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Sample records for calcaneal osteomyelitis presenting

  1. Delayed recognition of pediatric calcaneal osteomyelitis: a case report

    OpenAIRE

    Mallia, Alvin James; Ashwood, Neil; Arealis, Georgios; Bindi, Frank; Zamfir, Georgiana; Galanopoulos, Ilias

    2015-01-01

    Introduction The diagnosis of calcaneal osteomyelitis is a challenge, and diagnostic delays have been reported in the literature. The progression is often indolent, laboratory results commonly fail to reveal an underlying infectious process and radiographs changes are seen after 7 days. We discuss the literature on the diagnosis and treatment of calcaneal osteomyelitis which can result in long-term sequelae in the pediatric patient. Case presentation A 9-year-old white boy presented to our in...

  2. Calcaneal Osteomyelitis due to Non-tuberculous Mycobacteria: A Case Report

    Science.gov (United States)

    Yi, Tae-Im; Choe, Yeo-Reum; Kim, Joo-Sup; Kwon, Kye-Won

    2016-01-01

    Osteomyelitis is a bone infection caused by bacteria or other germs. Gram-positive cocci are the most common etiological organisms of calcaneal osteomyelitis; whereas, non-tuberculous mycobacteria (NTM) are rarely documented. We reported a case of NTM calcaneal osteomyelitis in a 51-year-old female patient. She had been previously treated in many local clinics with multiple local steroid injection over 50 times and extracorporeal shock-wave therapy over 20 times with the impression of plantar fasciitis for 3 years prior. Diagnostic workup revealed a calcaneal osteomyelitis and polymerase chain reaction assay on bone aspirate specimens confirmed the diagnosis of non-tuberculous mycobacterial osteomyelitis. The patient had a partial calcanectomy with antitubercular therapy. Six months after surgery, a follow-up magnetic resonance imaging showed localized chronic osteomyelitis with abscess formation. We continued anti-tubercular therapy without operation. At 18-month follow-up after surgery and comprehensive rehabilitation therapy, she was ambulating normally and able to carry out her daily activities without any discomfort. PMID:26949685

  3. Calcaneal Osteomyelitis due to Non-tuberculous Mycobacteria: A Case Report.

    Science.gov (United States)

    Yi, Tae-Im; Ha, Seung-A; Choe, Yeo-Reum; Kim, Joo-Sup; Kwon, Kye-Won

    2016-02-01

    Osteomyelitis is a bone infection caused by bacteria or other germs. Gram-positive cocci are the most common etiological organisms of calcaneal osteomyelitis; whereas, non-tuberculous mycobacteria (NTM) are rarely documented. We reported a case of NTM calcaneal osteomyelitis in a 51-year-old female patient. She had been previously treated in many local clinics with multiple local steroid injection over 50 times and extracorporeal shock-wave therapy over 20 times with the impression of plantar fasciitis for 3 years prior. Diagnostic workup revealed a calcaneal osteomyelitis and polymerase chain reaction assay on bone aspirate specimens confirmed the diagnosis of non-tuberculous mycobacterial osteomyelitis. The patient had a partial calcanectomy with antitubercular therapy. Six months after surgery, a follow-up magnetic resonance imaging showed localized chronic osteomyelitis with abscess formation. We continued anti-tubercular therapy without operation. At 18-month follow-up after surgery and comprehensive rehabilitation therapy, she was ambulating normally and able to carry out her daily activities without any discomfort. PMID:26949685

  4. Calcaneal Osteomyelitis Associated With a Severe Abscess

    OpenAIRE

    Memis, Ali; Mutluoglu, Mesut; Öztürk, Sinan; Kara, Kemal; Ay, Hakan

    2016-01-01

    Diabetic foot osteomyelitis (DFO) is a common complication of the diabetic foot and the majority of minor and major amputations are preceded by DFO. The diagnosis and treatment of DFO are both challenging. Early recognition and comprehensive management of diabetic foot infections may obviate DFO, hence the dreadful consequence-resection of the infected bone. Herein, we present the successful management of a patient presenting with DFO and severe abscess formation of the heel.

  5. Calcaneal Osteomyelitis Associated With a Severe Abscess.

    Science.gov (United States)

    Memis, Ali; Mutluoglu, Mesut; Öztürk, Sinan; Kara, Kemal; Ay, Hakan

    2014-12-01

    Diabetic foot osteomyelitis (DFO) is a common complication of the diabetic foot and the majority of minor and major amputations are preceded by DFO. The diagnosis and treatment of DFO are both challenging. Early recognition and comprehensive management of diabetic foot infections may obviate DFO, hence the dreadful consequence-resection of the infected bone. Herein, we present the successful management of a patient presenting with DFO and severe abscess formation of the heel. PMID:27104146

  6. Idiopathic cervical osteomyelitis presenting as dysphagia

    OpenAIRE

    Ghaly GA; Espeso A; Fish B

    2010-01-01

    We discuss a case of idiopathic cervical epidural abscess, complicated by osteomyelitis, presenting with dysphagia as the main complaint. No predisposing factors were identified and blood cultures were negative. Case was treated conservatively by long course of IV antibiotics. We present a review of presentation of spinal epidural abscesses and indications for surgical intervention.

  7. 肌皮瓣移植治疗跟骨慢性骨髓炎并皮肤缺损的护理%Nursing of the Chronic Calcaneal Osteomyelitis Combined with Soft Tissue Defect Repair with Myocutaneous Flaps

    Institute of Scientific and Technical Information of China (English)

    严若芬; 骆渊城; 于德美

    2012-01-01

    目的 探讨肌皮瓣移植治疗跟骨慢性骨髓炎并皮肤缺损的护理方法.方法 经过合理的术前指导,精心术后皮瓣血运观察,及时有效的处理血管危象,并做好持续冲洗引流的护理,观察皮瓣成活及慢性跟骨骨髓炎的愈合情况.结果 肌皮瓣移植治疗跟骨慢性骨髓炎并皮肤缺损的患者,皮瓣完全成活,伤口愈合,骨髓炎治愈无复发,患者术后功能恢复良好.结论 正确的术前指导,严格的术后观察,及时有效的处理,正确的术后持续冲洗,是肌皮瓣移植治疗跟骨慢性骨髓炎并皮肤缺损护理的关键.%Objective:Study on the nursing methods of the chronic calcaneal osteomyelitis combined with soft tissue defect repair with myocutaneous flaps Methods:By reasonable of preoperative instruction, elaborate flap blood revolve postoperative, timely and effective management of vascular crisis, and doing well the nurse of continuous irrigation, observed flap surviving and chronic calcaneal osteomyelitis healing Results:all cases transplanted myocutaneous flaps survived, the wound healed, without recurrence of calcaneal osteomyelitis. The function recovery is satisfactory. Conclusion:The key successful factors for the nursing of myocutaneous flap repairing chronic calcaneal osteomyelitis with soft tissue defect is correct preoperative instruction strict postoperative observation timely and effective management right continuous irrigation.

  8. Osteomyelitis

    International Nuclear Information System (INIS)

    This paper determines the characteristic appearance and accuracy of MR images in osteomyelitis by comparing prospective and retrospective image interpretations with final diagnoses. MR studies of 130 patients suspected of osteomyelitis were reviewed. Final diagnosis was established in 110 by means of histopathology (n = 81), clinical follow- up (n = 20), or other objective tests (n = 14). The prospective sensitivity of MR imaging was 96%, and the specificity 78%. Bacterial osteomyelitis always showed focal abnormal marrow signal. Nevertheless, 5/8 patients with septic arthritis had studies falsely positive for osteomyelitis

  9. Osteomyelitis

    Science.gov (United States)

    Bone infection; Infection - bone ... Bone infection is most often caused by bacteria. It can also be caused by fungi or other germs. When a person has osteomyelitis: Bacteria or other germs may spread to a ...

  10. Osteomyelitis

    Science.gov (United States)

    ... Kids For Parents MORE ON THIS TOPIC MRSA Staph Infections Dealing With Cuts First Aid & Safety Center Cellulitis ... Care Dealing With Broken Bones Osteomyelitis Hand Washing Staph Infections MRSA Bones, Muscles, and Joints Contact Us Print ...

  11. Presentation of Osteitis and Osteomyelitis Pubis as Acute Abdominal Pain

    OpenAIRE

    Pham, Diane V; Scott, Kendall G

    2007-01-01

    Osteitis pubis is the most common inflammatory condition of the pubic symphysis and may present as acute abdominal, pelvic, or groin pain. Osteomyelitis pubis can occur concurrently and spontaneously with osteitis pubis. Primary care physicians should consider these conditions in patients presenting with abdominal and pelvic pain. A thorough history, including type of physical activity, and a focused physical examination will be useful, and imaging modalities may be helpful. A biopsy and cult...

  12. Specific Antibodies to Staphylococcus aureus Biofilm Are Present in Serum from Pigs with Osteomyelitis

    DEFF Research Database (Denmark)

    Jensen, Louise Kruse; Jensen, Henrik Elvang; Koch, Janne;

    2015-01-01

    BACKGROUND: The Achilles heel in osteomyelitis is that bacteria, primarily Staphylococcus aureus, grow as a biofilm in the bone lesions. MATERIALS AND METHODS: In the present study, we explored the serum level of specific antibodies to S. aurues biofilm in porcine models of osteomyelitis. RESULTS......: Significantly increased levels of antibodies towards the specific biofilm antigen SA0688 were measured in serum from pigs with S. aureus-associated acute and chronic osteomyelitis 5-7 and 10-14 days after inoculation, respectively. Simultaneously with raised antibody levels, an increase in serum interleukin 6...... (IL 6) levels was also seen. CONCLUSION: The observed biofilm-specific antibody response represents a T-helper cell 17 (Th17) response and potentially a T-helper cell 1 (Th1) response. This is in agreement with previous studies in mice and rabbits speculating that S. aureus induces a Th1- and Th17...

  13. Neuroblastoma presenting clincally as hip osteomyelitis: a ''signature'' diagnosis on skeletal scintigraphy

    International Nuclear Information System (INIS)

    At their initial emergency room presentation, four children were thought to have hip osteomyelitis. Skeletal scintigraphy, however, demonstrated multiple areas of abnormal tracer uptake in the bones in all four, and in three there was abnormal uptake in a soft tissue abdominal mass. The skeletal scintigraphic findings promptly led to the correct diagnosis of neuroblastoma. (orig.)

  14. Neuroblastoma presenting clincally as hip osteomyelitis: a ``signature`` diagnosis on skeletal scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Applegate, K. [Div. of Nuclear Medicine, Dept. of Radiology, Children`s Hospital, Boston, MA (United States); Connolly, L.P. [Div. of Nuclear Medicine, Dept. of Radiology, Children`s Hospital, Boston, MA (United States); Treves, S.T. [Div. of Nuclear Medicine, Dept. of Radiology, Children`s Hospital, Boston, MA (United States)

    1995-11-01

    At their initial emergency room presentation, four children were thought to have hip osteomyelitis. Skeletal scintigraphy, however, demonstrated multiple areas of abnormal tracer uptake in the bones in all four, and in three there was abnormal uptake in a soft tissue abdominal mass. The skeletal scintigraphic findings promptly led to the correct diagnosis of neuroblastoma. (orig.)

  15. Spontaneous calcaneal fracture in patients with diabetic foot ulcer: Four cases report and review of literature.

    Science.gov (United States)

    Evran, Mehtap; Sert, Murat; Tetiker, Tamer; Akkuş, Gamze; Biçer, Ömer Sunkar

    2016-07-16

    Spontaneous calcaneal fractures in diabetic patients without obvious trauma may occur, sometimes accompanying diabetic foot ulcers. In the current study we report four cases who were hospitalized for diabetic foot ulcer with concomitant calcaneal fractures. There were four diabetic patients (one type 1 and three type 2) who registered with diabetic foot ulcers with coexisting calcaneal fractures, all of which were classified as Type A according to Essex Lopresti Calcaneal Fracture Classification. Two of the patients with renal failure were in a routine dialysis program, as well as vascular compromise and osteomyelitis in all of the patients. The diabetic foot ulcer of the 61 years old osteoporotic female patient healed with local debridement, vacuum assisted closure and then epidermal growth factor while the calcaneal fracture was then followed by elastic bandage. In two patients could not prevent progression of diabetic foot ulcers and calcaneal fractures to consequent below-knee amputation. The only patient with type 1 diabetes mellitus improved with antibiotic therapy and split thickness skin grafting, while the calcaneal fracture did not heal. In the current study we aimed to emphasize the spontaneous calcaneal fractures as possible co-existing pathologies in patients with diabetic foot ulcers. After all the medical treatment, amputation below knee had to be performed in 2 patients. It should be noted that other accompanying conditions such as impaired peripheral circulation, osteomyelitis, chronic renal failure, and maybe osteoporosis is a challenge of the recovery of calcaneal fractures and accelerate the progress to amputation in diabetic patients. PMID:27458594

  16. Spontaneous calcaneal fracture in patients with diabetic foot ulcer: Four cases report and review of literature

    Science.gov (United States)

    Evran, Mehtap; Sert, Murat; Tetiker, Tamer; Akkuş, Gamze; Biçer, Ömer Sunkar

    2016-01-01

    Spontaneous calcaneal fractures in diabetic patients without obvious trauma may occur, sometimes accompanying diabetic foot ulcers. In the current study we report four cases who were hospitalized for diabetic foot ulcer with concomitant calcaneal fractures. There were four diabetic patients (one type 1 and three type 2) who registered with diabetic foot ulcers with coexisting calcaneal fractures, all of which were classified as Type A according to Essex Lopresti Calcaneal Fracture Classification. Two of the patients with renal failure were in a routine dialysis program, as well as vascular compromise and osteomyelitis in all of the patients. The diabetic foot ulcer of the 61 years old osteoporotic female patient healed with local debridement, vacuum assisted closure and then epidermal growth factor while the calcaneal fracture was then followed by elastic bandage. In two patients could not prevent progression of diabetic foot ulcers and calcaneal fractures to consequent below-knee amputation. The only patient with type 1 diabetes mellitus improved with antibiotic therapy and split thickness skin grafting, while the calcaneal fracture did not heal. In the current study we aimed to emphasize the spontaneous calcaneal fractures as possible co-existing pathologies in patients with diabetic foot ulcers. After all the medical treatment, amputation below knee had to be performed in 2 patients. It should be noted that other accompanying conditions such as impaired peripheral circulation, osteomyelitis, chronic renal failure, and maybe osteoporosis is a challenge of the recovery of calcaneal fractures and accelerate the progress to amputation in diabetic patients.

  17. Multimodality imaging of osteomyelitis

    International Nuclear Information System (INIS)

    After a brief introduction outlining some basic principles regarding the diagnosis of osteomyelitis, pathophysiologic aspects are reviewed. Advantages and disadvantages of each imaging modality and their applications in different forms of osteomyelitis are discussed. The use of different imaging modalities in the diagnosis of special forms of osteomyelitis, including chronic, diabetic foot, and vertebral osteomyelitis, and osteomyelitis associated with orthopedic appliances and sickle cell disease is reviewed. Taking into account the site of suspected osteomyelitis and the presence or absence of underlying pathologic changes and their nature, an algorithm summarizing the use of various imaging modalities in the diagnosis of osteomyelitis is presented. (orig.). With 13 figs., 9 tabs

  18. Multimodality imaging of osteomyelitis

    Energy Technology Data Exchange (ETDEWEB)

    Elgazzar, A.H. [Cincinnati Univ. Medical Center, OH (United States); Abdel-Dayem, H.M. [Dept. Radiology, New York Medical College, Valhalla, NY (United States)]|[Dept. of Radiology, St. Vinvent`s Hospital and Medical Center, New York, NY (United States); Clark, J.D. [Cincinnati Univ. Medical Center, OH (United States); Maxon, H.R. [Cincinnati Univ. Medical Center, OH (United States)

    1995-09-01

    After a brief introduction outlining some basic principles regarding the diagnosis of osteomyelitis, pathophysiologic aspects are reviewed. Advantages and disadvantages of each imaging modality and their applications in different forms of osteomyelitis are discussed. The use of different imaging modalities in the diagnosis of special forms of osteomyelitis, including chronic, diabetic foot, and vertebral osteomyelitis, and osteomyelitis associated with orthopedic appliances and sickle cell disease is reviewed. Taking into account the site of suspected osteomyelitis and the presence or absence of underlying pathologic changes and their nature, an algorithm summarizing the use of various imaging modalities in the diagnosis of osteomyelitis is presented. (orig.). With 13 figs., 9 tabs.

  19. LATERAL APPROACH UNDER FLUROSCOPIC GUIDANCE WITH NONLOCKING CALCANEAL PLATE IS AN EFFECTIVE TECHNIQUE FOR CLOSED CALCANEAL FRACTURE

    OpenAIRE

    Alok Sobhan; De, Soumya; Rana

    2014-01-01

    Intra-articular calcaneal fractures which accounts for about 75% of calcaneal fractures is usually associated with poor functional outcome. The present was under taken to evaluate the efficacy of open reduction and internal fixation of displaced articular fractures of calcaneum in adults through lateral approach under fluroscopic guidance with non-locking calcaneal plate and ipsilateral iliac crest bone graft. 30 adult patients (25 males and 5 females) with closed displaced in...

  20. Chronic recurrent multifocal osteomyelitis with an atypical presentation in an adult man

    International Nuclear Information System (INIS)

    We present the case of a 33-year-old man with no significant medical history who developed right scapular pain, left-sided sacroiliac joint pain, and lower back pain, and was eventually diagnosed with chronic recurrent multifocal osteomyelitis (CRMO). Imaging demonstrated multiple scattered T2-hyperintense lesions on MRI at the spine and the left SI joint, some of which progressed and one regressed in size on follow-up. Histopathology demonstrated only non-specific chronic inflammation compatible with CRMO. No evidence of infectious organisms or neoplastic processes was found. The pain was relapsing and remitting in nature. Laboratory investigations were notable for no evidence of hematologic malignancy or infection, but only a mild increase in alkaline phosphatase. This case highlights that CRMO, despite being thought of as a childhood-onset disease, can present in adults as well, and also provides illustrative examples of imaging and histological findings. (orig.)

  1. Chronic recurrent multifocal osteomyelitis with an atypical presentation in an adult man

    Energy Technology Data Exchange (ETDEWEB)

    Hong, Cheng William [University of California San Francisco, Department of Radiology and Biomedical Imaging, San Francisco, CA (United States); Cleveland Clinic, Lerner College of Medicine, Cleveland, OH (United States); Hsiao, Edward C. [University of California San Francisco, Division of Endocrinology and Metabolism, and the Institute for Human Genetics, Department of Medicine, San Francisco, CA (United States); Horvai, Andrew E. [University of California San Francisco, Department of Pathology, San Francisco, CA (United States); Link, Thomas M. [University of California San Francisco, Department of Radiology and Biomedical Imaging, San Francisco, CA (United States)

    2015-09-15

    We present the case of a 33-year-old man with no significant medical history who developed right scapular pain, left-sided sacroiliac joint pain, and lower back pain, and was eventually diagnosed with chronic recurrent multifocal osteomyelitis (CRMO). Imaging demonstrated multiple scattered T2-hyperintense lesions on MRI at the spine and the left SI joint, some of which progressed and one regressed in size on follow-up. Histopathology demonstrated only non-specific chronic inflammation compatible with CRMO. No evidence of infectious organisms or neoplastic processes was found. The pain was relapsing and remitting in nature. Laboratory investigations were notable for no evidence of hematologic malignancy or infection, but only a mild increase in alkaline phosphatase. This case highlights that CRMO, despite being thought of as a childhood-onset disease, can present in adults as well, and also provides illustrative examples of imaging and histological findings. (orig.)

  2. Unusual presentation of osteoid osteoma mimicking osteomyelitis in a 27-month-old infant

    International Nuclear Information System (INIS)

    Osteoid osteoma is an uncommon, benign disorder of bone that is most often encountered in school-age children and in adolescents. It is quite rare in children under the age of 3 years. We report a case of osteoid osteoma with unusual clinical and imaging features in a 27-month-old toddler who presented with a limp and swelling of the right knee. Initial clinical evaluation, plain films, and computed tomography (CT) were strongly suggestive of chronic osteomyelitis involving the distal right femoral metadiaphysis. The appearance on nuclear medicine bone scan, however, was typical of osteoid osteoma. A biopsy of the lesion was taken and histological examination confirmed the diagnosis of osteoid osteoma. The misleading clinical and imaging features in this case are discussed. (orig.)

  3. Unusual presentation of osteoid osteoma mimicking osteomyelitis in a 27-month-old infant

    Energy Technology Data Exchange (ETDEWEB)

    Bhat, Ishwar; Zerin, Jeffrey Michael; Bloom, David Adam [Department of Pediatric Imaging, Children' s Hospital of Michigan, Detroit, Michigan (United States); Mooney, James Francis III [Department of Orthopedic Surgery, Children' s Hospital of Michigan, Detroit, Michigan (United States)

    2003-06-01

    Osteoid osteoma is an uncommon, benign disorder of bone that is most often encountered in school-age children and in adolescents. It is quite rare in children under the age of 3 years. We report a case of osteoid osteoma with unusual clinical and imaging features in a 27-month-old toddler who presented with a limp and swelling of the right knee. Initial clinical evaluation, plain films, and computed tomography (CT) were strongly suggestive of chronic osteomyelitis involving the distal right femoral metadiaphysis. The appearance on nuclear medicine bone scan, however, was typical of osteoid osteoma. A biopsy of the lesion was taken and histological examination confirmed the diagnosis of osteoid osteoma. The misleading clinical and imaging features in this case are discussed. (orig.)

  4. Micro-CT analyses of historical bone samples presenting with osteomyelitis

    International Nuclear Information System (INIS)

    Osteomyelitis is an inflammation of the bone marrow mainly caused by bacteria such as Staphylococcus aureus. It typically affects long bones, e.g. femora, tibiae and humeri. Recently micro-computed tomography (μCT) techniques offer the opportunity to investigate bone micro-architecture in great detail. Since there is no information on long bone microstructure in osteomyelitis, we studied historic bone samples with osteomyelitis by μCT. We investigated 23 femora of 22 individuals suffering from osteomyelitis provided by the Collection of Anatomical Pathology, Museum of Natural History, Vienna (average age 44 ±19 years); 9 femora from body donors made available by the Department of Applied Anatomy, Medical University of Vienna (age range, 56-102 years) were studied as controls. Bone microstructure was assessed by μCT VISCOM X 8060 II with a minimal resolution of 18 μm. In the osteomyelitic femora, most prominent alterations were seen in the cortical compartment. In 71.4 % of the individuals with osteomyelitis, cortical porosity occurred. 57.1 % of the individuals showed cortical thinning. In 42.9 % trabecularisation of cortical bone was observed. Osteomyelitis is associated with severe alterations of cortical bone structure otherwise typically observed at old age such as cortical porosity and cortical thinning. (orig.)

  5. Micro-CT analyses of historical bone samples presenting with osteomyelitis

    Energy Technology Data Exchange (ETDEWEB)

    Lamm, C.; Pietschmann, P. [Medical University Vienna (MUV), Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Vienna (Austria); Dockner, M.; Weber, G.W. [University of Vienna, Department of Anthropology, Vienna (Austria); University of Vienna, Core Facility for Micro-Computed Tomography, Vienna (Austria); Pospischek, B.; Winter, E.; Patzak, B. [Museum of Natural History (NHM), Collection of Anatomical Pathology in the Madhouse Tower, Vienna (Austria); Pretterklieber, M. [Medical University of Vienna (MUV), Department of Applied Anatomy, Vienna (Austria)

    2015-10-15

    Osteomyelitis is an inflammation of the bone marrow mainly caused by bacteria such as Staphylococcus aureus. It typically affects long bones, e.g. femora, tibiae and humeri. Recently micro-computed tomography (μCT) techniques offer the opportunity to investigate bone micro-architecture in great detail. Since there is no information on long bone microstructure in osteomyelitis, we studied historic bone samples with osteomyelitis by μCT. We investigated 23 femora of 22 individuals suffering from osteomyelitis provided by the Collection of Anatomical Pathology, Museum of Natural History, Vienna (average age 44 ±19 years); 9 femora from body donors made available by the Department of Applied Anatomy, Medical University of Vienna (age range, 56-102 years) were studied as controls. Bone microstructure was assessed by μCT VISCOM X 8060 II with a minimal resolution of 18 μm. In the osteomyelitic femora, most prominent alterations were seen in the cortical compartment. In 71.4 % of the individuals with osteomyelitis, cortical porosity occurred. 57.1 % of the individuals showed cortical thinning. In 42.9 % trabecularisation of cortical bone was observed. Osteomyelitis is associated with severe alterations of cortical bone structure otherwise typically observed at old age such as cortical porosity and cortical thinning. (orig.)

  6. Treatment of a High-Risk Diabetic Patient with Peripheral Vascular Disease and Osteomyelitis.

    Science.gov (United States)

    Allen, Latricia L; Kalmar, Garrett; Driver, Vickie R

    2016-06-01

    We report a case of calcaneal osteomyelitis that was surgically resected from a patient with diabetes and peripheral vascular disease. A 91-year-old male with history of type 2 diabetes, peripheral vascular disease, balloon angioplasty, and recent (2 months ago) stent of the superficial femoral artery presented to the emergency department with a left heel wound infection probed to bone. The patient reported having been on intravenous Zosyn for several months via an outside infectious disease provider for clinical suspicion of osteomyelitis, but noted no improvement. This report includes information regarding the clinical examination and imaging findings, which were used to assess this high-risk patient. Our patient underwent a partial calcanectomy and completed a 6-week course of intravenous antibiotics. The purpose of this case report is to illustrate limb preservation in a high-risk patient with compromised vascular supply who underwent a partial calcanectomy for treatment of calcaneal osteomyelitis. The patient underwent surgical resection of the calcaneus without complications and healed unremarkably with the ability to ambulate while wearing an ankle foot orthosis with a custom shoe. This report was authorized for publication as an educational report to contribute to generalizable knowledge and does not include any patient health information. PMID:27423990

  7. Calcaneal insufficiency avulsion fractures in diabetic patients

    International Nuclear Information System (INIS)

    This paper presents a calcaneal fracture pattern that appears to be unique to diabetic patients. Radiographs and clinical records of 58 patients with calcaneal fractures were evaluated, 18 were diabetic and 40 nondiabetic. All 18 diabetic patients were insulin dependent and had clinically evident peripheral neuropathy. Thirteen had juvenile-onset diabetes. The average time from the diagnosis of diabetes mellitus to insufficiency fracture was 21 years. Sixteen of the diabetic patients had no history of significant trauma, and 13 of them had insufficiency avulsion fractures limited to the posterior third of the calcaneus

  8. Salmonella osteomyelitis in an immunocompromized patient presenting as a primary lymphoma of the bone.

    Science.gov (United States)

    Schulze, Tobias; Lüdtke, Angelika; Rahlff, Ilka; Tunn, Per-Ulf; Hohenberger, Peter

    2009-03-01

    During the past few decades, an increasing number of immunosuppressive drugs have been developed to treat autoimmune and rheumatic diseases, as well as post-transplant patients. In parallel, the incidence of immunocompromized patients in the general population has risen, for example, patients who are HIV positive, undergoing hemodialysis or suffering from diabetes mellitus. In such predisposed patients, infections with organisms of even reduced invasive potential can result in atypical invasive manifestations. In industrialized countries, an increase in the number of human non-typhoid Salmonella infections was observed in the 1980-1990s [Shimoni Z, Pitlik S, Leibovici L, Samra Z, Konigsberger H, Drucker M, et al. Nontyphoid Salmonella bacteremia: age-related differences in clinical presentation, bacteriology, and outcome. Clin Infect Dis 1999;28:822-7]. Beyond the main clinical manifestation of gastroenteritis, there is an increasing prevalence of extra-intestinal infections by this pathogen. We report a patient with acute osteomyelitis due to Salmonella typhimurium without any previous signs of gastroenteritis. PMID:18845462

  9. Disseminated osteomyelitis or bone metastases of breast cancer. 18F-FDG-PET/CT helps unravel an unusual presentation

    International Nuclear Information System (INIS)

    We present a case wherein striking 18F-FDG-PET/CT findings initially considered consistent with recurrent disseminated skeletal metastases of breast cancer were later identified as an unusual presentation of disseminated chronic pyogenic osteomyelitis with Staphylococcus aureus and warneri identified on microbiological culture. A 76-year-old female with previous history of breast cancer presented with a 6-month history of pyrexia, myalgia and weight loss. Besides neutrophilia and elevated C-reactive protein, other blood indices, cultures and conventional imaging failed to identify the cause of pyrexia of unknown origin (PUO). 18F-FDG-PET/CT demonstrated multiple widespread foci of intense FDG uptake in lytic lesions throughout the skeleton. Coupled with previous history of malignancy, findings were strongly suggestive of disseminated metastases of breast cancer. Through targeting an FDG avid lesion, 18F-FDG-PET/CT aided CT-guided biopsy, which instead identified the lesions as chronic pyogenic osteomyelitis. Following prolonged antibiotic therapy, repeat 18F-FDG-PET/CT demonstrated significant resolution of lesions. This case demonstrated an unusual presentation of disseminated osteomyelitis on 18F-FDG-PET/CT and highlighted the use of 18F-FDG-PET/CT as a trouble shooter in PUO but demonstrated that unusual presentations of benign or malignant pathologies cannot always reliably be differentiated on imaging alone without aid of tissue sampling. Furthermore, this case highlights the potential role 18F-FDG-PET/CT could provide in assessing response to antibiotic therapy. (author)

  10. Imaging of chronic recurrent multifocal osteomyelitis of childhood first presenting with isolated primary spinal involvement

    International Nuclear Information System (INIS)

    Initial presentation with primary spinal involvement in chronic recurrent multifocal osteomyelitis of childhood (CRMO) is rare. Our objective was to review the imaging appearances of three patients who had CRMO who initially presented with isolated primary spinal involvement.Design and patients The imaging, clinical, laboratory and histology findings of the three patients were retrospectively reviewed. Imaging included seven spinal MR imaging scans, one computed tomography scan, nine bone scans, two tomograms and 16 radiographs. These were reviewed by two musculoskeletal radiologists and a consensus view is reported. All three patients presented with atraumatic spinal pain and had extensive bone spinal pathology. The patients were aged 11, 13 and 12 years. There were two females and one male.Results and conclusions The initial patient had thoracic T6 and T8 vertebra plana. Bone scan showed additional vertebral body involvement. Follow-up was available over a 3 year period. The second patient had partial collapse of T9 and, 2 years later, of C6. Subsequently extensive multifocal disease ensued and follow-up was available over 8 years. The third patient initially had L3 inferior partial collapse and 1 year later T8 involvement with multifocal disease. Follow-up was available over 3 years. The imaging findings of the three patients include partial and complete vertebra plana with a subchondral line adjacent to endplates associated with bone marrow MR signal alterations. Awareness of the imaging appearances may help the radiologist to include this entity in the differential diagnosis in children who present with spinal pathology and no history of trauma. Histopathological examination excludes tumor and infection but with typical imaging findings may not always be necessary. (orig.)

  11. Imaging of chronic recurrent multifocal osteomyelitis of childhood first presenting with isolated primary spinal involvement

    Energy Technology Data Exchange (ETDEWEB)

    Anderson, S.E. [Department of Radiology, University Hospital of Bern, Inselspital, 3010, Bern (Switzerland); Heini, P.; Kalbermatten, D. [Department of Orthopedic Surgery, University Hospital of Bern, Inselspital, Bern (Switzerland); Sauvain, M.J. [Department of Pediatric Rheumatology, University Hospital of Bern, Inselspital, Bern (Switzerland); Stauffer, E. [Department of Pathology, University Hospital of Bern, Inselspital, Bern (Switzerland); Geiger, L. [Section Nuclear Medicine, Department of Radiology, University Hospital of Bern, Inselspital, Bern (Switzerland); Johnston, J.O. [Department of Orthopedic Surgery, University of California at San Francisco, San Francisco, California (United States); Roggo, A. [Department of Surgery, University Hospital of Bern, Inselspital, Bern (Switzerland); Steinbach, L.S. [Department of Radiology, University of California at San Francisco, San Francisco, California (United States)

    2003-06-01

    Initial presentation with primary spinal involvement in chronic recurrent multifocal osteomyelitis of childhood (CRMO) is rare. Our objective was to review the imaging appearances of three patients who had CRMO who initially presented with isolated primary spinal involvement.Design and patients The imaging, clinical, laboratory and histology findings of the three patients were retrospectively reviewed. Imaging included seven spinal MR imaging scans, one computed tomography scan, nine bone scans, two tomograms and 16 radiographs. These were reviewed by two musculoskeletal radiologists and a consensus view is reported. All three patients presented with atraumatic spinal pain and had extensive bone spinal pathology. The patients were aged 11, 13 and 12 years. There were two females and one male.Results and conclusions The initial patient had thoracic T6 and T8 vertebra plana. Bone scan showed additional vertebral body involvement. Follow-up was available over a 3 year period. The second patient had partial collapse of T9 and, 2 years later, of C6. Subsequently extensive multifocal disease ensued and follow-up was available over 8 years. The third patient initially had L3 inferior partial collapse and 1 year later T8 involvement with multifocal disease. Follow-up was available over 3 years. The imaging findings of the three patients include partial and complete vertebra plana with a subchondral line adjacent to endplates associated with bone marrow MR signal alterations. Awareness of the imaging appearances may help the radiologist to include this entity in the differential diagnosis in children who present with spinal pathology and no history of trauma. Histopathological examination excludes tumor and infection but with typical imaging findings may not always be necessary. (orig.)

  12. Distal posterior tibial artery pseudoaneurysm after fracture calcaneous

    OpenAIRE

    Dey, Subhajeet; Das, Anjan K.; Dey, Rubi

    2008-01-01

    Here we report a case of pseudoaneurysm of distal posterior tibial artery following closed fracture of calcaneous. Association of pseudoaneurysm of posterior tibial artery with fracture of calcaneous is extremely uncommon. It is always suggested that pseudoaneurysm be treated by reconstruction, but here we present the case treated by ligation, obliteration and excision as it was situated distally and the plantar arch circulation was maintained. The purpose of this case report is to bring atte...

  13. Osteomyelitis of frontal bone

    OpenAIRE

    Chaturvedil, V. N.; Raizada, R. M.; Singh, A. K. Kennedy; Puttewar, M. P.; Bali, S.

    2004-01-01

    A case of Osteomyelitis of the frontal bone with a subperiosteal absces s, an extrudural abscess and a frontal sinus fistula is presented here for its rarity. A brief review of literature and management of the condition is also discussed.

  14. Radiographic imaging of calcaneal fractures - the surgeons view point

    International Nuclear Information System (INIS)

    This paper presents a detailed description of calcaneal fractures, which are underestimated and neglected despite their relatively high frequency. In association with significant anatomic destruction of the calcaneus they lead to unsatisfactory results of fracture treatment. Radiographic features of a healthy calcaneal bone together with pathomechanism and radiographic attributes of most common fracture types are presented. The prognostic role of the posterior talo-calcaneal joint and extraarticular anatomy of the calcaneus are emphasized. Special attention is directed to the methods of calcaneal imaging, especially the most valuable in the authors opinion - lateral radiographic view and computed tomography. Other commonly used views: axial, antero-posterior or Broden, are also described, with explanation why they are rarely recommended. The widely used standard classification system for calcaneal fractures introduced by Sanders, based on computed tomography is presented. Correct x-ray imaging is the basis for further diagnostic workup and treatment, giving also valuable prognostic information. The orthopedic surgeon, who undertakes the difficult task of treating the broken calcaneus receives thorough information about bone damage, which helps to realize the consequences of injury and of possible negligence. According to the authors experience, problems discussed in this paper are rarely fully appreciated by radiologists and orthopedic surgeons resulting in, often, catastrophic consequences. (author)

  15. Diagnostic strategies in osteomyelitis

    International Nuclear Information System (INIS)

    Technetium-99 pyrophosphate bone scanning often identifies patients with osteomyelitis before roentgenographic findings appear. However, recent studies have shown that 99Tc bone scanning often gives false-negative results, especially in neonates. The accuracy of computed tomographic scanning and indium-111 leukocyte scanning for diagnosis of early osteomyelitis has not been established. 99Tc bone scanning often gives false-positive results in patients with other conditions leading to bone injury and repair, such as trauma or recent surgery, further limiting the usefulness of this imaging procedure. Newer imaging techniques have not been adequately evaluated to establish their specificity. Because of their high cost and unproved accuracy, these new imaging procedures should not be routinely applied until their usefulness has been established. Bone biopsy remains the procedure of choice for establishing the diagnosis in patients suspected clinically to have osteomyelitis with negative findings on roentgenography and 99Tc bone scanning. Although Staphylococcus aureus is the leading cause of osteomyelitis, other pathogens cause 30 to 40 percent of cases. Aspiration or biopsy of the involved bone is usually required to choose appropriate antibiotic therapy. Bone biopsy is essential in chronic osteomyelitis, since cultures of sinus drainage are unreliable. Osteomyelitis in diabetics with foot infection and in association with decubitus ulcers presents special problems. Radionuclide scanning often give false-positive results in these patients. Proper diagnosis usually requires careful assessment of clinical and roentgenographic findings. 33 references

  16. Biomechanics – Elastic Foundation Applied in Modelling of Calcaneal Nails

    Directory of Open Access Journals (Sweden)

    Sejda František

    2015-12-01

    Full Text Available This paper presents a strength analysis of a calcaneal nail (material Ti6Al4V and stainless steel which is used to treat complex heel fractures. The application focuses on a unique calcaneal nail, the C-NAIL, produced by Medin a.s. (Nové Město na Moravě, Czech Republic. The paper first presents an analysis of fracture types, treatment methods and loading of the calcaneus. It then presents an analysis of limit conditions and loading. Calculations (displacement and stress are performed for 6 and 7 fixing screws using FEM (Ansys Workbench 14 software. The calculation involves a new, original application of an elastic foundation, which effectively replaces the complex interaction of the calcaneal nail and the heel bone.

