral insufficiency fractures of the knee as a precursor of primary osteonecrosis of the knee.
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Affiliation(s)
- P Za
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 21, 00128, Rome, Italy
| | - A Tecame
- Department of Orthopaedic and Trauma Surgery, Casa di Cura Città of Parma, 43123, Parma, Italy
| | - G F Papalia
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 21, 00128, Rome, Italy.
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.
| | - G Rizzello
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 21, 00128, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - P Adravanti
- Department of Orthopaedic and Trauma Surgery, Casa di Cura Città of Parma, 43123, Parma, Italy
| | - R Papalia
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 21, 00128, Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
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22
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Salva-Coll G, Esplugas M, Carreño A, Lluch-Bergada A. Kienböck's disease: preventing disease progression in early-stage disease. J Hand Surg Eur Vol 2023; 48:246-256. [PMID: 36799262 DOI: 10.1177/17531934221146851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Currently Kienböck's disease remains an 'unsolved' problem in hand surgery. Different factors have been associated with the avascular necrosis of the lunate. Mechanical, vascular and biological factors, alone or in combination, may have an influence in the aetiopathogenesis and determine the progress of the disease and even the results of the treatment. This is especially relevant in the early stages, in which conservative or surgical treatment may modify the natural history of the disease, maintaining the lunate structure and thus preserving the joint surfaces. There are multiple surgical treatments for Kienböck's disease in the early stages, before lunate collapse; each one is based on one of the possible factors that can cause avascular necrosis of the lunate. The objective is not only to treat symptoms but to prevent progression. This article is a review of the most frequent treatments used in the early stages and a personal view of the authors.Level of evidence: V.
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Affiliation(s)
- Guillem Salva-Coll
- Hand and Upper Extremity Surgery, Kaplan Institute, Barcelona, Spain
- Department of Hand Surgery and Microsurgery, Hospital Universitari Son Espases, Palma de Mallorca, Illes Balears, Spain
- Ibacma Institute, Balearic Institute for Hand Surgery, Palma de Mallorca, Illes Balears, Spain
| | - Mireia Esplugas
- Hand and Upper Extremity Surgery, Kaplan Institute, Barcelona, Spain
| | - Ana Carreño
- Hand and Upper Extremity Surgery, Kaplan Institute, Barcelona, Spain
- Hand and Elbow Surgery, Hospital Clinic, Barcelona, Spain
| | - Alex Lluch-Bergada
- Hand and Upper Extremity Surgery, Kaplan Institute, Barcelona, Spain
- Department of Hand and Upper Extremity Surgery, Hospital Vall d'Hebron, Barcelona
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Vitkos EN, Kounatidou NE, Agoropoulos K, Kyrgidis A. Avascular necrosis of the maxilla after orthognathic surgery, a devastating complication? A systematic review of reported cases and clinical considerations. Acta Chir Plast 2023; 65:117-127. [PMID: 38538299 DOI: 10.48095/ccachp2023117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
PURPOSE The purpose of this study was to collect and present all the available evidence regarding avascular maxillary necrosis following maxillary osteotomy for orthognathic surgery. METHODS We performed a systematic review of MEDLINE (via PubMed), Scopus and Cochrane Library dataset in accordance with the PRISMA guideline. We included studies that report on avascular maxillary necrosis after any maxillary osteotomy used in the frame of orthognathic surgery. RESULTS Sixteen studies reporting a total of 65 patients with postoperative avascular maxillary necrosis were included. Those reported avascular necrosis in 32 female patients and 19 male patients. Multisegmented Le Fort I osteotomy was the most common type of related operation amongst the patients followed by single segment Le Fort I osteotomy. CONCLUSIONS Although avascular maxillary necrosis is a very rare complication after maxillary orthognathic surgery it can be complicated with partial / complete loss of the maxilla. A personalized selection of the surgical technique should be made for any patient. Caution is warranted in cleft patients and in patients undergoing multisegmented Le Fort I osteotomies, so that the vitality of the maxilla and especially its anterior part is preserved. In the case when avascular necrosis arises, management should be immediate and precise. As for the reconstruction, it needs to be tailored according to the maxillary defect.
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24
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Cruz MA, Mouraria GG, Kikuta FK, Zogbi DR, Coelho SDP, Etchebehere M. The Hertel classification can't predict the risk of humeral head osteonecrosis after osteosynthesis using an anterolateral approach. Clinics (Sao Paulo) 2023; 78:100173. [PMID: 36871503 PMCID: PMC10009436 DOI: 10.1016/j.clinsp.2023.100173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 01/07/2023] [Accepted: 02/08/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Proximal humeral fractures can progress to osteonecrosis of the humeral head. Hertel developed a binary classification system (12 subtypes) and demonstrated that some patterns have more risk to develop osteonecrosis. Hertel described the prevalence and the risk factors for Humeral head osteonecrosis after osteosynthesis using a Deltopectoral approach. Few studies have evaluated the prevalence and the capacity of Hertel's classification to predict Humeral Head osteonecrosis following osteosynthesis of proximal Humeral fractures through the anterolateral approach. The objectives of this study were to correlate osteonecrosis predictors established by the Hertel classification with the risk of developing osteonecrosis and its prevalence after osteosynthesis using the anterolateral approach. METHODS This was a retrospective study of patients who underwent osteosynthesis of proximal humerus fractures using an anterolateral approach. Patients were divided into two groups: high risk for necrosis (group 1) and low risk for necrosis (group 2) according to Hertel's criteria. The overall prevalence of osteonecrosis and the prevalence in each group were calculated. A radiological examination was performed in the true anteroposterior (Grashey), scapular, and axillary views, before and after the operation (minimum 1 year after surgery). A Kaplan-Meier curve was used to assess the pattern of the temporal evolution of osteonecrosis. The groups were compared using the Chi-square test or Fisher's exact test. The unpaired t-test (parametric variables - age) and the Mann-Whitney test (non-parametric time between trauma and surgery) were used. RESULTS In total, 39 patients were evaluated. The postoperative follow-up time was 14.5 ± 3.3 months. The time to onset of necrosis was 14.1 ± 3.9 months. Sex, age, and time between trauma and surgery did not influence the risk of necrosis. Type 2, 9, 10, 11, and 12, or fractures with posteromedial head extension less than or equal to 8 mm, or diaphysis deviation greater than 2 mm, as well as grouping did not influence the risk for osteonecrosis. CONCLUSIONS Hertel's criteria were not able to predict the development of osteonecrosis after osteosynthesis of proximal humerus fractures performed through the anterolateral approach. The total prevalence of osteonecrosis was 17.9% with a tendency toward an increased incidence after 1 year of surgical treatment.
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Affiliation(s)
- Márcio Alves Cruz
- Orthopedics and Traumatology, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
| | - Guilherme Grisi Mouraria
- Orthopedics and Traumatology, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil.
| | - Fernando Kenji Kikuta
- Orthopedics and Traumatology, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
| | - Daniel Romano Zogbi
- Orthopedics and Traumatology, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
| | - Sérgio de Paula Coelho
- Orthopedics and Traumatology, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
| | - Maurício Etchebehere
- Orthopedics and Traumatology, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
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Wegner A, Wassenaar D, Busch A, Stanjek M, Mayer C, Jäger M. [Post-traumatic necrosis of the humeral head-Endoprosthesis or joint preservation]. Orthopadie (Heidelb) 2022; 51:822-828. [PMID: 36083347 DOI: 10.1007/s00132-022-04307-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/18/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Humerus fractures play a major role in daily clinical routine, and subsequent osteonecrosis is common after osteosyntheses. OBJECTIVES The current paper highlights the incidence and cause of osteonecrosis after proximal humerus fractures, with respect to presentation of anatomy and risk factors. METHODS Display of the literature and therapy options for humerus fracture and subsequent necrosis. RESULTS Humerus fractures are the seventh most frequent fractures in humans. The complication rate is 40%, and the described rate of necrosis is up to 34%. Accordingly, the surgical revision rate is at 19% according to recent literature. CONCLUSION The treatment of humerus head fracture must consider numerous variables. The individual type of fracture and the current individual situation of the patient must be included in the process of choosing the right treatment. Modern implants with screw locking features should be used, and for certain circumstances the direct implantation of a prosthesis should be considered. Thereby the expectations of the patient with respect to the postoperative activity level play a major role.
