Radiological diagnosis of prevalent osteoporotic vertebral fracture on radiographs: an interim consensus from a group of experts of the ESSR osteoporosis and metabolism subcommittee

When a low-energy trauma induces an acute vertebral fracture (VF) with clinical symptoms, a definitive diagnosis of osteoporotic vertebral fracture (OVF) can be made. Beyond that, a "gold" radiographic standard to distinguish osteoporotic from non-osteoporotic VFs does not exist. Fracture-shaped vertebral deformity (FSVD) is defined as a deformity radiographically indistinguishable from vertebral fracture according to the best of the reading radiologist's knowledge. FSVD is not uncommon among young populations with normal bone strength. FSVD among an older population is called osteoporotic-like vertebral fracture (OLVF) when the FSVD is likely to be associated with compromised bone strength. In more severe grade deformities or when a vertebra is collapsed, OVF diagnosis can be made with a relatively high degree of certainty by experienced readers. In "milder" cases, OVF is often diagnosed based on a high probability rather than an absolute diagnosis. After excluding known mimickers, singular vertebral wedging in older women is statistically most likely an OLVF. For older women, three non-adjacent minimal grade OLVF (< 20% height loss), one minimal grade OLVF and one mild OLVF (20-25% height loss), or one OLVF with ≥ 25% height loss, meet the diagnosis of osteoporosis. For older men, a single OLVF with < 40% height loss may be insufficient to suggest the subject is osteoporotic. Common OLVF differential diagnoses include X-ray projection artifacts and scoliosis, acquired and developmental short vertebrae, osteoarthritic wedging, oncological deformities, deformity due to high-energy trauma VF, lateral hyperosteogeny of a vertebral body, Cupid's bow, and expansive endplate, among others.

Parameters That Can Be Used to Quantify Reduction Accuracy in Talar Neck Fractures and Malunions: A PRISMA-Compliant Scoping Review and Meta-Analysis

Understanding the three-dimensional anatomy of the talar neck is essential in assessing the accuracy of reduction in talar neck fractures as well as for planning surgical correction for talar malunions. However, the geometrical parameters that describe this anatomy are sparsely reported in the orthopedics literature. We aimed to identify from the existing literature, geometrical parameters that describe the anatomy of the talar neck, determine how these are measured, and their normative values. A scoping literature review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews (PRISMA-ScR) guidelines. The primary searches were conducted on the PubMed, Embase, and Scopus databases. Any original research study looking at the human talus neck geometry was included. Parameters that described the anatomy of the talar neck were identified, and pooled estimates were determined by the random-effects meta-analysis model. Heterogeneity was assessed by the I2 test and leave-one-out meta-analysis. Subgroup analysis was done to compare the values of parameters between the Asian and Non-Asian populations. The risk of bias was assessed by the National Institutes of Health (NIH) Case Series Tool. The combined searches yielded 6326 results, of which 21 studies were included in the review and 15 in six different sets of metanalysis. The majority of the studies (n=19, 90.5%) evaluated adult tali, and only two (9.5%) evaluated pediatric tali. In most of the studies (n=13, 61.9%), talus neck geometry was evaluated on dry bones or anatomical specimens; evaluation by imaging techniques (radiographs, CT, MRI, and radiostereometric analysis) was used in eight studies, (39.1%). A total of eight different geometrical parameters (neck length, height, width, declination angle, inclination angle, torsion angle, circumference, and cross-sectional area) were identified. Except for talar torsion, variability was noted in methods of measurement of all other parameters. Subgroup analysis revealed that Asians had a higher neck height as compared to non-Asians; other parameters were not significantly different. Although the literature reports geometrical parameters to assess the talar geometry, the methods of measurement of these parameters are variable. Most of the available literature describes measurement techniques on cadaveric tali, and there is no literature on how these parameters should be measured on conventional CT or MRI slices. Further research needs to focus on the standardization of measurement techniques for these parameters on conventional CT and/or MRI scans.

Exploration of novel hydroxamate zinc binding group inhibitors against HDAC-1-3 enzymes by AI-based virtual screening: atomistic insights from steered molecular dynamics

Overexpression of histone deacetylase (HDAC) enzymes is linked to a wide variety of illnesses, including malignancies and neurological disorders, which makes HDAC inhibitors potentially therapeutic. However, most HDAC inhibitors lack subclass or isoform selectivity, which can be dangerous. Featuring both enhanced selectivity and toxicity profiles, slow-binding HDAC inhibitors offer promising treatment options for a variety of disorders. Diseases like cardiac, neurodegenerative disorders and diabetes are mainly associated with the HDAC1, HDAC2 and HDAC3 enzymes. The AI-based virtual screening tool PyRMD is implemented to identify the potential inhibitors from ∼2 million compounds. Based on the IC50 values, the top 10 compounds were selected for molecular docking. From the docking and ADMET study, the top-ranked three compounds were selected for molecular dynamics (MD) simulations. Further, to get more insights into the binding/unbinding mechanism of the ligand, we have employed the steered molecular dynamics (SMD) simulations. This study assists in developing Amber force field parameters for the HDAC1, HDAC2 and HDAC3 proteins and sheds light on the discovery of a potent drug. Our study suggests that hydroxamic acid derivative (i.e. referred to as Comp-1, CHEMBL600072) is the potential inhibitor for the series of HDAC-related diseases.Communicated by Ramaswamy H. Sarma.

MRI in shoulder arthropathies: A short review

Arthropathies are a frequent cause of shoulder pain and comprise of a wide range of clinical entities that may pose a diagnostic challenge. Though history and clinical examination remain vital, imaging plays a pivotal role in accurate diagnosis. Magnetic resonance imaging (MRI) remains an invaluable tool for imaging evaluation of shoulder involvement by various arthropathies. With attention to characteristic imaging features, radiologist may be able to differentiate between various disease processes affecting the shoulder joint. In this article, we have provided a brief review of common and uncommon MRI manifestations of various arthropathies affecting the shoulder joint.