  17. Bilateral polymicrobial osteomyelitis with Candida tropicalis and Candida krusei

    DEFF Research Database (Denmark)

    Kaldau, Niels Christian; Brorson, Stig; Jensen, Poul Einar;

    2012-01-01

    We present a case of bilateral polymicrobial osteomyelitis with Candida tropicalis and Candida krusei, and review the literature on Candida osteomyelitis.......We present a case of bilateral polymicrobial osteomyelitis with Candida tropicalis and Candida krusei, and review the literature on Candida osteomyelitis....

  18. Q Fever Chronic Osteomyelitis in Two Children.

    Science.gov (United States)

    Costa, Beatriz; Morais, Andreia; Santos, Ana Sofia; Tavares, Delfin; Seves, Graça; Gouveia, Catarina

    2015-11-01

    We report 2 cases of chronic Q fever osteomyelitis in 10- and 5-year-old girls who presented with distal right femoral and left parasternal granulomatous osteomyelitis, respectively. Both were treated with ciprofloxacin and rifampin with good response. Q fever osteomyelitis is a challenging diagnosis in children, and the choice of antimicrobial treatment is difficult because of limited available data. PMID:26226441

  19. Radiologic aspects of calcaneal fractures in childhood and adolescence

    International Nuclear Information System (INIS)

    One hundred and forty-three calcaneal fractures in 140 patients under the age of19 years were reviewed. Of the total number, 75% were in males. Eighty fractures were seen in females under 13 years of age and in males under 16 years of age. Fifteen (19%) of these fractures were initially not recognized. Four projections were available in the majority of the cases, and were reviewed: lateral, axial, straight dorsoplantar and oblique dorsoplantar views. The various types of fractures had different courses and localizations. The optimum demonstration of a fracture in a certain projection will therefore be dependent on the type of fracture present. It is clinically difficult to foresee a specific type of calcaneal fracture, and consequently it is recommended that all four views should be obtained routinely following trauma to the calcaneal region in patients of the pertinent age groups. (orig.)

  20. Outcome of open reduction and internal fixation of intraarticular calcaneal fracture fixed with locking calcaneal plate

    OpenAIRE

    Jain Saurabh; Jain Anil Kumar; Kumar Ish

    2013-01-01

    【Abstract】Objective: Debate continues regarding the management of calcaneal fractures, between open re- duction and internal fixation and closed treatment. Hence we aim at evaluating the radiological and functional out- comes of open reduction and internal fixation in displaced joint depression type of calcaneal fractures fixed with lock- ing calcaneal plate. Methods: In this series, 28 patients (26 unilateral and 2 bilateral) with joint depression type of calcaneal fr...

  1. Lymfom fejltolket som osteomyelitis

    DEFF Research Database (Denmark)

    Brand, Eske; Klit, Jakob

    2015-01-01

    Patients are admitted based on a tentative diagnosis. If that is incorrect it may have negative consequences for the patient and the system. In this case we present an eight-month elucidation with several diagnostic procedures with a tentative diagnosis of osteomyelitis. This diagnosis was kept...

  2. Multifocal Tubercular Osteomyelitis with Tubercular Breast Abscess: An Atypical Presentation of Tuberculosis

    Directory of Open Access Journals (Sweden)

    Mita Bar

    2015-01-01

    Full Text Available Tuberculosis of spine is common in a developing country like India. However, involvement of spine at multiple levels along with involvement of rib and tubercular breast abscess in an immunocompetent patient without any pulmonary involvement is extremely rare. Here we report a case of 53-year-old immunocompetent lady who presented with quadriparesis and MRI (magnetic resonance imaging of spine revealed multiple lesions involving cervical, thoracic, lumbar, and sacral region without any involvement of intervertebral disc. On detailed examination she was found to have a lump in right breast. Fine needle aspiration cytology of both paravertebral collection and breast lump revealed presence of acid fast bacilli. She was put on antitubercular drug for one year and she responded well to therapy.

  3. Vertebral osteomyelitis without disc involvement

    Energy Technology Data Exchange (ETDEWEB)

    Kamani, I.; Syed, I.; Saifuddin, A. E-mail: asaifuddin@aol.com; Green, R.; MacSweeney, F

    2004-10-01

    Vertebral osteomyelitis is most commonly due to pyogenic or granulomatous infection and typically results in the combined involvement of the intervertebral disc and adjacent vertebral bodies. Non-infective causes include the related conditions of chronic recurrent multifocal osteomyelitis (CRMO) and SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) syndrome. Occasionally, these conditions may present purely within the vertebral body, resulting in various combinations of vertebral marrow oedema and sclerosis, destructive lesions of the vertebral body and pathological vertebral collapse, thus mimicking neoplastic disease. This review illustrates the imaging features of vertebral osteomyelitis without disc involvement, with emphasis on magnetic resonance imaging (MRI) findings.

  4. A case of navicular osteomyelitis

    OpenAIRE

    Atlihan, Dogan; Iltar, Serkan; Sazak, Tamer; Karalezli, Nazim

    2004-01-01

    A five-year-old girl presented with complaints of pain, swelling, and localized fever on the dorsal side of the right foot. A diagnosis of navicular osteomyelitis was made and she underwent surgery. Cultures obtained intraoperatively revealed Staphylococcus aureus and broad-spectrum antibiotic therapy was administered. Postoperative follow-up showed no local or systemic signs or symptoms. Because of its rarity during childhood, clinical findings of navicular osteomyelitis are presented, along...

  5. Osteomyelitis Pubis: A Rare and Elusive Diagnosis

    OpenAIRE

    Justin Yax; David Cheng

    2014-01-01

    Osteomyelitis pubis is an infectious inflammation of the symphysis pubis and accounts for 2% of hematogenous osteomyelitis. This differs from osteitis pubis, a non-infectious inflammation of the pubic symphysis, generally caused by shear forces in young athletes. Both conditions present with similar symptoms and are usually differentiated on the basis of biopsy and/or culture. A case of osteomyelitis pubis is presented with a discussion of symphisis pubis anatomy, clinical and laboratory pres...

  6. Animal Models for the Study of Osteomyelitis

    OpenAIRE

    Patel, Mitul; Rojavin, Yuri; Jamali, Amir A.; Wasielewski, Samantha J.; Salgado, Christopher J.

    2009-01-01

    Osteomyelitis is an acute or chronic inflammatory process of the bone and its related structures secondary to an infection with pyogenic organisms. Because of the variety in disease presentations and pathophysiology of osteomyelitis, it is very difficult to evaluate in clinical studies. Therefore, animal models have been created for in vivo experimentation. A PubMed and OVID search was performed on March 31, 2008, using keywords osteomyelitis, animal model (rabbit, rat, mouse, avian, dog, she...

  7. Operative treatment for calcaneal fracture with plate

    International Nuclear Information System (INIS)

    We treated calcaneal fractures by means of lateral approach using a calcaneal plate, and evaluated the clinical results. The mean age at the time of surgery was 60.1 (range: 36 to 78). The mean duration of follow-up was 3.4 years. Eleven feet were treated with the ACE calcaneal plate, and two feet were treated with the Rabbit plate. The clinical result evaluation according to the Maxfield criteria was as follows: excellent in nine feet; very good in two feet; poor in one foot. Pre-and postoperative changes in radiographic findings were studied. The improvement of the Boehler angle, width index, and intra-articular displacement was reflected in the clinical result. This method is considered to be an effective treatment for intra-articular calcaneal fractures. (author)

  8. Osteomyelitis of the head and neck: sequential radionuclide scanning in diagnosis and therapy

    Energy Technology Data Exchange (ETDEWEB)

    Strauss, M.; Kaufman, R.A.; Baum, S.

    1985-01-01

    Sequential technetium and gallium scans of the head and neck were used to confirm the diagnosis of osteomyelitis and as an important therapeutic aid to delineate the transformation of active osteomyelitis to inactive osteomyelitis in 11 cases involving sites in the head and neck. Illustrative cases are presented of frontal sinus and cervical spine osteomyelitis and laryngeal osteochondritis.

  9. Osteomyelitis of the head and neck: sequential radionuclide scanning in diagnosis and therapy

    International Nuclear Information System (INIS)

    Sequential technetium and gallium scans of the head and neck were used to confirm the diagnosis of osteomyelitis and as an important therapeutic aid to delineate the transformation of active osteomyelitis to inactive osteomyelitis in 11 cases involving sites in the head and neck. Illustrative cases are presented of frontal sinus and cervical spine osteomyelitis and laryngeal osteochondritis

  10. Role of radiopharmaceuticals in detection of osteomyelitis

    International Nuclear Information System (INIS)

    Osteomyelitis can present as a significant diagnostic problem in medicine. Knowledge of the presence and extent of infection involving bone is important in determining treatment. In this paper the authors review the role played by radiopharmaceutical techniques in establishing the diagnosis of osteomyelitis. Osteomyelitis has been recognized as one of the most serious complications of emergency surgery to repair severe bone trauma. It is also a complication of surgery for prosthesis placement. In still other instances, osteomyelitis can be of hematogenous origin, without a major wound site. Unlike other infections, it rarely presents with acute symptoms. Osteomyelitis is divided into two categories that are time related: acute, in which clinical signs and symptoms of bone infection have been present for less than 1 month, and chronic, in which symptoms have been present for more than 1 month. The acute type is usually caused by Staphylococcus aureus in children (often secondary to skin infection), whereas in adults it can be secondary to intravenous drug abuse. Predisposing factors such as diabetes mellitus, peripheral vascular disease, and sickle cell disease are important to the outcome of osteomyelitis. One way to determine the microbe causing the infection is direct bone biopsy from the site of suspected osteomyelitis. There is one important limitation for needle biopsy in the diagnosis of osteomyelitis. Biopsies are contraindicated in the small bones of the hands and feet, because of risk of pathologic fracture (and may be relatively contraindicated after diphosphonate therapy and loss of bone mineral)

  11. Multifocal chronic osteomyelitis of unknown etiology

    International Nuclear Information System (INIS)

    Five cases of chronic, inflammatory, multifocal bone lesions of unknown etiology are reported. Although bone biopsy confirmed osteomyelitis in each case in none of them were organisms found inspite of an extensive work up. Different clinical course of the disease reflects different aetiology in respective cases. These cases present changing aspects of osteomyelitis emerging since introduction of antibiotics. (orig.)

  12. Anterior process calcaneal fractures: a systematic evaluation of associated conditions

    International Nuclear Information System (INIS)

    The objective was to evaluate the association, by MRI, of anterior calcaneal process fractures with tarsal coalitions, ankle sprains, and bifurcate ligament abnormalities. A retrospective review of 1,479 foot and ankle MR images was performed, over a period of 5 years, for isolated anterior process fractures of the calcaneus. Fifteen 1.5-T MR examinations were systematically evaluated by two radiologists in consensus. Marrow edema patterns, presence of a calcaneonavicular coalition, as well as bifurcate and anterior talofibular ligaments, were evaluated. There were 15 fractures of the anterior calcaneal process with an incidence of 1%. The average patient age was 51 years (range 25-82). Twelve patients were women and 3 were men. The majority of the fractures (14 out of 15) presented as an edema pattern on T2-weighted images, either diffuse (9 out of 15), or vertical (5 out of 15). One case did not show marrow edema, but rather a hypointense line. Nine patients (60%) demonstrated calcaneonavicular coalition and anterior calcaneal process fracture. In 6 patients (50%) the anterior talofibular ligament (ATFL) was thickened. Three patients did not have axial images, and were classified as non-conclusive for the ATFL evaluation. The bifurcate ligament was thickened with hyperintense signal demonstrating a sprain in 9 out of 13 (69%). Only 2 patients (16.5%) had an anterior calcaneal process fracture without any associated abnormality. We believe that there is a probable association of anterior process fractures and calcaneonavicular coalitions. We also feel, based on our results and the prior literature that there is likely also an association with both ATFL injuries and bifurcate ligament injuries. (orig.)

  13. Anterior process calcaneal fractures: a systematic evaluation of associated conditions

    Energy Technology Data Exchange (ETDEWEB)

    Petrover, David [NYU Hospital for Joint Disease, Radiology Department, New York, NY (United States); Hopital Beaujon, Service de Radiologie, Paris (France); Schweitzer, Mark E. [NYU Hospital for Joint Disease, Radiology Department, New York, NY (United States); Laredo, J.D. [Hopital Lariboisiere, Service de Radiologie, Paris (France)

    2007-07-15

    The objective was to evaluate the association, by MRI, of anterior calcaneal process fractures with tarsal coalitions, ankle sprains, and bifurcate ligament abnormalities. A retrospective review of 1,479 foot and ankle MR images was performed, over a period of 5 years, for isolated anterior process fractures of the calcaneus. Fifteen 1.5-T MR examinations were systematically evaluated by two radiologists in consensus. Marrow edema patterns, presence of a calcaneonavicular coalition, as well as bifurcate and anterior talofibular ligaments, were evaluated. There were 15 fractures of the anterior calcaneal process with an incidence of 1%. The average patient age was 51 years (range 25-82). Twelve patients were women and 3 were men. The majority of the fractures (14 out of 15) presented as an edema pattern on T2-weighted images, either diffuse (9 out of 15), or vertical (5 out of 15). One case did not show marrow edema, but rather a hypointense line. Nine patients (60%) demonstrated calcaneonavicular coalition and anterior calcaneal process fracture. In 6 patients (50%) the anterior talofibular ligament (ATFL) was thickened. Three patients did not have axial images, and were classified as non-conclusive for the ATFL evaluation. The bifurcate ligament was thickened with hyperintense signal demonstrating a sprain in 9 out of 13 (69%). Only 2 patients (16.5%) had an anterior calcaneal process fracture without any associated abnormality. We believe that there is a probable association of anterior process fractures and calcaneonavicular coalitions. We also feel, based on our results and the prior literature that there is likely also an association with both ATFL injuries and bifurcate ligament injuries. (orig.)

  14. Calcaneal tendon: imaging findings; Tendao calcaneo: avaliacao por imagem

    Energy Technology Data Exchange (ETDEWEB)

    Montandon, Cristiano; Fonseca, Cristiano Rezio; Montandon Junior, Marcelo Eustaquio [Colegio Brasileiro de Radiologia e Diagnostico por Imagem, Sao Paulo, SP (Brazil)]. E-mail: crismontandon@hotmail.com; Lobo, Leonardo Valadares; Ribeiro, Flavia Aparecida de Souza; Teixeira, Kim-Ir-Sen Santos [Goias Univ., Goiania, GO (Brazil). Hospital de Clinicas. Dept. de Diagnostico por Imagem e Anatomia Patologica

    2003-12-01

    We reviewed the radiological and clinical features of 23 patients with calcaneal tendon diseases, who were submitted to ultrasound or magnetic resonance imaging. The objective of this study was to characterize the lesions for a precise diagnosis of calcaneal tendon injuries. A wide range of calcaneal tendon diseases include degenerative lesions, inflammation of the peritendinous tissue such as peritendinitis and bursitis, and rupture. Imaging methods are essential in the diagnosis, treatment and follow-up of calcaneal tendon diseases. (author)

  15. Radionucleotide scanning in osteomyelitis

    International Nuclear Information System (INIS)

    Radionucleotide bone scanning can be an excellent adjunct to the standard radiograph and clinical findings in the diagnosis of osteomyelitis. Bone scans have the ability to detect osteomyelitis far in advance of the standard radiograph. The sequential use of technetium and gallium has been useful in differentiating cellulitis and osteomyelitis. Serial scanning with technetium and gallium may be used to monitor the response of osteomyelitis to antibiotic therapy

  16. Chronic osteomyelitis of the clavicle

    International Nuclear Information System (INIS)

    Osteomyelitis of the clavicle is an uncommon disease, but it should be considered in patients who present with pain, cellulitis, or drainage in the sternoclavicular area following head and neck surgery, irradiation, subclavian vein catheterization, or immunosuppression. An idiopathic presentation is possible. In contrast to primary osteomyelitis of the clavicle, which is occasionally seen in children, secondary osteomyelitis is quite rare. It is often mistaken for a fracture or a possible neoplasm on plain x-rays. Tomograms and CT scanning are confirmatory, and in early cases, technetium-99m bone scanning can be helpful. Treatment must include early, aggressive surgical debridement of all affected tissues, followed by wound coverage with a well-vascularized flap and perioperative antibiotics

  17. Cryptococcal osteomyelitis in the ribs

    Directory of Open Access Journals (Sweden)

    Sethi Somika

    2010-01-01

    Full Text Available Isolated cryptococcal osteomyelitis, in an immunocompetent, is rare and only a few cases have been reported in literature. We present the case of a 30-year-old man presented with pain on the left side of chest with fever and gradually increasing swelling in left lateral lower aspect of chest. Investigation revealed a lytic lesion in the anterior end of left 6 th rib with normal CD4 count. He was tested negative for HIV antigen. Excision of the sixth rib, morphologically revealed cryptococcal osteomyelitis and the patient was given anti-fungal treatment for six months.

  18. Garre′s sclerosing osteomyelitis

    Directory of Open Access Journals (Sweden)

    Suma R

    2007-05-01

    Full Text Available Garre′s sclerosing osteomyelitis is a specific type of chronic osteomyelitis that mainly affects children and young adults. This disease entity is well-described in dental literature and is commonly associated with an odontogenic infection resulting from dental caries. This paper describes a case of Garre′s osteomyelitis in a 10-year-old boy, in whom the condition arose following pulpoperiapical infection in relation to permanent mandibular right first molar. Clinically the patient presented with bony hard, non-tender swelling and the occlusal radiograph revealed pathognomic feature of "onion skin" appearance. The elimination of periapical infection was achieved by endodontic therapy and the complete bone remodeling was seen radiographically after three months follow-up.

  19. Radiation osteomyelitis of the mandible

    International Nuclear Information System (INIS)

    Radiation therapy for the head and neck malignant tumor may often cause osteoradionecrosis of the mandible, leading to radiation osteomyelitis with a source of infection. The present study demonstrates two cases with radiation osteomyelitis of the mandible to discuss the etiology, radiological findings and preventive measure for this type of bone disease. The result indicate that, 1) A higher dose in external radiotherapy may claimed to be a potent factor to cause osteoradionecrosis and post irradiation periodontitis of the tooth associated with pain, may be preliminary symptom of leading radiation osteomyelitis, where a delayed healing of tooth extraction is an accelerating factor responsible for rapid progress of osteomyelitic changes. 2) Once infection sets in post irradiated bone, radio-osteomyelitic change is quite progressive even after various conservative measure. 3) Only radiological change in those cases is a slow formation of sequestrum time ranging from 7 to 10 months, with a gradual separation of dead bone as a large mass. (author)

  20. Aspergillus Osteomyelitis of the Skull.

    Science.gov (United States)

    Nicholson, Simon; King, Richard; Chumas, Paul; Russell, John; Liddington, Mark

    2016-07-01

    Osteomyelitis of the craniofacial skeleton is rare, with fungal pathogens least commonly implicated. The authors present 2 patients of osteomyelitis of the skull caused by Aspergillus spp. and discuss the diagnosis, clinicopathological course, and management strategies.Late recurrence seen in this type of infection warrants long-term follow-up and a high index of suspicion for the clinical signs associated with recurrence.Such patients would benefit from their surgical debridement being planned and managed via a specialist craniofacial unit, so as to utilize the most aesthetically sensitive approach and the experience of specialists from several surgical disciplines. PMID:27391523

  1. Osteomyelitis Pubis: A Rare and Elusive Diagnosis

    Directory of Open Access Journals (Sweden)

    Justin Yax

    2014-11-01

    Full Text Available Osteomyelitis pubis is an infectious inflammation of the symphysis pubis and accounts for 2% of hematogenous osteomyelitis. This differs from osteitis pubis, a non-infectious inflammation of the pubic symphysis, generally caused by shear forces in young athletes. Both conditions present with similar symptoms and are usually differentiated on the basis of biopsy and/or culture. A case of osteomyelitis pubis is presented with a discussion of symphisis pubis anatomy, clinical and laboratory presentation, etiology and risk factors, and optimal imaging studies. [West J Emerg Med. 2014;15(7:–0.

  2. Osteomyelitis pubis: a rare and elusive diagnosis.

    Science.gov (United States)

    Yax, Justin; Cheng, David

    2014-11-01

    Osteomyelitis pubis is an infectious inflammation of the symphysis pubis and accounts for 2% of hematogenous osteomyelitis. This differs from osteitis pubis, a non-infectious inflammation of the pubic symphysis, generally caused by shear forces in young athletes. Both conditions present with similar symptoms and are usually differentiated on the basis of biopsy and/or culture. A case of osteomyelitis pubis is presented with a discussion of symphisis pubis anatomy, clinical and laboratory presentation, etiology and risk factors, and optimal imaging studies. PMID:25493141

  3. Do we really need radiographic assessment for the diagnosis of non-specific heel pain (calcaneal apophysitis) in children?

    Energy Technology Data Exchange (ETDEWEB)

    Kose, Ozkan [Diyarbakir Education and Research Hospital, Orthopaedics and Traumatology Clinic, Diyarbakir (Turkey); Diclekent Bulvari, Ataslar Serhat Evleri, Diyarbakir (Turkey)

    2010-04-15

    Non-specific heel pain (calcaneal apophysitis) is a common disorder, particularly in physically active growing children. Foot radiographs are usually obtained as part of the clinical evaluation in routine orthopaedic practice. However, there is still controversy about the specific findings on radiographs, and it is unclear what information is present on radiographs that may alter the diagnosis and management. The purpose of this study was to review a consecutive series of patients with the diagnosis of calcaneal apophysitis to assess the yield of routine radiographs of the foot. A prospective study was performed on 61 consecutive patients with a diagnosis of calcaneal apophysitis in a single-surgeon practice. Standard anteroposterior and lateral weight-bearing foot radiographs were obtained for each patient. Seventy-one sets of foot radiographs were reviewed to determine whether radiographs had an impact on diagnosis and management. Patients with antecedent trauma, penetrating injury, foot deformity, achilles tendonitis, bursitis and infections were excluded from the study. Seventy foot radiographs were considered to be normal. The radiographs changed the diagnosis in only one patient, in whom a simple bone cyst of the calcaneous was seen. Calcaneal apophysitis is a self-limiting disease, and patients can be treated conservatively. Neither the sclerosis nor the fragmentation of the apophysis could be used to establish the diagnosis of calcaneal apophysitis. Therefore, obtaining radiographs as an initial step in their evaluation does not seem to be justified. (orig.)

  4. An Atypical Calcaneal Fracture in a Child: A Literature Review Concerning the Treatment

    OpenAIRE

    Guterres, Leonardo Waihrich; Ribeiro, Deryck Aguiar; Ribeiro, Tiango Aguiar

    2014-01-01

    Calcaneal fractures are considered uncommon accounting for 0.005-0.41% of all children fractures. Few reports concerning treatment are available. Most of these fractures are non-displaced/minimally displaced and are associated with a fall of less than 1 m. The aim of this case report was to discuss the diagnosis and treatment of a child calcaneal fracture, an atypical presentation despite the high energy mechanism of trauma. A 7-year-old child fell from a 5-m ladder with all his weight on his...

  5. Cat-scratch disease osteomyelitis

    International Nuclear Information System (INIS)

    We report on a patient who presented with osteomyelitis of a rib and adjacent abscess as a rare and atypical manifestation of cat-scratch disease. Radiographic findings showed an osteolytic lesion with adjacent mass. Biopsy, serology and polymerase chain reaction technique are essential for the final diagnosis. Prognosis is excellent with full recovery. (orig.)

  6. Operative treatment of intra-articular calcaneal fractures with calcaneal plates and its complications

    Directory of Open Access Journals (Sweden)

    Rak Vaclav

    2009-01-01

    Full Text Available Background: In a retrospective study we analysed intra-articular calcaneal fracture treatment by comparing results and complications related to fracture stabilization with nonlocking calcaneal plates and locking compression plates. Materials and Methods: We performed 76 osteosynthesis (67 patients of intra-articular calcaneal fractures using the standard extended lateral approach from February 2004 to October 2007. Forty-two operations using nonlocking calcaneal plates (group A were performed during the first three years, and 34 calcaneal fractures were stabilized using locking compression plates (group B in 2007. In the Sanders type IV fractures, reconstruction of the calcaneal shape was attempted. Depending on the type of late complication, we performed subtalar arthroscopy in six cases, arthroscopically assisted subtalar distraction bone block arthrodesis in six cases, and plate removal with lateral-wall decompression in five cases. The patients were evaluated by the AOFAS Ankle-Hindfoot Scale. Results: Wound healing complications were 7/42 (17% in group A and 1/34 (3% in group B. No patient had deep osseous infection or foot rebound compartment syndrome. Preoperative size of Bφhler´s angle correlated with postoperative clinical results in both groups. There were no late complications necessitating corrective procedure or arthroscopy until December 2008 in Group B. All late complications ccurred in Group A. The overall results according to the AOFAS Ankle Hindfoot Scale were good or excellent in 23/42 (55% in group A and in 30/34 (85% in group B. Conclusion: Open reduction and internal fixation of intra-articular calcaneal fractures has become a standard surgical method. Fewer complications and better results related to treatment with locking compression plates confirmed in comparison to nonlocking ones were noted for all Sanders types of intra-articular calcaneal fractures. Age and Sanders type IV fractures are not considered to be the

  7. Radiodiagnostics of maxillary osteomyelitis

    International Nuclear Information System (INIS)

    Osteomyelitis is defined as an inflammation or infection in bone tissues - cancellous bone, bone marrow, bone compacta and periosteum due to invasion of infection from surrounding tissues. Maxillary osteomyelitis is less common disease than osteomyelitis of mandible. This can be explained by anatomical structure of maxilla which is mainly composed of sinuses and thin bone lamellae. Such a structure allows rapid propagation of the infection to the surface. There have been examined and treated 70 patients with osteomyelitis of facial bones within past 15 years at Department of stomatology and maxillo-facial surgery of P.J. Safarik University in Kosice. Only four cases were diagnosed as maxillary osteomyelitis. The aim of this study was to mention the differences in anatomy and symptoms of acute and chronic stage of maxillary osteomyelitis and to give a detailed radiographic picture of this affliction. (authors)

  8. Magnification radiography in osteomyelitis

    International Nuclear Information System (INIS)

    Osteomyelitis often eludes early diagnosis because plain film radiography is too insensitive and radionuclide bone scanning is nonspecific. In this study, 90 diabetic patients were studied with plain film and magnification radiographs of their feet. Among the 24 patients with osteomyelitis, plain radiographs suggested the diagnosis in 14 patients and magnification radiography was diagnostic in 18 of these patients. Thus, magnification radiography offers some diagnostic advantage in patients suspected of having osteomyelitis. (orig.)

  9. LATERAL APPROACH UNDER FLUROSCOPIC GUIDANCE WITH NONLOCKING CALCANEAL PLATE IS AN EFFECTIVE TECHNIQUE FOR CLOSED CALCANEAL FRACTURE

    Directory of Open Access Journals (Sweden)

    Alok Sobhan

    2014-06-01

    Full Text Available Intra-articular calcaneal fractures which accounts for about 75% of calcaneal fractures is usually associated with poor functional outcome. The present was under taken to evaluate the efficacy of open reduction and internal fixation of displaced articular fractures of calcaneum in adults through lateral approach under fluroscopic guidance with non-locking calcaneal plate and ipsilateral iliac crest bone graft. 30 adult patients (25 males and 5 females with closed displaced intra articular fractures of calcaneum of less than 15 days constituted the study group. All cases were operated by lateral approach as described by Seligson, a modification of Gould’s technique under spinal anaesthesia. All machers Arthrosis Rating Scale were used for the evaluation of posttraumatic posterior facet degenerative changes. Primarily27 of all 35 wounds (77% healed without any form of wound complications. Excellent to good results noted in 3 (100% patients with preoperative Bohler´s angle larger or equal to 20° (n = 3 whereas patients with preoperative Bohler´s angle smaller than 20° (n=32 achieved excellent to good results in 16 cases (50% Clinically significant subtalararthrosis (Allmacher grade 2-4 noted in 7 cases (20% cases with Bohler´s angle smaller than 20° (n=32. In 5 cases, clinically significant complaints (Allmachers Arthrosis Rating Scale grades II to V noted. Therapeutic success of such fracture depends on timely open reduction and internal fixation with proper fracture reduction and early rehabilitation. Thus management of these injuries as well as complications should be performed in a specialized orthopaedics or traumatology center.

  10. Infantile Maxillary Sinus Osteomyelitis Mimicking Orbital Cellulitis

    OpenAIRE

    Nagarajan Krishnan; Nathan Ramamoorthy; Suresh Panchanathan; Balasundaram, Jothiramalingam S

    2014-01-01

    Periorbital soft tissue swelling may result due to primary orbital pathology or from adjacent facio-maxillary or sino-nasal inflammatory causes. Osteomyelitis of maxilla in the pediatric age group is a rare entity in this era of antibiotics. We present an 11-month-old female infant who was brought with peri-orbital selling and purulent nasal discharge. Computed Tomography showed erosions of the walls of maxillary sinus suggestive of osteomyelitis. Culture of sinus scraping showed Staphylococc...

  11. Osteomyelitis of the Mandible in an Adolescent.

    Science.gov (United States)

    Di Fiore, Peter M; Cerrud, Clinio C; Buckley, Ian A; Demian, Nagi M

    2015-01-01

    A 13-year-old female, who had been experiencing episodes of mandibular pain and swelling for approximately six months, was referred to a university urgent care dental clinic for evaluation after receiving endodontic treatment. At the referral examination, clinical and radiographic findings were suggestive of osteomyelitis. The purpose of this report is to present the possible etiology, clinical and radiographic findings and surgical management of mandibular osteomyelitis in an adolescent patient. PMID:26349798

  12. Periostitis and osteomyelitis in chronic drug addicts

    International Nuclear Information System (INIS)

    Periostitis and osteomyelitis can occur in drug addicts not only by hematogeneous dissemination of the infecting organisms, but as a result of introduction of bacteria by direct injection into periosteum or injection through infected skin and subcutaneous tissues. A spectrum of examples of osteomyelitis of the bones of the forearm in drug addicts is presented to illustrate this phenomenon. Neglect of these infections and the trauma of continued injections can lead to extensive tissue and bone loss. (orig.)

  13. Periostitis and osteomyelitis in chronic drug addicts

    Energy Technology Data Exchange (ETDEWEB)

    Taylor, C.R.; Lawson, J.P.

    1986-03-01

    Periostitis and osteomyelitis can occur in drug addicts not only by hematogeneous dissemination of the infecting organisms, but as a result of introduction of bacteria by direct injection into periosteum or injection through infected skin and subcutaneous tissues. A spectrum of examples of osteomyelitis of the bones of the forearm in drug addicts is presented to illustrate this phenomenon. Neglect of these infections and the trauma of continued injections can lead to extensive tissue and bone loss.

  14. OSTEOMYELITIS AND PATHOLOGICAL FRACTURE OF TIBIA SECONDARY TO PEMPHIGUS VULGARIS

    OpenAIRE

    Shailesh Kumar

    2015-01-01

    We would like to present one rare and interesting case of a patient who suffered osteomyelitis and pathological fracture of tibia due to direct spread of infection from a skin lesion of pemphigus vulgaris. Patient had to suffer chronic osteomyelitis and pathological fracture due to delay in diagnosis and management . He had to undergo multiple surgeries before he could be relieved of his symptoms. Time and again it proves that osteomyelitis is always a clinical diagnosis and...

  15. Actinomycotic Osteomyelitis of Mandible.

    Science.gov (United States)

    Abbaszadeh, Hamid; Sheibani, Mohammad Sina Arab

    2016-07-01

    Actinomycosis is an infection of filamentous, gram-positive anaerobic bacteria. Actinomycosis of jaw bone is rare and the diagnosis is often difficult. The aim of this patient report is to present an actinomycotic osteomyelitis of mandible in a 30-year-old male patient. The patient presented with a chief complaint of pain and unhealed dental socket after mandibular teeth extractions. Radiographs showed ill-defined radiolucencies and perforation of buccal and lingual cortical plate; several biopsies and different therapy could not improve the lesion because of fault diagnosis and improper treatment. Finally, the authors' histopathological examination revealed granulation tissue surrounded bacterial colonies compatible with actinomycotic colonies. Follow-up examinations showed that the patient was well 6 months after prolonged treatment without any pain and discharge from dental socket. PMID:27391512

  16. MR imaging of osteomyelitis

    International Nuclear Information System (INIS)

    Seventeen MR studies were performed on 16 children with acute, chronic, or healed osteomyelitis. Abnormality was detected in the soft tissues and bone marrow in all patients with acute or chronic osteomyelitis. Two of three patients with heated osteomyelitis had normal soft tissues and bone marrow. There was overlap in the appearance of acute and chronic osteomyelitis. The patients with acute osteomyelitis, however, tended to have more extensive soft-tissue abnormality, to have more poorly defined margins to the soft-tissue abnormality, and more poorly defined interfaces between normal and diseased bone marrow. The signal characteristics of diseases soft tissue and marrow were compatible with prolongation of T1 and T2 relaxation times as compared with normal muscles

  17. Biomechanical comparison of conventional and anatomical calcaneal plates for the treatment of intraarticular calcaneal fractures - a finite element study.

    Science.gov (United States)

    Yu, Bin; Chen, Wen-Chuan; Lee, Pei-Yuan; Lin, Kang-Ping; Lin, Kun-Jhih; Tsai, Cheng-Lun; Wei, Hung-Wen

    2016-10-01

    Initial stability is essential for open reduction internal fixation of intraarticular calcaneal fractures. Geometrical feature of a calcaneal plate is influential to its endurance under physiological load. It is unclear if conventional and pre-contoured anatomical calcaneal plates may exhibit differently in biomechanical perspective. A Sanders' Type II-B intraarticular calcaneal fracture model was reconstructed to evaluate the effectiveness of calcaneal plates using finite element methods. Incremental vertical joint loads up to 450 N were exerted on the subtalar joint to evaluate the stability and safety of the calcaneal plates and bony structure. Results revealed that the anatomical calcaneal plate model had greater average structural stiffness (585.7 N/mm) and lower von Mises stress on the plate (774.5 MPa) compared to those observed in the conventional calcaneal plate model (stiffness: 430.9 N/mm; stress on plate: 867.1 MPa). Although both maximal compressive and maximal tensile stress and strain were lower in the anatomical calcaneal plate group, greater loads on fixation screws were found (average 172.7 MPa compared to 82.18 MPa in the conventional calcaneal plate). It was noted that high magnitude stress concentrations would occur where the bone plate bridges the fracture line on the lateral side of the calcaneus bone. Sufficient fixation strength at the posterolateral calcaneus bone is important for maintaining subtalar joint load after reduction and fixation of a Sanders' Type II-B calcaneal fracture. In addition, geometrical design of a calcaneal plate should worth considering for the mechanical safety in practical usage. PMID:26813403

  18. Cold defects in in-111 labeled leukocyte imaging of osteomyelitis in the axial skeleton

    International Nuclear Information System (INIS)

    Use of In-111 oxine labeled leukocytes in the detection of osteomyelitis of the peripheral skeleton usually presents few problems. However, the diagnosis of osteomyelitis is more difficult in marrow-bearing areas because uptake of indium is normal. Sixty-one In-111 labeled leukocyte scans, that had been performed to exclude osteomyelitis of the axial skeleton, pelvis, and proximal long bones, were reviewed. Eight cold defects were identified at sites of suspected osteomyelitis. Five of these were surgically proven osteomyelitis. Nineteen percent of all cases of osteomyelitis in these areas (5 of 26) presented as cold defects. This incidence of osteomyelitis presenting as cold defects is higher than previously reported. Therefore, the possibility of osteomyelitis should be strongly considered when a cold defect is identified in red marrow areas

  19. Conditions Affecting Treatment of Pertrochanteric Osteomyelitis

    Directory of Open Access Journals (Sweden)

    Steven Wen-Neng Ueng

    2007-10-01

    Full Text Available Background: Although osteomyelitis following treatment of pertrochanteric fractures israre, management can be difficult and often results in several physical andeconomic difficulties. Data regarding treatment of patients withpertrochanteric osteomyelitis is currently limited. This retrospective studyevaluates the management of pertrochanteric osteomyelitis and presents ourexperience using a two-stage treatment protocol.Methods: From 1984 to 1998, twenty-three pertrochanteric osteomyelitis cases weretreated with a two-stage protocol comprising of an external skeletal fixator orBuck traction after radical debridement in the first stage and reconstructionin the second stage. The study included sixteen males and seven femaleswith a mean age of 48.3 years (range 16-82 years. Patients were categorizedas “successful” or “difficult” according to the number of operations they hadundergone. Conditions including patient age, compromised host, intervalbefore treatment, fracture severity, nonunion, hip joint involvement, multipleorganisms and the presence of oxacillin-resistant Staphylococcus aureuswere recorded for analysis.Results: Only twelve of the twenty-three (52% cases were successfully managed andinfection recurred in four (17.4% cases at final follow-up. Difficult casesmanaged by the two-stage protocol were more likely to be characterized byyounger age (p = 0.03, unstable fractures (p = 0.003 and nonunions (p =0.027.Conclusion: The use of external skeletal fixation is not recommended for managingpertrochanteric osteomyelitis. Success using a two-stage protocol was difficultto achieve. Initial fracture severity should be carefully assessed whendevising a treatment protocol for pertrochanteric osteomyelitis.