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Affiliation(s)
- A Wegner
- Lehrstuhl für Orthopädie und Unfallchirurgie, Universität Duisburg-Essen, Essen, Deutschland.
- Klinik für Unfallchirurgie, Orthopädie und Handchirurgie, Klinikum Wolfsburg, Sauerbruchstr. 7, 38440, Wolfsburg, Deutschland.
| | - D Wassenaar
- Klinik für Orthopädie, Unfall- und Wiederherstellungschirurgie, St. Marien-Hospital Mülheim an der Ruhr GmbH, Kaiserstr. 50, 45468, Mülheim/Ruhr, Deutschland
- Lehrstuhl für Orthopädie und Unfallchirurgie, Universität Duisburg-Essen, Essen, Deutschland
| | - A Busch
- Klinik für Orthopädie, Unfall- und Wiederherstellungschirurgie, St. Marien-Hospital Mülheim an der Ruhr GmbH, Kaiserstr. 50, 45468, Mülheim/Ruhr, Deutschland
- Lehrstuhl für Orthopädie und Unfallchirurgie, Universität Duisburg-Essen, Essen, Deutschland
| | - M Stanjek
- Klinik für Orthopädie, Unfall- und Wiederherstellungschirurgie, St. Marien-Hospital Mülheim an der Ruhr GmbH, Kaiserstr. 50, 45468, Mülheim/Ruhr, Deutschland
- Lehrstuhl für Orthopädie und Unfallchirurgie, Universität Duisburg-Essen, Essen, Deutschland
| | - C Mayer
- Klinik für Orthopädie, Unfall- und Wiederherstellungschirurgie, St. Marien-Hospital Mülheim an der Ruhr GmbH, Kaiserstr. 50, 45468, Mülheim/Ruhr, Deutschland
- Lehrstuhl für Orthopädie und Unfallchirurgie, Universität Duisburg-Essen, Essen, Deutschland
| | - M Jäger
- Klinik für Orthopädie, Unfall- und Wiederherstellungschirurgie, St. Marien-Hospital Mülheim an der Ruhr GmbH, Kaiserstr. 50, 45468, Mülheim/Ruhr, Deutschland
- Lehrstuhl für Orthopädie und Unfallchirurgie, Universität Duisburg-Essen, Essen, Deutschland
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Kallas R, Li J, Petri M. Predictors of Osteonecrosis in Systemic Lupus Erythematosus: A Prospective Cohort Study. Arthritis Care Res (Hoboken) 2022; 74:1122-1132. [PMID: 33342072 PMCID: PMC10725725 DOI: 10.1002/acr.24541] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 10/01/2020] [Accepted: 12/15/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE We aimed at determining the predictors of osteonecrosis (ON) in a longitudinal lupus cohort. METHODS Data were reviewed from the initiation of the cohort in 1987 until October 2019. In total, 2,428 patients were included in the analysis based on 224,295 person-months of follow-up. We used pooled logistic regression to assess the relationship between risk factors and rates of ON events. After identifying a set of variables related to ON incidence, we fit a final multivariable model to identify the most important risk factors for incident ON. RESULTS In 18,691 person-years of follow-up after cohort entry, 122 incident ON events were observed (rate = 6.5/1,000 person-years). In the multivariable analysis, African American patients were at twice the risk for ON compared to White patients. Male patients and smokers had an increased risk for ON of ~80% and 50% compared to female patients and nonsmokers, respectively. For every 10-year increase in the age at diagnosis, there was a 20% reduced risk for ON. Patients diagnosed after the 1990s had a 50% reduced risk of ON compared to those diagnosed before the 1990s. A highest daily dosage of prednisone of 40 mg or higher, even when administered for a month or less, significantly increased the risk of ON. Use of pulse methylprednisolone or intramuscular triamcinolone was not associated with an increased risk of ON. CONCLUSION African American patients with systemic lupus erythematosus are at double the risk of experiencing ON compared to White patients. Oral prednisone at 20-39 mg for more than 1 month, or 40 mg daily for even 1 month, at any point in the disease course, remained the most important glucocorticoid predictor of ON.
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Affiliation(s)
- Romy Kallas
- Division of Rheumatology, Johns Hopkins University School of Medicine
| | - Jessica Li
- Division of Rheumatology, Johns Hopkins University School of Medicine
| | - Michelle Petri
- Division of Rheumatology, Johns Hopkins University School of Medicine
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Tsai HL, Chang JW, Lu JH, Liu CS. Epidemiology and risk factors associated with avascular necrosis in patients with autoimmune diseases: a nationwide study. Korean J Intern Med 2022; 37:864-876. [PMID: 35236014 PMCID: PMC9271726 DOI: 10.3904/kjim.2020.098] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 06/08/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Avascular necrosis (AVN) is a clinical condition characterized by the death of bone components due to interruption in the blood supply. This study aimed to investigate the epidemiology and determine the risk factors for AVN in patients with autoimmune diseases. METHODS We conducted a population-based retrospective cohort analysis using claims data from the Taiwan National Health Insurance Research Database. A total of 49,636 patients with autoimmune diseases between January 1, 2005 and December 31, 2013 were included. Cox regression analysis was used to identify associated risk factors for the development of AVN. RESULTS A total of 490/49,636 patients (1.0%) developed symptomatic AVN. The systemic lupus erythematosus patients had a higher risk of AVN compared to other autoimmune diseases. AVN was positively correlated with male sex (p < 0.001), alcoholism (p < 0.001), mean daily prednisolone dosage 7.51 to 30 mg (p < 0.001) and > 30 mg (p < 0.001), and total cumulative prednisolone dose 0 g to 5 g (p = 0.002). However, AVN was inversely correlated with cumulative duration of hydroxychloroquine exposure > 0.6 years (p < 0.001). CONCLUSION Male sex, systemic lupus erythematosus, alcoholism, mean daily corticosteroid > 7.5 mg and a total cumulative dose of corticosteroid 0 to 5 g were independently associated with the development of AVN in autoimmune patients. While hydroxychloroquine use > 0.6 years conferred significant protection against the development of AVN. Clinicians should regularly assess patients with risk factors to enable the early diagnosis of AVN.
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Affiliation(s)
- Hsin-Lin Tsai
- Division of Pediatric Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei,
Taiwan
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei,
Taiwan
| | - Jei-Wen Chang
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei,
Taiwan
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei,
Taiwan
| | - Jen-Her Lu
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei,
Taiwan
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei,
Taiwan
| | - Chin-Su Liu
- Division of Pediatric Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei,
Taiwan
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei,
Taiwan
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Mañón VA, Balandran S, Young S, Wong M, Melville JC. COVID-Associated Avascular Necrosis of the Maxilla - A Rare, New Side Effect of COVID-19. J Oral Maxillofac Surg 2022; 80:1254-1259. [PMID: 35588767 PMCID: PMC9072768 DOI: 10.1016/j.joms.2022.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/25/2022] [Accepted: 04/25/2022] [Indexed: 12/23/2022]
Abstract
Purpose The purpose of this article is to present an interesting, rare case of a patient who experienced avascular necrosis of the maxilla associated with COVID-19 infection. Methods and Results Our team retrospectively evaluated this patient's chart after completion of surgical management. The patient is a 72-year-old male who presented to the University of Texas Health Science Center at Houston for surgical management of his infarcted maxilla, which developed as a sequela of infection with COVID-19. A literature review was completed using PubMed. Twenty-five articles are reviewed and discussed. Conclusions Infection with COVID-19 confers a hypercoagulable state in patients, leading to various complications in the head and neck region. In our case report, we present a patient who developed avascular necrosis of the maxilla secondary to infection with COVID-19. Thromboembolic prophylaxis is imperative in COVID-19 patients due to the high rate of potential systemic complications.