Safety and Efficacy of Genicular Artery Embolization for the Treatment of Knee Pain Secondary to Osteoarthritis-Initial Indian Experience

Background  Osteoarthritis (OA) is the commonest form of arthritis with pain and disability as hallmark symptoms. Despite various nonpharmacologic, pharmacologic, and surgical approaches, pain control may be hard to achieve. Over the last few years, few studies have been conducted on managing knee OA using novel endovascular genicular artery embolization (GAE) with varied outcomes. No such study has been reported in India yet to the best of our knowledge. Purpose  The main aim of this article was to evaluate the efficacy and safety of transcatheter GAE in relieving knee pain in patients with mild-to-moderate OA. Materials and Methods  Ten patients with radiographic knee OA and moderate-to-severe pain refractory to conservative therapy were enrolled in a prospective observational study. GAE was performed with 100 to 300-μm spherical particles. Patients were assessed with magnetic resonance imaging at the baseline. Visual analog scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were used to assess pain and disability respectively at the baseline, 1 month, and 3 months. Clinical success was asserted by the downstaging of VAS and WOMAC scores. Adverse events were recorded at all-time points. Descriptive and inferential statistics have been performed using SPSS. A p -Value less than 0.05 was considered statistically significant. Results  Embolization of at least 1 genicular artery was achieved in all the patients (100%). Clinical success was demonstrated in 08 (80%) of the patients. Median VAS reduced from 07 at baseline to 3.5 at 3-month follow-up ( p  < 0.001). Median WOMAC score improved from 53 to 23.50 at 3-month follow-up ( p  < 0.001). Minor complications were seen in two patients in the form of puncture site hematoma and mild petechial spots over the knee. Conclusion  Our pilot study demonstrates GAE as a safe and efficacious procedure to treat knee pain secondary to OA. Further randomized comparative studies with a larger sample size are needed to determine the true treatment effect versus the placebo effect.

A novel WGF-LN based edge driven intelligence for wearable devices in human activity recognition

Human activity recognition (HAR) is one of the key applications of health monitoring that requires continuous use of wearable devices to track daily activities. The most efficient supervised machine learning (ML)-based approaches for predicting human activity are based on a continuous stream of sensor data. Sensor data analysis for human activity recognition using conventional algorithms and deep learning (DL) models shows promising results, but evaluating their ambiguity in decision-making is still challenging. In order to solve these issues, the paper proposes a novel Wasserstein gradient flow legonet WGF-LN-based human activity recognition system. At first, the input data is pre-processed. From the pre-processed data, the features are extracted using Haar Wavelet mother- Symlet wavelet coefficient scattering feature extraction (HS-WSFE). After that, the interest features are selected from the extracted features using (Binomial Distribution integrated-Golden Eagle Optimization) BD-GEO. The important features are then post-processed using the scatter plot matrix method. Obtained post-processing features are finally given into the WGF-LN for classifying human activities. From these experiments, the results can be obtained and showed the efficacy of the proposed model.

MDCT evaluation of distal radius fractures and their association with carpal and distal ulnar fractures

PURPOSE

The purpose of this study was to evaluate the characteristics of distal radius fractures (DRFs) in patients undergoing multi-detector computed tomography (MDCT) and their association with carpal and distal ulnar fractures.

METHODS

This retrospective study analyzed 120 patients, who underwent MDCT for evaluation of DRFs. Two radiologists independently evaluated the data for various fracture characteristics and for associated carpal and distal ulnar fractures.

RESULTS

Out of 120 DRFs, 74 were complete articular, 40 were partial articular and only 6 were extra-articular. Displacement was present in 99 fractures and intra-articular step off was present in 73 fractures. A total of 81 carpal bone fractures were identified in 46 (38.3%) patients, with more than one carpal bone fracture in 21 patients. Distal ulnar fractures were detected in 79 patients (65.8%), out of which 67 involved the ulnar styloid. DRFs with intra-articular step off were more frequently associated with carpal bone fracture (p value: 0.021), while displaced DRFs were more frequently associated with distal ulnar fracture (p value <0.001). Interobserver agreement for detection of carpal bone fractures (κ = 0.807) and distal ulnar fractures (κ = 0.923) was excellent.

CONCLUSION

Majority of DRFs in patients referred for MDCT were complete articular with high incidence of displacement and intra-articular step off. Associated carpal bone and distal ulna fractures were not uncommon.

Entropy Study of Hybrid (Al2O3–Cu/H2O) Nano-Fluid in a Cylindrical Cavity with Wavy Sides Under the Effect of a Parallel Magnetic Field

The convection and entropy of a hybrid nanofluid were investigated in a cylindrical chamber. Inside the cylinder, we have added a rectangular fin with a temperature of Th. Tc applied on the right waving wall. Insulation installed on both the top and bottom walls. The induction of a steady magnetic field is included in this research. Governing equations are resolved by Galerkin finite element method (GFEM) and it’s utilized to treat the controlling equations obtained by giving different characteristics of fluid like The porosity, cylinder rayon and the size of the nano particles with Rayleigh, Hartmann and Darcy numbers. This information is crucial for controlling both fluid flow and the heat transfer rate for normal convection. The results of the solution demonstrate that Da influences the entropy and leads to a decrease in the generation of entropy. The Nusselt mean differs in a straight line with the dynamic. The domain of flows through the sublime modes while it acts contrary with the magnetic force. The use of a rectangular fin inside a cylindrical enclosure rather than traditional ones, as well as the evaluation of its optimal dimensions, was novel in this paper. Moreover, the novelty of this study is that it fills a research gap by looking into the effect of the specific shape of the walls of the porous chamber on heat flux.

Ultrasound and magnetic resonance imaging of hands in systemic sclerosis: A cross-sectional analytical study of prevalence of inflammatory changes in patients with subclinical arthropathy

Objectives

Prevalence of synovitis, tenosynovitis, erosions, acro-osteolysis and bone marrow edema in systemic sclerosis is not extensively reported. We aimed to estimate the prevalence of changes in individual joints of hands in systemic sclerosis patients.

Method

A cross-sectional analytical study consisting of 34 adults (females, n = 32) with systemic sclerosis. Patients with clinical synovitis were excluded. All patients underwent ultrasound (US) and magnetic resonance imaging of bilateral hands.

Results

On US, synovitis, tenosynovitis, erosions, and acro-osteolysis were detected in 97%, 94%, 97%, and 29% patients. Grade I synovitis observed in 67% joints-first carpometacarpal joint (55%), first metacarpophalangeal joint (54%), distal radioulnar joint (50%), and intercarpal joints (47%) were commonly affected. Erosions were common in distal phalanges (first DP72% to fifth DP39%). On magnetic resonance imaging, synovitis, tenosynovitis, erosions, and bone edema were observed in 91%, 85%, 97%, and 85% patients. Grade I synovitis was seen in 70% joints, affecting intercarpal joint (70.6%) and third metacarpophalangeal joint (52.9%) commonly. Grade I erosions were seen in 61%, affecting distal phalanges (55.8%), capitate (60.3%), and lunate (55.8%). Grade I edema was commonly affecting lunate (39%) and capitate (26%). On magnetic resonance imaging, acro-osteolysis was present in 28% (97/340) distal phalanges. Fair agreement (0.21-0.40) was noted between US and magnetic resonance imaging for synovitis and erosions.