  20. Neonatal osteomyelitis in Nigerian infants

    International Nuclear Information System (INIS)

    Twenty-seven Nigerian infants with osteomyelitis are presented during the first 28 days of life to highlight the severity of the clinical manifestations and the radiological features of this infection. The clinical signs inlcude limitation of movement of the extremities involved and localised swelling. Severe constitutional changes such as fever (>390C) and abdominal distension were common. This contrasts with results from North America and Europe which emphasize the paucity of clinical signs despite involvement of multiple sites. Multiple site involvement was encountered in only eight cases. Staphylococcus aureus, proteus mirabilis and candida albicans were the main pathogens isolated. The long bones were more frequently affected. Aggressive bone destruction was a constant radiological finding peculiar to Staphylococcal osteomyelitis while the formation of Sequestrum, are rare occurrence in the newborn, was present in six patients. The mortality rate was 7.4% and the morbidity rate was equally low. (orig.)

  1. Neonatal osteomyelitis in Nigerian infants

    Energy Technology Data Exchange (ETDEWEB)

    Omene, J.A.; Okolo, A.A.; Odita, J.C.

    1984-07-01

    Twenty-seven Nigerian infants with osteomyelitis are presented during the first 28 days of life to highlight the severity of the clinical manifestations and the radiological features of this infection. The clinical signs include limitation of movement of the extremities involved and localised swelling. Severe constitutional changes such as fever (>39/sup 0/C) and abdominal distension were common. This contrasts with results from North America and Europe which emphasize the paucity of clinical signs despite involvement of multiple sites. Multiple site involvement was encountered in only eight cases. Staphylococcus aureus, proteus mirabilis and candida albicans were the main pathogens isolated. The long bones were more frequently affected. Aggressive bone destruction was a constant radiological finding peculiar to Staphylococcal osteomyelitis while the formation of Sequestrum, are rare occurrence in the newborn, was present in six patients. The mortality rate was 7.4% and the morbidity rate was equally low.

  2. Outcome of open reduction and internal fixation of intraarticular calcaneal fracture fixed with locking calcaneal plate

    Directory of Open Access Journals (Sweden)

    Jain Saurabh

    2013-12-01

    Full Text Available 【Abstract】Objective: Debate continues regarding the management of calcaneal fractures, between open re- duction and internal fixation and closed treatment. Hence we aim at evaluating the radiological and functional out- comes of open reduction and internal fixation in displaced joint depression type of calcaneal fractures fixed with lock- ing calcaneal plate. Methods: In this series, 28 patients (26 unilateral and 2 bilateral with joint depression type of calcaneal fractures as per Essex-Lopresti classification system were operated on with locking calcaneal plate within 3 weeks of injury. Patients were evaluated in terms of associated injuries and X-rays of anteroposterior, lateral and axial views of the calcaneum. CT scan was done to assess the amount of com- minution and articular depression. Patients were followed up clinically and radiologically at least for 1 year. Radiologi- cal assessment was done by Bohler’s angle and Gissane’s angle along with measurement of calcaneal height and width. Functional outcome was assessed using the American Or- thopaedics Foot and Ankle Society (AOFAS scale. Results: At average follow-up of 14.5 months, average AOFAS score was 86.3 (range 66 to 97, with 86% having excellent to good results and 2 (7.7% and 1 (3.7% having fair and poor results respectively. All patients had stable ankle joint with all having dorsiflexion and plantar flexion more than 30°. Average subtalar range of motion was 17°. The mean Bohler’s angle, mean Gissane’s angle, calcaneal height and width were 25.47°, 121.3°, 4.32 cm and 3.81cm respectively at final follow-up. Three patients had flap ne- crosis at incision site and one had superficial and deep infection. Subtalar arthritis was seen in 5 patients, whereas sural nerve hypoaesthesia in 1 patient. None of the patients had compartment syndrome, heel pad problems, peroneal tendinitis, reflex sympathetic dystropy or implant failure. Conclusion: Open reduction and

  3. Joint-Preserving Osteotomies for Malaligned Intraarticular Calcaneal Fractures.

    Science.gov (United States)

    Benirschke, Stephen K; Kramer, Patricia A

    2016-03-01

    Intraarticular calcaneal fracture treatments that result in malalignment often require reconstructive surgery. Seven cases are used to demonstrate the intricacies of reconstructive case management. Reestablishment of calcaneal height, length, orientation, and position relative to the other tarsals is necessary to reestablish appropriate foot function. Inherent or acquired gastrocnemius equinus should be treated with recession to reduce destructive forces on the reconstruction. PMID:26915782

  4. Chronic recurrent multifocal osteomyelitis (CRMO)

    International Nuclear Information System (INIS)

    Chronic recurrent multifocal osteomyelitis (CRMO) is an unusual clinical entity. More than 200 cases are described in the literature and it is presented here with special reference to its radiological aspects. It is an acquired disease of the skeleton which occurs predominantly during childhood and adolescence. About ten per cent of cases begin in early or, rarely, in later adult life. This variant is described here for the first time and is discussed as 'adult CRMO'. The underlying pathology is a bland, predominantly lympho-plasma cellular osteomyelitis which is self-limiting and leads to bone sclerosis (Garre). It probably involves an abnormal immune process which follows an infection but remains clinically latent and remains aseptic and sterile. In a quarter of cases there is an association with pustulosis palmo-plantaris and its relationship with psoriatic arthropathy is discussed. The clinical, histopathological and imaging features (radiological and particularly MRT) and the bone changes are described. (orig./AJ)

  5. Osteomyelitis Because of Mycobacterium Xenopi in an Immunocompetent Child.

    Science.gov (United States)

    Kuntz, Martin; Seidl, Maximilian; Henneke, Philipp

    2016-01-01

    We present the case of a 6-year-old, immunocompetent boy with chronic osteomyelitis of the calcaneus caused by Mycobacterium xenopi. Of note, typical histopathology was not visible on the first biopsy and developed only later over a period of 6 weeks, highlighting the difficult differential diagnosis of osteomyelitis caused by nontuberculous mycobacteria. PMID:26418244

  6. Nocardia osteomyelitis in the setting of previously unknown HIV infection

    International Nuclear Information System (INIS)

    We present a case of primary Nocardia osteomyelitis in the setting of HIV infection. The clinical and radiographic manifestations of musculoskeletal nocardiosis are nonspecific and resemble those of Mycobacterium tuberculosis infection. To our knowledge no other cases of Nocardia osteomyelitis have been reported in the radiology literature. (orig.)

  7. Post-traumatic osteomyelitis

    International Nuclear Information System (INIS)

    Only 24 patients with post-traumatic osteomyelitis were found from records covering a period of five years. Twenty-two of them with complete medical histories are reviewed here. The radiographs were usually taken through plaster of Paris, and therefore the radiological diagnosis was established later than the clinical one in half of the cases. There were only four cases with a true delay. The primary radiological signs leading to the osteomyelitis diagnosis appeared on average 4.3 months after the assumed time of infection. It is our feeling that the current widespread use of antibiotics causes the diagnosis to be delayed even more than it was in the days of haematogenous osteomyelitis. Continuous formation of periosteal new bone layers indicated poorer prospects for healing of the osteomyelitis. (orig.)

  8. Chronic complicated osteomyelitis

    International Nuclear Information System (INIS)

    Fourteen patients with prior trauma and/or surgery of the lower extremity and suspected active chronic osteomyelitis underwent MR imaging. Eleven patients also underwent In-111 scanning. All patients had surgical confirmation, MR imaging could assess the extent of abnormal marrow and distinguish abnormal marrow due to granulation tissue from active osteomyelitis. The presence and extent of soft-tissue infection could be determined and distinguished from bone involvement in spite of tissue distortion. The course and origin of sinus tracts could be followed. MR imaging was more sensitive to active infection than In-111 scanning. All 11 cases of active osteomyelitis were correctly diagnosed with MR imaging. In-111 scans were positive in only five of the eight cases of active infection in which scans were obtained. MR imaging is useful in chronic complicated osteomyelitis

  9. The imaging of osteomyelitis

    Science.gov (United States)

    Sadigh, Sufi; Mankad, Kshitij; Kapse, Nikhil; Rajeswaran, Gajan

    2016-01-01

    Osteomyelitis is an important cause of morbidity and mortality in children and adults. Imaging plays a crucial role in establishing a timely diagnosis and guiding early management, with the aim of reducing long-term complications. Recognition of the imaging features of osteomyelitis requires a good understanding of its pathogenesis. In this review, the key imaging findings in osteomyelitis are correlated with the underlying pathological processes. There is a particular emphasis on magnetic resonance imaging (MRI), which is the best available imaging modality owing to its high sensitivity for detecting early osteomyelitis, excellent anatomical detail and superior soft tissue resolution. However, other modalities such as nuclear medicine and computed tomography (CT) are also useful in many clinical contexts, and will also be described in this review. PMID:27190771

  10. Outcome of open reduction and internal fixation of intraarticular calcaneal fracture fixed with locking calcaneal plate

    Institute of Scientific and Technical Information of China (English)

    Saurabh Jain; Anil Kumar Jain; Ish Kumar

    2013-01-01

    Objective:Debate continues regarding the management of calcaneal fractures,between open reduction and internal fixation and closed treatment.Hence we aim at evaluating the radiological and functional outcomes of open reduction and internal fixation in displaced joint depression type of calcaneal fractures fixed with locking calcaneal plate.Methods:In this series,28 patients (26 unilateral and 2 bilateral) with joint depression type of calcaneal fractures as per Essex-Lopresti classification system were operated on with locking calcaneal plate within 3 weeks of injury.Patients were evaluated in terms of associated injuries and X-rays of anteroposterior,lateral and axial views of the calcaneum.CT scan was done to assess the amount ofcomminution and articular depression.Patients were followed up clinically and radiologically at least for 1 year.Radiological assessment was done by Bohler's angle and Gissane's angle along with measurement ofcalcaneal height and width.Functional outcome was assessed using the American Orthopaedics Foot and Ankle Society (AOFAS) scale.Results:At average follow-up of 14.5 months,average AOFAS score was 86.3 (range 66 to 97),with 86% having excellent to good results and 2 (7.7%) and 1 (3.7%) having fair and poor results respectively.All patients had stable ankle joint with all having dorsiflexion and plantar flexion more than 30°.Average subtalar range of motion was 17°.The mean Bohler's angle,mean Gissane's angle,calcaneal height and width were 25.47°,121.3°,4.32 cm and 3.81cm respectively at final follow-up.Three patients had flap necrosis at incision site and one had superficial and deep infection.Subtalar arthritis was seen in 5 patients,whereas sural nerve hypoaesthesia in 1 patient.None of the patients had compartment syndrome,heel pad problems,peroneal tendinitis,reflex sympathetic dystropy or implant failure.Conclusion:Open reduction and internal fixation with locking calcaneal plate gives sound functional outcome

  11. Chronic osteomyelitis mimicking sarcoma

    OpenAIRE

    Gulmann, C; Young, O.; Tolan, M.; O’Riordan, D.; Leader, M

    2003-01-01

    This report describes a rare case of chronic osteomyelitis in a 60 year old man mimicking a soft tissue sarcoma. Chronic osteomyelitis is an infrequent cause of a soft tissue mass and is usually diagnosed clinically by a combination of radiology and microbiology. Rarely, COM can mimic a primary bony neoplasm, but this is the first reported case where it mimicked a soft tissue sarcoma. The clinical, radiological, and histological appearances of this case will be discussed.

  12. Osteomyelitis of the os sacrum

    International Nuclear Information System (INIS)

    In the axial skeleton, osteomyelitis of the os sacrum is rare, although it occurs more frequently than tuberculosis of the sacrum. Secondary osteomyelitis as a complication of tumours, metastases or inflammatory processes of the adjacent areas is seen more often than primary sacrial osteomyelitis. (orig.)

  13. Ceftobiprole: First Reported Experience in Osteomyelitis

    Directory of Open Access Journals (Sweden)

    A MacDonald

    2010-01-01

    Full Text Available A 74-year-old man with long-standing diabetes presented with advanced infection of the right forefoot associated with septic arthritis and osteomyelitis involving the second and third metatarsophalangeal joints. Polymicrobial infection, which included methicillin-resistant Staphylococcus aureus, was documented. First-line antibiotic therapy, which included vancomycin, was not tolerated. A durable cure was obtained following a six-week course of intravenous ceftobiprole medocaril combined with local surgery. The present report is the first to administer intravenous ceftobiprole medocaril to a patient with methicillin-resistant S aureus-associated septic arthritis and osteomyelitis.

  14. Diagnosis and classification of calcaneal fractures in computed tomography

    International Nuclear Information System (INIS)

    Purpose: To compare image quality of single-slice spiral CT (SSCT) and multislice spiral CT (MSCT) in the diagnosis and classification of calcaneal fractures and to present a rapid and precise algorithm for the classification system of Stuermer. Materials and Methods: In 102 patients with 124 calcaneal fractures, spiral CT was performed, in 82 cases as SSCT with a slice thickness (SD) of 3 mm, a table speed (TS) of 3-4 mm/rot and an increment of 1.5 mm. In 42 cases, patients were scanned using MSCT (SD of 1.25 mm, increment 0.8 mm). For these examinations, 2 different scan protocols were used, with a TS of 3.75 mm/rot in one group(n=21) and a TS of 7.5 mm/rot in the other group (n=21). The image quality of axial sections and reconstructed images was assessed on a scale from 1 to 5 (1=very good; 5=insufficient). The fractures were evaluated using a classification system according to Stuermer, which assigns three main groups (A/B/C) and three subtypes (1/2/3). Results: MSCT had substantial advantages over SSCT with respect to scan time and image quality, especially for multiplanar reformatting (median 1.5 versus 4.0). TS showed no significant influence on the image quality. The standardized evaluation of the images enabled a classification of fractures within 5 minutes. All fractures could be assigned to the different types and subtypes. This classification system takes into account the severity of the fracture and the therapeutic approach. The most common type (90 of 124 fractures) were 'joint depression' fractures (type C), which were treated by surgery in 92%. Type A fractures were treated conservatively in 72%. (orig.)

  15. Imaging of chronic osteomyelitis

    International Nuclear Information System (INIS)

    The diagnosis of chronic osteomyelitis is made on the basis of clinical, radiologic and histologic findings. The role of imaging in patients with known chronic osteomyelitis is to detect and to delineate areas of active infection. To correctly interpret the imaging findings, it is essential to take both the individual clinical findings and previous imaging studies into account. Reliable signs of active infection are bone marrow abscess, sequestra and sinus tract formation. Only the combined evaluation of bony changes together with alterations of the adjacent soft tissues provides good diagnostic accuracy. Projection radiography gives an overview of the condition of the bone, which provides the basis for follow-up and the selection of further imaging modalities. Computed tomography can be used to evaluate even discrete or complex bony alterations and to guide percutaneous biopsy or drainage. Magnetic resonance imaging achieves the best diagnostic sensitivity and specificity and provides superior contrast as well as anatomical resolution in both bone marrow and soft tissues. In this paper the features and clinical relevance of imaging in primary chronic osteomyelitis, posttraumatic osteomyelitis, tuberculous spondylitis and osteomyelitis of the diabetic foot are reviewed, with particular respect to MRI. (orig.)

  16. A Study of Incidence of calcaneal spurs in North Indian population: A dry bone study

    Directory of Open Access Journals (Sweden)

    G. S. Ghindha

    2015-07-01

    Full Text Available The calcaneal spurs are the most common cause of pain in heel. The pain appears when patient stands on the foot for walking and pain disappears when patient walks some distance. The most common causes of spur formation is chronic fasciitis, wears and tears of ligaments and fascia present in the sole of foot. When the fasciitis heals, during the healing process the calcification of fascia or ligaments takes place, which results into the spur formation. The present study has been conducted on 325 dry human calcanei, irrespective of their sex, in the Department of Anatomy of M. M. Medical College and Hospital, Kumarhatti, District Solan (Himachal Pradesh. The objective of this study is to assess the rate of incidence of the presence of spurs in the calcanei and their types present in these calcanei. The photographs of all types of calcaneal spurs are taken and recorded and the study is compared with the standard literature and previous studies done by other authors. Out of 325 calcanei, 150 (35.38 % cases are having inferior, posterior calcaneal spurs. In 28 (8.62 % cases both types of spurs have been found. Other calcanei are having either inferior or posterior calcaneal spurs. The inferior spurs are more common on right and left side i.e out of 325 cases 75 (23.08 % cases, and posterior spurs found in 40 (12,31 % cases, respectively. In 2 (0.61 % cases a scale type of spurs was present which was attached in the middle of the inferior surface of the calcanei and their anterior ends are free, sharp and pointing forwards. These observations are definitely helpful to the orthopedician, traumatologist and surgeons in their diagnosis and treatment.

  17. Osteomyelitis in children

    International Nuclear Information System (INIS)

    In addition to the established methods of X-ray radiography, or conventional tomography, for the diagnostic imaging of osteomyelitis in children, ultrasonography is another very useful technique. In many cases, MRI well supplements the range of available methods, but CT is inferior to the latter. Bone scintiscanning is not applicable for a differential diagnosis, i.e. for discriminating osteomyelitis from other lesions such as bone tumors or tumorous lesions. Due to the very small contribution of scintigraphy to differential diagnosis or therapy selection in case of osteomyelitis or other skeletal lesions in children, the radiation dose to the children as a result of scintiscanning is an important factor, with the energy dose to the metaphyseal growth complexes being the crucial dose. Skeletal scintiscanning in children therefore requires extremely accurate indication, and its almost routine application for differential diagnosis of localised bone lesions in children is by no means justified. (orig./MG)

  18. Percutaneous reduction and fixation of intraarticular calcaneal fractures

    OpenAIRE

    Schepers, Tim; Vogels, Lucas; Schipper, Inger; Patka, Peter

    2008-01-01

    textabstractObjective: Percutaneous reduction by distraction and subsequent percutaneous screw fixation to restore calcaneal and posterior talocalcaneal facet anatomy. The aim of this technique is to improve functional outcome and to diminish the rate of secondary posttraumatic arthrosis compared to conservative treatment and, secondly, to reduce infectious complications compared to open reduction and internal fixation (ORIF). Indications: Sanders type II-IV displaced intraarticular calcaneal...

  19. The lateral calcaneal flap for sensate heel reconstruction revisited.

    Science.gov (United States)

    Korentager, R

    1994-06-01

    Defects of the heel can be difficult to treat because they require a thin, sensate, soft-tissue cover. The lateral calcaneal flap can provide this type of reconstruction in selected patients. A 27-year-old man had a painful defect in a grafted heel that prevented him from working. A satisfactory painless heel was provided by resurfacing the area with a lateral calcaneal flap. The donor defect was minimized by interfascicular dissection of the sural nerve. PMID:8199942

  20. Therapy of haematogenous osteomyelitis

    DEFF Research Database (Denmark)

    Johansen, Louise Kruse; Koch, Janne; Kirketerp-Møller, Klaus;

    2013-01-01

    It is generally accepted that surgery is necessary for the proper treatment of chronic haematogenous osteomyelitis (HO) in children. However, the correct timing of surgery and the technique most effective for debridement of infectious bone tissue is debated. Theoretically, large animal models of HO...

  1. Hematogenous osteomyelitis in children

    DEFF Research Database (Denmark)

    Rud, B; Halken, S; Damholt, V

    1986-01-01

    In a 10-year period, 31 children, including 9 infants, were treated for hematogenous osteomyelitis. Fifteen children were treated closed and 16 open. Thirteen of 14 positive cultures were Staphylococcus aureus. Three recurrences could possibly have been prevented by a more aggressive primary...

  2. Osteomyelitis in turkeys

    Science.gov (United States)

    Turkey osteomyelitis complex (TOC) is a condition in which apparently healthy, usually male birds have infections that are hidden in their bones, joints, and muscles. Some of these birds have a green liver, which provides a method for detecting these carcasses in the processing plant. Our research h...

  3. Ewing sarcoma versus osteomyelitis: differential diagnosis with magnetic resonance imaging

    International Nuclear Information System (INIS)

    To find and evaluate characteristic magnetic resonance imaging (MRI) patterns for the differentiation between Ewing sarcoma and osteomyelitis. We identified 28 consecutive patients referred to our department for MRI (1.5 T) of an unclear bone lesion with clinical symptoms suggestive of Ewing sarcoma or osteomyelitis. MRI scans were re-evaluated by two experienced radiologists, typical MR imaging features were documented and a diagnostic decision between Ewing sarcoma and osteomyelitis was made. Statistical significance of the association between MRI features and the biopsy-based diagnosis was assessed using Fisher's exact test. The most clear-cut pattern for determining the correct diagnosis was the presence of a sharp and defined margin of the bone lesion, which was found in all patients with Ewing sarcoma, but in none of the patients with osteomyelitis (P < 0.0001). Contrast enhancing soft tissue was present in all cases with Ewing sarcoma and absent in 4 patients with osteomyelitis (P = 0.0103). Cortical destruction was found in all patients with Ewing sarcoma, 4 patients with osteomyelitis did not present any cortical reaction (P = 0.0103). Cystic or necrotic areas were identified in 13 patients with Ewing sarcoma and in 1 patient with osteomyelitis (P = 0.004). Interobserver reliability was very good (kappa = 1) in Ewing sarcoma and moderate (kappa = 0.6) in patients with osteomyelitis. A sharp and defined margin, optimally visualized on T1-weighted images in comparison to short tau inversion recovery (STIR) images, is the most significant feature of Ewing sarcoma in differentiating from osteomyelitis. (orig.)

  4. Ewing sarcoma versus osteomyelitis: differential diagnosis with magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Henninger, B.; Glodny, B.; Rudisch, A.; Trieb, T.; Loizides, A.; Judmaier, W.; Schocke, M.F. [Innsbruck Medical University, Department of Radiology, Innsbruck (Austria); Putzer, D. [Innsbruck Medical University, Department of Nuclear Medicine, Innsbruck (Austria)

    2013-08-15

    To find and evaluate characteristic magnetic resonance imaging (MRI) patterns for the differentiation between Ewing sarcoma and osteomyelitis. We identified 28 consecutive patients referred to our department for MRI (1.5 T) of an unclear bone lesion with clinical symptoms suggestive of Ewing sarcoma or osteomyelitis. MRI scans were re-evaluated by two experienced radiologists, typical MR imaging features were documented and a diagnostic decision between Ewing sarcoma and osteomyelitis was made. Statistical significance of the association between MRI features and the biopsy-based diagnosis was assessed using Fisher's exact test. The most clear-cut pattern for determining the correct diagnosis was the presence of a sharp and defined margin of the bone lesion, which was found in all patients with Ewing sarcoma, but in none of the patients with osteomyelitis (P < 0.0001). Contrast enhancing soft tissue was present in all cases with Ewing sarcoma and absent in 4 patients with osteomyelitis (P = 0.0103). Cortical destruction was found in all patients with Ewing sarcoma, 4 patients with osteomyelitis did not present any cortical reaction (P = 0.0103). Cystic or necrotic areas were identified in 13 patients with Ewing sarcoma and in 1 patient with osteomyelitis (P = 0.004). Interobserver reliability was very good (kappa = 1) in Ewing sarcoma and moderate (kappa = 0.6) in patients with osteomyelitis. A sharp and defined margin, optimally visualized on T1-weighted images in comparison to short tau inversion recovery (STIR) images, is the most significant feature of Ewing sarcoma in differentiating from osteomyelitis. (orig.)

  5. Periostitis ossificans (Garrè's osteomyelitis): An unusual case.

    Science.gov (United States)

    Singh, Deepesh; Subramaniam, Priya; Bhayya, Panduranga Deepak

    2015-01-01

    Garrè's sclerosing osteomyelitis is a specific type of chronic osteomyelitis that mainly affects children and young adults and is commonly associated with odontogenic infection. The paper describes an unusual case of Garrè's osteomyelitis in an 11-year-old boy, in whom the condition arose following poor oral hygiene and periodontal problems in relation to permanent mandibular left first molar. Clinically the patient presented with bony hard, nontender swelling and the occlusal radiograph revealed pathognomic feature of "onion skin" appearance. PMID:26381640

  6. Diabetic foot complicated by vertebral osteomyelitis and epidural abscess

    Science.gov (United States)

    Trombetta, Maddalena; Imbriaco, Chiara; Rigolon, Riccardo; Mingolla, Lucia; Zamboni, Federica; Dal Molin, Francesca; Cioccoloni, Dario; Sanga, Viola; Bruti, Massimiliano; Brocco, Enrico; Conti, Michela; Ravenna, Giorgio; Perrone, Fabrizia; Stoico, Vincenzo; Bonora, Enzo

    2016-01-01

    Summary Vertebral osteomyelitis (or spondylodiscitis) is steadily increasing in Western countries and often results from hematogenous seeding, direct inoculation during spinal surgery, or contiguous spread from an infection in the adjacent soft tissue. We present the case of a 67-year-old white patient with type 2 diabetes who went to Hospital for high fever, back pain, and worsening of known infected ulcers in the left foot. Despite intravenous antibiotic treatment and surgical debridement of the foot infection, high fever and lower back pain continued. Bone biopsy and two consecutive blood cultures were positive for Staphylococcus aureus. A spinal magnetic resonance imaging (MRI) was performed, revealing serious osteomyelitis in L4 and L5 complicated by an epidural abscess. Contiguous or other distant focuses of infection were not identified. In this case, diabetic foot could be considered as a primary distant focus for vertebral osteomyelitis. Clinicians should consider vertebral osteomyelitis as a ‘possible’ diagnosis in patients with type 2 diabetes complicated by foot infection that is associated with fever and lower back pain. Learning points Vertebral osteomyelitis is increasing in Western countries, especially in patients with type 2 diabetes. The primary focus of infection is the genitourinary tract followed by skin, soft tissue, endocarditis, bursitis, septic arthritis, and intravascular access. Diabetic foot could be a rare primary focus of infection for vertebral osteomyelitis, and, however, vertebral osteomyelitis could be a serious, albeit rare, complication of diabetic foot. Clinicians should keep in mind the many potential complications of diabetic foot ulcerations and consider vertebral osteomyelitis as a “possible” diagnosis in patients with type 2 diabetes and foot ulcers associated with nonspecific symptoms such as lower back pain. Early diagnosis and correct management of vertebral osteomyelitis are crucial to improve clinical outcomes

  7. Symphysis Pubis Osteomyelitis with Bilateral Adductor Muscles Abscess

    Directory of Open Access Journals (Sweden)

    Saad M. Alqahtani

    2014-01-01

    Full Text Available Osteomyelitis of the pubis symphysis is a rare condition. There have been various reports in the literature of inflammation and osteomyelitis as well as septic arthritis of pubic symphysis. However, due to the fact that these conditions are rare and that the usual presenting symptoms are very nonspecific, osteomyelitis of the pubic symphysis is often misdiagnosed, thus delaying definitive treatment. We present a case that to our knowledge is the first case in literature of osteomyelitis of the pubic symphysis in a 17-year-old boy with juvenile idiopathic arthritis (JIA, which was initially misdiagnosed and progressed to bilateral adductor abscesses. A high suspicion of such condition should be considered in a JIA patient who presents with symphysis or thigh pain.

  8. Radiologic study of osteomyelitis of the jaw

    International Nuclear Information System (INIS)

    The author studied age and sex distribution, etiology, affected site and several radiographic features of osteomyelitis of the jaw. And radiologic classification of osteomyelitis was also done. The material consisted of 118 males and 96 females examined and/or treated under the diagnosis of osteomyelitis during past 11 years (1970-1980.6) in SNUDH. The obtained results were as followings. 1. The incidence is the highest in teen ages (22.9%) and the lowest in seventies. (2.8%). 2. 199 cases were found in lower jaw, and 15 cases in upper jaw. 30.8% of all cases were located at the posterior portion of mandibular body comprising alveolar region. 3. Radiographic examination of osteolytic lesion revealed that 21.5% of all patients had periapical and alveolar bone rarefaction combined with osteoporotic changes were present at the same time. 4. Sclerotic lesions were seen in 62.2% of all patients and 21.5% of sclerotic lesion were diffuse or homogenous type. 5. Based on the radiologic study, classification of the osteomyelitis of the jaw was made. Localized osteolytic type was the highest in incidence (38.8%) and localized sclerotic type was the lowest (7.0%).

  9. Maxillary Osteomyelitis: A Rare Entity

    Directory of Open Access Journals (Sweden)

    Ayaaz Habib

    2016-01-01

    Full Text Available Osteomyelitis of the maxilla is now a rare event with the advent of antibiotics. The two predominant causes are odontogenic infections and sinusitis. Immunocompromised states such as diabetes, HIV, and malnutrition increase the risk of osteomyelitis. It is important to recognize this early as it is a difficult entity to treat with potentially serious consequences. We report an unusual case of right sided maxillary osteomyelitis in a lady with poorly controlled diabetes in rural Lincolnshire. Biopsy of the right maxillary bone showed features of acute osteomyelitis. This responded well to a prolonged course of oral antibiotics.

  10. Radiodiagnosis of posttraumatic chronic osteomyelitis

    International Nuclear Information System (INIS)

    163 patients with posttraumatic chronic osteomyelitis were observed. Osteomyelitis developed after an open fracture in the absence of osteosynthesis in 9 cases only. In the rest 154 cases of osteomyelitis some type of osteosynthesis was used for fracture treatment. The X-ray signs of posttraumatic chronic osteomyelitis are varied. Correct and early recognition of this pathology requires a clear-cut idea of its features with relation to the nature of fracture, the type of osteosynthesis and peculiarity of reparative processes. It requires multiple use of various X-ray methods of which the main are roentgenography, tomography and fistulography

  11. Acute Osteomyelitis of the Symphysis Pubis after Inguinal Hernia Surgery

    Directory of Open Access Journals (Sweden)

    Recep Tekin

    2015-01-01

    Full Text Available Osteomyelitis of pubic symphysis is infectious inflammatory condition of the symphysis pubis and rare complication of surgery around inguinal and groin region. It should be kept in mind in the differential diagnosis of lower pelvic pain and should be sought in cases of pelvic insufficiency fractures. Herein, we present a case of a 55-year-old man with osteomyelitis of the symphysis pubis following inguinal hernia surgery for diagnosis and management of this rare condition.

  12. Problems in the scintigraphic detection of osteomyelitis in children

    International Nuclear Information System (INIS)

    /sup 99m/Tc pyrophosphate studies in 21 children with acute hematogenous osteomyelitis were compared with radiographic, clinical and surgical findings. Eleven /sup 99m/Tc studies revealed obvious abnormalities, four showed subtle abnormalities, two were misleading, and four were normal. No consistent explanation for the lack of positive radionuclide findings was found. We concluded that pediatric osteomyelitis presents a spectrum of scintigraphic appearances and interpretation is often difficult

  13. Nanocidals therapy for osteomyelitis

    Science.gov (United States)

    Qadri, Shahnaz Majid

    Infection is a major medical problem that causes serious complications including patient death. The mortality rate of invasive infection has reduced significantly since the introduction of antibiotherapy. However, the resistance to antibiotic is becoming a serious medical problem that resulted in high medical cost. The overall aim of this study is to evaluate a potential inorganic route (metalo-antibiotic) to treat localized infections that require long-term antibiotic treatment combined with medical and surgical intervention. In this study osteomyelitis (bone infection) was selected as a model to evaluate the inorganic route to treat infection. Osteomyelitis is a progressive infection that could result in amputation and patient death. The metalo-antibiotics are faster to develop than antibiotics and have shown great efficacy against a wide range of bacterial infection. A unique composition of particles with ability to extend their residual efficacy on bacteria for an extended time compared to conventional antibiotics was synthesized and evaluated in this study. The in vitro experiments demonstrated the metalo-antibiotics to treat cellular internal infections without damaging the home cell. The in vivo toxicity experiments demonstrated a tolerance of the particles for doses that are 20 times higher than the anticipated treatment dose. A murine mouse model for osteomyelitis was developed. The efficacy of the metalo-antibiotics on the induced osteomyelitis was evaluated. A significant decrease in infection in the bones treated with nanoparticles was observed. By delivering optimal concentration of nanoparticles in mouse models there was no sign of pathology seen in mouse. Overall, this study has two main impacts: a) creation of inorganic routes to fight against bacterial infection particularly those requiring long-term antibiotic or surgical treatment b) reduction of critical technical risk through generation of pre-clinical data of the employment of inorganic

  14. Mucormycosis causing maxillary osteomyelitis

    OpenAIRE

    Selvamani, Manickam; Donoghue, Mandana; Bharani, Shiva; G S Madhushankari

    2015-01-01

    Mucormycosis is an opportunistic fungal infection, more commonly observed in immunocompromised patients. The mode of infection is via the inhalation route and infection begins initially in the nose and paranasal sinuses with subsequent invasion into the vascular tissue, eventually leading to thrombosis and necrosis of nearby hard and soft tissues. Here, we report a case of chronic osteomyelitis of the maxillary bone with fungal infection (mucormycosis) and extensive tissue necrosis in an unco...

  15. Aspergillus fumigatus Empyema, Arthritis, and Calcaneal Osteomyelitis in a Lung Transplant Patient Successfully Treated with Posaconazole

    OpenAIRE

    Lodge, Barbara Alexander; Ashley, Elizabeth Dodds; Steele, Mark P.; John R Perfect

    2004-01-01

    A 64-year-old male with Aspergillus fumigatus infection that had disseminated from the lung to the ankle and adjacent bone was treated successfully with posaconazole after therapy with itraconazole and amphotericin B lipid complex failed. Marked clinical improvement occurred within 6 weeks of initiation of posaconazole therapy; after 6 months, infection had resolved at all sites. The patient has had no recurrence of infection.

  16. Osteomyelitis and pyogenic infection of the sacroiliac joint. MRI findings and review

    Energy Technology Data Exchange (ETDEWEB)

    Haliloglu, M. [Dept. of Radiology, Indiana University School of Medicine, Indianapolis, IN (United States); Kleiman, M.B. [Dept. of Pediatrics, Indiana University School of Medicine, Indianapolis, IN (United States); Siddiqui, A.R. [Division of Nuclear Medicine, Indiana University School of Medicine, Indianapolis, IN (United States); Cohen, M.D. [Dept. of Radiology, Indiana University School of Medicine, Indianapolis, IN (United States)

    1994-09-01

    Acute pyogenic sacroiliac joint infection and osteomyelitis of adjacent bones often present with severe, poorly localized lower back, pelvic of hip pain. Five cases of sacroiliac joint infection or sacroiliac bone osteomyelitis were evaluated by MRI. MRI may be a helpful diagnostic tool to evaluate early changes of infection in the sacroiliac area. It is very sensitive for detecting bone marrow abnormalities; however, it is non-specific and can not accurately differentiate osteomyelitis from sacroiliitis. (orig.)

  17. Fusobacterium nucleatum Osteomyelitis in 3 Previously Healthy Children: A Case Series and Review of the Literature.

    Science.gov (United States)

    Gregory, Seth W; Boyce, Thomas G; Larson, A Noelle; Patel, Robin; Jackson, Mary Anne

    2015-12-01

    Fusobacterium nucleatum is a rare cause of monomicrobial osteomyelitis in children. We describe the cases of 3 children with F. nucleatum osteomyelitis of the distal femoral epiphysis with concurrent septic arthritis and review 6 other cases reported in the literature. Our report emphasizes the importance of maintaining a high index of suspicion for anaerobic osteomyelitis, given its atypical presentation and the unique growth requirements of anaerobic bacteria. PMID:26407282

  18. Osteomyelitis and pyogenic infection of the sacroiliac joint. MRI findings and review

    International Nuclear Information System (INIS)

    Acute pyogenic sacroiliac joint infection and osteomyelitis of adjacent bones often present with severe, poorly localized lower back, pelvic of hip pain. Five cases of sacroiliac joint infection or sacroiliac bone osteomyelitis were evaluated by MRI. MRI may be a helpful diagnostic tool to evaluate early changes of infection in the sacroiliac area. It is very sensitive for detecting bone marrow abnormalities; however, it is non-specific and can not accurately differentiate osteomyelitis from sacroiliitis. (orig.)

  19. Periostitis ossificans (Garrè′s osteomyelitis): An unusual case

    OpenAIRE

    Deepesh Singh; Priya Subramaniam; Panduranga Deepak Bhayya

    2015-01-01

    Garrè′s sclerosing osteomyelitis is a specific type of chronic osteomyelitis that mainly affects children and young adults and is commonly associated with odontogenic infection. The paper describes an unusual case of Garrè′s osteomyelitis in an 11-year-old boy, in whom the condition arose following poor oral hygiene and periodontal problems in relation to permanent mandibular left first molar. Clinically the patient presented with bony hard, nontender swelling and the occlusal radiograph reve...