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Affiliation(s)
- Victoria A Mañón
- Resident, Katz Department of Oral & Maxillofacial Surgery, The University of Texas at Houston, Houston, Texas, United States of America.
| | - Steven Balandran
- Resident, Katz Department of Oral & Maxillofacial Surgery, The University of Texas at Houston, Houston, Texas, United States of America
| | - Simon Young
- Associate Professor, Katz Department of Oral & Maxillofacial Surgery, The University of Texas at Houston, Houston, Texas, United States of America
| | - Mark Wong
- Professor, Chair and Program Director, Katz Department of Oral & Maxillofacial Surgery, The University of Texas at Houston, Houston, Texas, United States of America
| | - James C Melville
- Associate Professor, Head and Neck Oncologic and Microvascular Reconstructive Surgery, Katz Department of Oral & Maxillofacial Surgery, The University of Texas at Houston, Houston, Texas, United States of America
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29
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Periasamy U, Chilutti M, Kaplan SL, Hickey CP, Hayes K, Pennington JW, Balamuth F, Fitzgerald JC, Weiss SL. Prevalence of and Associations With Avascular Necrosis After Pediatric Sepsis: A Single-Center Retrospective Study. Pediatr Crit Care Med 2022; 23:e153-e161. [PMID: 34991135 PMCID: PMC8897239 DOI: 10.1097/pcc.0000000000002880] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Avascular necrosis (AVN) is a rare, but serious, complication after sepsis in adults. We sought to determine if sepsis is associated with postillness diagnosis of AVN, as well as potential-associated risk factors for AVN in children with sepsis. DESIGN Retrospective observational study. SETTING Single academic children's hospital. PATIENTS Patients less than 18 years treated for sepsis or suspected bacterial infection from 2011 to 2017. Patients who developed AVN within 3 years after sepsis were compared with patients who developed AVN after suspected bacterial infection and with patients with sepsis who did not develop AVN. INTERVENTION None. MEASUREMENTS AND MAIN RESULTS AVN was determined using International Classification of Diseases, 9th Edition/10th Edition codes and confirmed by chart review. The prevalence of AVN after sepsis was 0.73% (21/2,883) and after suspected bacterial infection was 0.43% (53/12,276; risk difference, 0.30; 95% CI, 0.0-0.63; p = 0.05). Compared with 43 sepsis controls without AVN, AVN in the 21 sepsis cases was associated with being older, having sickle cell disease and malignancy, higher body mass index, unknown source of infection, and low platelet count in the first 7 days of sepsis. Half of sepsis patients were treated with corticosteroids, and higher median cumulative dose of steroids was associated with AVN (23.2 vs 5.4 mg/kg; p < 0.01). Older age at infection (odds ratio [OR], 1.3; 95% CI, 1.1-1.4), malignancy (OR, 8.8; 95% CI, 2.6-32.9), unknown site of infection (OR, 12.7; 95% CI, 3.3-48.6), and minimal platelet count less than 100,000/µL in first 7 days of sepsis (OR, 5.0; 95% CI, 1.6-15.4) were identified as potential risk factors for AVN after sepsis following adjustment for multiple comparisons. CONCLUSIONS Although rare, sepsis was associated with a higher risk of subsequent AVN than suspected bacterial infection in children. Older age, malignancy, unknown site of infection, and minimum platelet count were potential risk factors for AVN after sepsis.
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Affiliation(s)
- Uvaraj Periasamy
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston MA, USA
| | - Marianne Chilutti
- Department of Biomedical and Health Informatics, The Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia PA, USA
| | - Summer L. Kaplan
- Department of Radiology, The Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia PA, USA
| | - Christopher P. Hickey
- The Children’s Hospital of Philadelphia Pediatric Sepsis Program, Philadelphia PA, USA
| | - Katie Hayes
- The Children’s Hospital of Philadelphia Pediatric Sepsis Program, Philadelphia PA, USA
| | - Jeffrey W. Pennington
- Department of Biomedical and Health Informatics, The Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia PA, USA
| | - Fran Balamuth
- The Children’s Hospital of Philadelphia Pediatric Sepsis Program, Philadelphia PA, USA
- Department of Pediatrics, The Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia PA, USA
| | - Julie C. Fitzgerald
- The Children’s Hospital of Philadelphia Pediatric Sepsis Program, Philadelphia PA, USA
- Department of Anesthesiology and Critical Care, The Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia PA, USA
| | - Scott L. Weiss
- The Children’s Hospital of Philadelphia Pediatric Sepsis Program, Philadelphia PA, USA
- Department of Anesthesiology and Critical Care, The Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia PA, USA
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30
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Beckers G, Mazy D, Cermak K, Van den Dungen S, Van Nieuwenhove O, Kinnen L. Osteonecrosis of the trapezium: a case report and review of the literature. Acta Orthop Belg 2022; 88:186-189. [PMID: 35512170 DOI: 10.52628/88.1.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We describe the case of a 58-year-old woman with AVN of the left trapezium which was treated surgically. This paper aims to review the etiologies leading to the pathology and the different therapeutic options. Avascular necrosis (AVN) of the carpal bones most commonly involves the lunate and the scaphoid . AVN of the trapezium is extremely rare. To our knowledge only 3 cases have been published in the literature so far and they were all treated differently.
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31
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Masiak A, Kościńska I, Rutkowska B, Zdrojewski Z. Long-lasting severe knee pain in a SLE patient after renal transplantation: what is the reason? A case report and literature review. Rheumatol Int 2022; 42:349-358. [PMID: 34665297 PMCID: PMC8800873 DOI: 10.1007/s00296-021-05018-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 09/29/2021] [Indexed: 11/29/2022]
Abstract
Musculo-skeletal complaints in a patient suffering from systemic lupus, with co-existing chronic renal failure, undergoing immunosuppressive treatment after kidney transplantation, can have a varied etiology. The aim of this work was to present a case based review of differential diagnosis of knee pain in such a patient. A literature search was carried out using MEDLINE/PubMed, Google Scholar and EBSCO, with no time limit. We undertook a systematic review of the literature published in English, limited to full-text publications of original articles, letters to the editor, and case reports in peer-reviewed journals, for a discussion and analysis of studies reporting arthralgia in patients with lupus after kidney transplantation. We present a case report of a 45-year-old woman with lupus nephritis, after kidney transplantation, who started to complain of increasing pain in the knees, most pronounced at night and after physical activity approximately 2 years after transplantation. Extensive causal diagnostics were carried out, which revealed bilateral extensive regions of bone infarction in the femur and tibia, chondropathy, degenerative changes of medial meniscuses in the body and posterior horn as well as chondromalacia of the patella. Establishing the right diagnosis is crucial for implementing appropriate treatment.