Conclusion

High prevalence of low-grade inflammation is found in systemic sclerosis patients on US and magnetic resonance imaging. Distal joint assessment in addition to proximal joints improves accurate estimation of prevalence of early arthropathy.

An Efficient Hybrid Job Scheduling Optimization (EHJSO) approach to enhance resource search using Cuckoo and Grey Wolf Job Optimization for cloud environment

Cloud computing has now evolved as an unavoidable technology in the fields of finance, education, internet business, and nearly all organisations. The cloud resources are practically accessible to cloud users over the internet to accomplish the desired task of the cloud users. The effectiveness and efficacy of cloud computing services depend on the tasks that the cloud users submit and the time taken to complete the task as well. By optimising resource allocation and utilisation, task scheduling is crucial to enhancing the effectiveness and performance of a cloud system. In this context, cloud computing offers a wide range of advantages, such as cost savings, security, flexibility, mobility, quality control, disaster recovery, automatic software upgrades, and sustainability. According to a recent research survey, more and more tech-savvy companies and industry executives are recognize and utilize the advantages of the Cloud computing. Hence, as the number of users of the Cloud increases, so did the need to regulate the resource allocation as well. However, the scheduling of jobs in the cloud necessitates a smart and fast algorithm that can discover the resources that are accessible and schedule the jobs that are requested by different users. Consequently, for better resource allocation and job scheduling, a fast, efficient, tolerable job scheduling algorithm is required. Efficient Hybrid Job Scheduling Optimization (EHJSO) utilises Cuckoo Search Optimization and Grey Wolf Job Optimization (GWO). Due to some cuckoo species' obligate brood parasitism (laying eggs in other species' nests), the Cuckoo search optimization approach was developed. Grey wolf optimization (GWO) is a population-oriented AI system inspired by grey wolf social structure and hunting strategies. Make span, computation time, fitness, iteration-based performance, and success rate were utilised to compare previous studies. Experiments show that the recommended method is superior.

Metaheuristics with Deep Transfer Learning Enabled Detection and classification model for industrial waste management

Rapid industrialization has led to the generation of a considerable amount of waste, both solid and liquid, in industrial fields like food processing, sugar, pulp, sago or starch, dairies, paper, fruit processing, poultry, distilleries, slaughterhouses, tanneries, and so forth. Despite the requirement for pollution control measures, the waste is discharged into water bodies or generally dumped on land without appropriate management, and thus becomes a significant source of environmental pollution and health hazards. The most essential step of waste management is the segregation of waste into the various elements, and normally this process is done automatically by hand-picking. A smart waste material classification technique is required to simplify the procedures. Therefore, the study presents a new Metaheuristics with Deep Transfer Learning Enabled Detection and Classification Methods for Industrial Waste Management (MDTLDC-IWM) method. The presented MDTLDC-IWM model facilitates the use of DL models for the identification and classification of waste materials in the IWM system. To accomplish this, the presented MDTLDC-IWM model follows two key phases, namely waste object recognition and waste object classification. At the initial stage, the YOLO-v5 object detector with the Harris Hawks Optimization (HHO) algorithm is used. Next, in the second stage, the stacked sparse auto encoder (SSAE) model is applied for the waste object classification method. The SSAE model is effectively optimized using the Aquila Optimization Algorithm (AOA), which helps to accomplish maximum classification of waste objects. The MDTLDC-IWM model has achieved a precision of 96.84 percent and an F score of 96.71 percent. A benchmark dataset is used to test the experimental validity of the presented MDTLDC-IWM model. Extensive comparative analysis reported the enhanced performance of the MDTLDC-IWM model over recent state-of-the-art approaches.

Finite Element Methodology of Hybridity Nanofluid Flowing in Diverse Wavy Sides of Penetrable Cylindrical Chamber under a Parallel Magnetic Field with Entropy Generation Analysis

In a cylindrical cavity, the convection and entropy of the hybrid nanofluid were studied. We have introduced a rectangular fin inside the cylinder; the fin temperature is at Th. The right waving wall is cooled to Tc. The upper and lower walls are insulated. This study contains the induction of a constant magnetic field. The Galerkin finite element method (GFEM) is utilized to treat the controlling equations obtained by giving Rayleigh number values between Ra (10³-10⁶) and Hartmann number ratio Ha (0, 25, 50, 100) and Darcy ranging between Da (10^-2-10^-5) and the porosity ratio is ε (0.2, 0.4, 0.6, 0.8), and the size of the nanoparticles is ϕ (0.02, 0.04, 0.06, 0.08). The range is essential for controlling both fluid flow and the heat transport rate for normal convection. The outcomes show how Da affects entropy and leads to a decline in entropy development. The dynamic and Nusselt mean diverge in a straight line. The domain acts in opposition to the magnetic force while flowing. Highest entropy-forming situations were found in higher amounts of Ra, Da, and initial values of Ha. Parameters like additive nanoparticles (ϕ) and porosity (ε) exert diagonal dominant trends with their improving values.

Cloud-based blockchain technology to identify counterfeits

Multi-stakeholder and organizational involvement is an integral part of the medicine supply chain. Keeping track of the activities associated with medical products is difficult when the system is complex. Their complexity limits transparency and data provenance. Deficiencies within existing supply chains result in the counterfeiting of drugs, illegal imports, and inefficient operations. Due to these limitations, product integrity is compromised, resulting in product wastage. Visibility of the entire product supply chain is crucial for the pharmaceutical industry in terms of product safety and reduction of manufacturing costs. The Cloud-based Blockchain-powered architecture of the system provides a platform for addressing the need of pharma-material traceability, data storage, privacy of data, and quality assurance. This framework comprises of the identification of activities through tagging, information sharing in a secure environment; cloud-based storage using an off-chain Interplanetary File System (IPFS) and an on-chain couch DB; and access to this information that is controlled by the system's regulator. Electronic drug records will be accessed via a smart contract in Hyperledger Blockchain. The system assists in identifying false and cross-border products through the manufacturer and country of origin. A scan will identify counterfeit medications, showing that they are unauthorized products which may pose a risk to patients. Our experiments demonstrated the efficiency and usability of the design platform. Finally, we benchmarked the system using Hyperledger Caliper.