  20. Fungal osteomyelitis with vertebral re-ossification

    OpenAIRE

    O′Guinn, Devon J.; Serletis, Demitre; Kazemi, Noojan

    2015-01-01

    Introduction We present a rare case of thoracic vertebral osteomyelitis secondary to pulmonary Blastomyces dermatitides. Presentation of case A 27-year-old male presented with three months of chest pains and non-productive cough. Examination revealed diminished breath sounds on the right. CT/MR imaging confirmed a right-sided pre-/paravertebral soft tissue mass and destructive lytic lesions from T2 to T6. CT-guided needle biopsy confirmed granulomatous pulmonary Blastomycosis. Conservative ma...

  1. Infantile maxillary sinus osteomyelitis mimicking orbital cellulitis

    Directory of Open Access Journals (Sweden)

    Nagarajan Krishnan

    2014-01-01

    Full Text Available Periorbital soft tissue swelling may result due to primary orbital pathology or from adjacent facio-maxillary or sino-nasal inflammatory causes. Osteomyelitis of maxilla in the pediatric age group is a rare entity in this era of antibiotics. We present an 11-month-old female infant who was brought with peri-orbital selling and purulent nasal discharge. Computed Tomography showed erosions of the walls of maxillary sinus suggestive of osteomyelitis. Culture of sinus scraping showed Staphylococcus aureus growth and the child improved with intravenous cloxacillin therapy. This case is presented due to the rarity of its presentation in this age group and for awareness to consider this entity in children having fever and peri-orbital swelling.

  2. Phage therapy of staphylococcal chronic osteomyelitis in experimental animal model

    Directory of Open Access Journals (Sweden)

    Chandan Kishor

    2016-01-01

    Full Text Available Background & objectives: Methicillin resistant Staphylococcus aureus (MRSA are the commonest cause of osteomyelitis. The aim of this study was to evaluate the role of an alternative therapy i.e. application of S. aureus specific bacteriophages in cases of osteomyelitis caused by MRSA in animal model. Methods: Twenty two rabbits were included in this study. The first two rabbits were used to test the safety of phage cocktail while the remaining 20 rabbits were divided into three groups; group A (n=4 to assess the establishment of osteomyelitis; group B (n=4 osteomyelitis developed but therapy started only after six weeks; and group C (n=12 osteomyelitis developed and therapy started after three weeks. Groups B and C rabbits were treated with four doses of cocktail of seven virulent bacteriophages at the interval of 48 h. Comparison between three groups was made on the basis of observation of clinical, radiological, microbiological, and histopathological examinations. Results: Experimental group rabbits recovered from the illness in the subsequent two weeks of the therapy. Appetite and activity of the rabbits improved, local oedema, erythema and induration subsided. There were minimal changes associated with osteomyelitis in X-ray and histopathology also showed no signs of infection with new bone formation. Control B group rabbits also recovered well from the infection. Interpretation & conclusions: The present study shows a potential of phage therapy to treat difficult infections caused by multidrug resistant bacteria.

  3. Rare Case of Aspergillus ochraceus Osteomyelitis of Calcaneus Bone in a Patient with Diabetic Foot Ulcers

    Directory of Open Access Journals (Sweden)

    Farhang Babamahmoodi

    2015-01-01

    Full Text Available Diabetes is the most common metabolic disease in humans. One of the major complications of the disease is foot ulcer that is prone to infection. The most common causes of infection which have been reported in these patients are bacteria and fungi such as Candida, Aspergillus, and Rhizopus species. We report one such rare case with calcaneal osteomyelitis caused by Aspergillus ochraceus in a patient with diabetic foot osteomyelitis. The case was a 68-year-old male with a history of type II diabetes for 2 years. The patient had two ulcers on the right heel bones for the past 6 months with no significant improvement. One of the most important predisposing factors to infectious diseases, especially opportunistic fungal infection, is diabetes mellitus. Aspergillus species can involve bony tissue through vascular system, direct infection, and trauma. Proper and early diagnosis and treatment of diabetic foot infection can reduce or prevent complications, such as osteomyelitis and amputation. The annual examination of feet for skin and nail lesion, sensation, anatomical changes, and vascular circulation can be useful for prevention and control of infection.

  4. Rare Case of Aspergillus ochraceus Osteomyelitis of Calcaneus Bone in a Patient with Diabetic Foot Ulcers

    Science.gov (United States)

    Babamahmoodi, Farhang; Shokohi, Tahereh; Ahangarkani, Fatemeh; Nabili, Mojtaba; Afzalian Ashkezari, Elham; Alinezhad, Sosan

    2015-01-01

    Diabetes is the most common metabolic disease in humans. One of the major complications of the disease is foot ulcer that is prone to infection. The most common causes of infection which have been reported in these patients are bacteria and fungi such as Candida, Aspergillus, and Rhizopus species. We report one such rare case with calcaneal osteomyelitis caused by Aspergillus ochraceus in a patient with diabetic foot osteomyelitis. The case was a 68-year-old male with a history of type II diabetes for 2 years. The patient had two ulcers on the right heel bones for the past 6 months with no significant improvement. One of the most important predisposing factors to infectious diseases, especially opportunistic fungal infection, is diabetes mellitus. Aspergillus species can involve bony tissue through vascular system, direct infection, and trauma. Proper and early diagnosis and treatment of diabetic foot infection can reduce or prevent complications, such as osteomyelitis and amputation. The annual examination of feet for skin and nail lesion, sensation, anatomical changes, and vascular circulation can be useful for prevention and control of infection. PMID:26064128

  5. Calcaneal acrometastasis from urothelial carcinoma of the ureter: a case report and literature review

    Directory of Open Access Journals (Sweden)

    Ryder JH

    2013-04-01

    Full Text Available Jonathan H Ryder,1 Sean V McGarry,2 Jue Wang1  1Division of Oncology/Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA; 2Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, Nebraska, USA Purpose: Ureteral cancer is a rare entity. Typical symptoms are painless hematuria as well as flank pain. Bone metastasis of ureteral cancer can occur in nearby bone structures, such as the spine, pelvis, and hip bone. Distal bone metastasis, such as that in the calcaneus bone, however, is rare. Case report: An 82-year-old woman presented to the orthopedic clinic at the university hospital with a 3-month history of left heel pain. A magnetic resonance imaging (MRI of her foot demonstrated a calcaneal lytic lesion. A biopsy of the lytic lesion showed urothelial carcinoma with squamous differentiation. A computed tomography (CT scan of the abdomen and pelvis showed left hydronephrosis and an obstructive mass in the left ureter, at the iliac crossing. The patient received combined therapy that included local radiation, bisphosphonate, and chemotherapy, with complete resolution of her cancer-related symptoms. However, she eventually died from the progressive disease, 20 months after the initial diagnosis. Conclusion: This case highlights the rare presentation of ureter cancer with an initial presentation of foot pain, secondary to calcaneal metastasis. Multimodality therapy provides effective palliation of symptoms and improved quality of life. We also reviewed the literature and discuss the clinical benefits of multidisciplinary cancer care in elderly patients. Keywords: urothelial carcinoma, elderly, calcaneal acrometastasis, multimodality therapy, chemotherapy, radiation

  6. Differential diagnosis of infantile osteomyelitis - classification according to scintigraphic, radiologic and magnetic resonance tomographic findings

    International Nuclear Information System (INIS)

    We present a retrospective study on children with the final diagnosis osteomyelitis, who have been examined in Tuebingen from 1985 to 1991. The different types of infantile osteomyelitis were classified due to the causative organism and findings in 3-phase scintigraphy and X-ray films. For the chronic type of osteomyelitis the study was extended to the years from 1979 to 1991 and the results of an earlier report were included. We worked up 17 cases of acute/peracute osteomyelitis, including 5 cases of early infancy, 2 cases of tuberculosis, 2 Brodie's abscesses, 5 plasmacellular types, 2 cases of primary chronic multifocal osteomyelitis (PCMO), and 5 cases of unspecific chronic osteomyelitis. All cases were examined with scintigraphy, X-ray films and in part with magnetic resonance tomographic imaging. In 23 cases scintigrams and X-ray films were performed in the follow-up. We show the importance of scintigraphy for the early detection and localisation of osteomyelitis, the importance of findings on X-ray films for the specific diagnosis of osteomyelitis, and the importance of magnetic resonance tomography for high-resolution detection of the expansion of osteomyelitis. (orig.)

  7. [Chronic nonbacterial osteomyelitis].

    Science.gov (United States)

    Keskitalo, Paula; Remes-Pakarinen, Terhi; Vähäsalo, Paula; Niinimäki, Jaakko; Kröger, Liisa

    2016-01-01

    Chronic nonbacterial osteomyelitis is an autoinflammatory disease occurring mainly in children and adolescents, typically involving recurrent or persistent osteitic foci. The symptom is bone pain, possibly accompanied by soft tissue tenderness. Some patients exhibit symptoms of systemic inflammation. The. precise etiology of the disease is not known, but an imbalance of inflammatory and anti-inflammatory cytokines is presumed to play a role in the development of the disease. While an anti-inflammatory analgesic is in most cases sufficient to calm down the osteitis, the use of corticosteroids, anti- TNF-a inhibitors or bisphosphonates is required in some cases. PMID:26939487

  8. Salmonella Typhi Vertebral Osteomyelitis and Epidural Abscess

    Science.gov (United States)

    Chua, Ying Ying; Chen, John L. T.

    2016-01-01

    Salmonella vertebral osteomyelitis is an uncommon complication of Salmonella infection. We report a case of a 57-year-old transgender male who presented with lower back pain for a period of one month following a fall. Physical examination only revealed tenderness over the lower back with no neurological deficits. MRI of the thoracic and lumbar spine revealed a spondylodiscitis at T10-T11 and T12-L1 and right posterior epidural collection at the T9-T10 level. He underwent decompression laminectomy with segmental instrumentation and fusion of T8 to L3 vertebrae. Intraoperatively, he was found to have acute-on-chronic osteomyelitis in T10 and T11, epidural abscess, and discitis in T12-L1. Tissue and wound culture grew Salmonella Typhi and with antibiotics susceptibility guidance he was treated with intravenous ceftriaxone for a period of six weeks. He recovered well with no neurological deficits. PMID:27034871

  9. Oral ciprofloxacin for treatment of chronic osteomyelitis.

    Science.gov (United States)

    Yamaguti, A; Trevisanello, C; Lobo, I M; Carvalho, M C; Bortoletto, M L; Silva, M L; Brasil Filho, R; Levi, G C; Mendonça, J S

    1993-01-01

    Seventeen adult patients with chronic osteomyelitis were treated with oral ciprofloxacin, 750 mg twice daily. Treatment ranged from 28 to 254 days. Efficacy was considered to be good, based upon clinical resolution observed in 13 patients (76%). Clinical and microbiological failure was observed in 3 patients (18%), and there was one case of reinfection. Tolerance was very satisfactory, since the adverse reactions were mild and transitory; these occurred in 7 patients (41%), being cutaneous rash in 4 patients and diarrhoea in 3 patients. No patient had to discontinue treatment. Thus, oral ciprofloxacin may be useful option for the prolonged treatment of chronic osteomyelitis, provided that it is always associated with surgical debridement. Due to the probable development of ciprofloxacin resistance in the S. aureus multiresistant strain, already observed in two patients in the present investigation, it is suggested that for the treatment of such infections another drug with antistaphylococcal activity should be associated with the ciprofloxacin. PMID:8354592

  10. Osteomyelitis: a current challenge

    Directory of Open Access Journals (Sweden)

    Luciana Souza Jorge

    2010-06-01

    Full Text Available Over the last 30 years, the pathogenesis of osteomyelitis has almost been totally elucidated, and many factors responsible for the persistence of this infection have been identified. Numerous antimicrobial agents with distinct spectrums of action, pharmacokinetics, and pharmacodynamics have been used in its treatment. Surgical techniques, including muscle grafts, the Ilizarov technique, and antibiotic bone cements, have been applied. However, bone infections are still a challenge. Despite the importance of isolation and identification of microorganisms to determine the antimicrobial treatment of bone infections, there are few systematic national studies about the etiological profile of these diseases. This article describes the current knowledge of osteomyelitis and summarizes published national data based on the experience of different Orthopedic and Traumatology Services. In general, S. aureus was described as an important etiological agent; however, the difference in design of national studies makes a comparison between the prevalence of bone infection, the associated risk factors, and the different therapeutic approaches difficult. In conclusion, effort is necessary in order to stimulate systematic national studies in different Orthopedics and Traumatology Services to obtain a better consensus on preventive measures and therapies of bone infections.

  11. Non-infectious osteomyelitis of the mandible in a young woman

    DEFF Research Database (Denmark)

    Rasmussen, Anne Q; Andersen, Ulrik B; Jørgensen, Niklas R;

    2014-01-01

    INTRODUCTION: We present the case of a patient with non-infectious osteomyelitis of the mandible, which is a recognized but unusual condition of unknown cause. CASE PRESENTATION: A 14-year-old Caucasian girl presented with pain and edema in the left side of her jaw. A clinical examination led to a...... diagnosis of osteomyelitis and she was treated with antibiotics. Our patient continued antibiotic treatment for osteomyelitis and underwent decortication. Histology based on a biopsy showed new bone formation and chronic inflammation, and a diagnosis of sclerotic osteomyelitis was made. Over the next few...... after 12 months. The bone pain was significantly reduced six months after treatment and had disappeared 24 months after treatment. CONCLUSION: We report an unusual localization of non-infectious osteomyelitis of the jaw in a young woman. Even though the presentation was in the jaw, her condition...

  12. Rat-bite fever complicated by vertebral osteomyelitis: A case report.

    Science.gov (United States)

    Sato, Ryota; Kuriyama, Akira; Nasu, Michitaka

    2016-08-01

    Rat-bite fever (RBF) is a challenging diagnosis transmitted by the bite of the rats. We present the first reported case of RBF complicated by vertebral osteomyelitis. It is important to consider performing the MRI to differentiate vertebral osteomyelitis from simple back pain to determine the appropriate duration of antibiotic therapy. PMID:26948832

  13. Recurrent Osteomyelitis Caused by Infection with Different Bacterial Strains without Obvious Source of Reinfection

    Science.gov (United States)

    Uçkay, Ilker; Assal, Mathieu; Legout, Laurence; Rohner, Peter; Stern, Richard; Lew, Daniel; Hoffmeyer, Pierre; Bernard, Louis

    2006-01-01

    Recurrence of osteomyelitis by the same bacterial strain is well known. We report three patients with a second episode of osteomyelitis at the same site caused by different strains of bacteria from the original. Formerly infected and altered bone surface might present a region of diminished resistance for a new infection. PMID:16517930

  14. Recurrent Osteomyelitis Caused by Infection with Different Bacterial Strains without Obvious Source of Reinfection

    OpenAIRE

    Uckay, Ilker; Assal, Mathieu; Legout, Laurence; Rohner, Peter; Stern, Richard; Lew, Daniel Pablo; Hoffmeyer, Pierre; Bernard, Louis

    2006-01-01

    Recurrence of osteomyelitis by the same bacterial strain is well known. We report three patients with a second episode of osteomyelitis at the same site caused by different strains of bacteria from the original. Formerly infected and altered bone surface might present a region of diminished resistance for a new infection.

  15. Recurrent osteomyelitis caused by infection with different bacterial strains without obvious source of reinfection.

    Science.gov (United States)

    Uçkay, Ilker; Assal, Mathieu; Legout, Laurence; Rohner, Peter; Stern, Richard; Lew, Daniel; Hoffmeyer, Pierre; Bernard, Louis

    2006-03-01

    Recurrence of osteomyelitis by the same bacterial strain is well known. We report three patients with a second episode of osteomyelitis at the same site caused by different strains of bacteria from the original. Formerly infected and altered bone surface might present a region of diminished resistance for a new infection. PMID:16517930

  16. Risk factors for developing osteomyelitis in patients with diabetic foot wounds

    NARCIS (Netherlands)

    Lavery, Lawrence A.; Peters, Edgar J. G.; Armstrong, David G.; Wendel, Christopher S.; Murdoch, Douglas P.; Lipsky, Benjamin A.

    2009-01-01

    Aims: Osteomyelitis worsens the prognosis in the diabetic foot, but predisposing factors remain largely undefined, In a prospectively followed cohort we assessed risk factors for developing osteomyelitis. Methods: We enrolled consecutive persons with diabetes who presented to a managed-care diabetes

  17. Optimal management of chronic osteomyelitis: current perspectives

    Directory of Open Access Journals (Sweden)

    Pande KC

    2015-08-01

    Full Text Available Ketan C Pande Raja Isteri Pengiran Anak Saleha Hospital, Bandar Seri Begawan, BruneiAbstract: Chronic osteomyelitis is a challenging condition to treat. It is seen mostly after open fractures or in implant-related infections following treatment of fractures and prosthetic joint replacements. Recurrence of infection is well known, and successful treatment requires a multidisciplinary team approach with surgical debridement and appropriate antimicrobial therapy as the cornerstone of treatment. Staging of the disease and identification of the causative microorganism is essential before initiation of treatment. Important surgical steps include radical debridement of necrotic and devitalized tissue, removal of implants, management of resultant dead space, soft-tissue coverage, and skeletal stabilization or management of skeletal defects. The route of administration and duration of antimicrobial therapy continues to be debated. The role of biofilm is now clearly established in the chronicity of bone infection, and newer modalities are being developed to address various issues related to biofilm formation. The present review addresses various aspects of chronic osteomyelitis of long bones seen in adults, with a review of recent developments. Keywords: osteomyelitis, infection, biofilm, bone, therapy, treatment

  18. Early Weight-bearing Using Percutaneous External Fixator for Calcaneal Fracture

    OpenAIRE

    Sengodan, Vetrivel Chezian; Sengodan, Mugundhan Moongilpatti

    2012-01-01

    Calcaneal fracture, the most common tarsal bone fracture, occurs predominantly in manual labors and subsequently has got considerable socioeconomic implications. Treatment modality which can offer early weight bearing and early return to work is therefore needed for those patients. We have used a biplanar percutaneous external fixator for treating calcaneal fractures without operative and per operative visualization of the fractures. We have treated 17 calcaneal fractures in 16 patients, 12 i...

  19. Maxillary Chronic Osteomyelitis Caused by Domestic Violence: A Diagnostic Challenge

    Directory of Open Access Journals (Sweden)

    Tamyris Inácio Oliveira

    2014-01-01

    Full Text Available Maxillary osteomyelitis is a rare condition defined as inflammation of the bone primarily caused by odontogenic bacteria, with trauma being the second leading cause. The present report documents a rare case of maxillary osteomyelitis in a 38-year-old female who was the victim of domestic violence approximately a year prior to presentation. Intraoral examination revealed a lesion appearing as exposed bony sequestrum, with significant destruction of gingiva and alveolar mucosa in the maxillary right quadrant, accompanied by significant pain, local edema, and continued purulence. Teeth numbers 11, 12, 13, 14, and 15 were mobile, not responsive to percussion, and nonvital. Treatment included antibiotic therapy for seven days followed by total enucleation of the necrotic bone tissue and extraction of the involved teeth. Microscopic findings confirmed the clinical diagnosis of chronic suppurative osteomyelitis. Six months postoperatively, the treated area presented complete healing and there was no sign of recurrence of the lesion.

  20. Neonatal osteomyelitis examined by bone scintigraphy

    International Nuclear Information System (INIS)

    Thirty-three infants less than six weeks of age and suspected of having osteomyelitis were examined by bone scintigraphy. Each of the 25 sites of proved osteomyelitis in 15 individuals demonstrated abnormal radionuclide localization. Ten additional scintigraphically positive but radiographically normal sites were detected. Optimal quality scintigrams of the growth plate complex and osteomyelitis in neonates appeared similar to those in older children. All neonates suspected of having osteomyelitis should be studied with bone scintigraphy following initial radiographs

  1. Risk of injury to vascular-nerve bundle after calcaneal fracture: comparison among three techniques

    Directory of Open Access Journals (Sweden)

    Pedro José Labronici

    2016-04-01

    Full Text Available OBJECTIVE: To ascertain whether the number of screws or pins placed in the calcaneus might increase the risk of injury when three different techniques for treating calcaneal fractures. METHOD: 126 radiographs of patients who suffered displaced calcaneal fractures were retrospectively analyzed. Three surgical techniques were analyzed on an interobserver basis: 31 radiographs of patients treated using plates that were not specific for the calcaneus, 48 using specific plates and 47 using an external fixator. The risk of injury to the anatomical structures in relation to each Kirschner wire or screw was determined using a graded system in accordance with the Licht classification. The total risk of injury to the anatomical structures through placement of more than one wire/screw was quantified using the additive law of probabilities for the product, for independent events. RESULTS: All of the models presented high explanatory power for the risk evaluated, since the coefficient of determination values (R2 were greater than 98.6 for all the models. Therefore, the set of variables studied explained more than 98.6% of the variations in the risks of injury to arteries, veins or nerves and can be classified as excellent models for prevention of injuries. CONCLUSION: The risk of injury to arteries, veins or nerves is not defined by the total number of pins/screws. The region and the number of pins/screws in each region define and determine the best distribution of the risk.

  2. Risk of injury to vascular-nerve bundle after calcaneal fracture: comparison among three techniques

    Science.gov (United States)

    Labronici, Pedro José; Reder, Vitor Rodrigues; de Araujo Marins Filho, Guilherme Ferreira; Pires, Robinson Esteves Santos; Fernandes, Hélio Jorge Alvachian; Mercadante, Marcelo Tomanik

    2016-01-01

    Objective To ascertain whether the number of screws or pins placed in the calcaneus might increase the risk of injury when three different techniques for treating calcaneal fractures. Method 126 radiographs of patients who suffered displaced calcaneal fractures were retrospectively analyzed. Three surgical techniques were analyzed on an interobserver basis: 31 radiographs of patients treated using plates that were not specific for the calcaneus, 48 using specific plates and 47 using an external fixator. The risk of injury to the anatomical structures in relation to each Kirschner wire or screw was determined using a graded system in accordance with the Licht classification. The total risk of injury to the anatomical structures through placement of more than one wire/screw was quantified using the additive law of probabilities for the product, for independent events. Results All of the models presented high explanatory power for the risk evaluated, since the coefficient of determination values (R2) were greater than 98.6 for all the models. Therefore, the set of variables studied explained more than 98.6% of the variations in the risks of injury to arteries, veins or nerves and can be classified as excellent models for prevention of injuries. Conclusion The risk of injury to arteries, veins or nerves is not defined by the total number of pins/screws. The region and the number of pins/screws in each region define and determine the best distribution of the risk. PMID:27069891

  3. A Rare Case of Cranial Osteomyelitis Caused by Proteus Vulgaris

    Directory of Open Access Journals (Sweden)

    Hakan Uslu

    2011-03-01

    Full Text Available Osteomyelitis of the calvarial bones can cause serious complications such as brain abscess, due to the close proximity to adjacent brain structures. Development of the purulent secretion in surgery and traumatic scalp injuries must be considered as a possibility of osteomyelitis possibility. Generally gram positive, rarely gram negative bacteria and mix agents, can be isolated in infection. Especially chronic pyogenic osteomyelitis agents can be isolated from chronic infections such as tuberculosis. In cranial osteomyelitis diagnosis, radiological diagnosis has a very important place together with the clinical diagnosis. However, infection can usually show late findings radiologically. In treatment, antibiotic treatment is absolutely essential as well as removal of the infected part of the bone. Due to antibiotic treatment lasting between 6-12 weeks, organizing the antibiotic protocols according to the results of culture-antibiograms, which were provided from purulent secretions, has the most important role in the success of surgical treatment. In Proteus sp. infections, for choice of suitable treatment, determination of the type of bacteria is important. For exact diagnosis, histopathological examination of the bone tissue must be carried out. In this report, a case with cranial osteomyelitis caused by Proteus vulgaris which is a gram negative bacteria causing anaerobic infections and classified in the Enterobacteriaceae family is presented. The patient was treated with surgery and appropriate antibiotics. Early recognition of this condition, planning the best treatment strategy and taking precautions to prevent complications, is mandatory for a better outcome.

  4. 38 CFR 4.43 - Osteomyelitis.

    Science.gov (United States)

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Osteomyelitis. 4.43... DISABILITIES Disability Ratings The Musculoskeletal System § 4.43 Osteomyelitis. Chronic, or recurring, suppurative osteomyelitis, once clinically identified, including chronic inflammation of bone marrow,...

  5. Tuberculous osteomyelitis of zygoma: an unusual location.

    Science.gov (United States)

    Singh, Virendra; Khatana, Shruti; Gupta, Pranav; Bhagol, Amrish; Narwal, Anjali

    2013-09-01

    Tubercular osteomyelitis of midfacial bones is extremely rare, although tuberculosis of long bones and the vertebral column is not uncommon. Because of the rare incidence, myriad presentation, and lack of specific symptoms, this condition presents a challenge in diagnosis and calls for acute clinical awareness. This article presents a case report of a 12-year-old girl with complaints of gradually increasing swelling lateral to and below her right eye for 4 months with pus discharge. She was treated with surgical curettage and 4-drug antitubercular therapy and responded with complete remission of the sinus. PMID:22819461

  6. Radiation osteomyelitis of the mandible. Report of two cases

    Energy Technology Data Exchange (ETDEWEB)

    Molla, M.R.; Nishio, Juntaro; Matsuya, Tokuzo; Miyazaki, Tadashi (Osaka Univ. (Japan). School of Dentistry)

    1982-12-01

    Radiation therapy for the head and neck malignant tumor may often cause osteoradionecrosis of the mandible, leading to radiation osteomyelitis with a source of infection. The present study demonstrates two cases with radiation osteomyelitis of the mandible to discuss the etiology, radiological findings and preventive measure for this type of bone disease. The results indicate that, 1) A higher dose in external radiotherapy may claimed to be a potent factor to cause osteoradionecrosis and post irradiation periodontitis of the tooth associated with pain, may be preliminary symptom of leading radiation osteomyelitis, where a delayed healing of tooth extraction is an accelerating factor responsible for rapid progress of osteomyelitic changes. 2) Once infection sets in post irradiated bone, radio-osteomyelitic change is quite progressive even after various conservative measure. 3) Only radiological change in those cases is a slow formation of sequestrum time ranging from 7 to 10 months, with a gradual separation of dead bone as a large mass.

  7. Chronic nonbacterial osteomyelitis in children: a retrospective multicenter study

    OpenAIRE

    Kaiser, Daniela; Bolt, Isabel; Hofer, Michael; Relly, Christa; Berthet, Gerald; Bolz, Dieter; Saurenmann, Traudel

    2015-01-01

    Background To determine the clinical presentation, current treatment and outcome of children with nonbacterial inflammatory bone disease. Methods Retrospective multicenter study of patients entered into the Swiss Pediatric Rheumatology Working Group registry with a diagnosis of chronic nonbacterial osteomyelitis (CNO) and synovitis acne pustulosis hyperostosis osteitis (SAPHO) syndrome. The charts were reviewed for informations about disease presentation, treatment, course and outcome. Result...

  8. Chronic nonbacterial osteomyelitis in children: a retrospective multicenter study

    OpenAIRE

    Kaiser, Daniela; Bolt, Isabel; Hofer, Michael; Relly, Christa; Berthet, Gerald; Bolz, Dieter; Saurenmann, Traudel

    2015-01-01

    BACKGROUND: To determine the clinical presentation, current treatment and outcome of children with nonbacterial inflammatory bone disease. METHODS: Retrospective multicenter study of patients entered into the Swiss Pediatric Rheumatology Working Group registry with a diagnosis of chronic nonbacterial osteomyelitis (CNO) and synovitis acne pustulosis hyperostosis osteitis (SAPHO) syndrome. The charts were reviewed for informations about disease presentation, treatment, course and outcome. ...

  9. Multifocal Tubercular Osteomyelitis: A Case with Atypical Manifestations

    Directory of Open Access Journals (Sweden)

    Mukesh Thawani

    2011-01-01

    Full Text Available Skeletal tuberculosis (TB accounts for about 1–2% of all TB cases and 10% of extrapulmonary TB cases. We present a 19-year-old male with multifocal tubercular osteomyelitis, who presented with progressively worsening back pain, weight loss, fatigue, anorexia, decreased mobility, low-grade fever, and night sweats—but without pulmonary involvement.

  10. A longitudinal insufficiency fracture of the tibia in association with a healed chronic osteomyelitis

    International Nuclear Information System (INIS)

    Longitudinal stress fracture of the tibia often present with an atypical clinical presentation which can be mistaken for osseous tumor or osteomyelitis. We present a case of longitudinal stress fracture of the tibia which occurred in a patient with healed chronic osteomyelitis of the tibia. Magnetic resonance imaging failed to make the correct diagnosis. Accurate diagnosis was only obtained by helical CT which showed the longitudinal fracture line. Magnetic resonance imaging showed only non-specific signs of bone marrow edema, suggesting recurrence of osteomyelitis. Magnetic resonance imaging can be misleading in the absence of direct visualization of the fracture line. (orig.)

  11. A longitudinal insufficiency fracture of the tibia in association with a healed chronic osteomyelitis

    Energy Technology Data Exchange (ETDEWEB)

    Feydy, A.; Carlier, R.; Mutschler, C.; Leriverend, V.; Vallee, C. [Dept. of Radiology, Hopital Raymond Poincare, Garches (France); Bernard, L. [Dept. of Infectious Diseases, Hopital Raymond Poincare, Garches (France)

    2000-12-01

    Longitudinal stress fracture of the tibia often present with an atypical clinical presentation which can be mistaken for osseous tumor or osteomyelitis. We present a case of longitudinal stress fracture of the tibia which occurred in a patient with healed chronic osteomyelitis of the tibia. Magnetic resonance imaging failed to make the correct diagnosis. Accurate diagnosis was only obtained by helical CT which showed the longitudinal fracture line. Magnetic resonance imaging showed only non-specific signs of bone marrow edema, suggesting recurrence of osteomyelitis. Magnetic resonance imaging can be misleading in the absence of direct visualization of the fracture line. (orig.)

  12. Nuclear medical diagnosis of osteomyelitis

    International Nuclear Information System (INIS)

    Static bone scintigraphy is a sensitive but not very specific method of diagnosis of osteomyelitis. The specificity of this method may be increased by sequential use of several radiopharmaceutical drugs or by multi-stage scintigraphy. The possible fields of application of multi-stage scintigraphy for differential diagnosis are discussed in this paper. Multi-stage scintigraphy is indicated in cases of suspected primary osteomyelitis with negative X-ray findings and ambiguous clinical signs. In suspected secondary infections multi-stage scintigraphy also enables the differential diagnosis of instable osteosynthesis and infection to be established. (orig.)

  13. Plantar calcaneal spurs in older people: longitudinal traction or vertical compression?

    Directory of Open Access Journals (Sweden)

    Landorf Karl B

    2008-08-01

    Full Text Available Abstract Background Plantar calcaneal spurs are common, however their pathophysiology is poorly understood. This study aimed to evaluate the prevalence and correlates of plantar calcaneal spurs in a large sample of older people. Methods Weightbearing lateral foot radiographs of 216 people (140 women and 76 men aged 62 to 94 years (mean age 75.9, SD 6.6 were examined for plantar calcaneal and Achilles tendon spurs. Associations between the presence of spurs and sex, body mass index, radiographic measures of foot posture, self-reported co-morbidities and current or previous heel pain were then explored. Results Of the 216 participants, 119 (55% had at least one plantar calcaneal spur and 103 (48% had at least one Achilles tendon spur. Those with plantar calcaneal spurs were more likely to have Achilles tendon spurs (odds ratio [OR] = 2.0, 95% confidence interval [CI] 1.2 to 3.5. Prevalence of spurs did not differ according to sex. Participants with plantar calcaneal spurs were more likely to be obese (OR = 7.9, 95% CI 3.6 to 17.0, report osteoarthritis (OR = 2.6, 95% CI 1.6 to 4.8 and have current or previous heel pain (OR = 4.6, 95% CI 2.3 to 9.4. No relationship was found between the presence of calcaneal spurs and radiographic measures of foot posture. Conclusion Calcaneal spurs are common in older men and women and are related to obesity, osteoarthritis and current or previous heel pain, but are unrelated to radiographic measurements of foot posture. These findings support the theory that plantar calcaneal spurs may be an adaptive response to vertical compression of the heel rather than longitudinal traction at the calcaneal enthesis.

  14. Treatment of osteoradionecrosis combined with pathologic fracture and osteomyelitis of the mandible with electromagnetic stimulation

    International Nuclear Information System (INIS)

    Osteoradionecrosis, complicated by pathologic fracture and osteomyelitis, is difficult to treat. Electromagnetic stimulation therapy may present a solution to this problem. A case of a 66-year old woman, suffering from osteoradionecrosis, pathologic fracture and osteomyelitis of the mandible, 6 years after irradiation therapy and partial resection of the mandible for squamous cell carcinoma of the gingiva, treated by electromagnetic stimulation, is presented. After 9 months of treatment, the patient was asymptomatic. Radiographic examination and bone scintigraphy carried out upon termination of the treatment, proved that healing of osteoradionecrosis and osteomyelitis had occurred. As far as we know, no previous reports have been published regarding this type of treatment. (author)

  15. Bone scintigraphy, radiography and MRI in the diagnosis and evaluation of treatment response of calcaneal tuberculosis

    International Nuclear Information System (INIS)

    Aim: We describe the role of various imaging modalities in the diagnosis and follow up of calcaneal tuberculosis. Materials and methods: Six patients (5 males, 1 female; age range 16-49 years) presented with heel pain. All patients underwent routine laboratory and radiological investigations e.g. radiographs, MRI and skeletal scintigraphy as part of initial diagnostic work-up. In all patients the diagnosis of tuberculosis was confirmed based on histopathology or culture. Standard multi-drug anti-tubercular therapy (ATT) was administered for 15 months. All patients were subsequently followed up with clinical evaluation, laboratory investigations and imaging. Skeletal scintigraphy, MRI and radiographs were repeated at 12 to 15 months from the initiation of anti-tubercular treatment in all patients. Results: Five out of six patients had lytic lesions at presentation on radiographs. Four of these 5 patients also had surrounding sclerosis. Follow-up radiographs obtained 12-15 months after starting ATT, showed an increase in surrounding sclerosis with progressive reduction in area of osteopenia in four and mild sclerotic changes in one. In the remaining one patient radiograph were normal both at presentation and follow up. Three phase bone scintigraphy revealed increased blood flow and blood pool activity and 'hot spots' in 5 and a central photopenic area in the calcaneum in one patient at the time of diagnosis. After starting ATT, significant reduction in vascularity and reactive bone changes in 5 patients and mild improvement in one patient. MRI was done in three patients, which revealed hyperintense lesion with erosion of the superior articular surface in 2 and 'Bull's eye' lesion with a hypointense centre and a surrounding hyperintense rim on post contrast T1W images in one patient. Follow-up MRI showed intermediate signal intensity on T2 weighted images that corresponded to caseous necrosis and high signal intensity related to granulomas or effusion. Conclusion

  16. Acute osteomyelitis caused by Rhodococcus equi in an immunocompetent child

    Directory of Open Access Journals (Sweden)

    Sistla Sujatha

    2009-04-01

    Full Text Available Rhodococcus equi is an unusual pathogen causing infections mostly in immunocompromised patients, particularly in those with human immunodeficiency virus (HIV. It has rarely been reported to affect immunocompetent hosts, where it usually presents as an isolated extrapulmonary lesion. We report a case of osteomyelitis caused by this organism in an immunocompetent host.

  17. Spinal osteomyelitis caused by Proteus mirabilis in a child

    NARCIS (Netherlands)

    deWeerd, W; Kimpen, JLL; Miedema, CJ

    1997-01-01

    Osteomyelitis due to Proteus mirabilis is rare. Spinal osteomyelitis caused by this organism has only been described in adults. This is the first paediatric case of P. mirabilis vertebral osteomyelitis.

  18. Vertebral osteomyelitis: assessment using MR

    International Nuclear Information System (INIS)

    Thirty-seven patients who were clinically suspected of having vertebral osteomyelitis were prospectively evaluated with magnetic resonance (MR), radiography, and radionuclide studies. These findings were correlated with the final clinical, microbiologic, or histologic diagnoses. Based on the results of these latter studies, 23 patients were believed to have osteomyelitis. MR examinations consisted of at least a sagittal image (TE = 30 msec, TR = 0.5 sec) and an image obtained at TE = 120 msec, TR = 2-3 sec. All patients underwent radiographic and MR examinations, 36 underwent technetium 99m-HDP bone scanning, and 20 patients underwent gallium 67 scanning. Nineteen patients underwent both bone and gallium scanning. The imaging studies were reviewed independently by investigators blinded to the final diagnoses. MR had a sensitivity of 96%, specificity of 92%, and accuracy of 94%. Combined gallium and bone scan studies (19 cases) had a sensitivity of 90%, specificity of 100%, and accuracy of 94%. Bone scans alone had a sensitivity of 90%, specificity of 78%, and accuracy of 86%. Plain radiographs had a sensitivity of 82%, specificity of 57%, and accuracy of 73%. The MR appearance of vertebral osteomyelitis in this study was characteristic, and MR was as accurate and sensitive as radionuclide scanning in the detection of osteomyelitis

  19. Cryptococcal osteomyelitis: a report of 5 cases and a review of the recent literature.

    Science.gov (United States)

    Medaris, Leigh Ann; Ponce, Brent; Hyde, Zane; Delgado, Dennis; Ennis, David; Lapidus, William; Larrison, Matthew; Pappas, Peter G

    2016-06-01

    Cryptococcus neoformans is a fungal pathogen associated with advanced HIV disease and other disorders associated with immune dysfunction. The pulmonary and the central nervous system are the most common manifestations of the disease. Localised osteomyelitis as the sole manifestation of extrapulmonary disease is rare. Herein, we present five cases of Cryptococcus osteomyelitis as the only manifestation of extrapulmonary disease. We also identified 84 additional cases of isolated cryptococcal osteomyelitis in the literature. Using these data, we have made some general recommendations regarding an approach to treatment of this uncommon clinical entity. PMID:26968335

  20. Periostitis ossificans (Garrè′s osteomyelitis: An unusual case

    Directory of Open Access Journals (Sweden)

    Deepesh Singh

    2015-01-01

    Full Text Available Garrè′s sclerosing osteomyelitis is a specific type of chronic osteomyelitis that mainly affects children and young adults and is commonly associated with odontogenic infection. The paper describes an unusual case of Garrè′s osteomyelitis in an 11-year-old boy, in whom the condition arose following poor oral hygiene and periodontal problems in relation to permanent mandibular left first molar. Clinically the patient presented with bony hard, nontender swelling and the occlusal radiograph revealed pathognomic feature of "onion skin" appearance.