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Affiliation(s)
- Anna Masiak
- Department of Internal Medicine, Connective Tissue Diseases and Geriatrics, Medical University of Gdansk, ul. Dębinki 7, 80-952, Gdańsk, Poland.
| | - Iga Kościńska
- Department of Internal Medicine, Connective Tissue Diseases and Geriatrics, Medical University of Gdansk, ul. Dębinki 7, 80-952, Gdańsk, Poland
| | - Beata Rutkowska
- Department of Radiology, Medical University of Gdansk, Gdansk, Poland
| | - Zbigniew Zdrojewski
- Department of Internal Medicine, Connective Tissue Diseases and Geriatrics, Medical University of Gdansk, ul. Dębinki 7, 80-952, Gdańsk, Poland
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Badescu MC, Rezus E, Ciocoiu M, Badulescu OV, Butnariu LI, Popescu D, Bratoiu I, Rezus C. Osteonecrosis of the Jaws in Patients with Hereditary Thrombophilia/Hypofibrinolysis-From Pathophysiology to Therapeutic Implications. Int J Mol Sci 2022; 23:ijms23020640. [PMID: 35054824 PMCID: PMC8776054 DOI: 10.3390/ijms23020640] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 12/29/2021] [Accepted: 01/04/2022] [Indexed: 12/24/2022] Open
Abstract
Osteonecrosis of the jaws (ONJ) usually has a clear etiology. Local infection or trauma, radiotherapy and drugs that disrupt the vascular supply or bone turnover in the jaws are its major contributors. The thrombotic occlusion of the bone’s venous outflow that occurs in individuals with hereditary thrombophilia and/or hypofibrinolysis has a less known impact on jaw health and healing capability. Our research provides the most comprehensive, up-to-date and systematized information on the prevalence and significance of hereditary thrombophilia and/or hypofibrinolysis states in ONJ. We found that hereditary prothrombotic abnormalities are common in patients with ONJ refractory to conventional medical and dental treatments. Thrombophilia traits usually coexist with hypofibrinolysis traits. We also found that frequently acquired prothrombotic abnormalities coexist with hereditary ones and enhance their negative effect on the bone. Therefore, we recommend a personalized therapeutic approach that addresses, in particular, the modifiable risk factors of ONJ. Patients will have clear benefits, as they will be relieved of persistent pain and repeated dental procedures.
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Affiliation(s)
- Minerva Codruta Badescu
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (M.C.B.); (D.P.); (C.R.)
- III Internal Medicine Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Elena Rezus
- Department of Rheumatology and Physiotherapy, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania;
- I Rheumatology Clinic, Clinical Rehabilitation Hospital, 14 Pantelimon Halipa Street, 700661 Iasi, Romania
- Correspondence: (E.R.); (O.V.B.)
| | - Manuela Ciocoiu
- Department of Pathophysiology, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania;
| | - Oana Viola Badulescu
- Department of Pathophysiology, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania;
- Hematology Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
- Correspondence: (E.R.); (O.V.B.)
| | - Lacramioara Ionela Butnariu
- Department of Mother and Child Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania;
| | - Diana Popescu
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (M.C.B.); (D.P.); (C.R.)
- III Internal Medicine Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
| | - Ioana Bratoiu
- Department of Rheumatology and Physiotherapy, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania;
- I Rheumatology Clinic, Clinical Rehabilitation Hospital, 14 Pantelimon Halipa Street, 700661 Iasi, Romania
| | - Ciprian Rezus
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania; (M.C.B.); (D.P.); (C.R.)
- III Internal Medicine Clinic, “St. Spiridon” County Emergency Clinical Hospital, 1 Independence Boulevard, 700111 Iasi, Romania
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Thankappan A, Nasimudeen N, Thomas A, Karikkanthra J, Pullockara J. An unusual case of metaphyseal osteonecrosis of humerus in a post covid patient: a case report. Pan Afr Med J 2022; 42:244. [PMID: 36303824 PMCID: PMC9587748 DOI: 10.11604/pamj.2022.42.244.34337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 06/21/2022] [Indexed: 11/11/2022] Open
Abstract
Osteonecrosis of the metaphysis is often rare as it is a highly vascular region. Here we report an unusual case of non-traumatic osteonecrosis of the humerus predominantly involving the metaphysis in a post covid elderly female. The patient had a pathological fracture of humerus during the post-operative period of intertrochanteric femur fracture surgery. She was evaluated for the causes of pathological fracture and the fracture was managed with hemi replacement of the shoulder because of the extensive bone loss. The pathology here could only be explained as some sequelae of hyper inflammatory state associated with COVID-19 infection. The possible differentials are also discussed here. This case report will help clinicians to consider COVID-19 infection as a cause for non-traumatic osteonecrosis among other reported causes of osteonecrosis.
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Affiliation(s)
- Ajayakumar Thankappan
- Department of Orthopaedics, Apollo Adlux Hospital, Kochi, Kerala, India
- Corresponding author: Ajayakumar Thankappan, Department of Orthopaedics, Apollo Adlux Hospital, Kochi, Kerala, India.
| | - Nizaj Nasimudeen
- Department of Orthopaedics, Apollo Adlux Hospital, Kochi, Kerala, India
| | - Arun Thomas
- Department of Radiodiagnosis, Apollo Adlux Hospital, Kochi, Kerala, India
| | | | - Jojo Pullockara
- Department of Nephrology, Apollo Adlux Hospital, Kochi, Kerala, India
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Bravo Vázquez LA, Moreno Becerril MY, Mora Hernández EO, de León Carmona GG, Aguirre Padilla ME, Chakraborty S, Bandyopadhyay A, Paul S. The Emerging Role of MicroRNAs in Bone Diseases and Their Therapeutic Potential. Molecules 2021; 27:molecules27010211. [PMID: 35011442 PMCID: PMC8746945 DOI: 10.3390/molecules27010211] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/16/2021] [Accepted: 12/24/2021] [Indexed: 01/24/2023]
Abstract
MicroRNAs (miRNAs) are a class of small (20-24 nucleotides), highly conserved, non-coding RNA molecules whose main function is the post-transcriptional regulation of gene expression through sequence-specific manners, such as mRNA degradation or translational repression. Since these key regulatory molecules are implicated in several biological processes, their altered expression affects the preservation of cellular homeostasis and leads to the development of a wide range of pathologies. Over the last few years, relevant investigations have elucidated that miRNAs participate in different stages of bone growth and development. Moreover, the abnormal expression of these RNA molecules in bone cells and tissues has been significantly associated with the progression of numerous bone diseases, including osteoporosis, osteosarcoma, osteonecrosis and bone metastasis, among others. In fact, miRNAs regulate multiple pathological mechanisms, including altering either osteogenic or osteoblast differentiation, metastasis, osteosarcoma cell proliferation, and bone loss. Therefore, in this present review, aiming to impulse the research arena of the biological implications of miRNA transcriptome in bone diseases and to explore their potentiality as a theragnostic target, we summarize the recent findings associated with the clinical significance of miRNAs in these ailments.
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Affiliation(s)
- Luis Alberto Bravo Vázquez
- Tecnologico de Monterrey, School of Engineering and Sciences, Campus Querétaro, Av. Epigmenio González, No. 500 Fracc. San Pablo, Querétaro 76130, Mexico; (L.A.B.V.); (M.Y.M.B.); (G.G.d.L.C.); (M.E.A.P.)
| | - Mariana Yunuen Moreno Becerril
- Tecnologico de Monterrey, School of Engineering and Sciences, Campus Querétaro, Av. Epigmenio González, No. 500 Fracc. San Pablo, Querétaro 76130, Mexico; (L.A.B.V.); (M.Y.M.B.); (G.G.d.L.C.); (M.E.A.P.)
| | - Erick Octavio Mora Hernández
- Tecnologico de Monterrey, School of Engineering and Sciences, Campus Mexico City, Calle del Puente, No. 222 Col. Ejidos de Huipulco, Tlalpan, Mexico City 14380, Mexico;
| | - Gabriela García de León Carmona
- Tecnologico de Monterrey, School of Engineering and Sciences, Campus Querétaro, Av. Epigmenio González, No. 500 Fracc. San Pablo, Querétaro 76130, Mexico; (L.A.B.V.); (M.Y.M.B.); (G.G.d.L.C.); (M.E.A.P.)
| | - María Emilia Aguirre Padilla
- Tecnologico de Monterrey, School of Engineering and Sciences, Campus Querétaro, Av. Epigmenio González, No. 500 Fracc. San Pablo, Querétaro 76130, Mexico; (L.A.B.V.); (M.Y.M.B.); (G.G.d.L.C.); (M.E.A.P.)
| | - Samik Chakraborty
- Division of Nephrology, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
| | - Anindya Bandyopadhyay
- International Rice Research Institute, Manila 4031, Philippines;
- Reliance Industries Ltd., Navi Mumbai 400701, India
| | - Sujay Paul
- Tecnologico de Monterrey, School of Engineering and Sciences, Campus Querétaro, Av. Epigmenio González, No. 500 Fracc. San Pablo, Querétaro 76130, Mexico; (L.A.B.V.); (M.Y.M.B.); (G.G.d.L.C.); (M.E.A.P.)