Multilevel Annotation of Germline MEN1 Variants of Synonymous, Nonsynonymous, and Uncertain Significance in Indian Patients With Sporadic Primary Hyperparathyroidism

Primary hyperparathyroidism (PHPT) is third most common endocrine disorder characterized by hypercalcemia with elevated or nonsuppressed parathyroid hormone levels by parathyroid tumors. Familial PHPT, as part of multiple endocrine type-1, occurs due to the germline mutation in the MEN1 gene. The involvement and the role of germline MEN1 variations in sporadic PHPT of Indian PHPT patients are unknown. Precise classifications of different types of MEN1 variations are fundamental for determining clinical relevance and diagnostic role. This prospective cohort study was performed on 82 patients with PHPT (with no clinical or history of MEN1) who underwent screening for MEN1 variations through Sanger sequencing. Multilevel computational analysis was performed to determine the structure-function relationship of synonymous, nonsynonymous, and variants of uncertain significance (VUS). Of the 82 PHPT patients, 42 (51%) had 26 germline MEN1 variants, including eight nonsynonymous, seven synonymous, nine VUS, one splice site, and one regulatory variation. Five most common germline variations (c.1838A>G, c.1817C>T, c.1525C>A, c.-35A>T, and c.250T>C) were observed in this study. c.-35A>T (5' untranslated region [UTR]) was associated with recurrence of PHPT (odds ratio [OR] = 5.4; p = 0.04) and subsequent detection of other endocrine tumors (OR = 13.6, p = 0.035). c.1525C>A was associated with multi glandular parathyroid tumor (OR = 13.6, p = 0.035). Align-Grantham variation and Grantham deviation (Align-GVGD), functional analysis through hidden Markov MODEL (FATHMM), and MutationTaster analysis reported the disease-specific potential of VUS and synonymous variations. Significant linkage disequilibrium was observed in c.1785G>A and c.1817C>T (r²  = 0.3859, p = 0.0001), c.1475C>G and c.1525C>A (r²  = 0.385, p = 0.0004), and c.1569T>C and c.1838A>G (r²  = 0.488, p = 0.0001). The detection of MEN1 variations, especially those with disease-specific potential, can prompt early screening for other MEN1-related tumors and disease recurrence. © 2022 American Society for Bone and Mineral Research (ASBMR).

Imaging of Metabolic Bone Diseases: The Spine View, Part II

Metabolic bone diseases comprise a wide spectrum. Osteoporosis, the most frequent, characteristically involves the spine, with a high impact on health care systems and on the morbidity of patients due to the occurrence of vertebral fractures (VFs).Part II of this review completes an overview of state-of-the-art techniques on the imaging of metabolic bone diseases of the spine, focusing on specific populations and future perspectives. We address the relevance of diagnosis and current status on VF assessment and quantification. We also analyze the diagnostic techniques in the pediatric population and then review the assessment of body composition around the spine and its potential application. We conclude with a discussion of the future of osteoporosis screening, through opportunistic diagnosis and the application of artificial intelligence.

Imaging of Metabolic Bone Diseases: The Spine View, Part I

Metabolic bone diseases comprise a wide spectrum. Of them, osteoporosis is the most frequent and the most commonly found in the spine, with a high impact on health care systems and on morbidity due to vertebral fractures (VFs).This article discusses state-of-the-art techniques on the imaging of metabolic bone diseases in the spine, from the well-established methods to the latest improvements, recent developments, and future perspectives.We review the classical features of involvement of metabolic conditions involving the spine. Then we analyze the different imaging techniques for the diagnosis, characterization, and monitoring of metabolic bone disease: dual-energy X-ray absorptiometry (DXA) and DXA-based fracture risk assessment applications or indexes, such as the geometric parameters, Bone Strain Index, and Trabecular Bone Score; quantitative computed tomography; and magnetic resonance and ultrasonography-based techniques, such as radiofrequency echographic multi spectrometry. We also describe the current possibilities of imaging to guide the treatment of VFs secondary to metabolic bone disease.

Role of Shear-Wave Elastography in Achilles Tendon in Psoriatic Arthritis and Its Correlation with Disease Severity Score, Psoriasis Area and Severity Index

Purpose  The aim of this study was to compare accuracy of shear-wave elastography (SWE) with gray scale (GS) ultrasound and power Doppler (pD) for diagnosing Achilles tendinopathy in psoriatic patients with and without arthritis and correlation with achillodynia and disease severity score, psoriasis area and severity index (PASI).

Methods  A total of 100 Achilles tendons were evaluated where 56% were cases of psoriatic arthritis with achillodynia; 44% were controls of psoriasis without arthritis in this prospective study. Evaluation was done with GS, pD, SWE at proximal, mid, and distal third of the tendon. Qualitative (color maps) and quantitative data, elastic modulus, kilopascal (kPa), were generated. Pearson's correlation was done to see association between kPa, PASI and clinical symptoms, achillodynia, scored using visual analog scale (VAS).

Results  Significant negative correlation was seen between duration of arthritis, VAS and PASI with SWE values with r  = −0.34, −0.47, and −0.41, respectively. SWE could identify abnormal tendons in 71/100 (71%) in the overall study, 53/56 (94.6%) in cases, and 18/44 (40.9%) in control. The statistical significance was set at p  ≤ 0.05. In comparison, conventional ultrasound, GS, and pD together could identify 13/56 (23.21%) in cases and no abnormal tendon was identified in the control group.

Conclusion  SWE is a reliable, noninvasive, and valuable tool to detect early tendinopathy and monitor progression of disease.

Clinical indications for image-guided interventional procedures in the musculoskeletal system: a Delphi-based consensus paper from the European Society of Musculoskeletal Radiology (ESSR)-part VII, nerves of the lower limb

OBJECTIVES

To perform a Delphi-based consensus on published evidence on image-guided interventional procedures for peripheral nerves of the lower limb (excluding Morton's neuroma) and provide clinical indications.

METHODS

We report the results of a Delphi-based consensus of 53 experts from the European Society of Musculoskeletal Radiology who reviewed the published literature for evidence on image-guided interventional procedures offered around peripheral nerves in the lower limb (excluding Morton's neuroma) to derive their clinical indications. Experts drafted a list of statements and graded them according to the Oxford Centre for evidence-based medicine levels of evidence. Consensus was considered strong when > 95% of experts agreed with the statement or broad when > 80% but < 95% agreed. The results of the Delphi-based consensus were used to write the paper.