  1. The conundrum of calcaneal spurs: do they matter?

    LENUS (Irish Health Repository)

    Moroney, Paul J

    2013-12-30

    Background: Chronic plantar heel pain is a common and potentially debilitating condition, often caused by plantar fasciitis. Plantar calcaneal spurs were originally considered the cause of plantar fasciitis but are now regarded as an incidental finding by most authors. We aimed to test this hypothesis and to investigate predisposing factors for the development of spurs. Methods: We reviewed all lateral ankle X rays taken in our institution over a 6-month period and identified all X rays demonstrating calcaneal spurs. Then, we identified a similar number of age- and sex-matched controls without spurs. We contacted both groups by telephone and compared symptoms of heel pain, plantar fasciitis, associated comorbidities, and foot and ankle outcome scores (FAOSs). Results: We reviewed the X rays of 1103 consecutive patients and found a spur prevalence of 12.4%, more common in women and older patients. Questioning of the spur group and control group found a higher body mass index in the spur group. Patients with spurs were 4 times more likely to have diabetes mellitus and 10 times more likely to have lower-limb osteoarthritis. Patients with spurs had more foot pain and poorer FAOS than the control group, even when patients with plantar fasciitis were excluded. Conclusion: Our results demonstrate that the presence of a plantar calcaneal spur may be an indicator of foot pain independent of plantar fasciitis. Although spurs may not cause foot pain themselves, they may be an indication of other associated conditions. Clinical relevance: We have demonstrated the relevance of a radiographic finding once considered irrelevant.

  2. Closed Reduction and Percutaneous Fixation of Calcaneal Fractures in Children.

    Science.gov (United States)

    Feng, Yongzeng; Yu, Yang; Shui, Xiaolong; Ying, Xiaozhou; Cai, Leyi; Hong, Jianjun

    2016-07-01

    Open reduction and internal fixation has been widely used to treat displaced intra-articular calcaneus fractures in children. However, the complications of surgical trauma and the wound created through the extended lateral approach cannot be ignored. This study analyzed the outcomes of displaced intra-articular calcaneal fractures in children treated with closed reduction and percutaneous fixation. Medical records of pediatric patients who had displaced intra-articular calcaneus fractures and underwent closed reduction and percutaneous fixation at the study institution between January 2008 and January 2013 were reviewed. Preoperative radiographs and computed tomography scans were used to evaluate and classify the fractures. Clinical outcomes and radiographic findings were assessed at postoperative follow-up. The study included 14 displaced intra-articular calcaneal fractures in 11 patients (7 boys and 4 girls). Mean patient age was 11.18 years (range, 6-16 years), and average follow-up time was 42.8 months postoperatively (range, 12-72 months). There were 6 tongue-type fractures and 8 joint depression-type fractures, based on the Essex-Lopresti classification, and there were 11 type II and 3 type III fractures, based on the Sanders classification. Average Böhler angle was 8.00° (range, -5° to 18°) preoperatively and 30.79° (range, 26° to 40°) postoperatively (P<.001). Average subjective American Orthopaedic Foot and Ankle Society hindfoot score was 65.7 (range, 52-68). No patients had wound breakdown or infection. In the treatment of displaced intra-articular calcaneal fractures in pediatric patients, closed reduction and percutaneous fixation achieved good outcomes, with few complications. [Orthopedics. 2016; 39(4):e744-e748.]. PMID:27111072

  3. The surgical dilemma of the malunited calcaneal joint depression fracture: the VAMC Miami experience.

    Science.gov (United States)

    Cohen, M

    1996-01-01

    During the period of October 1985 through March 1995, 25 patients presented to the Veterans Affairs Medical Center, Miami with a chief complaint of chronic pain status post calcaneal joint depression fracture. Their acute injury was treated conservatively at this and various other institutions. Nine patients were managed conservatively with orthotics, University of California Biomechanics Laboratory braces (UCBLs), shoe modification, or prosthetics. Sixteen patients underwent hindfoot fusions. Good to excellent results were obtained in 15 of the 16 fusions. The remaining patient, having an isolated subtalar fusion, was later diagnosed with multiple sclerosis. Proper evaluation of the chronic pain patient is critical when mapping out an appropriate treatment plan. Hindfoot arthrodesis with soft tissue decompression is a successful tool in eliminating chronic pain due to malunited depression fractures. PMID:8722881

  4. TUBERCULOUS OSTEOMYELITIS OF PATELLA: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Babu B

    2015-10-01

    Full Text Available The knee joint is the third most frequent skeletal location for tuberculosis after spine and hip. Isolated patellar osteomyelitis of tubercular etiology is rare with literature reporting an incidence of 0.09% to 0.15%. Here we report a case of tuberculous osteomyelitis affecting the patella. CASE REPORT: A 24 year old young male o f Indian origin, working in Australia for a period of 3 years, presented with complaints of pain in the left knee since 3 months. There was minimal swelling of left knee and tenderness over medial border of patella. There were no signs of involvement of kn ee joint proper. Diagnosis was confirmed by imaging and histopathology studies. Curettage followed by anti - tubercular treatment was given for 9 months. CONCLUSIONS: Tuberculosis of the patella is a rare finding. The diagnosis frequently is delayed because of its rarity and variable presentation, which may be acute with systemic signs or insidious with mild local signs. Surgical debridement combined with ATT for 9 months ensures recovery.

  5. Imaging in osteomyelitis: Special features in childhood

    International Nuclear Information System (INIS)

    The prognosis of acute hematogenous osteomyelitis in children ist mainly influenced by early diagnosis and prompt initiation of antibiotic and surgical therapy. In this age group, two forms of manifestation are differentiated: Osteomyelitis in infants up to 18 months and juvenile osteomyelitis until the closure of the epiphyseal plate. Osteomyelitis in infants is often accompanied by septic arthritis of the adjacent joint. In juvenile osteomyelitis, the disease is mostly confined to the metaphysis. Plain films and ultrasonography represent the basic imaging modalities. Depending on the age of the child, the clinical course of the disease and the availability of the various methods, MRI and multiphase bone scintigraphy can be performed for further imaging. CT is of only limited value and should only be used for special cases concerning chronic osteomyelitis. (orig.)

  6. Odontoid Osteomyelitis in Children: Illustrative Case Reports and Review of the Literature.

    Science.gov (United States)

    Zimmermann, Petra; Ritz, Nicole; Stranzinger, Enno

    2016-08-01

    Odontoid osteomyelitis is a rare disease which is frequently misdiagnosed as torticollis, leading to a delay in diagnosis. We present 2 illustrative cases and a systematic literature review summarizing previously reported cases. Odontoid osteomyelitis should be considered in children presenting with decreased head movements and with elevated erythrocyte sedimentation rate, particularly without improvement while receiving antiinflammatory treatment. Plain radiographs can be misleading, and magnetic resonance imaging should be performed for better visualization. PMID:27164466

  7. Sanders II–III calcaneal fractures fixed with locking plate in elderly patients

    OpenAIRE

    Long, Cheng; Fang, Yue; HUANG Fu-guo; Zhang, Hui; Wang, Guang-Lin; YANG Tian-fu; Liu, Lei

    2016-01-01

    Purpose To evaluate the clinical outcomes of locking calcaneal plate in treating calcaneal fracture (Sanders II–III) in elderly patients. Methods From October 2012 to December 2013, 23 elderly patients suffering from calcaneal fracture (Sanders II–III) were treated and followed up. There were 15 males and 8 females with the mean age of 68.5 years (range: 65–79 years). According to Sander's classification, 16 cases (16 feet) were type II fractures and 7 cases (7 feet) were type III fractures. ...

  8. Management of osteomyelitis of the skull base

    International Nuclear Information System (INIS)

    Osteomyelitis of the skull base is the most severe form of malignant otitis externa. As a result of having treated 13 patients with skull base osteomyelitis over a 4-year period, we have developed a method of staging and monitoring this malady using gallium and technetium scanning techniques. Stage I is localized to soft tissues, stage II is limited osteomyelitis, and stage III represents extensive skull base osteomyelitis. All stages are treated with appropriate antipseudomonal antibiotics. The duration of therapy depends upon the clearing of inflammation as shown on the gallium scan. Each case must be looked at independently and not subjected to an arbitrary treatment protocol

  9. Management of osteomyelitis of the skull base

    Energy Technology Data Exchange (ETDEWEB)

    Benecke, J.E. Jr. (Otologic Medical Group, Inc., Los Angeles, CA (USA))

    1989-12-01

    Osteomyelitis of the skull base is the most severe form of malignant otitis externa. As a result of having treated 13 patients with skull base osteomyelitis over a 4-year period, we have developed a method of staging and monitoring this malady using gallium and technetium scanning techniques. Stage I is localized to soft tissues, stage II is limited osteomyelitis, and stage III represents extensive skull base osteomyelitis. All stages are treated with appropriate antipseudomonal antibiotics. The duration of therapy depends upon the clearing of inflammation as shown on the gallium scan. Each case must be looked at independently and not subjected to an arbitrary treatment protocol.

  10. Management of osteomyelitis of the skull base.

    Science.gov (United States)

    Benecke, J E

    1989-12-01

    Osteomyelitis of the skull base is the most severe form of malignant otitis externa. As a result of having treated 13 patients with skull base osteomyelitis over a 4-year period, we have developed a method of staging and monitoring this malady using gallium and technetium scanning techniques. Stage I is localized to soft tissues, stage II is limited osteomyelitis, and stage III represents extensive skull base osteomyelitis. All stages are treated with appropriate antipseudomonal antibiotics. The duration of therapy depends upon the clearing of inflammation as shown on the gallium scan. Each case must be looked at independently and not subjected to an arbitrary treatment protocol. PMID:2601534

  11. Primary Osteomyelitis of the Clavicle in Children.

    Science.gov (United States)

    Ghate, Sushant; Thabet, Ahmed M; Gosey, G Max; Southern, Edward P; Bégué, Rodolfo E; King, Andrew G

    2016-07-01

    Osteomyelitis of the clavicle is a rare entity with a broad differential diagnosis and high potential for complications if not diagnosed promptly and treated appropriately. The threshold for surgical intervention should be low to prevent osteonecrosis and bony resorption. In addition, although rare, life-threatening complications have been reported. This report describes primary osteomyelitis of the clavicle that was diagnosed in a 22-month-old girl on her third clinical evaluation after 4 days of symptoms. She presented to a children's tertiary care emergency department with fever and acute pain and swelling of her right shoulder and arm. The diagnosis was confirmed through clinical, laboratory, and imaging studies including ultrasound; these revealed subperiosteal abscess formation, which may have developed in part as the result of a delayed diagnosis from the 2 prior emergency department visits. The patient was treated initially with intravenous antibiotics and underwent therapeutic as well as diagnostic needle-guided tissue aspiration under ultrasound guidance. This ruled out malignancy but was not curative, and the subperiosteal abscess recurred within 24 hours, prompting formal operative irrigation and debridement. The patient was seen for 12-month follow-up and has had no complications or evidence of recurrence. This case emphasizes the need for a high index of suspicion to prevent diagnostic delays as well as the importance of a low threshold for surgical debridement to minimize the potential for complications that could prolong the treatment course. [Orthopedics. 2016; 39(4):e760-e763.]. PMID:27280623

  12. Imaging osteomyelitis and the diabetic foot

    International Nuclear Information System (INIS)

    The clinical diagnosis of osteomyelitis and the diabetic foot is in most of the patients not possible without imaging the bone. The clinical problem is to diagnose infection as early, as reliable and as cheap as possible to prevent the possible longstanding and life-threatening complications. For imaging a lot of different radiological and nuclear medicine methods are available. This article focuses on the possible results of conventional plain radiography and tomography, computed tomography and magnetic resonance imaging as radiological and on bone scan, autologous white blood cell scintigraphy with 111In-oxin or 99mTc-HMPAO, antigranulocyte antibodies, 99mTc/111In-human immunoglobulin,67 Ga-citrate and 99mTc-nanocelloids. Different methods after different answers. Radiological methods give detailed pathological answers, nuclear medicine methods answer questions of specificity such as leukocyte infiltration. If osteomyelitis is suspected, plain radiography should be the first, three phase bone scintigraphy the second and infection specific radiopharmaceuticals the third step of examination. Only in negative images with high clinical suspicion CT or MRI should be the final imaging procedure. In the diabetic foot imaging cascade should also start with plain radiography, followed by three phase bone scintigraphy or MRI. If clinically neuropathy is present specific nuclear medicine imaging should be performed

  13. Imaging osteomyelitis and the diabetic foot

    Energy Technology Data Exchange (ETDEWEB)

    Becker, W. (Gottingen Univ. (Germany). Dep. of Nuclear Medicine)

    1999-03-01

    The clinical diagnosis of osteomyelitis and the diabetic foot is in most of the patients not possible without imaging the bone. The clinical problem is to diagnose infection as early, as reliable and as cheap as possible to prevent the possible longstanding and life-threatening complications. For imaging a lot of different radiological and nuclear medicine methods are available. This article focuses on the possible results of conventional plain radiography and tomography, computed tomography and magnetic resonance imaging as radiological and on bone scan, autologous white blood cell scintigraphy with [sup 111]In-oxin or [sup 99m]Tc-HMPAO, antigranulocyte antibodies, [sup 99m]Tc/[sup 111]In-human immunoglobulin,[sup 67] Ga-citrate and [sup 99m]Tc-nanocelloids. Different methods after different answers. Radiological methods give detailed pathological answers, nuclear medicine methods answer questions of specificity such as leukocyte infiltration. If osteomyelitis is suspected, plain radiography should be the first, three phase bone scintigraphy the second and infection specific radiopharmaceuticals the third step of examination. Only in negative images with high clinical suspicion CT or MRI should be the final imaging procedure. In the diabetic foot imaging cascade should also start with plain radiography, followed by three phase bone scintigraphy or MRI. If clinically neuropathy is present specific nuclear medicine imaging should be performed.

  14. Post-surgical care of a professional ballet dancer following calcaneal exostectomy and debridement with re-attachment of the left Achilles tendon

    OpenAIRE

    Kobsar, Bradley; Alcantara, Joel

    2009-01-01

    The extraordinary physical demands placed upon ballet dancers are only now being appreciated as comparable to that of other highly competitive athletic pursuits. The professional ballet dancer presents with an array of injuries associated with their physically vigorous performance requirements. In keeping with evidence-based practice, we describe the chiropractic care of a professional ballet dancer following surgical calcaneal exostectomy and debridement with re-attachment of the left Achill...

  15. Neglected Foreign Body, the Cause of Navicular Osteomyelitis in A Paediatric Foot: A Case Report

    OpenAIRE

    Chandrashekara C.M; George M.A; Bader Said Khamis Al-Marboi

    2013-01-01

    Introduction: Foreign body injuries with date thorns, metal and wooden splinters are common in Middle East region, as most of it is desert. Some of the injuries lead to cellulitis or abscess formation, if neglected or improperly managed results in osteomyelitis or septic arthritis of foot structures. This is the first report of isolated navicular osteomyelitis following neglected foreign body in a paediatric foot. Case Report: A 10 year old male patient presented with discharging sinus in...

  16. Skull involvement in a pediatric case of chronic recurrent multifocal osteomyelitis

    OpenAIRE

    Watanabe, Toru; Ono, Hiroyuki; Morimoto, Yoshitaka; Otsuki, Yoshiro; Shirai, Masami; Endoh, Akira; Naito, Masaaki; Inoue, Yoshiya; Hongo, Teruaki

    2015-01-01

    ABSTRACT An 11-year-old boy was diagnosed with chronic recurrent multifocal osteomyelitis (CRMO) and presented with right sacro-femoral and occipital lesions. Initially, a tumor was suspected. However, the bone biopsy showed osteomyelitis with a negative bacterial culture. Bone scintigraphy revealed inflammatory changes on multiple bone lesions. The slight elevation in inflammatory markers such as C-reactive protein was of little clinical value. He was diagnosed with CRMO by sacral biopsy, an...

  17. Problems in the scintigraphic detection of osteomyelitis in children. [/sup 99m/Tc-pyrophosphate

    Energy Technology Data Exchange (ETDEWEB)

    Sullivan, D.C.; Rosenfield, N.S.; Ogden, J.; Gottschalk, A.

    1980-06-01

    /sup 99m/Tc pyrophosphate studies in 21 children with acute hematogenous osteomyelitis were compared with radiographic, clinical and surgical findings. Eleven /sup 99m/Tc studies revealed obvious abnormalities, four showed subtle abnormalities, two were misleading, and four were normal. No consistent explanation for the lack of positive radionuclide findings was found. We concluded that pediatric osteomyelitis presents a spectrum of scintigraphic appearances and interpretation is often difficult.

  18. Salvage of Diffuse Ankle Osteomyelitis by Single-Stage Resection and Circumferential Frame Compression Arthrodesis

    OpenAIRE

    Saltzman, Charles L

    2005-01-01

    Salvage of diffuse ankle osteomyelitis, especially in compromised hosts, is a challenging problem. The purpose of this report was to evaluate early complications and results using a standardized salvage protocol. Eight patients with diffuse ankle osteomyelitis were treated by resection of all infected tissue and hybrid-frame compression arthrodesis. At presentation, five had open wounds. According to the Cierny/Mader classification, all had diffuse anatomic involvement and six of eight were c...

  19. Actinomycetes as the causative organism of osteomyelitis in sickle cell disease

    International Nuclear Information System (INIS)

    The case of a 17-year-old girl with sickle cell anaemia who presented with extensive osteomyelitis due to actinomycetes is reported. Osteomyelitis in the long bones due to actinomycosis is extremely rare. A review of the literature reveals only six cases in which actinomycetes have been isolated from lesions affecting a long bone. The occurence of this condition in sickle cell haemoglobinopathy has not been previously reported. (orig.)

  20. Phalangeal fractures and metacarpophalangeal luxations subsequent to post-traumatic osteomyelitis and cellulitis in a dog.

    Science.gov (United States)

    Langley-Hobbs, S J; Lascelles, B D X

    2004-07-01

    A working Border collie suffered a puncture wound to the metacarpal pad. No fractures or luxations were identified at initial presentation. Treatment was instigated with various antibacterials for a period of months. At subsequent visits, the dog's condition progressed with development of metacarpophalangeal joint luxation and phalangeal fractures secondary to cellulitis and chronic osteomyelitis. Amputation was curative. Prompt treatment of the acute condition with debridement and drainage may have prevented osteomyelitis becoming established in the first instance. PMID:15266860

  1. Extra-osseous fat fluid level: a specific sign for osteomyelitis

    International Nuclear Information System (INIS)

    Osteomyelitis may pose as a diagnostic dilemma on various imaging modalities and may be confused with neoplasms and other pathology. Although a rare finding, extra-osseous fat fluid level, especially when associated with spongy bone destruction, can be considered a specific sign of osteomyelitis. Previously, only two cases of extra-osseous fat fluid level in osteomyelitis have been reported, one on computed tomography (CT) and the other on magnetic resonance imaging (MRI). The former was a case of septic arthritis with intra-articular fat fluid level. A case of osteomyelitis is presented with the demonstration of extra-osseous fat fluid level. Our case is unique in providing exquisite CT and MRI correlation. (orig.)

  2. The scintigraphic and radiographic appearance of the ischiopubic synchondroses in normal children and in osteomyelitis

    International Nuclear Information System (INIS)

    Five cases of hematogenous osteomyelitis of the ischiopubic synchondrosis (IPS) were encountered amoung 180 patients with osteomyelitis treated over a 5-year period. Symptoms were poorly localized in all these IPS osteomyelitis patients. The IPS can normally show expansion and irregular mineralization radiographically and focal hyperconcentration of radiophosphates on scintigrams. Findings are frequently asymmetrical negating comparison with the contralateral side. In the cases of osteomyelitis, radiographs were abnormal at the time of presentation in only one of these five cases. In two of the four patients who had radionuclide bone scans, activity at the IPS exceeded that seen in a normal control population, but all showed loss of definition of the IPS and regional increased uptake permitting an early diagnosis. (orig.)

  3. Pseudomonas pelvic osteomyelitis in a healthy child

    Directory of Open Access Journals (Sweden)

    Nour Akhras

    2011-12-01

    Full Text Available Pediatric pelvic osteomyelitis is a rare entity. The diagnosis is frequently delayed due to difficulty in confirming the diagnosis. To our knowledge, this is the first case report of Pseudomonas pelvic osteomyelitis in a previously healthy adolescent boy. The diagnosis was made radiographically and confirmed by culture. The patient was treated with Levofloxacin and Gentamicin resulting in a complete recovery.

  4. Pseudomonas pelvic osteomyelitis in a healthy child

    OpenAIRE

    Akhras, Nour; Blackwood, Alexander

    2011-01-01

    Pediatric pelvic osteomyelitis is a rare entity. The diagnosis is frequently delayed due to difficulty in confirming the diagnosis. To our knowledge, this is the first case report of Pseudomonas pelvic osteomyelitis in a previously healthy adolescent boy. The diagnosis was made radiographically and confirmed by culture. The patient was treated with Levofloxacin and Gentamicin resulting in a complete recovery.

  5. Conservative Surgery of Diabetic Forefoot Osteomyelitis: How Can I Operate on This Patient Without Amputation?

    Science.gov (United States)

    Aragón-Sánchez, Javier; Lázaro-Martínez, Jose L; Alvaro-Afonso, Francisco Javier; Molinés-Barroso, Raúl

    2015-06-01

    Surgery is necessary in many cases of diabetic foot osteomyelitis. The decision to undertake surgery should be based on the clinical presentation of diabetic foot osteomyelitis. Surgery is required when the bone is protruding through the ulcer, there is extensive bone destruction seen on x-ray or progressive bone damage on sequential x-ray while undergoing antibiotic treatment, the soft tissue envelope is destroyed, and there is gangrene or spreading soft tissue infection. Several issues should be taken into account when considering surgery for treating diabetic foot osteomyelitis. It is necessary to have a surgeon available with diabetic foot expertise. Regarding location of diabetic foot osteomyelitis, it is important to consider whether isolated bone or a joint is involved. In cases in which osteomyelitis is associated with a bone deformity, surgery should be able to correct this. The surgeon should always reflect about whether extensive/radical surgery could destabilize the foot. The forefoot is the most frequent location of diabetic foot osteomyelitis and is associated with better prognosis than midfoot and hindfoot osteomyelitis. Many surgical procedures can be performed in patients with diabetes and forefoot ulcers complicated by osteomyelitis while avoiding amputations. Performing conservative surgeries without amputations of any part of the foot is not always feasible in cases in which the infection has destroyed the soft tissue envelope. Attempting conservative surgery in such cases risks infected tissues remaining in the wound bed leading to failure. The election of different surgical options depends on the expertise of the surgeons selected for the multidisciplinary teams. It is the aim of this article to provide a sample of surgical techniques in order to remove the bone infection from the forefoot while avoiding amputations. PMID:25256285

  6. Osteofibrous dysplasia of clavicle clinically mimicking chronic osteomyelitis

    Directory of Open Access Journals (Sweden)

    Nirmal Raj Gopinathan

    2016-01-01

    Full Text Available Osteofibrous dysplasia or ossifying fibroma is an uncommon benign fibro-osseous lesion of childhood, commonly described in the maxilla and the mandible. Among long bones, it usually presents in the tibia as a painless swelling or anterior bowing. Ossifying fibroma of clavicle has never been reported in English literature, to the best of our knowledge. Here, we would like to present an unusual case of osteofibrous dysplasia of clavicle clinically mimicking chronic osteomyelitis.

  7. Increased mast cell numbers in a calcaneal tendon overuse model

    DEFF Research Database (Denmark)

    Pingel, Jessica; Wienecke, Jacob; Kongsgaard Madsen, Mads;

    2013-01-01

    Tendinopathy is often discovered late because the initial development of tendon pathology is asymptomatic. The aim of this study was to examine the potential role of mast cell involvement in early tendinopathy using a high-intensity uphill running (HIUR) exercise model. Twenty-four male Wistar rats...... were divided in two groups: running group (n = 12); sedentary control group (n = 12). The running-group was exposed to the HIUR exercise protocol for 7 weeks. The calcaneal tendons of both hind limbs were dissected. The right tendon was used for histologic analysis using Bonar score......, immunohistochemistry, and second harmonic generation microscopy (SHGM). The left tendon was used for quantitative polymerase chain reaction (qPCR) analysis. An increased tendon cell density in the runners were observed compared to the controls (P = 0.05). Further, the intensity of immunostaining of protein kinase B, P...

  8. Optimized preoperative planning of calcaneal fractures using spiral computed tomography

    International Nuclear Information System (INIS)

    The aim of this study was the evaluation of spiral-CT examinations in preoperative planning of calcaneal fractures supported by 3D reconstructions after electronic disarticulation. We examined 45 patients with 47 calcaneal fractures with diagnostic spiral-CT examinations in a prospective study. In addition to the conventional axial slices and sagittal reconstructions, 3D reconstructions prior to and after electronic disarticulation were performed and rated by orthopaedic surgeons and radiologists. The following diagnostic criteria were rated: involvement of articular facets, number of fragments and hindfoot deformities. Axial slices were considered to be the gold standard, because not all patients underwent surgical treatment. Axial slices showed involvement of 90 articular facets (100 %). Three-dimensional reformations after electronic disarticulation depicted 82 fractures (82 of 90, 91 %), sagittal reconstructions 63 fractures (63 of 90, 70 %). Three-dimensional reconstructions without electronic disarticulation showed five fractures (5 of 90, 5.5 %). The number of fragments was demonstrated best on sagittal reconstructions (two, three or four fragments); five fragments were diagnosed best on axial slices, and 3D reconstruction without electronic disarticulation showed only a very small number of fragments, due to overlaying bones. Hindfoot deformities (lateralisation, varus deformation, shortening) were demonstrated best on axial slices, except in terms of showing height reduction, which was demonstrated better on sagittal and 3D reconstructions. Three-dimensional reconstructions after electronic disarticulation support a clear understanding of the 3D position of the fragments and of their displacement in comparison with 3D reconstruction without electronic disarticulation, which is essential for an effective surgical reduction. Due to the potential manipulation of surface-oriented 3D reconstructions, regardless of whether electronic disarticulation is used

  9. Optimized preoperative planning of calcaneal fractures using spiral computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Freund, M.; Hohendorf, B.; Heller, M. [Department of Radiology, Medical School, University of Kiel (Germany); Thomsen, M. [Department of Orthopedic Surgery, Medical School, University of Heidelberg (Germany); Zenker, W. [Department of Traumatology, Medical School, University of Kiel (Germany)

    1999-06-01

    The aim of this study was the evaluation of spiral-CT examinations in preoperative planning of calcaneal fractures supported by 3D reconstructions after electronic disarticulation. We examined 45 patients with 47 calcaneal fractures with diagnostic spiral-CT examinations in a prospective study. In addition to the conventional axial slices and sagittal reconstructions, 3D reconstructions prior to and after electronic disarticulation were performed and rated by orthopaedic surgeons and radiologists. The following diagnostic criteria were rated: involvement of articular facets, number of fragments and hindfoot deformities. Axial slices were considered to be the gold standard, because not all patients underwent surgical treatment. Axial slices showed involvement of 90 articular facets (100 %). Three-dimensional reformations after electronic disarticulation depicted 82 fractures (82 of 90, 91 %), sagittal reconstructions 63 fractures (63 of 90, 70 %). Three-dimensional reconstructions without electronic disarticulation showed five fractures (5 of 90, 5.5 %). The number of fragments was demonstrated best on sagittal reconstructions (two, three or four fragments); five fragments were diagnosed best on axial slices, and 3D reconstruction without electronic disarticulation showed only a very small number of fragments, due to overlaying bones. Hindfoot deformities (lateralisation, varus deformation, shortening) were demonstrated best on axial slices, except in terms of showing height reduction, which was demonstrated better on sagittal and 3D reconstructions. Three-dimensional reconstructions after electronic disarticulation support a clear understanding of the 3D position of the fragments and of their displacement in comparison with 3D reconstruction without electronic disarticulation, which is essential for an effective surgical reduction. Due to the potential manipulation of surface-oriented 3D reconstructions, regardless of whether electronic disarticulation is used

  10. Erysipelothrix rhusiopathiae endocarditis and presumed osteomyelitis.

    Science.gov (United States)

    Romney, M; Cheung, S; Montessori, V

    2001-07-01

    Erysipelothrix rhusiopathiae is known to cause infections in humans following exposure to decaying organic matter or animals colonized with the organism, such as swine and fish. Invasive infections with this organism are unusual and are manifested primarily as infective endocarditis. The present report is believed to be the first to report a case of E rhusiopathiae endocarditis and presumptive osteomyelitis. E rhusiopathiae appears to have intrinsic resistance to vancomycin. Because vancomycin is often used empirically for the treatment of endocarditis, rapid differentiation of E rhusiopathiae from other Gram-positive organisms is critical. In patients with endocarditis caused by a Gram-positive bacillus and epidemiological risk factors for E rhusiopathiae exposure, empirical treatment with vancomycin should be reconsidered. PMID:18159347

  11. Effect of Intraoperative Three-Dimensional Imaging During the Reduction and Fixation of Displaced Calcaneal Fractures on Articular Congruence and Implant Fixation

    DEFF Research Database (Denmark)

    Eckardt, Henrik; Lind, Marianne

    2015-01-01

    BACKGROUND: Operative treatment of displaced calcaneal fractures should restore joint congruence, but conventional fluoroscopy is unable to fully visualize the subtalar joint. We questioned whether intraoperative 3-dimensional (3D) imaging would aid in the reduction of calcaneal fractures...

  12. Extended lateral approach for intra-articular calcaneal fractures: an inverse relationship between surgeon experience and wound complications.

    Science.gov (United States)

    Schepers, Tim; Den Hartog, Dennis; Vogels, Lucas M M; Van Lieshout, Esther M M

    2013-01-01

    The current reference standard for the treatment of displaced intra-articular calcaneal fractures is open reduction and internal fixation using an extended lateral approach. In the present retrospective study, we evaluated the results of a consecutive series of patients treated in the same fashion from June 2005 to September 2011 using a subcuticular single-layer closure technique. We also determined the risk factors for the development of wound complications and the rate of wound complications. Also, we assessed which patient, fracture, and surgical characteristics affected these complications. During the 75-month study period, we operated on 53 displaced intra-articular calcaneal fractures in 50 patients using the extended lateral approach. The incision was closed using the subcuticular technique in 49 cases (92.45%). In the subcuticular closure group 2 (4.1%) deep infections and 2 (4.1%) superficial wound complications (1 dehiscence and 1 infection) occurred. Wound edge or flap necrosis was not encountered. The use of bone-void filler and the experience of the surgical team were significantly (p rate combined with the extended lateral approach. The effect of bone void fillers on the incidence of complications should receive more attention in future research. The association between wound complications and the experience level of the surgical team supports the need for centralization of this complex injury. PMID:23318101

  13. Radioactive scanning in diagnosis of acute sacroiliac osteomyelitis

    International Nuclear Information System (INIS)

    Acute infection of the pelvic bones and of the sacroiliac joint is uncommonly reported. Morgan and Yates, however, found a frequency of 5 percent among all cases of osteomyelitis and Green and associates reported 11 instances of involvement of a pelvic bone in 99 patients with acute hematogenous osteomyelitis. Difficulty in making the correct diagnosis is related primarily to two factors: (1) The disease usually is not included in the early differential diagnosis of inflammatory disease presenting with immobilization of thigh and hip joint and (2) the initial symptoms in the pediatric patient may be quite variable and misleading. Two case reports are presented to illustrate acute infection of the pelvic bones in children. In each patient the initial roentgenograms were interpreted as normal and the diagnosis was suspected because bone scans were abnormal

  14. Radioactive scanning in diagnosis of acute sacroiliac osteomyelitis

    Energy Technology Data Exchange (ETDEWEB)

    Trauner, D.A.; Connor, J.D.

    1975-11-01

    Acute infection of the pelvic bones and of the sacroiliac joint is uncommonly reported. Morgan and Yates, however, found a frequency of 5 percent among all cases of osteomyelitis and Green and associates reported 11 instances of involvement of a pelvic bone in 99 patients with acute hematogenous osteomyelitis. Difficulty in making the correct diagnosis is related primarily to two factors: (1) The disease usually is not included in the early differential diagnosis of inflammatory disease presenting with immobilization of thigh and hip joint and (2) the initial symptoms in the pediatric patient may be quite variable and misleading. Two case reports are presented to illustrate acute infection of the pelvic bones in children. In each patient the initial roentgenograms were interpreted as normal and the diagnosis was suspected because bone scans were abnormal.

  15. Successful treatment of multi-focal XDR tuberculous osteomyelitis.

    Science.gov (United States)

    Alshukairi, Abeer N; Alrajhi, Abdulrahman A; Alamri, Abdulfattah W; Alothman, Adel F

    2016-01-01

    We herein describe the nosocomial transmission of a pre-XDR or MDR case of pulmonary tuberculosis in a HIV-negative health care worker in an area endemic for MDR and XDR tuberculosis. Following inadequate therapy and non-compliance, he presented with extra-pulmonary XDR tuberculosis in the form of multi-focal osteomyelitis and encysted pleural effusion. He was cured after two years of treatment with various anti-tuberculous drugs in addition to interferon gamma. PMID:26631433

  16. Fluconazole in the therapy of multiple osteomyelitis in African histoplasmosis

    OpenAIRE

    Onwuasoigwe, O.

    1999-01-01

     Amphotericin B has been the standard treatment for deep mycoses including African histoplasmosis, but its use is complicated by its toxicity. More recently, Fluconazole, a water-soluble triazole with antimycotic activity and little side effects, has become available. A case of African histoplasmosis from Nigeria, manifesting as multiple osteomyelitis and successfully treated with oral Fluconazole, is presented. Fluconazole may be preferred in the therapy of African histoplasmosis.

  17. Lumbar spine osteomyelitis and epidural abscess formation secondary to acupuncture

    OpenAIRE

    Godhania, Vinesh

    2016-01-01

    A 39-year-old male with no previous medical history presented with abdominal and low back pain. Based on clinical and radiological findings he was diagnosed with L1/L2 osteomyelitis and epidural abscess. Further history taking revealed recent use of acupuncture for treatment of mechanical back pain. The patient was treated conservatively with an extended course of antibiotics, monitored with repeat MRI scans and had a full recovery with no neurological deficit. This is the first reported case...

  18. Osteomyelitis variolosa with fracture: A unique case report

    Directory of Open Access Journals (Sweden)

    Pradeep K Singh

    2012-01-01

    Full Text Available Smallpox has been eradicated completely but its unique pathology and sequlae are still found in routine clinical practice. We present a report of a patient having osteomyelitis variolosa in both elbow joints and wrist with fracture of humerus. The condyles were typically elongated as central portion of distal humerus absorbed. The fracture united uneventfully following stabilization with dynamic compression plate and bone grafting. Patient had satisfactory elbow function at the end of the last follow-up.

  19. Candida albicans osteomyelitis of the cervical spine

    Energy Technology Data Exchange (ETDEWEB)

    Cha, Jang-Gyu; Hong, Hyun-Sook [Soonchunhyang University Bucheon Hospital, Department of Radiology, Bucheon-Si, Gyeonggi-Do (Korea); Koh, Yoon-Woo [Soonchunhyang University Bucheon Hospital, Department of Otolaryngology - Head and Neck Surgery, Bucheon-Si, Gyeonggi-Do (Korea); Kim, Hee-Kyung [Soonchunhyang University Bucheon Hospital, Department of Pathology, Bucheon-Si, Gyeonggi-Do (Korea); Park, Jung-Mi [Soonchunhyang University Bucheon Hospital, Department of Nuclear Medicine, Bucheon-Si, Gyeonggi-Do (Korea)

    2008-04-15

    Fungal osteomyelitis is a rare infection that usually develops in immunocompromised patients. Additionally, involvement of the cervical spine by Candida albicans is extremely rare; only three previous cases of Candida vertebral osteomyelitis have been reported in the literature. The diagnosis may be delayed due to nonspecific radiologic findings and a slow progression. We report the CT, MRI, bone scan, and PET-CT findings in a patient who developed Candida osteomyelitis, which was initially misdiagnosed as metastasis, at the atlas and axis following treatment for nasopharyngeal cancer. (orig.)