- Correspondence:
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Sulewski A, Sieroń D, Szyluk K, Dąbrowski M, Kubaszewski Ł, Lukoszek D, Christe A. Avascular Necrosis Bone Complication after Active COVID-19 Infection: Preliminary Results. Medicina (Kaunas) 2021; 57:medicina57121311. [PMID: 34946256 PMCID: PMC8709043 DOI: 10.3390/medicina57121311] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/16/2021] [Accepted: 11/26/2021] [Indexed: 12/22/2022]
Abstract
Background and objectives: The course of SARS-CoV-2 (COVID-19) is still under analysis. The majority of complications arising from the infection are related to the respiratory system. The adverse effect of the viral infection on bone and joint tissue has also been observed. Materials and Methods: We present a group of 10 patients with degeneration of large joints and adjacent epiphyses of long bones and the spine, with a background of bone infarctions and avascular necrosis (AVN) immediately after infection with the COVID-19 virus. In MR imaging, changes in the characteristics of AVN were documented. Results: Observation of this group showed a clear correlation among the history of COVID-19 disease in the patients, moderately severe symptoms, high levels of IgG antibodies, and the time of occurrence of joint changes. No other clinically significant complications were observed following COVID-19 infection in the study group. No other risk factors for AVN or autoimmune or degenerative diseases were found in the study group. The group of patients responded well to empirical treatment with steroids, which normalized acute inflammatory symptoms and pain in the joints. Conclusions: During coronavirus (COVID-19) infection, there are complications in the locomotor system, such as microembolism and the formation of AVN; hence, more research is needed.
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Affiliation(s)
- Adam Sulewski
- Adult Spine Orthopaedics Department, Poznan University of Medical Sciences, 61545 Poznan, Poland; (M.D.); (Ł.K.)
- Correspondence:
| | - Dominik Sieroń
- Division of Magnetic Resonance Imaging, Silesian Center for Heart Diseases, 41800 Zabrze, Poland;
| | - Karol Szyluk
- Department of Physiotherapy, Faculty of Health Sciences in Katowice, Medical University of Silesia in Katowice, 40752 Katowice, Poland;
- I Department of Orthopaedic and Trauma Surgery, District Hospital of Orthopaedics and Trauma Surgery, Bytomska 62 Str., 41940 Piekary Śląskie, Poland
| | - Mikołaj Dąbrowski
- Adult Spine Orthopaedics Department, Poznan University of Medical Sciences, 61545 Poznan, Poland; (M.D.); (Ł.K.)
| | - Łukasz Kubaszewski
- Adult Spine Orthopaedics Department, Poznan University of Medical Sciences, 61545 Poznan, Poland; (M.D.); (Ł.K.)
| | - Dawid Lukoszek
- Dawid Lukoszek Physiotherapy Osteopathy, 42690 Hanusek, Poland;
| | - Andreas Christe
- Department of Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland;
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Abstract
The etiology of avascular necrosis (AVN) of the proximal humerus can be classified as idiopathic or posttraumatic, the latter being mainly due to proximal humerus fractures. Evidence suggests that posttraumatic AVN may require surgical intervention more often than idiopathic AVN of the proximal humerus. This article provides a comprehensive review of the management of posttraumatic AVN of the proximal humerus. Early stage AVN (stages 1 to 3) is commonly treated with nonoperative intervention or core decompression of the humeral head, whereas later stage disease (stages 4 and 5) may require hemiarthroplasty or total shoulder arthroplasty to restore function. [Orthopedics. 2021;44(6):367-375.].
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Gallego Peñalver FJ, Romero de la Higuera SB, Pueyo Ruiz CM, Prados Lumbierres AM. [Childhood Lunatomalacia Or Kienböck Disease With VISI Conformation In A Child: A Case Report And Literature Review]. Rehabilitacion (Madr) 2021; 55:316-319. [PMID: 33276983 DOI: 10.1016/j.rh.2020.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 08/02/2020] [Indexed: 06/12/2023]
Abstract
Semilunar osteonecrosis or Kienböck's disease has a low prevalence, usually occurring in young men aged between 20 and 40 years. This disease is even less common in childhood. The aetiology varies, with postulation of the vascular trauma theory and the non-traumatic theory, in which the disease is caused by various other mechanisms. Semilunar involvement can occur with bone oedema, fragmentation, and scapholunate misalignment and progresses towards collapse. We present the case of an adolescent boy with Kienböck's disease, with no attributable traumatic antecedent, who developed a complex classification injury on the Litchman scale. Partial improvement of symptoms was achieved with conservative treatment but without definitive pain elimination. Future surgery for this patient is currently being discussed, bearing in mind his skeletal maturity and the pathophysiological progression of the injury.
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Affiliation(s)
- F J Gallego Peñalver
- Servicio de Medicina Física y Rehabilitación, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España.
| | - S B Romero de la Higuera
- Servicio de Medicina Física y Rehabilitación, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - C M Pueyo Ruiz
- Servicio de Medicina Física y Rehabilitación, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - A M Prados Lumbierres
- Servicio de Medicina Física y Rehabilitación, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
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Thapa J, Shrestha D, Kayastha SR, Dhoju D, Shrestha R, Sharma R, Regmi R. Osteosynthesis of Neck of Femur Fracture below 65 years of Age: does timing of surgery influence osteonecrosis, nonunion and functional outcome? Kathmandu Univ Med J (KUMJ) 2021; 19:467-473. [PMID: 36259190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Background Influence of timing of injury surgery interval in outcome of osteosynthesis of neck of femur has always been a matter of debate. Patients in our set up have been surgically treated for neck of femur fracture with wide range of injury surgery interval which could have resulted in varied functional outcome and radiological outcome. Objective To evaluate the difference in functional outcome, femoral head osteonecrosis and non-union in fracture neck of femur fixed within and after twenty-four hours. Method All patients, who had undergone osteosynthesis for the neck of femur fractures via open or closed technique from 2010 to 2018 were analyzed retrospectively. The cases were examined and evaluated in terms of injury surgery interval, fracture union, functional status using Modified Harris Hip Score, complications like femoral head osteonecrosis and non-union. Result Fifty patients with an average injury surgery interval of 34±28 hours were evaluated. Twenty three (46%) cases were included in early surgery group (< 24 hours) and 27 (54%) patients were included in delayed (> 24 hours) surgery group. Incidence of femoral head osteonecrosis was reported in two (4%) cases, both being in delayed fixation group (p=0.49). Non-union was reported in four (8%) patients, one in early fixation group and three in delayed fixation group (p=0.61). The average Modified Harris Hip Score in early fixation group was 87 and in delayed fixation group was 84 (p=0.1). Forty two (84%) cases had a good quality of reduction and eight (16%) had a poor reduction. Non-union and functional outcome significantly differed between the good and poor reduction group (p=0.001 and 0.004 respectively). Conclusion There is no significant difference in the functional and radiological outcome of cases operated before and after 24 hours for osteosynthesis of neck of femur fractures in patients 16 to 65 years age group. However, poor reduction is significantly associated with the increased rate of non-union and poor functional outcome.