RESULTS

Nine statements on image-guided interventional procedures for peripheral nerves of the lower limb have been drafted. All of them received strong consensus. Image-guided pudendal nerve block is safe, effective, and well tolerated with few complications. US-guided perisciatic injection of anesthetic provides good symptom relief in patients with piriformis syndrome; however, the addition of corticosteroids to local anesthetics still has an unclear role. US-guided lateral femoral cutaneous nerve block can be used to provide effective post-operative regional analgesia.

CONCLUSION

Despite the promising results reported by published papers on image-guided interventional procedures for peripheral nerves of the lower limb, there is still a lack of evidence on the efficacy of most procedures.

KEY POINTS

• Image-guided pudendal nerve block is safe, effective, and well tolerated with few complications. • US-guided perisciatic injection of anesthetic provides good symptom relief in patients with piriformis syndrome; however, the addition of corticosteroids to local anesthetics still has an unclear role. • US-guided lateral femoral cutaneous nerve block can be used to provide effective post-operative regional analgesia. The volume of local anesthetic affects the size of the blocked sensory area.

Heat flow saturate of Ag/MgO-water hybrid nanofluid in heated trigonal enclosure with rotate cylindrical cavity by using Galerkin finite element

MHD Natural convection, which is one of the principal types of convective heat transfer in numerous research of heat exchangers and geothermal energy systems, as well as nanofluids and hybrid nanofluids. This work focuses on the investigation of Natural convective heat transfer evaluation inside a porous triangular cavity filled with silver-magnesium oxide/water hybrid nanofluid [H₂O/Ag-MgO]^hnf under a consistent magnetic field. The laminar and incompressible nanofluid flow is taken to account while Darcy-Forchheimer model takes account of the advection inertia effect in the porous sheet. Controlled equations of the work have been approached nondimensional and resolved by Galerkin finite element technique. The numerical analyses were carried out by varying the Darcy, Hartmann, and Rayleigh numbers, porosity, and characteristics of solid volume fraction and flow fields. Further, the findings are reported in streamlines, isotherms and Nusselt numbers. For this work, the parametric impact may be categorized into two groups. One of them has an effect on the structural factors such as triangular form and scale on the physical characteristics of the important outputs such as fluidity and thermal transfer rates. The significant findings are the parameters like Rayleigh and slightly supported by Hartmann along with Darcy number, minimally assists by solid-particle size and rotating factor as clockwise assists the cooler flow at the center and anticlockwise direction assists the warmer flow. Clear raise in heat transporting rate can be obtained for increasing solid-particle size.

Early versus delayed thromboprophylaxis with LMWH in pelvic-acetabular trauma- a prospective study

BACKGROUND

Delayed presentation of pelvic-acetabular fractures is a common scenario in developing countries and there is usually a delay of more than 24 h in their presentation.

OBJECTIVES

We aim to comparatively analyse early(<24 h) versus delayed (>24 h) thromboprophylaxis with low molecular weight heparin (LMWH) in prevention of deep venous thrombosis (DVT) in Pelvic Acetabular fractures.

METHODS

Patients of pelvic-acetabular fractures who presented during 1 year of study period were divided into 2 groups after exclusion of patients with contraindications for thromboprophylaxis. Group A included patients who received LMWH prophylaxis within 24 h of injury. Group B included patients who received LMWH prophylaxis after 24 h of injury. All patients underwent CT venography at day 14 and were followed up with doppler ultrasound on 4th and 8th week.

RESULTS

110 patients with pelvic-acetabular fractures were included after exclusion of 61 patients. 4 out of 29 patients in group A (13.8%) and 12 out of 81 patients (14.8%) in group B developed DVT. There was no significant difference in incidence of DVT between Group A and B (P value-0.893).

CONCLUSION

There was no difference between early and delayed thromboprophylaxis with LMWH in pelvic-acetabular trauma.

Fragmentation dynamics of CH3Clq+ (q = 2,3): theory and experiment

We use advanced theoretical treatments and energetic ion collision induced fragmentation to investigate the unimolecular decomposition dynamics of CH3Clq+ (q = 2,3) ions, where both obvious bond breaking and bond rearrangement products are observed.

Role of shear wave elastography of synovium to differentiate rheumatoid and tubercular arthritis

Background:

Synovitis is the underlying pathology in various arthritis, and sometimes, it is difficult to differentiate various arthritis clinically or even by imaging. The purpose of our study was to use shear wave elastography (SWE) to evaluate rheumatoid arthritis (RA) and tubercular (TB) arthritis and to differentiate them using synovial stiffness.

Methods:

The prospective study was performed on Supersonic Imagine Aixplorer Ultrasound (USG) machine using a linear array probe SL10-2 (2–10 MHz). A total of 29 participants, 15 of RA (ACR/EULAR criteria) and 14 of proven TB arthritis were included. Region of interest of 1 mm was applied on the hypertrophied synovium and quantitative SWE data in form of elasticity (kPa) and velocity (m/s) were measured. Discrete categorical data were presented as n (%). Mean values were recorded along with standard deviation and the range of values. To find a maximal cutoff value of elasticity and velocity - receiver operating characteristic curve were plotted.

Results:

The mean elasticity and velocity values were 54.81 ± 10.6 kPa and 4.2 m/s ± 0.42 for RA and 37 ± 10 kPa and 3.4 ± 0.47 m/s for TB group. Significant difference (P < 0.001) was seen in elastic modulus values between rheumatoid and TB group with cutoff of 43.6 kPa to differentiate the two groups (sensitivity – 86.7% and specificity – 80%). Similar significant (P < 0.001) results were seen with velocity values, with cutoff of 3.76 m/s (sensitivity – 86.7% and specificity – 80%).

Conclusion:

SWE shows the potential to be a useful adjunct to gray scale and color Doppler USG in differentiating various arthritis on the basis of elastic properties of the synovium. Elastic modulus and velocity are useful SWE quantitative parameters for synovial evaluation and can differentiate RA and TB arthritis.

Baseline renal dysfunction determines mortality following parathyroidectomy in primary hyperparathyroidism: analysis of Indian PHPT registry

INTRODUCTION

Primary hyperparathyroidism (PHPT) in India is mostly symptomatic with renal and skeletal complications. Evidence on mortality outcomes following parathyroidectomy from India, where the disease is predominantly symptomatic is limited.

MATERIAL AND METHODS

This was a prospective study to evaluate mortality outcomes in the Indian PHPT registry over the past 25 years (n = 464). Pre- and postoperative parameters and mortality data were obtained from medical records and/or by verbal autopsy, a method validated by WHO for data collection in settings where several deaths are noninstitutional. Patients were divided into survivor (SG) and nonsurvivor groups (NSG) to ascertain differences in presentation and the effect of parathyroidectomy.