  20. Candida albicans osteomyelitis of the cervical spine

    International Nuclear Information System (INIS)

    Fungal osteomyelitis is a rare infection that usually develops in immunocompromised patients. Additionally, involvement of the cervical spine by Candida albicans is extremely rare; only three previous cases of Candida vertebral osteomyelitis have been reported in the literature. The diagnosis may be delayed due to nonspecific radiologic findings and a slow progression. We report the CT, MRI, bone scan, and PET-CT findings in a patient who developed Candida osteomyelitis, which was initially misdiagnosed as metastasis, at the atlas and axis following treatment for nasopharyngeal cancer. (orig.)

  1. Lumbar spine osteomyelitis and epidural abscess formation secondary to acupuncture.

    Science.gov (United States)

    Godhania, Vinesh

    2016-01-01

    A 39-year-old male with no previous medical history presented with abdominal and low back pain. Based on clinical and radiological findings he was diagnosed with L1/L2 osteomyelitis and epidural abscess. Further history taking revealed recent use of acupuncture for treatment of mechanical back pain. The patient was treated conservatively with an extended course of antibiotics, monitored with repeat MRI scans and had a full recovery with no neurological deficit. This is the first reported case of epidural abscess formation and osteomyelitis after acupuncture in the UK. As acupuncture becomes more commonly used in western countries, it is important to be aware of this rare but serious complication. PMID:26976275

  2. Osteomyelitis: diagnosis with In-111-labeled leukocytes

    International Nuclear Information System (INIS)

    In a retrospective review, 485 patients with suspected osteomyelitis were studied. Of these, 453 patients were studied with both bone and indium-111 leukocyte scanning (173 sequentially and 280 simultaneously). The ability to determine that the infection was in bone rather than in adjacent soft tissue was greater with simultaneous bone scan and In-111 leukocyte studies than with sequential studies. The locations of suspected osteomyelitis were divided into central (containing active bone marrow), peripheral (hands and feet), and middle (between central and peripheral). Specificity remained high (about 90%) regardless of the location. Overall sensitivity was significantly lower in the central location than in the peripheral or middle location. Determination of whether the In-111 leukocyte activity was in bone or adjacent soft tissue was also more difficult when the infection was in the central location. For acute osteomyelitis, sensitivity was high regardless of the location. For chronic osteomyelitis, sensitivity was lower in the central location

  3. Quantitative bone gallium scintigraphy in osteomyelitis

    International Nuclear Information System (INIS)

    Gallium imaging offers many practical advantages over indium-111-labeled leukocyte imaging, and calculating quantitative ratios in addition to performing the routine bone-gallium images allows accurate and easy evaluation of patients with suspected osteomyelitis. To add objectivity and improve the accuracy and confidence in diagnosis of osteomyelitis, quantitative comparison of abnormalities seen on bone scans and gallium scans was performed. One hundred and ten adult patients with 126 sites of suspected osteomyelitis were evaluated and categorized by gallium-to-bone ratios, gallium-to-background ratios, and spatial incongruency of gallium and bone activity. Combined evaluation using these criteria gave a 70% sensitivity and 93% specificity for the diagnosis of osteomyelitis. (orig.)

  4. Congenital multifocal osteomyelitis at 24 weeks' gestation

    International Nuclear Information System (INIS)

    We report an extremely rare case of congenital nonsyphilitic osteomyelitis in a very preterm infant, providing a unique illustration of the radiological appearances at birth, which may serve as a reference to facilitate diagnosis. (orig.)

  5. Bilateral clavicle osteomyelitis: A case report

    Directory of Open Access Journals (Sweden)

    Fevzi Saglam

    2014-01-01

    CONCLUSION: In cases of clavicular osteomyelitis where infection continues despite debridement and antibiotic therapy, excision of the sequestered clavicular section is a successful treatment approach and has been seen to improve quality of life without any functional loss.

  6. Problems in the scintigraphic detection of osteomyelitis

    International Nuclear Information System (INIS)

    Bone imaging has played a major role in the early detection of pediatric osteomyelitis. The single gamma camera view (rather than whole body imaging) successfully delineates the growth zones of the long bones and can detect subtle changes in these regions. If a high suspicion of osteomyelitis is entertained despite a normal bone scan, gallium imaging should be employed. Cases have been reported in which delayed scans were normal but the blood pool image was not

  7. Management of sternal osteomyelitis and mediastinal infection following median sternotomy

    Institute of Scientific and Technical Information of China (English)

    GAO Ju; WANG Wen-zhang; WANG You-li; LU Shu-qiang; CAI Ai-bing; YANG Zhi-fu; HAN Zhi-yi; LI Jiu-jiang; WEN Yu-ming; GENG Feng-yong

    2010-01-01

    Background Median sternotomy is considered the most usually performed procedure in cardiac operations. This study aimed to assess clinical effectiveness of bilateral pectoralis major muscle flaps (BPMMF) for management of sternal osteomyelitis and mediastinal infection following median sternotomy.Methods Clinical data were collected and retrospectively analyzed from twelve patients who underwent the BPMMF transposition for management of sternal osteomyelitis and mediastinal infection following median sternotomy from January 2006 to June 2009. Procedure consisted of rigorous debridement of necrotic tissues, dead space obliteration using the BPMMF, and placement of drainage tubes connected to a negative pressures generator for adequate drainage.Results No patients died of drainage, and all 12 patients had viable BPMMF when discharged from hospital. At 1 week post discharge, 2 patients presented with sternal infection but recovered following local debridement and medication. No patients showed infection recurrence during the follow-up period over 10 months.Conclusions Sternal osteomyelitis and mediastinal infection following median sternotomy may be effectively managed through rigorous debridement of infected soft tissues, resection of the damaged stermal segment, transposition of the BPMMF to fill the damaged sternum resulting from debridement, and adequate postoperative drainage.

  8. Osteomyelitis diagnosis by {sup 99m}Tc radiolabeled aptamers

    Energy Technology Data Exchange (ETDEWEB)

    Santos, S.R.; Ferreira, I.M.; Andrade, A.S.R., E-mail: sararoberta7@hotmail.com, E-mail: imendesf@yahoo.com.br, E-mail: antero@cdtn.br [Centro de Desenvolvimento da Tecnologia Nuclear (CDTN/CNEN-MG), Belo Horizonte, MG (Brazil); Barros, A.L.B.; Cardoso, V.N.; Diniz, O.F., E-mail: brancodebarros@yahoo.com.br, E-mail: valbertcardoso@yahoo.com.br, E-mail: simoneodilia@yahoo.com.br [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Faculdade de Farmacia. Departamento de Analises Clinicas e Toxicologicas

    2015-07-01

    Osteomyelitis, which is characterized by progressive inflammatory destruction and new opposition of bone, is still a difficult infection to treat. The clinical diagnosis in late stages is achieved easily, but an early diagnosis is more challenging. Staphylococcus aureus is a common agent found in osteomyelitis and bone prostheses infection. Diagnosis by scintigraphy has advantages because it is a non-invasive procedure and is able to perform an early diagnosis even before anatomic changes. Thus, nuclear medicine could contribute to an accurate diagnosis since specific radiopharmaceuticals were developed. In this study, aptamers selected to Staphylococcus aureus were labeled with {sup 99m}Tc and used for bacteria identification in an osteomyelitis experimental model. The aptamers selected to S. aureus were directly labelled with {sup 99m}Tc and were evaluated by biodistribution studies. Wistar rats with intraosseous infection in the right paw were used. A random aptamer labelled with {sup 99m}Tc was as control. Six animals were used in each group. The aptamers labeled with {sup 99m}Tc were able to identify the infection foci caused by S. aureus displaying a target/non-target ratio of 2,23 ± 0,20, after 3 h. The control group presented a target/non-target ratio 1,08 ± 0.23. The results indicated that the radiolabeled aptamers were able to identify specifically the infection foci and they should be further explored for infection diagnosis by scintigraphy. (author)

  9. Mycobacterium haemophilum osteomyelitis: case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Read Ron

    2006-04-01

    Full Text Available Abstract Background Mycobacterium haemophilum is a slow-growing, fastidious, iron-requiring microorganism that, relative to other non-tuberculous mycobacterial species, has rarely been documented as a cause of human infection. This microorganism appears to be acquired via environmental exposure although its natural habitat and mode of acquisition are unknown. It has primarily been implicated as a cause of ulcerating cutaneous or subcutaneous nodular skin lesions, particularly in immunocompromised patients, although infections at extracutaneous sites have also been described. Osteomyelitis, while rarely documented, appears to be an important complication of infection with M. haemophilum in these patients. Case presentation We describe a unique case of culture-confirmed M. haemophilum osteomyelitis in an adult woman with polycythemia vera and review the world literature on bone infections due to this organism. Conclusion Mycobacterium haemophilum is an important but infrequently encountered cause of osteomyelitis in immunocompromised patients, often requiring months to years of medical therapy, with or without surgery, to effect a clinical cure.

  10. Osteomyelitis diagnosis by 99mTc radiolabeled aptamers

    International Nuclear Information System (INIS)

    Osteomyelitis, which is characterized by progressive inflammatory destruction and new opposition of bone, is still a difficult infection to treat. The clinical diagnosis in late stages is achieved easily, but an early diagnosis is more challenging. Staphylococcus aureus is a common agent found in osteomyelitis and bone prostheses infection. Diagnosis by scintigraphy has advantages because it is a non-invasive procedure and is able to perform an early diagnosis even before anatomic changes. Thus, nuclear medicine could contribute to an accurate diagnosis since specific radiopharmaceuticals were developed. In this study, aptamers selected to Staphylococcus aureus were labeled with 99mTc and used for bacteria identification in an osteomyelitis experimental model. The aptamers selected to S. aureus were directly labelled with 99mTc and were evaluated by biodistribution studies. Wistar rats with intraosseous infection in the right paw were used. A random aptamer labelled with 99mTc was as control. Six animals were used in each group. The aptamers labeled with 99mTc were able to identify the infection foci caused by S. aureus displaying a target/non-target ratio of 2,23 ± 0,20, after 3 h. The control group presented a target/non-target ratio 1,08 ± 0.23. The results indicated that the radiolabeled aptamers were able to identify specifically the infection foci and they should be further explored for infection diagnosis by scintigraphy. (author)

  11. Systematic approach to treat chronic osteomyelitis through localized drug delivery system: Bench to bed side

    International Nuclear Information System (INIS)

    Chronic osteomyelitis is a challenging setback to the orthopedic surgeons in deciding an optimal therapeutic strategy. Conversely, patients feel frustrated of the therapeutic outcomes and development of adverse drug effects, if any. Present investigation deals with extensive approach incorporating in vivo animal experimentation and human application to treat chronic osteomyelitis, using antibiotic loaded porous hydroxyapatite scaffolds. Micro- to macro-porous hydroxyapatite scaffolds impregnated with antibiotic ceftriaxone–sulbactam sodium (CFS) were fabricated and subsequently evaluated by in vivo animal model after developing osteomyelitis in rabbit tibia. Finally 10 nos. of human osteomyelitis patients involving long bone and mandible were studied for histopathology, radiology, pus culture, 3D CT etc. up to 8–18 months post-operatively. It was established up to animal trial stage that 50N50H samples [with 50–55% porosity, average pore size 110 μm, higher interconnectivity (10–100 μm), and moderately high drug adsorption efficiency (50%)] showed efficient drug release up to 42 days than parenteral group based on infection eradication and new bone formation. In vivo human bone showed gradual evidence of new bone formation and fracture union with organized callus without recurrence of infection even after 8 months. This may be a new, alternative, cost effective and ideal therapeutic strategy for chronic osteomyelitis treatment in human patients. - Highlights: • Chronic osteomyelitis is challenging setback to decide optimal therapeutic strategy. • Micro- to macro-porous antibiotic CFS impregnated HAp scaffolds were fabricated. • Complete in vivo animal trial done after developing osteomyelitis in rabbit tibia. • Clinical trial showed fracture union without recurrence of infection after 8 months. • This may be a new, alternative, cost effective and ideal therapeutic strategy

  12. Systematic approach to treat chronic osteomyelitis through localized drug delivery system: Bench to bed side

    Energy Technology Data Exchange (ETDEWEB)

    Bhattacharya, Rupnarayan [Department of Plastic Surgery, R. G. Kar Medical College and Hospital (RGKMCH), Kolkata 700004 (India); Kundu, Biswanath, E-mail: biswa_kundu@rediffmail.com [Biocermics and Coating Division, CSIR — Central Glass and Ceramic Research Institute (CSIR-CGCRI), Kolkata 700032 (India); Nandi, Samit Kumar, E-mail: samitnandi1967@gmail.com [Department of Veterinary Surgery and Radiology, West Bengal University of Animal and Fishery Sciences (WBUAFS), Kolkata 700037 (India); Basu, Debabrata [Biocermics and Coating Division, CSIR — Central Glass and Ceramic Research Institute (CSIR-CGCRI), Kolkata 700032 (India)

    2013-10-15

    Chronic osteomyelitis is a challenging setback to the orthopedic surgeons in deciding an optimal therapeutic strategy. Conversely, patients feel frustrated of the therapeutic outcomes and development of adverse drug effects, if any. Present investigation deals with extensive approach incorporating in vivo animal experimentation and human application to treat chronic osteomyelitis, using antibiotic loaded porous hydroxyapatite scaffolds. Micro- to macro-porous hydroxyapatite scaffolds impregnated with antibiotic ceftriaxone–sulbactam sodium (CFS) were fabricated and subsequently evaluated by in vivo animal model after developing osteomyelitis in rabbit tibia. Finally 10 nos. of human osteomyelitis patients involving long bone and mandible were studied for histopathology, radiology, pus culture, 3D CT etc. up to 8–18 months post-operatively. It was established up to animal trial stage that 50N50H samples [with 50–55% porosity, average pore size 110 μm, higher interconnectivity (10–100 μm), and moderately high drug adsorption efficiency (50%)] showed efficient drug release up to 42 days than parenteral group based on infection eradication and new bone formation. In vivo human bone showed gradual evidence of new bone formation and fracture union with organized callus without recurrence of infection even after 8 months. This may be a new, alternative, cost effective and ideal therapeutic strategy for chronic osteomyelitis treatment in human patients. - Highlights: • Chronic osteomyelitis is challenging setback to decide optimal therapeutic strategy. • Micro- to macro-porous antibiotic CFS impregnated HAp scaffolds were fabricated. • Complete in vivo animal trial done after developing osteomyelitis in rabbit tibia. • Clinical trial showed fracture union without recurrence of infection after 8 months. • This may be a new, alternative, cost effective and ideal therapeutic strategy.

  13. A CLINICO-MICROBIOLOGICAL STUDY OF OSTEOMYELITIS IN A TERTIARY CARE HOSPITAL IN KARNATAKA

    Directory of Open Access Journals (Sweden)

    Anjana

    2016-01-01

    Full Text Available BACKGROUND Bone and joint infections are painful for patients and frustrating for both doctors and patients. Osteomyelitis presents a variety of challenges to the physician. The severity of the disease is staged depending upon the infection’s particular features, including its aetiology, pathogenesis, extent of bone involvement, duration, and host factors. The high success rates of antimicrobial therapy in most infectious diseases have not yet been achieved in bone and joint infections. AIM To determine the microbiological profile and antibiotic susceptibility patterns of organisms isolated from cases of osteomyelitis. METHODS Pus samples were collected for bacterial culture from 90 cases of osteomyelitis between June 2013 and August 2015 and processed in the laboratory. RESULTS Among the 90 patients studied, most of them were men (79, with median age group 30-50 years, affected by chronic osteomyelitis (77% or acute osteomyelitis (22%, with predominant involvement of lower limbs (90.5%. A total of 70 isolates of bacteria were obtained from 90 clinical samples. The most frequently isolated pathogens were Staphylococcus aureus (51.4%, Klebsiella pneumoniae (11.4%, Enterococcus faecalis (8.5%, Pseudomonas aeruginosa and Proteus mirabilis (7%. Susceptibility of gram positive organisms to linezolid, tetracycline, vancomycin and gentamicin was 100%. Gram negative organisms are highly susceptible to aminoglycosides, levofloxacin, piperacillin and tazobactam (87.5%. Four methicillin resistant Staphylococcus aureus were isolated. CONCLUSION Osteomyelitis remains a serious therapeutic challenge, especially when associated with gram negative bacteria. We emphasize the need to consider these agents in diagnosed cases of osteomyelitis, so that an ideal antimicrobial treatment can be administered since the very beginning of the therapy.

  14. Plantar fasciitis and calcaneal spur formation are associated with abductor digiti minimi atrophy on MRI of the foot

    Energy Technology Data Exchange (ETDEWEB)

    Chundru, Usha [Maimonides Medical Center, Department of Radiology, Brooklyn, NY (United States); Liebeskind, Amy; Beltran, Javier [Maimonides Medical Center, Department of Radiology, Brooklyn, NY (United States); Beachwood, Franklin and Seidelmann Subspecialty Radiology, Beachwood, OH (United States); Seidelmann, Frank; Franklin, Peter [Beachwood, Franklin and Seidelmann Subspecialty Radiology, Beachwood, OH (United States); Fogel, Joshua [Maimonides Medical Center, Department of Radiology, Brooklyn, NY (United States); Brooklyn College, Department of Economics, Brooklyn, NY (United States)

    2008-06-15

    To determine the association of atrophy of the abductor digiti minimi muscle (ADMA), an MRI manifestation of chronic compression of the inferior calcaneal nerve suggesting the clinical diagnosis of Baxter's neuropathy, with MRI markers of potential etiologies, including calcaneal spur formation, plantar fasciitis, calcaneal edema, Achilles tendinosis and posterior tibial tendon dysfunction (PTTD). Prevalence of calcaneal spur formation, plantar fasciitis, calcaneal edema, Achilles tendinosis and PTTD was assessed retrospectively on 100 MRI studies with ADMA and 100 MRI studies without ADMA. Patients ranged in age from 10-92 years. Pearson chi-square analyses and Fisher's exact test were used to compare prevalence of the above findings in patients with and without ADMA. Logistic regression was used to determine which variables were significantly associated with ADMA. Among patients with ADMA, there was significantly greater age (57.2 years vs 40.8 years, p < 0.001), presence of Achilles tendinosis (22.0% vs 3.0%, P<0.001), calcaneal edema (15.0% vs 3.0%, P = 0.005), calcaneal spur (48.0% vs 7.0%, P < 0.001), plantar fasciitis (52.5% vs 11.0%, P<0.001), and PTTD (32.0% vs 11.0%, P<0.001). After multivariate logistic regression analysis, only age [odds ratio (OR) 1.06, 95% confidence interval (CI) 1.03, 1.09], calcaneal spur (OR 3.60, 95% CI 1.28, 10.17), and plantar fasciitis (OR 3.35, 95% CI 1.31, 8.56) remained significant. Advancing age, calcaneal spur, and plantar fasciitis are significantly associated with ADMA. Their high odds ratios support the notion of a possible etiologic role for calcaneal spur and plantar fasciitis in the progression to Baxter's neuropathy. (orig.)

  15. Non-infectious osteomyelitis of the mandible in a young woman

    DEFF Research Database (Denmark)

    Schwarz, Peter; Rasmussen, Anne Q; Jørgensen, Niklas R; Andersen, Ulrik B

    2014-01-01

    INTRODUCTION: We present the case of a patient with non-infectious osteomyelitis of the mandible, which is a recognized but unusual condition of unknown cause. CASE PRESENTATION: A 14-year-old Caucasian girl presented with pain and edema in the left side of her jaw. A clinical examination led to a...... after 12 months. The bone pain was significantly reduced six months after treatment and had disappeared 24 months after treatment. CONCLUSION: We report an unusual localization of non-infectious osteomyelitis of the jaw in a young woman. Even though the presentation was in the jaw, her condition...

  16. Osteomyelitis caused by Achromobacter xylosoxidans

    Directory of Open Access Journals (Sweden)

    Takashi Shinha

    2015-01-01

    Full Text Available Achromobacter xylosoxidans is an aerobic, nonfermenting gram-negative rod and described as a waterborne bacterium since it habits aquatic environments ubiquitously. It has frequently been isolated from aquatic surroundings in the hospital and from various human body sites. Although occasionally considered a non-pathogen, A. xylosoxidans has been associated with outbreaks of nosocomial infection due to contaminated fluids. Moreover, a wide variety of infectious etiologies due to A. xylosoxidans has been reported primarily in immunocompromised individuals. Heightened awareness of this bacterium and associated clinical importance is warranted for clinicians since its broad disease spectrum in humans and frequent multi-drug resistance may result in an increased mortality rate. In this report, we describe a case of osteomyelitis caused by A. xylosoxidans in a patient with a history of diabetes mellitus.

  17. Tensile properties of fresh human calcaneal (Achilles) tendons.

    Science.gov (United States)

    Louis-Ugbo, John; Leeson, Benjamin; Hutton, William C

    2004-01-01

    The purpose of this study was to measure the tensile properties of fresh human calcaneal (Achilles) tendons. Twenty fresh cadaveric (age range = 57-93 years) bone-Achilles tendon complexes were harvested within 24 hr postmortem. The calcaneus together with 15 cm of the Achilles tendon extending proximally from the insertion on the calcaneus was clamped and biomechanically tested. Each tendon was firmly fixed in clamps in an MTS Systems Corporation MTS testing machine and tension was applied at a displacement rate of 8 cm per minute until the tendon failed. The tensile force and tensile strain (as measured using an extensometer) were recorded and plotted using onboard software. The narrow age range of our donors prevented any meaningful correlation between age and tensile properties; however, the results showed that: 1) the average ultimate tensile strength (UTS) of the human Achilles tendon was 1189 N (range = 360-1,965), 2) there was a correlation between left and right legs for UTS, 3) there was a correlation between left and right legs in regard to cross sectional area, and 4) there was no correlation between UTS and cross-sectional area. PMID:14695585

  18. Treatment of the calcaneal spur with infrared laser

    International Nuclear Information System (INIS)

    The treatment with low power laser offers a beneficial and regenerating effect over nervous, muscular and skeletal tissues, soft tissues, and skin. This therapy has been used for more than three decades, based on the properties and effects of lasers in almost all medical specialties, due to it constitutes a novel, painless, non invasive, and easy to apply, in addition to the absence of any risk for patient and to have very good clinical results. Knowing the biological effects of the low power laser therapy (analgesic, anti-inflammatory, an tissue regenerator), we were dedicated to investigate the analgesic effect achieved with the application of infrared laser radiation in patients that suffering form calcaneal spur, who attended to the Natural and Traditional Medical Service of the clinic '30 de november', from January 2005 to January 2008. The whole of patients was 62, and the sample included 52 individuals from different sexes, races, and ages between 20 and 80 years, excluding pregnant women and neoplasia patients. Pain relief was achieved since second session of treatment, with 61,5 % of cases cured and 38,5 % improved, no one was worse, neither keep the same initial symptoms. (Author)

  19. A STUDY OF FUNCTIONAL OUT COME OF INTRA - ARTICULAR CALCANEAL FRACTURES TREATED SURGICALLY

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    Prashanth

    2015-10-01

    Full Text Available The calcaneus (O scalcis is the largest and most often fractured tarsal bone. The treatment of calcaneal fractures continues to pose a challenge for the trauma surgeons despite advancement in surgical technique and implant devices. The prognosis for an extra - articular fra cture is uniformly good, but that for an intra - articular fracture is varied. The management of every aspect of intra - articular calcaneal fractures is controversial. Although some studies have demonstrated good results after open reduction and internal fixa tion of intra - articular calcaneal fractures, a few other studies say otherwise. The method of internal fixation is also a point of debate, with various proponents advocating fixation with pins, screws or plate fixation with screws. Even there is no consens us regarding the surgical approach, with many having been described, including medial, lateral, combined medial and lateral, extended lateral and sinus tarsi approaches. So it is the need of the hour, to identify treatment techniques, which use lesser hard ware, to provide better functional outcomes in terms of shorter duration of treatment, better stability and early weight bearing and so also the role of non - operative treatment in the calcaneal fracture management. In this study, we have attempted to evalu ate the results of calcaneal fracture management by open reduction and internal fixation. Ours is a prospective study centered in the Gandhi hospital from Nov 2012 to April 2014 in which 30 patients with intra - articular calcaneal fractures were treated by open reduction and internal fixation and the results were evaluated with AOFAS scoring system. In our analysis, we observed that an anatomical reduction to restore Bohler’s and Gissanes angles associated with rigid internal fixation is essential for better fu n ctional results.

  20. Diabetic Foot Osteomyelitis: An Update on Correlative Imaging Diagnosis

    International Nuclear Information System (INIS)

    Infection still common 3000 years after initial description by Ancient Egyptians, diagnosis is still difficult in many situations. Inflammation: Nonspecific tissue reaction to injury physical, chemical, radiation, Immunologic or Microorganisms (leading to infection in this case) Osteomyelitis occurs in approximately 15% of diabetic patients mostly due to adjacent infection (ulcers). Foot ulceration occurs 50 times more common in diabetics and is due to abnormal pressure distribution secondary to diabetic neuropathy and vascular disease with diminished blood supply. Staphylococcus aureus is the most common organism causing diabetic foot osteomyelitis. Metatarsal bones and prox. phalanges: most commonly involved. Osteomyelitis was found to occur in 68% of ulcers, 68% of cases of osteomyelitis: silent and not diagnosed clinically and all cases with ulcers exposing bone were associated with osteomyelitis. Clinical diagnosis is not possible in most patients without imaging. The clinical problem is to diagnose infection as early, as reliable and as cost effectively as possible and differentiate it from the common neuroarthropathy. Standard Radiograph is cost effective as no additional Imaging if positive. However it has low sensitivity of 28%. It still is the initial modality of choice. Magnetic resonance imaging provides improved soft tissue contrast resolution and excellent delineation of soft tissue vs. bone infections. Data indicate high accuracy (90% sensitive and 81% specific) in diabetic foot infections. Regarding functional modalities, multiphase bone scan using Tc99m MDP offers early detection (24-48 h after infection), very high sensitivity, whole body imaging helping detect infection at other unsuspected sites. However it is nonspecific (average 30%)* Ga-67 is nonspecific and is positive in inflammation and neuroarthropathy. Labeled leukocyte imaging (WBC) using In111 or Tc99m HMP AO is high specific (88%) for infection (91-94% when combined with bone scan

  1. Temporal Bone Osteomyelitis: The Relationship with Malignant Otitis Externa, the Diagnostic Dilemma, and Changing Trends

    Directory of Open Access Journals (Sweden)

    Jia-Cheng Chen

    2014-01-01

    Full Text Available Fifty-five patients hospitalized for osteomyelitis of the temporal bone between 1990 and 2011 were divided into two study groups: group 1 was patients collected from 1990 to 2001 and group 2 was composed of patients between 2002 and 2011. Clinical diagnostic criteria and epidemiologic data were analyzed to illustrate the altering features of osteomyelitis of the temporal bone. Group 1 patients were characterized by high prevalence of diabetes and more commonly suffered from otalgia, otitis externa and granulation tissue in the external auditory canal and higher positive culture for Pseudomonas aeruginosa. Noticeable changing trends were found between both groups, including declining prevalence of diabetes, fewer patients complaining of pain or presenting with otitis externa, and canal granulation, and increased variety of pathogens in group 2. We should highlight the index of clinical suspicion for osteomyelitis of the temporal bone, even in nondiabetic or immunocompetent patients. Painless otorrhea patients were also at risk of osteomyelitis of the temporal bone, especially patients with previous otologic operation. Increased multiplicity of pathogens amplified the difficulty of diagnosis for osteomyelitis of the temporal bone.

  2. Radionuclide imaging of spinal osteomyelitis: prospective comparison of FDG-PET and Ga-SPECT

    International Nuclear Information System (INIS)

    Aim: MRI is currently recognized as the imaging modality of choice for diagnosing spinal osteomyelitis. Radionuclide imaging with 67Ga citrate (Ga) is usually reserved for those situations in which the MRI cannot be performed or is inconclusive. The delay between injection of radiogallium and imaging, typically 48 -72 hours, as well as the unfavorable imaging characteristics of this radionuclide are disadvantages of the procedure. There are data that suggest that 18F-FDG-PET (FDG-PET) imaging may be useful for diagnosing spinal osteomyelitis. We are prospectively studying the role of FDG-PET in the diagnosis of spinal osteomyelitis, and comparing it to Ga for this purpose. Materials and Methods: To date, 8 patients, 5 males and 3 females, 44 - 74 years old have undergone Ga-SPECT and FDG-PET imaging within 48 hours of each other. The regions of concern were: cervical spine (n=1), thoracic spine (n=2), and lumbar spine (n=5). Results: Five patients had spinal osteomyelitis; one patient also had an adjacent psoas abscess. Final diagnoses in the 3 remaining patients were degenerative joint disease, soft tissue infection, and chronic demyelinating polyneuropathy. Imaging results are presented. FDG-PET vs Gallium-SPECT. Results of FDG-PET and Ga-SPECT were concordant in all 8 patients. Conclusion: Although further study in a larger population is needed, FDG-PET, which is rapidly completed and has superior image quality, may emerge as the radionuclide imaging procedure of choice for diagnosing spinal osteomyelitis

  3. Neglected Foreign Body, the Cause of Navicular Osteomyelitis in A Paediatric Foot: A Case Report

    Directory of Open Access Journals (Sweden)

    Chandrashekara C.M

    2013-07-01

    Full Text Available Introduction: Foreign body injuries with date thorns, metal and wooden splinters are common in Middle East region, as most of it is desert. Some of the injuries lead to cellulitis or abscess formation, if neglected or improperly managed results in osteomyelitis or septic arthritis of foot structures. This is the first report of isolated navicular osteomyelitis following neglected foreign body in a paediatric foot. Case Report: A 10 year old male patient presented with discharging sinus in left mid-foot 3 years after penetrating injury with wooden splinter. The diagnosis of navicular osteomelitis is confirmed with plain radio-graphs. The ultrasound of foot was done to localize the foreign bodies. Patient was treated with complete removal of foreign body (wooden splinters, surgical debridement and combination of IV and oral cloxacillin for period of 6 weeks. At 18 months follow up, patient had painless foot with no recurrence or collapse of navicular bone. Conclusion: The neglected foreign body can result in osteomyelitis of small bones of foot in pediatric patient. The ultrasound is more useful tool in localizing foreign bodies; those are not radio-opaque. Early and prompt diagnosis with adequate treatment of established osteomyelitis by complete removal of foreign body, curettage and antibiotics can give good results. Keywords: Osteomyelitis; Navicular bone; Foreign body; Paediatric.

  4. Systematic approach to treat chronic osteomyelitis through localized drug delivery system: bench to bed side.

    Science.gov (United States)

    Bhattacharya, Rupnarayan; Kundu, Biswanath; Nandi, Samit Kumar; Basu, Debabrata

    2013-10-01

    Chronic osteomyelitis is a challenging setback to the orthopedic surgeons in deciding an optimal therapeutic strategy. Conversely, patients feel frustrated of the therapeutic outcomes and development of adverse drug effects, if any. Present investigation deals with extensive approach incorporating in vivo animal experimentation and human application to treat chronic osteomyelitis, using antibiotic loaded porous hydroxyapatite scaffolds. Micro- to macro-porous hydroxyapatite scaffolds impregnated with antibiotic ceftriaxone-sulbactam sodium (CFS) were fabricated and subsequently evaluated by in vivo animal model after developing osteomyelitis in rabbit tibia. Finally 10 nos. of human osteomyelitis patients involving long bone and mandible were studied for histopathology, radiology, pus culture, 3D CT etc. up to 8-18 months post-operatively. It was established up to animal trial stage that 50N50H samples [with 50-55% porosity, average pore size 110 μm, higher interconnectivity (10-100 μm), and moderately high drug adsorption efficiency (50%)] showed efficient drug release up to 42 days than parenteral group based on infection eradication and new bone formation. In vivo human bone showed gradual evidence of new bone formation and fracture union with organized callus without recurrence of infection even after 8 months. This may be a new, alternative, cost effective and ideal therapeutic strategy for chronic osteomyelitis treatment in human patients. PMID:23910305

  5. Mycobacterial Osteomyelitis of the Spine Following Intravesical BCG Therapy for Bladder Cancer.

    Science.gov (United States)

    Mackel, Charles E; Burke, Shane M; Huhta, Taylor; Riesenburger, Ron; Weller, Simcha J

    2016-01-01

    Osteomyelitis is an infection of the bone that can involve the vertebral column. A rare cause of vertebral osteomyelitis is Mycobacterium bovis after intravesical Bacillus Calmette-Guerin (BCG) therapy for transitional cell carcinoma of the bladder. In this report, we describe the case of a 64-year-old male presenting with constitutional symptoms, progressive thoracic kyphosis, and intractable T11 and T12 radiculopathies over the proceeding six months. A CT scan revealed erosive, lytic changes of the T12 and L1 vertebrae with compression of the T12 vertebra. An MRI demonstrated T11-12 osteomyelitis with intervening discitis and extensive paraspinal enhancement with a corresponding hyperintensity on a short tau inversion recovery (STIR) sequence. A needle aspiration grew out Mycobacterial tuberculosis complex that was pansensitive to all antimicrobial agent therapies, except pyrazinamide on culture, a finding consistent with an M. bovis infection. The patient's infection and neurologic compromise resolved after transthoracic T11-12 vertebrectomies with decompression of the spinal cord and nerve roots as well as T10-L1 instrumented fusion and protracted antimicrobial therapy. The epidemiology and natural history of M. bovis osteomyelitis are reviewed and the authors emphasize a mechanism of vertebral inoculation to explain the predilection of M. bovis osteomyelitis in males after intravesical BCG therapy. PMID:27158574

  6. Herpes Zoster Induced Osteomyelitis in the Immunocompromised Patients: A 10-year Multicenter Study

    Directory of Open Access Journals (Sweden)

    Reza Tabrizi

    2014-09-01

    Full Text Available Statement of the Problem: Alveolar bone necrosis induced by Herpes zoster infection is considered as a rare manifestation of osteomyelitis and few case reports are presented in the literature. Purpose: The aim of this study was to evaluate mandibular osteomyelitis caused by herpes zoster in the immunocompromised patients with histopathologically documented osteomyelitis in the mandible and herpes zoster infection. Materials and Method: 30 patients were recruited in this cross-sectional study. 19 patients were completely edentulous, 4 patients were partially edentulous and 7 with complete dentition. In all cases, specimens were analyzed using a conventional polymerase chain reaction (PCR test for varicella zoster virus. Results: 16 patients underwent dialysis, 9 patients received chemotherapy treat-ments and 5 patients had transplantation (four kidneys and one liver. Histopa-thological assessment demonstrated a nonspecific bone necrosis exhibiting an eosinophilic, homogeneous non-vital bone tissue with peripheral resorption sur-rounded by reactive connective tissue. PCR test was positive in 21 cases. Conclusion: This study demonstrated that the frequency of osteomyelitis induced by herpes zoster could be more than the records provided by previous studies. Histopathological findings might be nonspecific in such patients. PCR test was not positive for all HZ induced osteomyelitis patients.

  7. Ultrastructural Analyses of Alveolar Bone in a Patient With Osteomyelitis Secondary to Osteopetrosis: A Review of the Literature.

    Science.gov (United States)

    Mikami, Toshinari; Miake, Yasuo; Bologna-Molina, Ronell; Takeda, Yasunori

    2016-08-01

    Osteopetrosis is a generic term for generalized sclerotic conditions caused by rare genetic disorders. Decreased osteoclastic activities disturb bone remodeling, resulting in greater mineral density and greater compressive strength; therefore, bone fracture is a major physical symptom of osteopetrosis. Osteomyelitis of the maxilla or mandible is a common and well-documented complication of osteopetrosis. Local infection, such as odontogenic infection, is more likely to lead to osteomyelitis, and treatment strategies can be challenging. However, detailed ultrastructural analyses of bone from patients with osteopetrosis and odontogenic infection are limited. This report describes a case of osteomyelitis of the maxilla and mandible secondary to osteopetrosis in an adult patient and presents ultrastructural data of alveolar bone tissue analyzed by contact microradiography, electron probe microanalysis, and x-ray diffraction. Cases of osteomyelitis of the jaw secondary to osteopetrosis also are reviewed. PMID:27000409

  8. Prospective evaluation of bone and leukocyte scintigraphy for diagnosis of chronic osteomyelitis in patients with coexistent soft-tissue pathology

    International Nuclear Information System (INIS)

    This paper reports on a study involving twenty-four patients with soft-tissue infections or wounds and radiographic abnormalities in contiguous bones possibly representing osteomyelitis who underwent three-phase Tc-99 m methylene diphosphonate (MDP) bone scanning, followed by In-111 leukocyte scintigraphy (22 patients) and bone biopsy (21 patients). Chronic osteomyelitis was confirmed in 12 patients by means of biopsy cultures and in one by means of histologic findings following amputation. Four patterns of leukocyte uptake in bone were identified: definitely increased, possibly increased, normal, and decreased. The prevalence of osteomyelitis for these four leukocyte scan patterns was as follows: 89% (eight of nine patients), 40% (two of five), 20% (one of five), and 67% (two of three), respectively. A definite increase in bone uptake of In-111-labeled leukocytes usually reflects osteomyelitis, but bone biopsy may be necessary to establish the diagnosis when other scan patterns are present

  9. Clinical Management of Suppurative Osteomyelitis, Bisphosphonate-Related Osteonecrosis, and Osteoradionecrosis: Report of Three Cases and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Eduardo Pereira Guimarães

    2013-01-01

    Full Text Available In the past, osteomyelitis was frequent and characterized by a prolonged course, treatment response uncertainty, and occasional disfigurement. Today, the disease is less common; it is believed that the decline in prevalence may be attributed to increased availability of antibiotics and improvement of overall health patterns. Currently, more common osteomyelitis variants are seen, namely, osteoradionecrosis (ORN and bisphosphonate-related osteonecrosis of the jaws (BRONJ. Osteomyelitis, ORN, and BRONJ can present with similar symptoms, signs, and radiographic findings. However, each condition is a separate entity, with different treatment approaches. Thus, accurate diagnosis is essential for adequate management and improved patient prognosis. The aim of this paper is to report three cases of inflammatory lesions of the jaws—osteomyelitis, ORN, and BRONJ—and to discuss their etiology, clinical aspects, radiographic findings, histopathological features, treatment options, and preventive measures.