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Affiliation(s)
- J Thapa
- Department of Orthopedics and Traumatology, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - D Shrestha
- Department of Orthopedics and Traumatology, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - S R Kayastha
- Department of Orthopedics and Traumatology, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - D Dhoju
- Department of Orthopedics and Traumatology, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - R Shrestha
- Department of Orthopedics and Traumatology, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - R Sharma
- Department of Orthopedics and Traumatology, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - R Regmi
- Department of Orthopedics and Traumatology, Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
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An HJ, Ko KR, Baek M, Jeong Y, Lee HH, Kim H, Kim DK, Lee SY, Lee S. Pro-Angiogenic and Osteogenic Effects of Adipose Tissue-Derived Pericytes Synergistically Enhanced by Nel-like Protein-1. Cells 2021; 10:cells10092244. [PMID: 34571892 PMCID: PMC8470876 DOI: 10.3390/cells10092244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/19/2021] [Accepted: 08/24/2021] [Indexed: 11/16/2022] Open
Abstract
An important objective of vascularized tissue regeneration is to develop agents for osteonecrosis. We aimed to identify the pro-angiogenic and osteogenic efficacy of adipose tissue-derived (AD) pericytes combined with Nel-like protein-1 (NELL-1) to investigate the therapeutic effects on osteonecrosis. Tube formation and cell migration were assessed to determine the pro-angiogenic efficacy. Vessel formation was evaluated in vivo using the chorioallantoic membrane assay. A mouse model with a 2.5 mm necrotic bone fragment in the femoral shaft was used as a substitute for osteonecrosis in humans. Bone formation was assessed radiographically (plain radiographs, three-dimensional images, and quantitative analyses), and histomorphometric analyses were performed. To identify factors related to the effects of NELL-1, analysis using microarrays, qRT-PCR, and Western blotting was performed. The results for pro-angiogenic efficacy evaluation identified synergistic effects of pericytes and NELL-1 on tube formation, cell migration, and vessel formation. For osteogenic efficacy analysis, the mouse model for osteonecrosis was treated in combination with pericytes and NELL-1, and the results showed maximum bone formation using radiographic images and quantitative analyses, compared with other treatment groups and showed robust bone and vessel formation using histomorphometric analysis. We identified an association between FGF2 and the effects of NELL-1 using array-based analysis. Thus, combinatorial therapy using AD pericytes and NELL-1 may have potential as a novel treatment for osteonecrosis.
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Affiliation(s)
- Hyun-Ju An
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, 59 Yatap-Ro, Seongnam-si 13496, Gyeonggi-do, Korea; (H.-J.A.); (M.B.); (Y.J.); (H.H.L.)
| | - Kyung Rae Ko
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul 06351, Korea;
| | - Minjung Baek
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, 59 Yatap-Ro, Seongnam-si 13496, Gyeonggi-do, Korea; (H.-J.A.); (M.B.); (Y.J.); (H.H.L.)
| | - Yoonhui Jeong
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, 59 Yatap-Ro, Seongnam-si 13496, Gyeonggi-do, Korea; (H.-J.A.); (M.B.); (Y.J.); (H.H.L.)
| | - Hyeon Hae Lee
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, 59 Yatap-Ro, Seongnam-si 13496, Gyeonggi-do, Korea; (H.-J.A.); (M.B.); (Y.J.); (H.H.L.)
| | - Hyungkyung Kim
- Department of Pathology, Kyung Hee University Hospital at Gangdong, Kyung Hee University, College of Medicine, 892 Dongnam-Ro, Gangdong-gu, Seoul 05278, Korea;
| | - Do Kyung Kim
- CHA Graduate School of Medicine, 120 Hyeryong-Ro, Pocheon-si 11160, Gyeonggi-do, Korea;
| | - So-Young Lee
- Department of Internal Medicine, CHA Bundang Medical Center, CHA University School of Medicine, 59 Yatap-Ro, Seongnam-si 13496, Gyeonggi-do, Korea;
| | - Soonchul Lee
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, 59 Yatap-Ro, Seongnam-si 13496, Gyeonggi-do, Korea; (H.-J.A.); (M.B.); (Y.J.); (H.H.L.)
- Correspondence: ; Tel.: +82-317-805-289; Fax: +82-317-083-578
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Wei Q, Zhou M, Liu J, Zhang S, Gao F, Lin H, Chen Z. Relationship between osteonecrosis and antiphospholipid antibodies in patients with systemic lupus erythematosus: a systematic review protocol. BMJ Open 2021; 11:e046163. [PMID: 34301653 PMCID: PMC8728347 DOI: 10.1136/bmjopen-2020-046163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Osteonecrosis (ON) is characterised by the destruction of the normal blood supply to the bone tissue. ON is the main cause of disability in patients with systemic lupus erythematosus (SLE). Studies have reported the existence of many risk factors for SLE complicated by ON, including the use of high-dose glucocorticoids and high disease activity. The correlation between antiphospholipid antibodies (aPLs) and ON in SLE has been controversial. We aim to conduct a systematic review of the literature related to SLE, aseptic ON and aPLs, to provide a reference for the clinical screening of high-risk patients and for early prevention. METHODS AND ANALYSIS The following six databases will be searched: MEDLINE/PubMed, Embase, Web of Science, Chinese Biomedical Literature Database, Wan-Fang Database and China National Knowledge Infrastructure. The database searches will not be restricted by date. Case-control studies, cohort studies or observational studies that compare aPLs between SLE patients with and without ON will be considered eligible. Articles published in English and Chinese will be included. Two researchers will independently perform the processes of study selection, data extraction and study quality assessment. The Newcastle-Ottawa Quality Assessment Scale will be used to assess the quality of the retrieved studies. A meta-analysis will be performed after screening the studies. Data will be analysed using ORs for dichotomous data. ETHICS AND DISSEMINATION Ethical approval is not required because this systematic review will use published data. The systematic review will be electronically disseminated through a peer-reviewed publication or conference presentations. PROSPERO REGISTRATION NUMBER CRD42020209637.
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Affiliation(s)
- Qijiao Wei
- Rheumatology, Fujian Medical University Provincial Clinical Medical College, Fuzhou, Fujian, China
- Rheumatology, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Meng Zhou
- Rheumatology, Fujian Medical University Provincial Clinical Medical College, Fuzhou, Fujian, China
- Rheumatology, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Jianwen Liu
- Rheumatology, Fujian Medical University Provincial Clinical Medical College, Fuzhou, Fujian, China
- Rheumatology, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Shengli Zhang
- Rheumatology, Fujian Medical University Provincial Clinical Medical College, Fuzhou, Fujian, China
- Rheumatology, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Fei Gao
- Rheumatology, Fujian Medical University Provincial Clinical Medical College, Fuzhou, Fujian, China
- Rheumatology, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - He Lin
- Rheumatology, Fujian Medical University Provincial Clinical Medical College, Fuzhou, Fujian, China
- Rheumatology, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Zhihan Chen
- Rheumatology, Fujian Medical University Provincial Clinical Medical College, Fuzhou, Fujian, China
- Rheumatology, Fujian Provincial Hospital, Fuzhou, Fujian, China
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Carbajal V, Bajwa NS, Toy JO, Ahn UM, Ahn NU. Volar and Dorsal Blood Supply to the Lunate: A Cadaveric Study. Orthopedics 2021; 44:e243-e247. [PMID: 33238013 DOI: 10.3928/01477447-20201119-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Although various studies have proposed vascular and mechanical factors, the etiology of Kienböck disease is unknown. Kienböck theorized that lunatomalacia resulted from traumatic disruption of blood supply and bony nutrition to the lunate. Extraosseous supply to the lunate, as far as volar or dorsal vessels are concerned, is still controversial. This study evaluated the extraosseous nutrient foramina from the dorsal and volar aspects of lunate specimens. A total of 913 specimens from the Hamann-Todd Osteological Collection in Cleveland, Ohio, were examined. The nutrient artery foramina on left and right lunate specimens were examined from dorsal and volar aspects. The number of nutrient artery foramen was tabulated. Age, sex, and race data were collected. Specimens were divided into groups according to the number of nutrient artery foramina, and the dorsal and volar foramina were compared. The average number of foramina on the dorsal aspect of the lunate (1.71) was greater than the volar aspect (1.64), except in specimens younger than 35 years. A greater number of specimens had 3 or more foramina on the dorsal side compared with the volar aspect. Based on this study, there was significant contribution of dorsal arterial vessels to the blood supply of lunate specimens older than 35 years, which contrasts with findings in earlier studies. The disruption of dorsal intercarpal and radiocarpal ligaments leading to the disruption of the dorsal arterial arches may contribute to vascular insufficiency of the lunate and should be evaluated further in the etiopathogenesis of Kienböck disease. [Orthopedics. 2021;44(2):e243-e247.].