RESULTS

The overall mortality was 8.8% at a median follow-up of 8 years (IQR 1-13) after parathyroidectomy. Chronic kidney disease was the most common background cause of death (43.5%), followed by pancreatitis (28.2%). NSG had significantly more frequent renal dysfunction (91.9% vs 73.9%), anaemia (50 vs 16.6%) and pancreatitis (24.3 vs 6.4%). PTH (61.9 vs 38.3 pmol/l) and baseline creatinine (97.2 vs 70.7 µmol/l) were significantly higher and eGFR lower (66.7 vs 90.7 ml/min/1.73m²) in the NSG than SG. By Cox proportional modelling, renal dysfunction [HR 2.88 (1.42-5.84)], anaemia [HR 2.45 (1.11-5.42)] and pancreatitis [HR 2.65 (1.24-5.66)] on univariate and renal dysfunction [HR 3.33 (1.13-9.77)] on multivariate analysis were significant for mortality. Survival curves demonstrated a significantly higher mortality with lower eGFR values.

CONCLUSIONS

Nonsurvivors in PHPT had greater prevalence and more severe baseline renal dysfunction than survivors. Survival after parathyroidectomy was significantly associated with estimated glomerular filtration rate at baseline.

Clinical indications for image-guided interventional procedures in the musculoskeletal system: a Delphi-based consensus paper from the European Society of Musculoskeletal Radiology (ESSR)-part VI, foot and ankle

Objectives

Clarity regarding accuracy and effectiveness for interventional procedures around the foot and ankle is lacking. Consequently, a board of 53 members of the Ultrasound and Interventional Subcommittees of the European Society of Musculoskeletal Radiology (ESSR) reviewed the published literature to evaluate the evidence on image-guided musculoskeletal interventional procedures around this anatomical region.

Methods

We report the results of a Delphi-based consensus of 53 experts from the European Society of Musculoskeletal Radiology who reviewed the published literature for evidence on image-guided interventional procedures offered around foot and ankle in order to derive their clinical indications. Experts drafted a list of statements and graded them according to the Oxford Centre for evidence-based medicine levels of evidence. Consensus was considered strong when > 95% of experts agreed with the statement or broad when > 80% but < 95% agreed. The results of the Delphi-based consensus were used to write the paper that was shared with all panel members for final approval.

Results

A list of 16 evidence-based statements on clinical indications for image-guided musculoskeletal interventional procedures in the foot and ankle were drafted after a literature review. The highest level of evidence was reported for four statements, all receiving 100% agreement.

Conclusion

According to this consensus, image-guided interventions should not be considered a first-level approach for treating Achilles tendinopathy, while ultrasonography guidance is strongly recommended to improve the efficacy of interventional procedures for plantar fasciitis and Morton’s neuroma, particularly using platelet-rich plasma and corticosteroids, respectively.

Key Points

• The expert panel of the ESSR listed 16 evidence-based statements on clinical indications of image-guided musculoskeletal interventional procedures in the foot and ankle.

• Strong consensus was obtained for all statements.

• The highest level of evidence was reached by four statements concerning the effectiveness of US-guided injections of corticosteroid for Morton’s neuroma and PRP for plantar fasciitis.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00330-021-08125-z.

Identification of a Grotthuss proton hopping mechanism at protonated polyhedral oligomeric silsesquioxane (POSS) - water interface

The attachment and dissociation of a proton from a water molecule and the proton transfers at solid-liquid interfaces play vital roles in numerous biological, chemical processes and for the development of sustainable functional materials for energy harvesting and conversion applications. Using first-principles computational methodologies, we investigated the protonated forms of polyhedral oligomeric silsesquioxane (POSS-H⁺) interacting with water clusters (W_n, where n = 1-6) as a model to quantify the proton conducting and localization ability at solid-liquid interfaces. Successive addition of explicit water molecules to POSS-H⁺ shows that the assistance of at least three water molecules is required to dissociate the proton from POSS with the formation of an Eigen cation (H₉O₄⁺), whereas the presence of a fourth water molecule highly favors the formation of a Zundel ion (H₅O₂⁺). Reaction pathway and energy barrier analysis reveal that the formation of the Eigen cation requires significantly higher energy than the Zundel features. This confirms that the Zundel ion is destabilized and promptly converts in to Eigen ion at this interface. Moreover, we identified a Grotthuss-type mechanism for the proton transfer through a water chain close to the interface, where symmetrical and unsymmetrical arrangements of water molecules around H⁺ of protonated POSS-H⁺ are involved in the conduction of proton through water wires where successive Eigen-to-Zundel and Zundel-to-Eigen transformations are observed in quick succession.

Methods to address metal artifacts in post-processed CT images - A do-it-yourself guide for orthopedic surgeons

Computed tomography (CT) scans are often used for postoperative imaging in orthopedics. In the presence of metallic hardware, artifacts are generated, which can hamper visualization of the CT images, and also render the study ineffective for 3-D printing. Various solutions are available to minimize metal artifacts, and radiologists can employ these before or after processing the CT study. However, the orthopedic surgeon may be faced with situations where the metal artifacts were not addressed. To counter such problems, we present three do-it-yourself (DIY) techniques that can be used to manage metal artifacts.

Role of shear wave elastography in treatment follow-up of leprosy neuropathy

PURPOSE

Grayscale ultrasonography when complemented with shear wave elastography helps in better evaluation of treatment response of leprosy neuropathy and in guiding appropriate management of the patient. There is limited literature regarding the use of shear wave elastography in ulnar nerve neuropathy. Our purpose was to evaluate the role of shear wave elastography in assessing stiffness changes within the ulnar nerve during treatment of leprosy.

METHODS

This was a prospective study which included 30 patients diagnosed with leprosy neuropathy. Recruited patients were followed up, during the course of treatment, i.e. for 1 year. Serial ultrasonography of these patients was done at 0, 3, 6 and 12 months interval.

RESULTS

Significant (P < 0.05) decrease in elastography parameters was seen in transverse imaging plane between first and third, as well as first and fourth visits (mean stiffness and velocity pretreatment ~ 25.78 ± 18 kPa and 2.74 ± 0.98 m/s, mean stiffness and velocity post-treatment 15.67 ± 5.89 kPa and 2.24 ± 0.428 m/s). Although elastography parameters decreased during these visits in the long-axis imaging plane, they were not found to be statistically significant. However, gross morphology and cross-sectional area of the nerve did not change significantly across visits. Interestingly, elastography values were higher in patients with neuritis, though not statistically significant.