  10. Staphylococcus aureus sternal osteomyelitis: a rare cause of chest pain

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    Kaur M

    2015-10-01

    Full Text Available Chest pain is a common presenting symptom with a broad differential. Life-threatening cardiac and pulmonary etiologies of chest pain should be evaluated first. However, it is critical to perform a thorough assessment for other sources of chest pain in order to limit morbidity and mortality from less common causes. We present a rare case of a previously healthy 45 year old man who presented with focal, substernal, reproducible chest pain and Staphylococcus aureus bacteremia who was later found to have primary Staphylococcus aureus sternal osteomyelitis.

  11. Combination of diagnostic medial calcaneal nerve block followed by pulsed radiofrequency for plantar fascitis pain: A new modality

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    Deepak Thapa

    2014-01-01

    Full Text Available Plantar fasciitis (PF is the most common cause of chronic heel pain which may be bilateral in 20 to 30% of patients. It is a very painful and disabling condition which can affect the quality of life. The management includes both pharmacological and operative procedures with no single proven effective treatment modality. In the present case series, we managed three patients with PF (one with bilateral PF. Following a diagnostic medial calcaneal nerve (MCN block at its origin, we observed reduction in verbal numerical rating scale (VNRS in all the three patients. Two patients has relapse of PF pain which was managed with MCN block followed with pulsed radio frequency (PRF. All the patients were pain-free at the time of reporting. This case series highlights the possible role of combination of diagnostic MCN block near its origin followed with PRF as a new modality in management of patients with PF.

  12. Pathology and biofilm formation in a porcine model of staphylococcal osteomyelitis

    DEFF Research Database (Denmark)

    Johansen, L K; Koch, J; Frees, D;

    2012-01-01

    A porcine model was used to examine the potential of human and porcine Staphylococcus aureus isolates to induce haematogenously spread osteomyelitis. Pigs were inoculated in the right femoral artery with one of the following S. aureus strains: S54F9 (from a porcine lung abscess; n = 3 animals......), NCTC-8325-4 (a laboratory strain of human origin; n = 3 animals) and UAMS-1 (a human osteomyelitis isolate; n = 3 animals). Two pigs were sham inoculated with saline. At 11 or 15 days post infection the animals were scanned by computed tomography before being killed and subjected to necropsy...... examination. Osteomyelitis lesions were present in the right hind limb of all pigs inoculated with strain S54F9 and in one pig inoculated with strain NCTC-8325-4. Microscopically, there was extensive loss of bone tissue with surrounding granulation tissue. Sequestrated bone trabeculae were intermingled with...

  13. Diagnostic imaging of pediatric hematogenous osteomyelitis: lessons learned from a multi-modality approach

    Energy Technology Data Exchange (ETDEWEB)

    Mellado Santos, Jose M. [Hospital Reina Sofia de Tudela, Servicio de Radiodiagnostico, Tudela, Navarra (Spain)

    2006-09-15

    Pediatric hematogenous osteomyelitis may present highly variable radiological expression, which is influenced by the age and condition of the patient, the virulence of the causative agent, the stage of the disease, or the selected imaging tool. Given the multiplicity of available modalities and the multi-faceted nature of the process, purposeful imaging of pediatric hematogenous osteomyelitis may be difficult. In order to avoid diagnostic delays and complications, familiarity with the variable expression of the disease and assumption of the potentialities, roles and limitations of the various imaging modalities is required. In this pictorial essay we review, illustrate and discuss, in a multi-modality approach, the various radiological patterns that may be found in pediatric hematogenous osteomyelitis, with emphasis on strategies, staging, uncommon distribution patterns, and differential diagnosis. (orig.)

  14. Diagnostic imaging of pediatric hematogenous osteomyelitis: lessons learned from a multi-modality approach

    International Nuclear Information System (INIS)

    Pediatric hematogenous osteomyelitis may present highly variable radiological expression, which is influenced by the age and condition of the patient, the virulence of the causative agent, the stage of the disease, or the selected imaging tool. Given the multiplicity of available modalities and the multi-faceted nature of the process, purposeful imaging of pediatric hematogenous osteomyelitis may be difficult. In order to avoid diagnostic delays and complications, familiarity with the variable expression of the disease and assumption of the potentialities, roles and limitations of the various imaging modalities is required. In this pictorial essay we review, illustrate and discuss, in a multi-modality approach, the various radiological patterns that may be found in pediatric hematogenous osteomyelitis, with emphasis on strategies, staging, uncommon distribution patterns, and differential diagnosis. (orig.)

  15. Ceftriaxone-resistant Salmonella septicemia and osteomyelitis in sickle cell disease adults.

    Science.gov (United States)

    Morgan, James S; Laber, Damian A

    2006-06-01

    The majority of data evaluating Salmonella infections in sickle cell anemia (SCD) comes from studies performed in children. We report a SCD adult who presented with ceftriaxone-resistant Salmonella bacteremia. After appropriate initial therapy, persistent back pain prompted evaluation by magnetic resonance imaging of the spine, which revealed osteomyelitis and a psoas abscess. The patient responded to percutaneous drainage and antibiotics. This report summarizes some of the findings of large SCD studies evaluating Salmonella bacteremia and osteomyelitis, focusing on adults. Our case exemplifies the need for antibiotic coverage for Salmonella species in adult SCD patients with septicemia. We argue that imaging studies looking for osteomyelitis should be done routinely in SCD patients with Salmonella bacteremia. PMID:16800421

  16. Osteomyelitis pubis caused by Kingella kingae in an adult patient: Report of the first case

    Directory of Open Access Journals (Sweden)

    Wilmes Dunja

    2012-10-01

    Full Text Available Abstract Background Kingella kingae is the second most common pathogen causing paediatric arthritis and is described to be the causative bacteria in some paediatric osteomyelitis. Its microbiological detection is particularly difficult due to its slow growing. To our best knowledge this is the first case description of osteomyelitis pubis caused by this microorganism. Case presentation We report the unusual case of pubic osteomyelitis with soft tissue abcess caused by Kingella kingae in an adult patient of 66 years with a history of end-stage renal disease and breast carcinoma. Diagnosis was based on imaging and the microorganism was isolated from Computed Tomography-guided aspiration of synovial fluid. The infection resolved completely after twelve weeks of treatment with oral amoxicillin. Conclusion This case description highlights the importance in osteoarticular infections of systematic inoculation of synovial liquid in BACTEC vials to optimise the detection of causative organisms, which can necessitate specific treatments.

  17. Conservative treatment in a patient with diabetic osteomyelitis

    DEFF Research Database (Denmark)

    Jeppesen, Sune Møller; Frokjaer, J.; Yderstraede, K.

    2015-01-01

    Diabetic foot ulcers are commonly complicated by bone involvement and osteomyelitis. Diagnosing diabetic osteomyelitis can be problematic. However, positive findings at clinical examination and X-ray may set the diagnosis. Recent guidelines suggest that selected cases of diabetic osteomyelitis can...... be treated conservatively with antibiotics. We report on the successful treatment of a 52-year-old man with diabetes with osteomyelitis in the distal phalanx of a toe. On X-ray, the affected phalanx appeared completely eroded. However, regeneration of the bone tissue was observed following outpatient...... treatment with antibiotics. We therefore encourage doctors to provide conservative treatment for selected cases of diabetic osteomyelitis....

  18. A Novel Technique for Closed Reduction and Fixation of Paediatric Calcaneal Fracture Dislocation Injuries

    Science.gov (United States)

    Faroug, Radwane; Stirling, Paul; Ali, Farhan

    2013-01-01

    Paediatric calcaneal fractures are rare injuries usually managed conservatively or with open reduction and internal fixation (ORIF). Closed reduction was previously thought to be impossible, and very few cases are reported in the literature. We report a new technique for closed reduction using Ilizarov half-rings. We report successful closed reduction and screwless fixation of an extra-articular calcaneal fracture dislocation in a 7-year-old boy. Reduction was achieved using two Ilizarov half-ring frames arranged perpendicular to each other, enabling simultaneous application of longitudinal and rotational traction. Anatomical reduction was achieved with restored angles of Bohler and Gissane. Two K-wires were the definitive fixation. Bony union with good functional outcome and minimal pain was achieved at eight-weeks follow up. ORIF of calcaneal fractures provides good functional outcome but is associated with high rates of malunion and postoperative pain. Preservation of the unique soft tissue envelope surrounding the calcaneus reduces the risk of infection. Closed reduction prevents distortion of these tissues and may lead to faster healing and mobilisation. Closed reduction and screwless fixation of paediatric calcaneal fractures is an achievable management option. Our technique has preserved the soft tissue envelope surrounding the calcaneus, has avoided retained metalwork related complications, and has resulted in a good functional outcome. PMID:23819090

  19. A Novel Technique for Closed Reduction and Fixation of Paediatric Calcaneal Fracture Dislocation Injuries

    Directory of Open Access Journals (Sweden)

    Radwane Faroug

    2013-01-01

    Full Text Available Paediatric calcaneal fractures are rare injuries usually managed conservatively or with open reduction and internal fixation (ORIF. Closed reduction was previously thought to be impossible, and very few cases are reported in the literature. We report a new technique for closed reduction using Ilizarov half-rings. We report successful closed reduction and screwless fixation of an extra-articular calcaneal fracture dislocation in a 7-year-old boy. Reduction was achieved using two Ilizarov half-ring frames arranged perpendicular to each other, enabling simultaneous application of longitudinal and rotational traction. Anatomical reduction was achieved with restored angles of Bohler and Gissane. Two K-wires were the definitive fixation. Bony union with good functional outcome and minimal pain was achieved at eight-weeks follow up. ORIF of calcaneal fractures provides good functional outcome but is associated with high rates of malunion and postoperative pain. Preservation of the unique soft tissue envelope surrounding the calcaneus reduces the risk of infection. Closed reduction prevents distortion of these tissues and may lead to faster healing and mobilisation. Closed reduction and screwless fixation of paediatric calcaneal fractures is an achievable management option. Our technique has preserved the soft tissue envelope surrounding the calcaneus, has avoided retained metalwork related complications, and has resulted in a good functional outcome.

  20. In-111 white blood cell sensitivity depends on the location of the osteomyelitis

    International Nuclear Information System (INIS)

    The authors studied 76 patients with osteomyelitis and found a sensitivity of 95% in scute appendicular osteomyelitis (16 patients), 91% in chronic appendicular osteomyelitis (43 patients), 100% in acute axial osteomyelitis (three patients), and 57% in chronic axial osteomyelitis (14 patients). Thus, chronic osteomyelitis in the axials skeleton had significantly reduced sensitivity. This difference is due both to the different cellular response to acute and chronic osteomyelitis and to the location of the osteomyelitis. The appendicular skeleton contains no active bone marrow in the adult. The axial skeleton contains active bone marrow, which accumulates In-111 white blood cells, making the localization of the osteomyelitis more difficult

  1. A porcine model of acute, haematogenous, localized osteomyelitis due to Staphylococcus aureus

    DEFF Research Database (Denmark)

    Johansen, Louise Kruse; Frees, Dorte; Aalbæk, Bent;

    2011-01-01

    A porcine model of acute, haematogenous, localized osteomyelitis was established. Serial dilutions of Staphylococcus aureus [5–50–500–5000–50 000 CFU/kg body weight (BW) suspended in saline or saline alone] were inoculated into the right brachial artery of pigs (BW 15 kg) separated into six groups...... developed microabscesses in bones of the infected legs. In the centre of microabscesses, S. aureus was regularly demonstrated together with necrotic neutrophils. Often, bone lesions resulted in trabecular osteonecrosis. The present localized model of acute haematogenous osteomyelitis revealed a pattern of...

  2. Primary Sternal Osteomyelitis: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Zubair Hasan

    2016-03-01

    Full Text Available Primary sternal osteomyelitis is a rare clinical entity generally caused by Staphylococcus aureus or Pseudomonas aeruginosa.Although rare it carries significant morbidity including spread to mediastinal structures and even mortality. Diagnosis is generally made on clinical suspicion in a patient with and anterior chest pain and swelling, fever and raised inflammatory markers. Management is generally aggressive surgical debridement and intravenous antibiotics. Hyperbaric oxygen can be used where available and reconstructive options need to be considered in those with extensive dissection. Herein we report the case of a 55 year old male with no previous chest surgery or trauma who presented with primary sternal osteomyelitis.

  3. Association between vitamin D status and serum parathyroid hormone concentration and calcaneal stiffness in Japanese adolescents: sex differences in susceptibility to vitamin D deficiency.

    Science.gov (United States)

    Tsugawa, Naoko; Uenishi, Kazuhiro; Ishida, Hiromi; Ozaki, Reo; Takase, Tomoki; Minekami, Takuya; Uchino, Yuri; Kamao, Maya; Okano, Toshio

    2016-07-01

    There is currently insufficient information on serum 25-hydroxyvitamin D (25OHD) and parathyroid hormone (PTH) concentrations, and bone mineral status in healthy adolescents to allow reference values to be set. This study aimed to provide comparable data on vitamin D status in Japanese adolescents and to assess sex differences in susceptibility to vitamin D insufficiency. Serum 25OHD and PTH concentrations were measured in 1,380 healthy adolescents (aged 12-18 years). Subjects completed a questionnaire on exercise history, diet, and lifestyle factors. Calcaneal stiffness was evaluated by quantitative ultrasound. Serum 25OHD concentrations in boys and girls were 60.8 ± 18.3 and 52.8 ± 17.0 nmol/L, respectively. Approximately 30 % of boys and 47 % of girls had suboptimal 25OHD concentrations (<50 nmol/L). Serum PTH concentration was negatively correlated with serum 25OHD concentration in boys, but negatively correlated with calcium intake rather than serum 25OHD in girls. In contrast, the increment in calcaneal stiffness as a result of elevation of serum 25OHD was higher in girls than in boys. As vitamin D deficiency is common in Japanese adolescents, it was estimated that intakes of ≥12 and ≥14 μg/day vitamin D would be required to reach 25OHD concentrations of 50 nmol/L in boys and girls, respectively. Moreover, the results of the present study indicate that vitamin D deficiency has a greater association with calcaneal stiffness in girls than in boys. PMID:26260151

  4. Chronic multifocal non-bacterial osteomyelitis in hypophosphatasia mimicking malignancy

    Directory of Open Access Journals (Sweden)

    Warmuth-Metz Monika

    2007-01-01

    Full Text Available Abstract Background Hypophosphatasia (HP is characterized by a genetic defect in the tissue-nonspecific alkaline phosphatase (TNSALP gene and predominantly an autosomal recessive trait. HP patients suffer from reduced bone mineralization. Biochemically, elevated concentrations of substrates of TNSALP, including pyridoxal-5'-phosphate and inorganic pyrophosphate occur in serum, tissues and urine. The latter has been associated with chronic inflammation and hyperprostaglandinism. Case presentation We report on 2 affected children presenting with multifocal inflammatory bone lesions mimicking malignancy: A 6 years old girl with short stature had been treated with human growth hormone since 6 months. Then she started to complain about a painful swelling of her left cheek. MRI suggested a malignant bone lesion. Bone biopsy, however, revealed chronic inflammation. A bone scan showed a second rib lesion. Since biopsy was sterile, the descriptive diagnosis of chronic non-bacterial osteomyelitis (CNO was established. The diagnostic tests related to growth failure were repeated and subsequent analyses demonstrated a molecular defect in the TNSALP gene. The second girl (10 years old complained about back pain after she had fallen from her bike. X rays of her spine revealed compressions of 2 thoracic vertebrae. At first these were considered trauma related, however a bone scan did show an additional lesion in the right 4th rib. A biopsy of this rib revealed a sterile lympho- plasmocytoid osteomyelitis suggesting multifocal CNO. Further analyses did show a decreased TNSALP in leukocytes and elevated pyridoxal phosphate in plasma, suggesting a heterozygous carrier status of HP. Conclusion Chronic bone oedema in adult HP and chronic hyper-prostaglandinism in childhood HP do suggest that in some HP patients bone inflammation is present in conjunction with the metabolic defect. Sterile multifocal osteomyelitis could be demonstrated. Non-steroidal anti

  5. Uncommon mandibular osteomyelitis in a cat caused by Nocardia africana

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    de Farias Marconi

    2012-12-01

    Full Text Available Abstract Background Nocardiosis is an unusual infection in companion animals characterized by suppurative to pyogranulomatous lesions, localized or disseminated. Cutaneous-subcutaneous, pulmonary and systemic signs are observed in feline nocardiosis. However, osteomyelitis is a rare clinical manifestation in cats. Nocardia cyriacigeorgica (formerly N. asteroides sensu stricto, Nocardia brasiliensis, Nocardia otitidiscaviarum, and Nocardia nova are the most common pathogenic species identified in cats, based on recent molecular classification (16S rRNA gene. The present report is, to our knowledge, the first case of mandibular osteomyelitis in a cat caused by Nocardia africana, diagnosed based upon a combination of methods, including molecular techniques. Case presentation A one-year-old non-neutered female cat, raised in a rural area, was admitted to the Companion Animal Hospital-PUCPR, São José dos Pinhais, State of Paraná, Brazil, with a history a progressive facial lesion, difficulty apprehending food, loss of appetite, apathy and emaciation. Clinical examination showed fever, submandibular lymphadenitis, and a painless, 8 cm diameter mass, which was irregularly-shaped, of firm consistency, and located in the region of the left mandible. The skin around the lesion was friable, with diffuse inflammation (cellulitis, multiple draining sinuses, and exudation of serosanguinous material containing whitish “sulfur” granules. Diagnosis was based initially in clinical signs, microbiological culture, cytological, and histopathological findings, and radiographic images. Molecular sequencing of 16S rRNA of isolate allowed diagnosis of Nocardia africana. Despite supportive care and antimicrobial therapy based on in vitro susceptibility testing the animal died. Conclusion The present report describes a rare clinical case of feline osteomyelitis caused by Nocardia africana, diagnosed based upon a combination of clinical signs, microbiological

  6. Physeal involvement in chronic recurrent multifocal osteomyelitis

    International Nuclear Information System (INIS)

    Chronic recurrent multifocal osteomyelitis is a recently recognized disease characterized by remissions and exacerbations of multiple bone lesions which radiographically and pathologically have the appearance of hematogenous osteomyelitis. No consistent etiology can be identified, and antimicrobial agents seem to have no beneficial effect. A review of the appearances on imaging modalities and the clinical and pathologic manifestations is undertaken in seven cases of CRMO. No therapeutic regimen resulted in consistent clinical or radiographic improvement. We suggest the sequelae of this process are not as benign as previously reported. (orig.)

  7. Physeal involvement in chronic recurrent multifocal osteomyelitis

    Energy Technology Data Exchange (ETDEWEB)

    Manson, D. (McMaster Univ., Hamilton, Ontario (Canada). Dept. of Radiology); Wilmot, D.M. (Hospital for Sick Children, Toronto, Ontario (Canada). Dept. of Radiology); King, S. (Hospital for Sick Children, Toronto, ON (Canada). Dept. of Infectious Diseases); Laxer, R.M. (Hospital for Sick Children, Toronto, ON (Canada). Div. of Immunology)

    1989-11-01

    Chronic recurrent multifocal osteomyelitis is a recently recognized disease characterized by remissions and exacerbations of multiple bone lesions which radiographically and pathologically have the appearance of hematogenous osteomyelitis. No consistent etiology can be identified, and antimicrobial agents seem to have no beneficial effect. A review of the appearances on imaging modalities and the clinical and pathologic manifestations is undertaken in seven cases of CRMO. No therapeutic regimen resulted in consistent clinical or radiographic improvement. We suggest the sequelae of this process are not as benign as previously reported. (orig.).

  8. Poor accuracy of calcaneous ultrasounds in the selection of postmenopausal women affected by vertebral osteoporosis diagnosed by DXA

    International Nuclear Information System (INIS)

    Aim: Bone Mineral Density (BMD) is the strongest skeletal predictor of fractures. DXA densitometric technique is the reference method to diagnose osteoporosis. Large prospective studies have confirmed that both Broad Band Ultrasound Attenuation (BUA) and Speed Of Sound (SOS) measurements at calcaneus predict vertebral fractures independently of densitometry. The aim of this study was to verify the capacity of calcaneal ultrasound (US) to detect women with vertebral osteoporosis diagnosed by DXA. Material and Methods: 453 women (aged 60-70 yrs), were investigated both with calcaneal US and spine DXA. WHO diagnostic criteria were applied both to DXA and US. Results: 202 and 251 women resulted osteoporotic and non osteoporotic at spine, respectively. Calcaneal US were not able to detect with sufficient accuracy the women diagnosed as osteoporotic at the spine (71-73 % of false negative and 11% of false positive results both for BUA and SOS). Conclusion: In conclusion, calcaneal US do not permit to individually diagnose vertebral osteoporosis

  9. Pseudo-osteomyelitic crisis upon presentation of Gaucher disease

    International Nuclear Information System (INIS)

    We report on a 4-year-old boy adopted from Paraguay who presented with an acute onset of thigh pain. Initial clinical, imaging, and histopathologic findings suggested florid osteomyelitis. However, the development of pancytopenia on intravenous antibiotics prompted further investigation and the ultimate diagnosis of Gaucher disease. In retrospect, characteristic changes on conventional radiographic and MR images, as well as growth of a contaminant organism, pointed to the diagnosis of pseudo-osteomyelitis rather than osteomyelitis. (orig.)

  10. Candida Osteomyelitis: Analysis of 207 Pediatric and Adult Cases (1970–2011)

    OpenAIRE

    Gamaletsou, Maria N; Kontoyiannis, Dimitrios P.; Sipsas, Nikolaos V.; Moriyama, Brad; Alexander, Elizabeth; Roilides, Emmanuel; Brause, Barry; Thomas J Walsh

    2012-01-01

    Candida osteomyelitis most frequently presents subacutely with local symptoms but minimally elevated inflammatory biomarkers, hematogenous dissemination caused by C. albicans involving vertebrae in adults and femur/humerus in children, high relapse rate requiring extended therapy (median 3 months), and often surgical intervention.

  11. Osteomyelitis in lower limbs and pulmonary septic emboli - a case report and radiological diagnosis

    International Nuclear Information System (INIS)

    The authors describe a case of osteomyelitis in the lower limbs with subsequent septic emboli pulmonary spread, as a complication of the prior clinical presentation. They discuss clinical and pathological aspects, as well as, the possibility of diagnosis utilizing plain radiography, computed tomography and scintigraphy. (author)

  12. Whole body MRI in the diagnosis of chronic recurrent multifocal osteomyelitis.

    LENUS (Irish Health Repository)

    Kennedy, M T

    2012-06-01

    Chronic recurrent multifocal osteomyelitis (CRMO) is a diagnosis of exclusion primarily in children and adolescents. As part of the essential criteria for the diagnosis of CRMO, multifocal lesions must be identified. We present the case of an 11-year-old boy with CRMO, whose diagnosis was facilitated by the use of whole body magnetic resonance imaging (WBMR), but not isotope bone scanning.

  13. Osteomyelitis - imaging methods and their ranking

    International Nuclear Information System (INIS)

    Various imaging modalities are used in diagnosis of acute and chronic infectious endogenous osteomyelitis and exogenous ostitis. The pathophysiological changes of osteomyelitis/ostitis in the bone and surrounding soft tissue are known. Findings in plain film radiography show these changes only in relatively advanced stages of disease. Hence, plain film radiographs are useful as a basic imaging modality by excluding other differentials and as a follow-up modality under therapy. Ultrasound -- using advanced technology -- offers diagnostic help in acute osteomyelitis, especially in infants. The various techniques of nuclear medicine show much higher sensitivity for detecting osteomyelitis than plain film radiography, but do not permit good separation for bone involvement and infectious changes in the surrounding soft tissue. While computed tomography offers the ability to display bone and soft tissue separately, it has been widely replaced by magnetic resonance imaging using fat-suppressed sequences and paramagnetic contrast media which show the spread of the infectious changes with higher sensitivity and accuracy. (orig.)

  14. Pyogenic osteomyelitis of long bone: MR findings

    International Nuclear Information System (INIS)

    To evaluate the usefulness of MR in the osteomyelitis, we reviewed MR examinations of 14 patients with pyogenic osteomyelitis of the long bone. All 14 patients were confirmed to have osteomyelitis either surgically (13/14) or by aspiration (1/14). MRI was performed with 0.5 T (n=8) or 2.0 T (n=6) SE technique, and Gd-DTPA enhanced T1WI was obtained in 10 examinations. Anatomic location of lesions were femur (8/14), tibia (5/14) , and fibula (1/14). The marrow cavity and soft tissue were involved in 13/14, 12/14 respectively. The signals of both intraosseous and extraosseous infected area were iso to low signal intensity to muscles on T1WI and high signal intensity on PDWI and T2WI. Rim or diffuse enhancement of the marrow cavity and soft tissue were seen in all (10/10) case. Sequestra, periosteal reaction, and cortical defect were found in 12/14, 10/14, 9/14. MR provided more accurate and detailed anatomic information including extent of disease and possible activity than bone scintigraphy, CT, or conventional radiography. We conclude that MR might be the choice of modality in the diagnosis of osteomyelitis of the long bone

  15. Salmonella osteomyelitis by sickle cell anemia

    International Nuclear Information System (INIS)

    Case report of a 28 year old black sickle cell anemia patient with salmonella osteomyelitis of the radius. Aside from sickle cell anemia patients this skeletal complication of enteric salmonellosis is an extreme rarity. Description of the typical roentgenological features includes intracortical fissures and sequestration. (orig.)

  16. Osteomyelitis of a long bone due to Fusobacterium nucleatum and Actinomyces meyeri in an immunocompetent adult: A case report and literature review

    Directory of Open Access Journals (Sweden)

    Lee Min

    2012-07-01

    Full Text Available Abstract Background Fusobacterium species are uncommon causes of osteomyelitis. These organisms are normal flora of the oral cavity. Therefore, they mostly cause osteomyelitis of the head and neck. Hematogenous osteomyelitis at distant sites other than the head and neck has rarely been reported in pediatric or immunocompromised patients. Here, we report the first case of osteomyelitis of a long bone combined with a muscle abscess due to Fusobacterium nucleatum in an otherwise healthy adult. Case presentation A 59-year-old Korean man was admitted for pain and swelling of the right lower leg, which had been persistent for two weeks. Magnetic resonance imaging showed osteomyelitis of the right fibula with a surrounding muscle abscess of the right lower leg. Incision and drainage was performed, and repetitive tissue cultures grew F. nucleatum. In this patient, it was presumed that recurrent periodontitis caused hematogenous seeding of F. nucleatum to a distant site leading to osteomyelitis with a muscle abscess. The patient was successfully treated with intravenous ampicillin-sulbactam for three weeks and oral amoxicillin-clavulanate for eight weeks. He also underwent repeated surgical drainage. He has no evidence of recurrence after seven months of follow-up. Conclusions Clinicians should be aware that F. nucleatum could be the etiologic agent of hematogenous osteomyelitis of a long bone in an immunocompetent patient.

  17. Involvement of the opportunistic pathogen Aspergillus tubingensis in osteomyelitis of the maxillary bone: a case report

    Directory of Open Access Journals (Sweden)

    Bathoorn Erik

    2013-02-01

    Full Text Available Abstract Background Aspergillus tubingensis is a black Aspergillus belonging to the Aspergillus section Nigri, which includes species that morphologically resemble Aspergillus niger. Recent developments in species determination have resulted in clinical isolates presumed to be Aspergillus niger being reclassified as Aspergillus tubingensis by sequencing. We present a report of a patient with an osteomyelitis of the maxillary bone with a probable invasive Aspergillus tubingensis infection. Case presentation We describe an immune compromised patient suffering from osteomyelitis of the maxillary bone after tooth extraction. The osteomyelitis probably resulted in dentogenic pansinusitis presenting as an acute ethmoiditis. Histologic examination of biopsy samples showed osteomyelitis, and inflammation of the surrounding connective tissue. Cultures of the alveolar wound grew Aspergillus tubingensis. The patient was treated with liposomal amphoterocin B, which was changed to oral treatment with voriconazole based on susceptibility testing (MIC for voriconazole was 1 μg/ml. Conclusion This case shows that Aspergillus tubingensis may have the potential to cause severe invasive infections in immunocompromised hosts. A larger proportion of Aspergillus tubingensis isolates are less susceptible to azoles compared to Aspergillus niger. Therefore, correct species identification and susceptibility testing is crucial for the choice of anti-fungal treatment, screening of azole resistance, and characterization of the pathogenic potential of the various species within Aspergillus section Nigri.

  18. A novel observation of pubic osteomyelitis due to Streptococcus viridans after dental extraction: a case report

    Directory of Open Access Journals (Sweden)

    Naqvi Naseem

    2008-07-01

    Full Text Available Abstract Introduction Pubic osteomyelitis should be suspected in athletic individuals with sudden groin pain, painful restriction of hip movements and fever. It is an infrequent and confusing disorder, which is often heralded by atypical gait disturbance and diffuse pain in the pelvic girdle. The most common pathogen is Staphylococcus aureus but, on occasions, efforts to identify infectious agents sometimes prove negative. Pubic osteomyelitis due to Streptococcus viridans has not been reported previously in the literature. Case presentation We describe the case of a fit 24-year-old athlete, who had a wisdom tooth extracted 2 weeks prior to the presentation, which could have served as a port of entry and predisposed the patient to transient bacteraemia. Conclusion S. viridans is well known for causing infective endocarditis of native damaged heart valves, but to the best of the authors' knowledge it has not been reported previously as a cause of pubic osteomyelitis. We believe that this case should alert physicians to the association between dental procedures and osteomyelitis of the pubis secondary to S. viridans.

  19. Radionuclide imaging in the evaluation of osteomyelitis and septic arthritis

    International Nuclear Information System (INIS)

    Despite controversy over its exact role, radionuclide imaging plays an important role in the evaluation of patients suspected of having osteomyelitis. The differentiation between osteomyelitis and cellulitis is best accomplished by using a three-phase technique using Tc-99m methylene diphosphonate (MDP). Frequently, it is necessary to obtain multiple projections and magnification views to adequately assess suspected areas. It is recommended that a Ga-67 or In-111 leukocyte scan be performed in those cases where osteomyelitis is strongly suspected clinically and the routine bone scan is equivocal or normal. Repeated bone scan after 48 to 72 h may demonstrate increased radioactivity in the case of early osteomyelitis with the initial photon-deficient lesion. In-111 leukocyte imaging is useful for the evaluation of suspected osteomyelitis complicating recent fracture or operation, but must be used in conjunction with clinical and radiographic correlation. The recognition of certain imaging patterns appears helpful to separate osteomyelitis from septic arthritis or cellulitis. 83 references

  20. Diode laser osteoperforation and its application to osteomyelitis treatment

    Science.gov (United States)

    Privalov, Valeriy A.; Krochek, Igor V.; Lappa, Alexander V.

    2001-10-01

    Laser osteoperforation, previously studied in experiment in rabbits at treatment for acute purulent osteomyelitis (Privalov V. et.al., SPIE Proc., v.3565., pp. 72-79), was applied in clinic to 36 patients with chronic purulent osteomyelitis and to 6 patients (children) with acute haematogenic osteomyelitis. Diode lasers of 805 and 980 nm wavelength were used. There was achieved full recovery in all acute cases, and stable remission in chronic cases during all the observation period (1 - 2.5 years).

  1. A Rare Case of Cranial Osteomyelitis Caused by Proteus Vulgaris

    OpenAIRE

    Hakan Uslu; Gökşin Şengül; Osman Aktaş

    2011-01-01

    Osteomyelitis of the calvarial bones can cause serious complications such as brain abscess, due to the close proximity to adjacent brain structures. Development of the purulent secretion in surgery and traumatic scalp injuries must be considered as a possibility of osteomyelitis possibility. Generally gram positive, rarely gram negative bacteria and mix agents, can be isolated in infection. Especially chronic pyogenic osteomyelitis agents can be isolated from chronic infections such as tuberc...

  2. Osteomyelitis of the Patella Caused by Legionella anisa

    OpenAIRE

    Sanchez, Martha Cristina; Sebti, Rani; Hassoun, Patrice; Mannion, Ciaran; Goy, Andre H.; Feldman, Tatyana; Mato, Anthony; Hong, Tao

    2013-01-01

    A 51-year-old man with a history of stage IV angioimmunoblastic T-cell lymphoma was diagnosed with osteomyelitis of the patella. Legionella anisa was identified by 16S rRNA gene sequencing and culture. The patient had pneumonia 2 months prior to this osteomyelitis episode. L. anisa was retrospectively detected in his lung tissue by 16S rRNA gene sequencing and was considered the source of the L. anisa that caused his patella osteomyelitis.

  3. Precise and feasible measurements of lateral calcaneal lengthening osteotomies by radiostereometric analysis in cadaver feet

    DEFF Research Database (Denmark)

    Martinkevich, P; Rahbek, Ole; Møller-Madsen, B;

    2015-01-01

    OBJECTIVES: Lengthening osteotomies of the calcaneus in children are in general grafted with bone from the iliac crest. Artificial bone grafts have been introduced, however, their structural and clinical durability has not been documented. Radiostereometric analysis (RSA) is a very accurate and...... precise method for measurements of rigid body movements including the evaluation of joint implant and fracture stability, however, RSA has not previously been used in clinical studies of calcaneal osteotomies. We assessed the precision of RSA as a measurement tool in a lateral calcaneal lengthening...... poorly dispersed markers. Precision was assessed as systematic bias and 95% repeatability limits. RESULTS: Systematic bias was generally below 0.10 mm for translations. Precision of migration measurements was below 0.2 mm for translations in the osteotomy. CONCLUSION: RSA is a precise tool for the...

  4. Traitement chirurgical des fractures articulaires du calcanéum par plaque vissée

    OpenAIRE

    Hammou, Nassreddine; Abid, Hatim; Shimi, Mohammed; El Ibrahimi, Abdelhalim; El Mrini, Abdelmajid

    2015-01-01

    Les fractures du calcanéum sont peu fréquentes mais le plus souvent graves. Le traitement chirurgical par plaque vissée est ardemment défendu. L'objectif de notre travail rétrospectif est d’évaluer les résultats du traitement chirurgical des fractures articulaires du calcanéum à travers une série de 12 patients opérée aux service d'orthopédie du CHU Hassan II de Fès sur une durée de 3 ans, et les comparer aux données de la littérature. L’âge moyen dans notre série était de 34 ans, le geste op...

  5. Diaphyseal osteomyelitis of the long bone : evaluation of radiograph and MRI

    International Nuclear Information System (INIS)

    To describe the radiographic and MR characteristics of subacute diaphyseal osteomyelitis of the long bone. We retrospectively analyzed plain radiographs and MR images in nine children and two young adults with surgically-proven diaphyseal osteomyelitis of the long bones. MR imaging was carried out before and after Gd-DPTA administration. Patients charts were reviewed for clinical and laboratory data and histologic correlation was available in all cases. All patients had a history of a minimum of 2 weeks' duration. All presented with an insidious onset of mild pain; they showed apyrexia and normal erythrocyte sedimentation rate. In all patients, plain radiographs showed single or multiple linear periosteal reaction with cortical irregularity. Medullary abnormality was not found except in one case which showed an abscess cavity. MR images revealed thickening or irregularity of the cortex, periosteal reaction, bone marrow signal alteration, and perilesional edema. Subacute diaphyseal osteomyelitis of the long bone is broadly based on the cortex, and elicits more sclerosis and periosteal reaction. Familarity with plain radiographs and MR features may be useful in the diagnosis of subacute diaphyseal osteomyelitis

  6. Acute postoperative osteomyelitis in femur fracture: contribution of bone scintilography (case report)

    Energy Technology Data Exchange (ETDEWEB)

    Borges, Natalie Ferreira; Rezende, Cleuza Maria de Faria; Sanchez-Ucros, Natalia; Laguardia, Priscilla [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Escola de Veterinaria; Diniz, Simone Odilia Fernandes; Cardoso, Valbert Nascimento [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Faculdade de Farmacia; Rodrigues, Carlos Jorge Simal [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Faculdade de Medicina; Santos, Raquel Gouvea dos [Centro de Desenvolcimento da Tecnologia Nuclear (CDTN/CNEN-MG), Belo Horizonte, MG (Brazil). Lab. de Radiobiologia

    2009-07-01

    The treatment of bone fractures is aimed at consolidating and returns of function as soon as possible and can be performed by different methods. Treatment with the plate in fractures of the femur in bridge aims not to address the location of fracture and stabilize it, maintaining the anatomical axis by the fixation of proximal and distal segments. Postoperative follow-up of the fracture is necessary to evaluate the irrigation of the bone structure and the effect of the method. The scintigraphy is a method capable of assessing the degree of bone remodeling and the presence or absence of local bone homeostasis. The objective of this report is to present the case of a rabbit, male, which was subjected to osteotomy and fixation of the femoral diaphysis by means of the plate in the bridge. After 10 days the animal was subjected to scintigraphic and radiographic evaluations. The animal came to death and an autopsy was performed on the same when it was observed macroscopy consistent with acute osteomyelitis due to contamination postoperative time. Radiographic evaluation in acute osteomyelitis is unclear. The methods assist in the scintigraphic diagnosis of osteomyelitis by allowing the detection of functional changes in this infectious process. The bone scintigraphy with diphosphonates labeled with technetium-99m shows increased bone turnover in the infected area and its high sensitivity, even in an early stage makes it the method of choice in the diagnosis of acute osteomyelitis in patients without prior bone disease and bone radiologically normal. (author)

  7. Rib osteomyelitis in children. Early radiologic and ultrasonic findings

    International Nuclear Information System (INIS)

    The earliest radiographic changes of osteomyelitis in the long bones is deep-seated edema manifesting as soft tissue swelling and obliteration of the intermuscular planes adjacent to the affected bone. Similarly, the early change of rib osteomyelitis is pericostal edema demonstrated by soft tissue swelling of the thoracic wall accompanied by an adjacent inward pleural displacement. In both osteomyelitis of the rib and the long bones, the bony changes will appear 1-2 weeks later. Pericostal edema can be readily diagnosed by ultrasound scan. Pericostal edema, although non specific and can occur in other conditions, yet it is a strong warning sign, set wihin the overall clinical picture of osteomyelitis. (orig.)