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Sax OC, Pervaiz SS, Douglas SJ, Remily EA, Mont MA, Delanois RE. Osteoarthritis and Osteonecrosis in Total Hip Arthroplasty: 90-Day Postoperative Costs and Outcomes. J Arthroplasty 2021; 36:2343-2347. [PMID: 33199099 DOI: 10.1016/j.arth.2020.10.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/16/2020] [Accepted: 10/22/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Two common diagnoses for patients undergoing total hip arthroplasty (THA) are osteoarthritis (OA) and osteonecrosis (ON), pathologically different diseases that affect postoperative complication rates. The underlying pathology of ON may predispose patients to a higher rate of certain complications. Previous research has linked ON with higher mortality and revisions, but a comparison of costs and complication rates may help elucidate further risks. This study reports 90-day costs, lengths of stay (LOS), readmission rates, and complication rates between patients undergoing THA for OA and ON. METHODS The Nationwide Readmissions Database was retrospectively reviewed for primary THAs, with 90-day readmissions assessed from the index procedure. Patients diagnosed with OA (n = 1,577,991) and ON (n = 55,034) were identified. Costs, LOS, and any readmission within 90 days for complications were recorded and analyzed with the chi-square and t-tests. RESULTS Patients with ON had higher 90-day costs ($20,110.80 vs. 22,462.79, P < .01) and longer average LOS (3.48 vs. 4.49 days, P < .01). Readmission rates within 90 days of index THA were significantly higher among patients with ON (7.7% vs. 13.1%, P < .01). Patients with OA had a lower incidence of 90-day overall complications (4.1 vs. 6.4%, P < .01). CONCLUSIONS Patients undergoing THA for ON incur higher readmission-related costs and complication rates. Understanding the predisposing factors for increased complications in ON may improve patient outcomes.
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Affiliation(s)
- Oliver C Sax
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, MD
| | - Sahir S Pervaiz
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, MD
| | - Scott J Douglas
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, MD
| | - Ethan A Remily
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, MD
| | - Michael A Mont
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, NY
| | - Ronald E Delanois
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, MD
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Fernández Reyes D, García-Fogeda Romero JL, de la Hera Fernández FJ. Acute back pain due to avascular necrosis of the vertebral body (Kummel disease). Emergencias 2021; 33:245-246. [PMID: 33978346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Daniel Fernández Reyes
- Servicio de Medicina Interna, Hospital Universitario Clínico San Cecilio. Granada, España
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Mohan K, Hintze JM, Morrissey D, Molony D. Incidence of avascular necrosis following biceps tenodesis during proximal humerus open reduction and internal fixation. Acta Orthop Belg 2021; 87:339-346. [PMID: 34529390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Avascular necrosis (AVN) may occur in up to 77% of proximal humeral fractures and can cause fixation failure. Risk factors include fracture position, calcar length and medial hinge integrity. We routinely perform intra-articular biceps tenotomy with tenodesis at the level of pectoralis major to facilitate fragment identification and potentially ameliorate post-operative pain relief. Concern exists that tenotomising the biceps damages the adjacent arcuate artery, potentially increasing the rate of AVN. The purpose of this study was to evaluate whether biceps tenodesis is associated with an increased risk of radiographically evident humeral head AVN. 61 fractures surgically treated over a 52-month period were retrospectively reviewed and radiographically assessed in accordance with Neer's classification, calcar-length and medial hinge integrity. 40, 20 and 1 were four-, three- and two-part fractures respectively. 37 had a calcar-length less than 8mm and 26 suffered loss of the medial hinge. The median radiographic follow-up was 23 months. There was radiographic evidence of humeral head AVN in only one case, comparing favourably to rates quoted in current literature. In our experience, intra-articular biceps tenotomy with the deltopectoral approach was thus not associated with a significantly increased risk of humeral head AVN, even in complex four-part fractures.
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Fan XL, Wang WT, Wang J, Liao Y, Xiao R, Hu YH. Conservative management of avascular necrosis of the metacarpal head: A case report and brief review. Medicine (Baltimore) 2021; 100:e26083. [PMID: 34011129 PMCID: PMC8136993 DOI: 10.1097/md.0000000000026083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/06/2021] [Indexed: 11/27/2022] Open
Abstract
RATIONALE Avascular necrosis (AVN) of the metacarpal head is rare, and there is no clear consensus on treatment. The main aim of this study was to discuss the possible pathologic-mechanics of its development, epidemiology, radiographic features, and outcome after conservative treatment. PATIENT CONCERNS A 14-year-old male with a history of fractures in little finger complained of right-hand pain with a limited range of motion for 1 month. Diagnosis: Imaging examination confirmed the diagnosis of AVN in the long metacarpal finger and ring finger. INTERVENTIONS The patient was treated using non-surgical management, such as splint immobilization, non-steroidal anti-inflammatory drugs, and physiotherapy. OUTCOMES At the last follow-up 26 months later, the patient was in complete remission with no residual symptoms. Magnetic resonance imaging (MRI) confirmed excellent remodeling and regeneration in the metacarpal head. LESSONS Metacarpal head necrosis typically occurs in adolescent patients with a history of trauma. Conservative treatment may sometimes have an excellent prognosis.
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Affiliation(s)
- Xiao-Lei Fan
- Department of Orthopaedic Surgery, Xiangya Hospital, Central South University, Changsha
| | | | - Jian Wang
- Department of Orthopaedic Surgery, Karamay Central Hospital, Karamay, China
| | - Yi Liao
- Department of Orthopaedic Surgery, Karamay Central Hospital, Karamay, China
| | - Rui Xiao
- Department of Orthopaedic Surgery, Karamay Central Hospital, Karamay, China
| | - Yi-He Hu
- Department of Orthopaedic Surgery, Xiangya Hospital, Central South University, Changsha
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Kim SC, Lim YW, Jo WL, Park SB, Kim YS, Kwon SY. Long-Term Results of Total Hip Arthroplasty in Young Patients With Osteonecrosis After Allogeneic Bone Marrow Transplantation for Hematological Disease: A Multicenter, Propensity-Matched Cohort Study With a Mean 11-Year Follow-Up. J Arthroplasty 2021; 36:1049-1054. [PMID: 33036842 DOI: 10.1016/j.arth.2020.09.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/31/2020] [Accepted: 09/09/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The number of young patients with hematological disease requiring total hip arthroplasty (THA) is expected to increase. We aimed to investigate the long-term THA outcomes in patients with osteonecrosis of the femoral head (ONFH) following allogeneic bone marrow transplantation (BMT) for hematological disease. METHODS All patients who underwent THA for osteonecrosis after BMT from 1997 to 2012 were identified at 2 institutions. Using propensity scores, 75 THAs in 45 patients were matched for age, gender, body mass index, American Society of Anesthesiologists score, and year of surgery with 75 THAs in 58 patients with idiopathic ONFH without a history of hematological disease (1:1 ratio). The mean age at surgery was 36.7 years and 52% were men. Clinical and radiographic evaluations were performed and clinical scores were obtained at last follow-up. Kaplan-Meier analyses were used to compare survivorship. RESULTS At a mean follow-up of 10.6 ± 3.5 years, clinical, radiographic, and survivorship outcomes, and the Harris hip scores were similar between both groups. The 13-year survivorship for all-cause revision was 93.4% for the BMT group and 95% for the control group (P = .928). No significant differences were observed between groups in the rates of reoperation (4% vs 5.3%, P = 1.000), 90-day readmission (all 5.3%), or overall mortality (4.4% vs 1.7%, P = .681). No hips had periprosthetic joint infection or septic loosening in either group. Osteolysis occurred in none of the BMT patients and in 2 hips (2.7%) of the control patients (P = .497). CONCLUSION This large cohort multicenter survey at 11-year follow-up shows that contemporary cementless THA in young hematological disease patients after allogeneic BMT is not associated with a higher risk for surgical complications, revision, reoperation, readmission, and mortality compared to a matched cohort of idiopathic ONFH.