CONCLUSION

Shear wave elastography is a novel, upcoming modality in musculoskeletal imaging especially in the evaluation of peripheral neuropathy. It can act as an adjunct to grey-scale imaging, which can help in early diagnosis and in guiding treatment of leprosy neuropathy.

Primary elbow osteoarthritis presenting as ulnar nerve palsy with claw hand

A 59-year-old woman was referred with weakness, paraesthesia, numbness and clawing of the little and ring fingers for the last 2 years. MRI of the cervical spine was normal and nerve conduction velocity revealed abnormality of the ulnar nerve. Ultrasound and MRI showed medial osteophytes and effusion of the elbow joint with stretched and thinned ulnar nerve in the cubital tunnel. The patient underwent release and anterior transposition of the ulnar nerve with significant relief of symptoms.

Evaluation through outbreak simulation exercise points to the need for considerable improvement in the capacity of peripheral health workers for outbreak detection and response, South India, 2018

Background:

Outbreaks are emergencies, requiring skilled peripheral health workers in the health system. Given the lack of evaluation of the knowledge and practices of peripheral health workers regarding outbreak investigation and response, we surveyed to estimate the performance level of health workers in outbreak detection and response.

Methods:

We developed a simulation exercise based on hepatitis and fever outbreak to ascertain knowledge and skills in outbreak detection and response. Following a pilot test and with inputs from public health experts, we finalized the instrument in the local language. The simulation exercise was self-administered among all health inspectors (HI) (n = 39) from a district in South India responsible for outbreak investigation. We collected sociodemographic factors, training, education level, awareness about the surveillance program, outbreak triggers, and prior experience with an outbreak. We assigned a score of 0.25 for each correct response (range 0 to 10.75). We categorized a score of <75% as poor performance. The academic ethics committee of ICMR-National Institute of Epidemiology approved the protocol.

Results:

All the HIs were male except one. Median age is 51 years (Range: 37.5–54). The median years of service is 12 (range 5.3 to 23). Twenty-two received training, and fifteen had prior exposure to an outbreak in the previous year. The overall performance of HIs was poor, with the highest mark being below 40%. The median score in the section of history taking was 0.25 [interquartile range (IQR) 0–0.5], 31% (n = 12) scored zero. The median score in the section of data entry, analysis, and outbreak detection was 0.25 (0–0.25), 28% (n = 11) scored zero. The median score in the section of outbreak response was 0.75 (IQR 0.75–1.13), 5% (n = 2) scored zero.

Conclusion:

The HIs performed poorly in outbreak preparedness and response. We recommend improving their performance through field-epidemiology training and regular field or facility-based evaluations.

Eumycetoma of the Foot due to Fusarium solani in a Person with Diabetes Mellitus: Report of a Case and Review of Literature

Eumycetomas are chronic suppurative granulomas caused by fungi characterised by invasive tumefactive lesions, sinuses and discharging grains. Herein, we describe a case of pedal eumycetoma due to Fusarium solani sensu stricto in a person with diabetes mellitus. A 45-year-old gentleman presented with an insidious onset swelling over his right foot with nodules and discharging grains. He had received itraconazole and anti-tuberculous therapy elsewhere, without response. Re-evaluation included a biopsy which confirmed eumycetoma and newly diagnosed diabetes. Surgical excision followed by histopathological, microbiological and multigene sequencing analyses [translation elongation factor, calmodulin and internal transcribed spacer region of rDNA] of the mould on culture were performed. Histopathology revealed septate fungal hyphae amidst a dense inflammatory infiltrate (Splendore-Hoeppli) reaction. Oral voriconazole was started and good glycemic control attained. Tissue growth sequences showed > 99% similarity with Fusarium solani sensu stricto. Antifungal susceptibility testing showed lowest MIC to voriconazole (0.5 mg/L). The patient showed excellent response to combined therapeutic modality with a near-complete resolution in size of lesion and obliteration of sinuses following 4 months of therapy and is planned for prolonged voriconazole therapy till complete radiological resolution. Diabetes predisposes to fungal infections of foot but eumycetomas are uncommon. Combined surgery and antifungals can improve morbidity and avoid amputations.

Machine learning augmented near-infrared spectroscopy: In vivo follow-up of cartilage defects

OBJECTIVE

To assess the potential of near-infrared spectroscopy (NIRS) for in vivo arthroscopic monitoring of cartilage defects.

METHOD

Sharp and blunt cartilage grooves were induced in the radiocarpal and intercarpal joints of Shetland ponies and monitored at baseline (0 weeks) and at three follow-up timepoints (11, 23, and 39 weeks) by measuring near-infrared spectra in vivo at and around the grooves. The animals were sacrificed after 39 weeks and the joints were harvested. Spectra were reacquired ex vivo to ensure reliability of in vivo measurements and for reference analyses. Additionally, cartilage thickness and instantaneous modulus were determined via computed tomography and mechanical testing, respectively. The relationship between the ex vivo spectra and cartilage reference properties was determined using convolutional neural network.

RESULTS

In an independent test set, the trained networks yielded significant correlations for cartilage thickness (ρ = 0.473) and instantaneous modulus (ρ = 0.498). These networks were used to predict the reference properties at baseline and at follow-up time points. In the radiocarpal joint, cartilage thickness increased significantly with both groove types after baseline and remained swollen. Additionally, at 39 weeks, a significant difference was observed in cartilage thickness between controls and sharp grooves. For the instantaneous modulus, a significant decrease was observed with both groove types in the radiocarpal joint from baseline to 23 and 39 weeks.

CONCLUSION

NIRS combined with machine learning enabled determination of cartilage properties in vivo, thereby providing longitudinal evaluation of post-intervention injury development. Additionally, radiocarpal joints were found more vulnerable to cartilage degeneration after damage than intercarpal joints.

Prognostic Role of Measurement of Renal Resistive Index in Systemic Sclerosis

Objective:

The spectrum of vascular involvement in systemic sclerosis (SSc) includes digital ulcers, gangrene, Raynaud’s phenomenon, renovascular disease, and pulmonary hypertension (PH). Recognition of markers of subclinical vascular disease in SSc is an area of active research, but such studies are limited. This study assesses the role of measurement of the renal resistive index (RRI) as an early marker of renal and systemic vasculopathy. It is a step forward towards examining the possibility of a “unified vascular phenotype’ in SSc.

Methods:

In this single-centre prospective study, RRI was calculated for SSc patients >18 years age. Elevated RRI (>0.7) was correlated with renal function (eGFR and proteinuria) and systemic vasculopathy manifestations like digital ulcers, digital infarcts, and PH.

Results:

A total of 73 patients with mean (SD) age 41.8(10.9) years were included. Mean (SD) RRI in the right and left renal artery was 0.65(0.08) and 0.66(0.07), respectively. 16 (21.9%) patients had elevated RRI (>0.7). A strong negative correlation was noted between elevated RRI and eGFR (r= −0.96, p=0.03). The percentage of patients with overt proteinuria was higher in the group with elevated RRI (20% versus 7%) (p=0.16). Similarly, digital ulcers (56% vs 33%) and digital pitting (50% vs 35%.) were numerically higher in the group with raised RRI, although statistical significance was not reached because of small numbers (p=0.09 and 0.28, respectively). No correlation of RRI with PH was identified.

Conclusion:

RRI correlates well with asymptomatic renal dysfunction and holds promise in the assessment of systemic vasculopathy. However, validation in studies with a larger sample size is needed.

Combining Platelet-Rich Plasma Instillation With Core Decompression Improves Functional Outcome and Delays Progression in Early-Stage Avascular Necrosis of Femoral Head: a 4.5- to 6-Year Prospective Randomized Comparative Study

BACKGROUND

Avascular necrosis of femoral head is a debilitating disease frequently progressing to femoral head collapse and joint destruction. The efficacy of core decompression (CD) remains controversial.

METHODS

About 40 consecutive age-matched and gender-matched patients (53 hips) were randomized into 2 groups by computer-generated algorithm table in a prospective randomized double-blinded comparative study. Group A (platelet-rich plasma [PRP] with CD) included 19 patients (25 hips), and group B (CD only) included 21 patients (28 hips). Postoperative Harris Hip Score and magnetic resonance imaging to quantify the necrotic area by using modified Kerboul angle were done and evaluated. Mean follow-up was 64.3 months (range, 54-72) and 63.7 months (range, 56-72) in groups A and B, respectively.

RESULTS

There was statistically significant difference between PRP and control groups in pain score (P = .00), functional score (P = .02), and Harris Hip Score (P = .00) at final follow-up. There was no progression in stage 1 disease. Stage 2 disease showed 24% progression in group A and 43% progression in group B. The difference was statistically significant (P = .025). Survivorship from femoral head collapse, any procedure, and total hip arthroplasty was 84%/68% (P = .00), 76%/57% (P = .02), and 92%/78% (P = .01) in 2 groups, which was statistically significant.

CONCLUSION

PRP use after CD provides significant pain relief, better midterm functional outcome, retards the progression, and enhances the survivorship free from reoperation for hip arthroplasty and femoral head collapse in early stages of avascular necrosis of hip than CD alone.

Structured Optimal Graph-Based Clustering With Flexible Embedding

In the real world, the duality of high-dimensional data is widespread. The coclustering method has been widely used because they can exploit the co-occurring structure between samples and features. In fact, most of the existing coclustering methods cluster the graphs in the original data matrix. However, these methods fail to output an affinity graph with an explicit cluster structure and still call for the postprocessing step to obtain the final clustering results. In addition, these methods are difficult to find a good projection direction to complete the clustering task on high-dimensional data. In this article, we modify the flexible manifold embedding theory and embed it into the bipartite spectral graph partition. Then, we propose a new method called structured optimal graph-based clustering with flexible embedding (SOGFE). The SOGFE method can learn an affinity graph with an optimal and explicit clustering structure and does not require any postprocessing step. Additionally, the SOGFE method can learn a suitable projection direction to map high-dimensional data to a low-dimensional subspace. We perform extensive experiments on two synthetic data sets and seven benchmark data sets. The experimental results verify the superiority, robustness, and good projection direction selection ability of our proposed method.

Cytomorphometric Study of Changes in Buccal Mucosal Cells in Alcoholics

Background:

Chronic alcohol consumption carries a high risk for oral and pharyngeal cancers among persons who have never smoked. Excessive alcohol consumption displays cytogenetic changes in oral mucosa cells. Cytomorphometric analysis of oral mucosal cells helps in the early detection of cytomorphological transformations in alcoholics before and after the onset of carcinoma.

Materials and Methods:

A prospective, hospital-based, comparative study was done after written informed consent. Smears were obtained from the clinically normal buccal mucosa of 102 randomly selected alcoholic patients attending the medicine outpatient department aged above 25 years who consumed a minimum of 45 ml alcohol per day for at least 10 years and of 102 nonalcoholics as control. The slides were immediately fixed in absolute methanol and stained by the Papanicolaou (Pap) staining technique. PAP-stained smears were examined under the light microscope. Using the image J 1.47 image analysis software, a morphometric analysis of around 50 cells/case was done.

Results:

A statistically significant increase in mean cytoplasmic area (P < 0.001), mean nuclear area (P < 0.01), and cell-to-nuclear parameter ratio (P < 0.001) was seen in the alcohol group in comparison with the control group.

Conclusion:

Prolonged consumption of alcohol produces cytomorphometric changes in buccal mucosal cells before the onset of premalignant lesions.

Patellar Osteoid Osteoma as a Cause of Intractable Anterior Knee Pain - A Case Report and Systematic Review of Literature

Introduction:

Patellar involvement by osteoid osteoma is very rare. Osteoid osteomas that present as anterior knee pain are frequently misdiagnosed which leads to initial delay in treatment. Plain radiology has poor diagnostic yield. A combination of high index of suspicion, appropriate imaging, and complete ablation of the lesion is necessary to achieve good outcomes.

Case Report:

A 16-year-old male presented with insidious onset anterior knee pain for the past 2 years. The pain was intermittent and mild; however, it increased progressively in intensity and frequency, which was worse at night. Examination reveals minimal effusion in the suprapatellar pouch, full range of motion of the knee, and wasting of the quadriceps. Serum biochemistry parameters were in normal limits. Plain radiographs did not reveal any significant abnormality. On magnetic resonance imaging, a hypointense, punctate lesion surrounded by a small hyperintense zone was noted at medial aspect of patella. A computed tomography scan showed the lesion with a central nidus, surrounded by a sclerotic rim, confirming the diagnosis of osteoid osteoma. Radiofrequency ablation was carried out without any post-procedural complications. The patient was pain free a few days after the procedure. At 14-month follow-up, there was no recurrence of symptoms.

Conclusion:

Osteoid osteomas that present as anterior knee pain are frequently misdiagnosed. Plain radiology has poor diagnostic yield. A combination of high index of suspicion, appropriate imaging, and complete ablation of the lesion is necessary to achieve good outcomes.