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Affiliation(s)
- Seung-Chan Kim
- Department of Orthopaedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Young-Wook Lim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Woo-Lam Jo
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Soo-Bin Park
- Department of Orthopaedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Yong-Sik Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Soon-Yong Kwon
- Department of Orthopaedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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Köroğlu C, Özdemir E, Çolak M, Şensöz E, Öztuna FV. Open reduction and Salter innominate osteotomy combined with femoral osteotomy in the treatment of developmental dysplasia of the hip: Comparison of results before and after the age of 4 years. Acta Orthop Traumatol Turc 2021; 55:28-32. [PMID: 33650507 DOI: 10.5152/j.aott.2021.17385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study aimed to compare the clinical and radiological findings of radical reduction (open reduction and Salter innominate osteotomy combined with femoral osteotomy) for children of walking age, younger and older than 4 years in the treatment of with developmental dysplasia of the hip (DDH). METHODS In this retrospective study, children of walking age with DDH who underwent radical reduction between 2008 and 2014 were identified. They were then divided into 2 groups according to the age at which the surgery was performed: before and after the age of 4 years. Improvement in the acetabular index was examined on follow-up radiographs. The presence of avascular necrosis (AVN) was determined and classified on the basis of the Kalamchi-MacEwen classification on final follow-up radiographs. Clinical assessment was performed with the modified McKay criteria at the final follow-up appointment. RESULTS A total of 19 children (14 girls, 5 boys; mean age=37.5±21 months) (25 hips) were included. Their mean age was 27.9±4.9 and 63.3±19.7 months in children operated before and after the age of 4 years, respectively. The mean follow-up time was 29.9±19 and 19.6±5 months in children operated before and after the age of 4 years, respectively. No significant difference was observed in improvements in the acetabular index between children younger than 4 years (24±6.9°) and those older than 4 years (20.7±6.7°) (p=0.25). According to the modified McKay criteria, all the children younger than 4 years exhibited excellent or good clinical results compared with those operated after the age of 4 years (67%) (p=0.013). At the final follow-up, 64% of all patients demonstrated no radiographical sign of AVN. The rates of AVN were significantly higher in children operated after the age of 4 years (33%) than in those operated before the age of 4 years (19%) (p=0.049). CONCLUSION Better clinical and radiographical results can be expected from radical reduction in children undergoing surgery before the age of 4 years. LEVEL OF EVIDENCE level III, Therapeutic Study.
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Affiliation(s)
- Cenk Köroğlu
- Department of Orthopedics and Traumatology, Mersin University, School of Medicine, Mersin, Turkey
| | - Emre Özdemir
- Department of Orthopedics and Traumatology, Mersin University, School of Medicine, Mersin, Turkey
| | - Mehmet Çolak
- Department of Orthopedics and Traumatology, Mersin University, School of Medicine, Mersin, Turkey
| | - Ersin Şensöz
- Clinic of Orthopedics and Traumatology, Ardahan State Hospital, Ardahan, Turkey
| | - Fehmi Volkan Öztuna
- Department of Orthopedics and Traumatology, Mersin University, School of Medicine, Mersin, Turkey
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Zadik Y, Ganor Y, Rimon O, Bersudski E, Meirovitz A. Assessment of jaw osteonecrosis diagnostic criteria in cancer patients with a history of radiation therapy and exposure to bone-modifying agents. Radiother Oncol 2020; 156:275-280. [PMID: 33373641 DOI: 10.1016/j.radonc.2020.12.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 12/15/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Osteoradionecrosis (ORN) of the jaw is currently defined by the development of osteonecrosis in head/neck irradiated patients, regardless of lesion exposure. To diagnose medication-related osteonecrosis of the jaw (MRONJ), a history of any radiation therapy to the jaw region must be ruled out. The aim of this study was to assess the accuracy of current osteonecrosis criteria, while introducing new modifications for improved diagnosis and treatment. METHODS One hundred and forty-one necrotic lesions were analyzed from patients exposed to bone-modifying agents (BMAs) and/or received head and neck regional radiation therapy, where the maximal dose of radiation exposure to the jaw osteonecrosis site was calculated. Modified diagnostic criteria were used to reassess all cases and a comparison of outcomes was performed using Pearson's Chi-Square/Fisher's exact test. RESULTS Only in patients with primary head and neck carcinomas did the maximal mean radiation dose in the necrotic jaw site reach ranges associated with ORN formation (>40 Gy), with individual cases showing exposures as low as 0-2 Gy. Based on the modified diagnostic criteria almost 2/3 of the necrotic cases diagnosed as ORN should be diagnosed as MRONJ. CONCLUSIONS ORN diagnosis should only be considered in cases of radiation exposure >40 Gy to prevent misdiagnosis and suboptimal treatment. A modified criterion for MRONJ diagnosis is recommended where radiation exposure <40 Gy in the necrotic site is included. In cases with exposure >40 Gy and BMA administration, an additional modification to diagnostic criteria of 'medication- and radiation-related osteonecrosis of the jaw', should be used.
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Affiliation(s)
- Yehuda Zadik
- Department of Military Medicine, Faculty of Medicine, Hebrew University of Jerusalem, Israel; Department of Oral Medicine, Hebrew University-Hadassah School of Medicine, Jerusalem, Israel.
| | - Yotam Ganor
- Dental Branch, Medical Corps, Israel Defense Forces, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Ori Rimon
- Dental Branch, Medical Corps, Israel Defense Forces, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Evgeniya Bersudski
- Sharett Institute of Oncology, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Amichay Meirovitz
- Sharett Institute of Oncology, Hebrew University-Hadassah Medical Center, Jerusalem, Israel.
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Dang LHN, Kim DY, Lee KB. Total Loss of the Intermediate Cuneiform by Posttraumatic Avascular Necrosis: A Case Report. J Am Podiatr Med Assoc 2020; 110:447704. [PMID: 33179061 DOI: 10.7547/19-120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We report a unique case of the total loss of the intermediate cuneiform by posttraumatic avascular necrosis resulting from a left foot open fracture and dislocation of the navicular bone and medial and intermediate cuneiforms at the Chopart and Lisfranc joints in a 64-year-old woman. The injury was managed with open reduction and internal fixation with Kirschner wires and cannulated screws. During postoperative follow-up, we observed avascular necrosis of the intermediate cuneiform and the total loss of the bone. An extensive English literature search revealed only one case report published on this topic. Thus, we provide this case study to help guide clinical decision making in the future.
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Wustrack R, Rao SS, Morris CD. Musculoskeletal Effects of Cancer and Cancer Treatment. J Am Acad Orthop Surg 2020; 28:e716-e728. [PMID: 32769720 DOI: 10.5435/jaaos-d-18-00491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Improvements in cancer treatment have led to prolonged survival and increased rates of cure. An estimated 14 million cancer survivors live in the United States. The cornerstones of cancer treatment, including radiation, chemotherapy, and surgery, give rise to a host of chronic health conditions, some of which affect the musculoskeletal system. As survivorship continues to improve, orthopaedic surgeons across all subspecialties will be tasked with managing these complications of treatment. This article reviews orthopaedic health concerns secondary to cancer treatment that are likely to present to orthopaedic surgeons for evaluation, such as osteoporosis, osteonecrosis, secondary malignancies, radiation-associated fractures, exercise tolerance, and perioperative evaluation.
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Affiliation(s)
- Rosanna Wustrack
- From the Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA (Dr. Wustrack), and the Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD (Dr. Rao and Dr. Morris)
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