  8. Mycotic aneurysm of the femoral artery resulting from mismanagement of a pathological femur fracture due to chronic osteomyelitis: a case report

    Directory of Open Access Journals (Sweden)

    Mwaka Erisa Sabakaki

    2013-01-01

    Full Text Available Abstract Introduction Mycotic aneurysms are rarely listed among the possible complications of osteomyelitis of the long bones. To the best of our knowledge this is the first case of chronic osteomyelitis associated with a pathological fracture of the femur and a mycotic aneurysm of the femoral artery. Case presentation We present the case of a 13-year-old Ugandan boy who was referred to our hospital with chronic osteomyelitis associated with a pathological fracture of the right femur and a mycotic aneurysm of the femoral artery. He underwent a successful above-knee amputation and is currently undergoing rehabilitation. Conclusions Aneurysms associated with chronic osteomyelitis of the long bones are very rare. However, in Africa, where people often still believe in crude traditional remedies, they should be considered among the possible diagnoses especially where acute injuries of the limbs are massaged and manipulated.

  9. [Anatomical variants of the medial calcaneal nerve and the Baxter nerve in the tarsal tunnel].

    Science.gov (United States)

    Martín-Oliva, X; Elgueta-Grillo, J; Veliz-Ayta, P; Orosco-Villaseñor, S; Elgueta-Grillo, M; Viladot-Perice, R

    2013-01-01

    The tarsal tunnel is composed of the posterior border of the medial malleoulus, the posterior aspect of the talus and the medial aspect of the calcaneus. The medial calcaneal nerve emerges from the posterior aspect of the posterior tibial nerve in 75% of cases and from the lateral plantar nerve in the remaining 25%. Finally, the medial calcaneal nerve ends as a single terminal branch in 79% of cases and in numerous terminal branches in the remaining 21%. To describe the anatomical variants of the posterior tibial nerve and its terminal branches. To describe the steps for tarsal tunnel release. To describe Baxter nerve release. The anatomical variants of the posterior tibial nerve and its terminal branches within the tarsal tunnel were studied. Then the Lam technique was performed; it consists of: 1) opening of the laciniate ligament, 2) opening of the fascia over the abductor hallucis muscle, 3) exoneurolysis of the posterior tibial nerve and its terminal branches, identifying the emergence and pathway of the medial calcaneal branch, the lateral plantar nerve and its Baxter nerve branch and the medial plantar nerve. Baxter nerve was found in 100% of cases. In 100% of cases in our series the nerve going to the abductor digiti minimi muscle of the foot was found; 87.5% of cases had two terminal branches. The dissections proved that a crucial step was the release of the distal tarsal tunnel. PMID:24701749

  10. Acute lymphocytic Leukemia masquerading as acute osteomyelitis

    International Nuclear Information System (INIS)

    Two children each developed a focal destructive bone lesion accompanied by intermittent fever, swelling, tenderness and elevated ESR. Blood counts were normal; bone marrow aspiration showed acute leukemia. The bone lesions healed in both patients after anti-leukemic therapy. We suggest that the similar roentgenographic appearance of osteomyelitis, bone infarction and focal destructive lesions in leukemia probably reflects a common, basically ischemic process of bone. (orig.)

  11. Optimal management of chronic osteomyelitis: current perspectives

    OpenAIRE

    Pande KC

    2015-01-01

    Ketan C Pande Raja Isteri Pengiran Anak Saleha Hospital, Bandar Seri Begawan, BruneiAbstract: Chronic osteomyelitis is a challenging condition to treat. It is seen mostly after open fractures or in implant-related infections following treatment of fractures and prosthetic joint replacements. Recurrence of infection is well known, and successful treatment requires a multidisciplinary team approach with surgical debridement and appropriate antimicrobial therapy as the cornerstone of treatment. ...

  12. Imaging of acute and chronic osteomyelitis

    International Nuclear Information System (INIS)

    For the diagnosis of acute and chronic osteomyelitis imaging methods have become essential. This paper reviews the potential of the different imaging modalities. When there is clinical suspicion of acute osteomyelitis plain films are still the mainstay of diagnosis. In newborns and young children this primary diagnostic modality will be supplemented by sonography. If there is a need for further imaging, MRI and the different scintigraphic methods may be used interchangeably. However, for the spine and other complex anatomical regions MRI is preferred. In contrast, three-phase bone scanning is mostly accepted as the primary additional tool to radiography and sonography in the newborn and in small children. If an abscess is suspected, MRI is the primary imaging modality. In cases of chronic osteomyelitis radiography still forms the basis for obtaining information about the bone. Further imaging is regularly needed, not only because of its diagnostic value but also because radiographs do not demonstrate the extent of lesions correctly. The evaluation of disease extent in bone is a domain of MRI, while scintigraphic methods, like 111In leucocyte scintigraphy and MRI, are of equivalent diagnostic value. CT may have its role in disclosing a sequestrum when radiographs and MRI are equivocal. (orig.)

  13. A therapeutic delivery system for chronic osteomyelitis via a multi-drug implant based on three-dimensional printing technology.

    Science.gov (United States)

    Wu, Weigang; Ye, Chenyi; Zheng, Qixin; Wu, Gui; Cheng, Zhaohui

    2016-08-01

    Chronic osteomyelitis is difficult to be cured and often relapses, which presents to be a great challenge to clinicians. We conducted this original study to explore the efficiency of therapeutic alliance for chronic osteomyelitis by a multi-drug implant based on three-dimensional printing technology. We designed and fabricated preciously a multi-drug implant with a multi-layered concentric cylinder construction by three-dimensional (3D) printing technology. Levofloxacin and tobramycin were incorporated into the drug implant in a specific sequence. The drug release property of the drug implant was assayed in vitro We also developed an animal model of chronic osteomyelitis to estimate the effect of the 3D printed multi-drug implant. The results showed that the multi-drug implant had a sustained and programmed drug release property. Levofloxacin and tobramycin which were released from the multi-drug implant worked in tandem to enhance pharmacodynamic action which was similar to a tumor chemotherapy program and were sufficient to treat chronic osteomyelitis. These findings imply that the administration of 3D printed multi-drug implant would be a potential therapeutic method for chronic osteomyelitis. Further studies are required. PMID:27013218

  14. Percutaneous reduction combined with bone graft in treatment of displaced intra-articular calcaneal fractures

    Institute of Scientific and Technical Information of China (English)

    Wang Xianhui; Mei Jiong; Li Shanzhu; Ni Ming; Shang Hongjing

    2009-01-01

    Objective: To introduce the experience and key points of percutaneous reduction combined with bone graft to treat calcaneal fractures. Methods: Percutaneous reduction and internal fixation combined with bone graft was performed from April 2004 to April 2006 on 15 cases (16 sides) with intra-articular calcaneal fractures including 13 males (14 feet) and 2 females (2 feet) ,with average age of 36. 6 years (24-61 years). All patients underwent radiography including lateral and axial views for calcaneus, oblique view for foot and three-dimensional CT imaging reconstruction. According to Sanders classification, there were 12 feet of type Ⅱ (3 type Ⅱ a, 3 type Ⅱ b and 8 type Ⅱ c)and 2 feet of type lilac. The length of calcaneus was recovered through traction by Steinmann pin which passed through calcaneal tubercle perpendicularly and the posterior facet was elevated until reduction by a curve scissors through an 0.5 cm incision along the primary fracture line of lateral calcaneus. The calcaneus was fixed with different cannulated cancellous screws according to the type of fractures. Then bone graft was injected to fill the defect of calcaneus through lateral incision. Results: All patients were followed up for an average of 18.4 months (ranged, 12 to 34 months). No complication such as wound infection, screw breakage and calcaneum varus was found postoperatively. The average time for bone healing was 10 weeks. The results were excellent in 12 cases, good in 4 cases according to the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score. The rate of excellent and good clinical results was 100%. The mean AOFAS hindfoot score in tongue type group (86.5+4.4) was better than in joint depression type group (81.2±1.7, P<0.05). Radiography showed basic restoration of Bohler's angle, Gissane's angle and calcaneal shape. Conclusion: The combination of percutaneous reduction and injectable bone graft is suitable for surgical treatment of Sanders 11 and III type

  15. MANAGEMENT OF OSTEOMYELITIS CAUSED BY SALMONELLA ENTERICA SUBSP. HOUTENAE IN A TAYLOR'S CANTIL (AGKISTRODON BILINEATUS TAYLORI) USING AMIKACIN DELIVERED VIA OSMOTIC PUMP.

    Science.gov (United States)

    Clancy, Meredith M; Newton, Alisa L; Sykes, John M

    2016-06-01

    An adult female Taylor's cantil (Agkistrodon bilineatus taylori) presented with marked spinal and mandibular osteomyelitis that cultured positive for Salmonella enterica subsp. houtenae, serovar IV 43:z4,z32:-. Progression of osteomyelitis was arrested by treatment using amikacin (0.026 mg/kg per hour) delivered via subcutaneous osmotic pump for 10 mo, replacing the pump every 4 wk. No adverse effects on renal function were appreciated throughout the course of therapy. Amikacin therapy was discontinued after improvement with treatment, but 5 mo later, bony lesions worsened, and an additional abscess formed at the previous pump site. The animal's condition declined and euthanasia was elected. Postmortem examination confirmed marked osteomyelitis with Salmonella infection of same serovar as the initial biopsy. This report highlights the pathogenicity of the S. enterica subsp. houtenae serovar and the ability to deliver effective amikacin dosage via osmotic pump to arrest osteomyelitis due to salmonellosis in a venomous snake. PMID:27468053

  16. THE STUDY OF OUTCOME OF CHRONIC PYOGEN IC LONG BONE OSTEOMYELITIS TREATED BY ANTIBIOTIC IMPREGNATED BONE CEMENT BEADS AND NAILS

    Directory of Open Access Journals (Sweden)

    Soumyajit

    2015-01-01

    Full Text Available OBJECTIVE: In developing country the incidence of chronic pyogenic infection of long bone is high among children and adults. This entity is difficult to be managed by conventional systemic antibiotics alone. Many treatment methods for long bone osteomyelitis were attempted but unfortunately the eradication of chronic osteomyelitis remains a problem. Local antibiotic therapy has been introduced by arthroplasty surgeons and subsequently this method has been tried for treating chronic osteomyelitis. Treatment of chronic osteomyelitis using antibiotic - impregnated bone cement beads or nail after thorough debride ment has become a good option of treatment. Therefore this prospective study has been designed to evaluate the effect of local antibiotic therapy in the form of bone cement beads or nail for eradication of chronic pyogenic long bone osteomyelitis. METHODS: Thirty patients with chronic osteomyelitis of metaphyseal and diaphyseal area of long bones were studied prospectively about outcome of treatment. The diagnosis of chronic osteomyelitis was made on the basis of clinical and radiological features and confirmed by deep aspiration, staining and culture sensitivity of the aspirate. Patients suffering from fungal or tubercular osteomyelitis were excluded. Also the patients with small bones osteomyelitis or open injury more than Gustilo type 2 were excluded. Antibiotic impregnated polymethylmethacrylate beads or nails were implanted after thorough debridement and wound closed primarily. Two dose of intervenous antibiotic were used, one before and another after operation. Beads or nails were removed at the end of six weeks. Patients were followed up for an average period of two years. RESULT: Out of thirty patients in this study, twenty eight patients were cured completely and two patients had persistent discharge till the last follow up visit. No organism found in six cases. No systemic adverse reactions were seen. CONCLUSION: The present study

  17. Presentations

    International Nuclear Information System (INIS)

    The presented materials consist of presentations of international workshop which held in Warsaw from 4 to 5 October 2007. Main subject of the meeting was progress in manufacturing as well as research program development for neutron detector which is planned to be placed at GANIL laboratory and will be used in nuclear spectroscopy research

  18. Case Report: Rare occurrence of Pseudomonas aeruginosa osteomyelitis of the right clavicle in a patient with IgA nephropathy

    Science.gov (United States)

    Damodaran, Aishwarya; Rohit, Anusha; Abraham, Georgi; Nair, Sanjeev; Yuvaraj, Anand

    2014-01-01

    We describe the case of a 47 year old patient with proven primary IgA nephropathy who presented with osteomyelitis of the medial end of the right clavicle. The patient was not on immunosuppressive medications. He underwent aspiration curettage and CT scan of the clavicle which yielded pus that grew Pseudomonas aeruginosa. Following treatment with appropriate antibiotic therapy the patient presented a complete recovery of the lesion with no loss of renal function. This case highlights the importance of positive cultures in the choice of the appropriate therapy in an extremely rare case of an immunocompetent patient with osteomyelitis of the clavicle. PMID:25566352

  19. Sonographic evaluation of acute osteomyelitis in infants

    International Nuclear Information System (INIS)

    To analyze the related sonographic findings and to determine the value of sonography in establishing the diagnosis of acute osteomyelitis in infants. The sonographic findings of eleven infants aged 10 days-4 months (mean, 45 days) with acute osteomyelitis were retrospectively evaluated. The involved bones were the femur (n=5), humerus (n=2), tibia (n=2), rib(n=1), sternum (n=1), and calcaneus (n=1). Discontinuity or destruction of cortical margins, echotexture of the metaphysis and epiphysis, the presence of subperiosteal hypoechoic lesion, adjacent soft tissue swelling, distension of the joint capsule, the echotexture of joint effusion, and dislocation or subluxation of the involved joint were evaluated. The sonographic findings were compared with the plain radiographic (n=12) and MR (n=5) findings, with special attention to the identification of the metaphyseal or epiphyseal bony lesions and the involvement of adjacent joints. The sonographic findings of osteomyelitis were cortical discontinuity or destruction (n=12), hypoechoic lesions with an echogenic rim in the metaphysis (n=12), subperiosteal hypoechoic lesions (n=8), soft tissue swelling (n=9), a distended hip joint, with echogenic fluid (n=5), ill-demarcated echogenic lesions in the capital femoral epiphysis (n=5), and a subluxated hip joint (n=3). Plain radiographs revealed well or ill-defined osteolytic lesions in the metaphysis, accompanied by cortical destruction (n=8), new periosteal bone formation (n=3) and reactive sclerosis (n=2). Abnormality of the femoral epiphyses and joint involvement were not detected on plain radiographs, and in four cases no abnormality was noted. MR imaging showed that at T1WI, affected bony lesions were of low signal intensity and enhaned, with high signal intensity at T2WI. In all cases, both metaphyseal and epiphyseal lesions were demonstrated at MRI, but in one of the three cases in which an epiphyseal lesion was seen at MRI, this was not detected at US. Sonography is

  20. Parenteral and oral antibiotic duration for treatment of pediatric osteomyelitis: a systematic review protocol

    OpenAIRE

    Grimbly, Chelsey; Odenbach, Jeff; Vandermeer, Ben; Forgie, Sarah; Curtis, Sarah

    2013-01-01

    Background Pediatric osteomyelitis is a bacterial infection of bones requiring prolonged antibiotic treatment using parenteral followed by enteral agents. Major complications of pediatric osteomyelitis include transition to chronic osteomyelitis, formation of subperiosteal abscesses, extension of infection into the joint, and permanent bony deformity or limb shortening. Historically, osteomyelitis has been treated with long durations of antibiotics to avoid these complications. However, with ...

  1. Plasma cellular osteomyelitis of the thoracic spine - a case report

    International Nuclear Information System (INIS)

    The authors report the case of a young patient suffering from plasmacellular osteomyelitis of the thoracic spine, an unusual localisation of this type of chronic osteomyelitis. They discuss the role of imaging diagnostic modalities in this disease, focussing on MRI. (orig.)

  2. Screening for Osteomyelitis Using Thermography in Patients with Diabetic Foot

    Directory of Open Access Journals (Sweden)

    Makoto Oe

    2013-01-01

    Full Text Available One of the most serious complications of diabetic foot (DF is osteomyelitis, and early detection is important. To assess the validity of thermography to screen for osteomyelitis, we investigated thermographic findings in patients with both DF and osteomyelitis. The subjects were 18 diabetic patients with 20 occurrences of DF who visited a dermatology department at a hospital in Tokyo and underwent evaluation by magnetic resonance imaging (MRI and thermography between June 2010 and July 2012. Osteomyelitis was identified by MRI. Thermographs were taken of the wounds and legs after bed rest of more than 15 minutes. Two wound management researchers evaluated the range of increased skin temperature. There were three types of distribution of increased skin temperature: the periwound, ankle, and knee patterns. Fisher’s exact test revealed that the ankle pattern was significantly more common in the group with osteomyelitis than in the group without osteomyelitis (P=0.011. The positive predictive value was 100%, and the negative predictive value was 71.4%. Our results suggest that an area of increased skin temperature extending to the ankle can be a sign of osteomyelitis. Thermography might therefore be useful for screening for osteomyelitis in patients with DF.

  3. Disseminated Osteomyelitis Caused by Clostridium novyi in a Cat

    OpenAIRE

    Dunn, J. K.; Farrow, C. S.; Doige, C E

    1983-01-01

    The history, clinical signs, laboratory and radiological findings of a cat with polyostotic osteomyelitis are described. A disseminated periosteal reaction involving the femur, humerus and tibia bilaterally was evident on radiographs. The joints were not affected. Diagnosis of osteomyelitis was confirmed by bone marrow aspiration and bone biopsy. Clostridium novyi was cultured from the bone marrow.

  4. Skull Base Osteomyelitis in the Emergency Department: A Case Report

    Directory of Open Access Journals (Sweden)

    Mustafa Burak Sayhan

    2011-01-01

    Full Text Available Skull base osteomyelitis (SBO is a rare clinical presentation and usually occurs as a complication of trauma or sinusitis. A 5-year-old child presented to the emergency department with a three-week history of fever associated with drowsiness and left parietal headache, and a week's history of swelling on the left frontoparietal soft tissue. He had suffered a penetrating scalp injury four month ago. On physical examination, there was a tender swelling with purulent stream on the lateral half of his scalp. His vital signs are within normal limits. Plain X-ray of the skull showed a lytic lesion on the left frontoparietal bone. A cranial computed tomography (CT scan demonstrated a large subgaleal abscess at the left frontoparietal region. SBO possesses a high morbidity and mortality; therefore, prompt diagnosis and appropriate treatment are mandatory to prevent further complications and to reduce morbidity and mortality significantly.

  5. MR imaging detection of early periostitis in acute experimental osteomyelitis

    International Nuclear Information System (INIS)

    This paper reports on thirty cases of acute experimental Staphylococcus aureus osteomyelitis in New Zealand white rabbits imaged with MR imaging, unenhanced CT, and plain film radiography (PFR) 4 days following infection. Periostitis was histologically present in 26 cases. Periosteal reaction was demonstrated by PFR and CT in 20 (77%) of cases each. Periosteal new bone formation present histologically in 22 cases accounts for this finding. MR imaging depicted the ossification in the elevated periosteum in 19 cases. However, evidence of periostitis was demonstrated by MR imaging in all 26 cases (100%). The sensitivities of MR imaging, CT, and PFR were 100%, 77%, and 77%, respectively; the specificities, 85%, 100%, and 100%; and the accuracies, 95%, 85%, and 85%

  6. Osteomyelitis complicating fracture: pitfalls of 111In leukocyte scintigraphy

    International Nuclear Information System (INIS)

    111In-labeled leukocyte imaging has shown greater accuracy and specificity than alternative noninvasive methods in the detection of uncomplicated osteomyelitis. Forty patients with suspected osteomyelitis complicating fractures (with and without surgical intervention) were evaluated with 111In-labeled leukocytes. All five patients with intense focal uptake, but only one of 13 with no uptake, had active osteomyelitis. However, mild to moderate 111In leukocyte uptake, observed in 22 cases, indicated the presence of osteomyelitis in only four of these; the other false-positive results were observed in noninfected callus formation, heterotopic bone formation, myositis ossificans, and sickle-cell disease. These results suggest that 111In-labeled leukocyte imaging is useful for the evaluation of suspected osteomyelitis complicating fracture but must be used in conjunction with clinical and radiographic correlation to avoid false-positive results

  7. MRI in diagnostic evaluation of osteomyelitis in children

    International Nuclear Information System (INIS)

    Several MRI investigations for detecting or excluding acute and non-post-traumatic chronic osteomyelitis were performed in 31 children, osteomyelitis was evident in 21 patients. The sensitivity of MRI for osteomyelitis was 90%, and specificity was 100%. In children with confirmed osteomyelitis 23 follow-up investigations were carried out in order to evaluate duration of the medullary edema. In uncomplicated cases only treated by antibiotics edema regression was evident after 4 weeks and completed after 12-16 weeks. In cases in whom extended concomitant soft-tissue infection was depicted regression of edema was prolonged independent of surgical intervention. The study reveals that at onset of acute osteomyelitis in children MRI can replace technetium 99m-labeled scintigraphy and reduce plain-film investigations. The results support the usefulness of MRI in discrimination of isolated soft-tissue infection and noninfectious diseases of bone. (orig.)

  8. Size and separability of the calcaneal and the medial and lateral plantar nerves in the distal tibial nerve

    DEFF Research Database (Denmark)

    Struijk, Lotte N. S. Andreasen; Birn, Henrik; Teglbjærg, Peter Stubbe; Haase, Jens; Struijk, Johannes

    2010-01-01

    The tibial nerve (TN) has three main terminal branches: the medial and lateral plantar nerves and the calcaneal branch (CB), which innervates the foot sole. The design and implantation of nerve cuff electrodes with separate channels for each of these three terminal branches would provide signific......The tibial nerve (TN) has three main terminal branches: the medial and lateral plantar nerves and the calcaneal branch (CB), which innervates the foot sole. The design and implantation of nerve cuff electrodes with separate channels for each of these three terminal branches would provide...... electrodes. Therefore, the branching pattern, the fascicular separability and the fascicular size of the TN posterior to the medial malleolar-calcaneal axis were examined in this study, using ten human TN specimens. The TN branching patterns were highly dispersed. For the CBs, multiple branches were...

  9. Comparative imaging study for soft tissue changes in osteomyelitis and malignant bone tumor

    International Nuclear Information System (INIS)

    Objective: To investigate the value of the imaging findings of soft tissue abnormality in the differential diagnosis between osteomyelitis and malignant bone tumor. Methods: The CT and MRI findings of soft tissue changes in 57 cases of osteomyelitis and 70 cases of malignant bone tumor were retrospectively defined,observed, recorded and statistically analyzed. Results: In 57 cases of osteomyelitis, 54 cases were examined with CT, and soft tissue swelling was presented in 52 cases (degree I in 19 cases, degree II in 16 cases, degree III in 17 cases). Abscess-like cysts in soft tissue occurred in 6 cases, masses in 5, air in 1, fat-fluid level in 1 and sinus tract in 1. Among 14 cases examined with MR imaging, soft tissue swelling was presented in all cases (degree I in 2 cases, degree II in 6 cases and degree III in 6 cases). Abscess-like cysts appeared in 3 cases and showed high signal in diffusion weighted imaging, mass in 1 and fat-fluid level in 1. Among 54 cases examined with CT in 70 cases of malignant bone tumor, soft tissue swelling was presented in 44 cases (degree I in 29 cases, degree II in 12 cases, degree III in 3 cases). Soft tissue masses appeared in 49 cases, bone shell and shell-like calcification in 16 cases, and neoplastic bone and neoplastic calcified cartilage within soft tissue mass in 25 cases. Among 49 cases examined with MR imaging, soft tissue swelling was presented in 46 cases (degree I in 21 cases, degree II in 17 cases and degree III in 8 cases), and soft tissue masses appeared in 43 cases. The degree of soft tissue swelling and the occurrence of abscess-like cyst, mass, bone shell or shell-liked calcification in the rim of mass, neoplastic bone or neoplastic calcified cartilage in masses showed significant difference (P<0.05) between osteomyelitis group and malignant bone tumor group on CT examination. The degree of Soft tissue swelling and the occurrence frequency of abscess-like cysts and mass were significantly different (P<0

  10. Presentations

    International Nuclear Information System (INIS)

    The PARIS meeting held in Cracow, Poland from 14 to 15 May 2007. The main subjects discussed during this meeting were the status of international project dedicated to gamma spectroscopy research. The scientific research program includes investigations of giant dipole resonance, probe of hot nuclei induced in heavy reactions, Jacobi shape transitions, isospin mixing and nuclear multifragmentation. The mentioned programme needs Rand D development such as new scintillations materials as lanthanum chlorides and bromides as well as new photo detection sensors as avalanche photodiodes - such subjects are also subjects of discussion. Additionally results of computerized simulations of scintillation detectors properties by means of GEANT- 4 code are presented

  11. Presentation

    OpenAIRE

    Eduardo Vicente; Rosana de Lima Soares; Eduardo Victorio Morettin

    2013-01-01

    In the present edition of Significação – Scientific Journal for Audiovisual Culture and in the others to follow something new is brought: the presence of thematic dossiers which are to be organized by invited scholars. The appointed subject for the very first one of them was Radio and the invited scholar, Eduardo Vicente, professor at the Graduate Course in Audiovisual and at the Postgraduate Program in Audiovisual Media and Processes of the School of Communication and Arts of the University ...

  12. Osteomyelitis of the Mandibular Symphysis Caused by Brown Recluse Spider Bite

    OpenAIRE

    Naidu, Deepak K.; Ghurani, Rami; Salas, R. Emerick; Mannari, Rudolph J.; Robson, Martin C.; Payne, Wyatt G.

    2008-01-01

    Background: Brown recluse spider bites cause significant trauma via their tissue toxic venom. Diagnosis of these injuries and envenomation is difficult and many times presumptive. Treatment is varied and dependent upon presentation and course of injury. Materials and Methods: We present a case of a previously unreported incidence of osteomyelitis of the mandible as a result of a brown recluse spider bite. A review of the literature and discussion of diagnosis and treatment of brown recluse sp...

  13. Schnitzler's Disease as an Important Differential Diagnosis of Chronic Recurrent Multifocal Osteomyelitis: A Case Report

    Directory of Open Access Journals (Sweden)

    Kathrin Schrödl

    2012-01-01

    Full Text Available Introduction. At first sight, chronic recurrent multifocal osteomyelitis (CRMO and Schnitzler's disease are diagnoses of exclusion and can be similar in their manifestation. Methods. In this paper we present the reevaluation of the 13-year-old diagnosis of chronic recurrent osteomyelitis of a 58-year-old man with chronic ostealgia, night sweat, and pruritic urticarial lesions on the extremities and trunk. For further examination, we performed blood analysis, bone and skin biopsies, CT scans, and magnetic resonance imaging. Results. Laboratory findings showed increased inflammation parameters. Magnetic resonance imaging (MRI revealed a diffuse bone marrow infiltration. A bone and skin biopsy showed a sclerotic bone marrow involvement and a superficial dermal and perivascular infiltrate of neutrophils. Based on these findings, the diagnosis of Schnitzler’s disease was made. Conclusion. Here, we want to present Schnitzler's disease as an important differential diagnosis to CRMO in adults presenting with signs suggestive of CRMO.

  14. Case Study: Chronic Recurrent Multifocal Osteomyelitis in the Femoral Diaphysis of a Young Female

    Directory of Open Access Journals (Sweden)

    Jeffrey S. Quon

    2012-01-01

    Full Text Available Chronic recurrent multifocal osteomyelitis (CRMO is relatively uncommon. Even though the name suggests it is the result of infection, this is not likely the case. Instead it is more likely the result of genetic, autoimmune, or autoinflammatory causes. Although CRMO has a benign course and responds well to anti-inflammatory medications, it can have a very aggressive clinical and imaging presentation overlapping with infectious osteomyelitis and malignancy. Therefore, radiologists and clinicians need to be aware of its clinical and imaging presentation to avoid morbidity associated with more aggressive treatment. We present the case of a ten-year-old female with CRMO as a solitary expansile-mixed lytic and sclerotic lesion in the distal femoral diaphysis. The diaphyseal location and mixed lytic and sclerotic appearance are less common and have an aggressive imaging appearance. We also review the pathophysiology, imaging findings, and therapeutic approach to this uncommon but clinically important condition.

  15. Streptococcal vertebral osteomyelitis: multiple faces of the same disease.

    Science.gov (United States)

    Murillo, O; Roset, A; Sobrino, B; Lora-Tamayo, J; Verdaguer, R; Jiménez-Mejias, E; Nolla, J M; Colmenero, J de D; Ariza, J

    2014-01-01

    The role of Streptococcus species as an aetiological microorganism of vertebral osteomyelitis (VO) is considered to be of little relevance. We aimed to describe a large number of cases of streptococcal vertebral osteomyelitis (SVO), to analyze the clinical features associated with different Streptococcus species, and to compare them with a cohort of patients with VO caused by Staphylococcus aureus. An incidence study and a retrospective, multicenter, observational clinical study of cases of SVO (1991-2011) were performed. Statistical comparison of SVO by different species and between them and staphylococcal VO was carried out. Over the whole period there was an increasing incidence in the number of VOs and SVOs per year (p <0.05). Among 58 cases of SVO, those caused by non-viridans streptococcus (Streptococcus pneumoniae, Streptococcus agalactiae and Streptococcus pyogenes; n = 26) mimicked VO by S. aureus, and presented with more fever, neurological symptoms and paravertebral abscesses in comparison with those caused by the viridans group (remaining species). In contrast, the latter have a sub-acute clinical picture and were associated with the presence of endocarditis (p <0.05). Among non-viridans SVOs, concomitant infection was specifically related to S. pneumoniae (p <0.05). In conclusion, SVO presents a wide range of clinical patterns. The relationship between VO and diagnosis of endocarditis was established with SVO caused by the viridans group. Whereas non-viridans SVO mimics acute characteristics of VO caused by S. aureus, cases of viridans SVO are significantly more likely to have a sub-acute clinical presentation. The increased incidence of SVO during the last decades could support a new epidemiological scenario. PMID:23889700

  16. Presentation

    Directory of Open Access Journals (Sweden)

    Paulo Henrique Freire Vieira

    2013-12-01

    Full Text Available This dossier focuses on one of the essential debate topics today about the territorial dimension of the new development strategies concerned with the worsening of the global socioecological crisis, that is: the challenges related to the activation and integration in networks of localized agri-food systems. For its composition, some contributions presented and debated during the VI International Conference on Localized Agri-food System - The LAFS facing the opportunities and challenges of the new global context have been gathered. The event took place in the city of Florianópolis, from May 21th to 25th of 2013. The event was promoted by the Federal University of Santa Catarina (UFSC and by the Center for the International Cooperation on Agricultural Research for Development (CIRAD. Besides UFSC and CIRAD, EPAGRI, State University of Santa Catarina (UDESC, as well as research institutes and universities from other states (UFMG, IEA/SP, UFS, UFRGS and Mexican and Argentinian partners from the RED SIAL Latino Americana also participated in the organization of lectures, discussion tables and workshops.

  17. Endogenous Candida endophthalmitis and osteomyelitis associated with CARD9 deficiency.

    Science.gov (United States)

    Jones, Nicholas; Garcez, Tomaz; Newman, William; Denning, David

    2016-01-01

    A 25-year-old woman presented with unilateral red eye and visual blur, and was found to have panuveitis with an inflammatory white mass at the macula, initially presumed to be Toxoplasma retinitis. After failure to respond, she underwent vitrectomy, which produced Candida albicans. Despite intraocular and systemic antifungal treatment, she lost all vision in that eye. Two years later, she developed unilateral hip osteomyelitis leading to total hip replacement and also revealing Candida infection. By clinical exome sequencing, she was then found to have caspase recruitment domain 9 (CARD9) deficiency, an autosomal recessive disorder that causes a specific susceptibility to candidal infections. She remains otherwise well but on lifelong fluconazole prophylaxis. PMID:26941346

  18. Subtalar Joint Distraction Arthrodesis to Correct Calcaneal Valgus in Pediatric Patients with Tarsal Coalition: A Case Series.

    Science.gov (United States)

    Schwartz, Jaclyn M; Kihm, Carl A; Camasta, Craig A

    2015-01-01

    Subtalar joint middle facet coalitions commonly present in children who have a painful, rigid, pes planovalgus foot type. The middle facet coalition allows rearfoot forces to be distributed medially through the coalition, and this can result in arthritis or lateral tarsal wedging. The senior author has used a wedged bone graft distraction subtalar joint arthrodesis to correct calcaneal valgus and restore the talar height in these patients. The tight, press-fit nature of the tricortical iliac crest allograft provides stability and can negate the need for internal fixation. We retrospectively reviewed 9 pediatric subtalar joint distraction arthrodesis procedures performed on 8 patients during a 6-year period. All patients began weightbearing at 6 weeks after surgery. All patients had osseous union, and no complications developed that required a second surgery. The clinical outcomes, assessed at a mean of 25.5 (range, 6.3 to 75.8) months postoperatively, were satisfactory. The mean American Orthopaedic Foot and Ankle Society score was 90.1 (range, 79 to 94), on a 94-point scale. The wedged distraction arthrodesis technique has not been previously described for correction of pediatric patients with lateral tarsal wedging, but it is an effective option and yields successful outcomes. PMID:25704449

  19. Presentation

    Directory of Open Access Journals (Sweden)

    Isidor Marí Mayans

    2004-04-01

    Full Text Available As was the case at the conference, "Humanities professions in the knowledge society", the Director of Humanities and Philology Studies at the UOC, Isidor Marí, presents this Dossier, and the subsequent virtual debate, with the aim of gaining useful conclusions, with specific repercussions on the organisation of the degree studies and its professional projection, especially at this time, which requires study plans to be redesigned in line with the Bologna process. In the author's opinion, we can only make the right operative decisions when we are able to understand the transformations taking place in the humanistic culture framed by the knowledge society, and to do so, debate has to be opened in which students, graduates, academics, researchers, professionals and analysts can all take part.In this article, Isidor Marí analyses the tensions and contradictions that arise when attempts are made to relate the concepts of the professional world, Humanities and the knowledge society. Firstly, neither are Humanities a profession nor the study of Humanities seen by students or society to be adaptable to the definition of professional profiles. However, this highlights an important paradox, as the culture economy, (and, thus, occupations in the cultural sector, is growing increasingly throughout western societies. Likewise, in terms of the relationship between Humanities and the knowledge society, the author describes and analyses how there currently coexist voices foreseeing the worst alongside those that see information and communications technologies opening the way for an enormously positive transformation in human civilisation and a new cultural era.

  20. Presentation

    Directory of Open Access Journals (Sweden)

    Eduardo Vicente

    2013-06-01

    Full Text Available In the present edition of Significação – Scientific Journal for Audiovisual Culture and in the others to follow something new is brought: the presence of thematic dossiers which are to be organized by invited scholars. The appointed subject for the very first one of them was Radio and the invited scholar, Eduardo Vicente, professor at the Graduate Course in Audiovisual and at the Postgraduate Program in Audiovisual Media and Processes of the School of Communication and Arts of the University of São Paulo (ECA-USP. Entitled Radio Beyond Borders the dossier gathers six articles and the intention of reuniting works on the perspectives of usage of such media as much as on the new possibilities of aesthetical experimenting being build up for it, especially considering the new digital technologies and technological convergences. It also intends to present works with original theoretical approach and original reflections able to reset the way we look at what is today already a centennial media. Having broadened the meaning of “beyond borders”, four foreign authors were invited to join the dossier. This is the first time they are being published in this country and so, in all cases, the articles where either written or translated into Portuguese.The dossier begins with “Radio is dead…Long live to the sound”, which is the transcription of a thought provoking lecture given by Armand Balsebre (Autonomous University of Barcelona – one of the most influential authors in the world on the Radio study field. It addresses the challenges such media is to face so that it can become “a new sound media, in the context of a new soundscape or sound-sphere, for the new listeners”. Andrew Dubber (Birmingham City University regarding the challenges posed by a Digital Era argues for a theoretical approach in radio studies which can consider a Media Ecology. The author understands the form and discourse of radio as a negotiation of affordances and

  1. Presentation

    Directory of Open Access Journals (Sweden)

    Nicanor Lopes

    2010-11-01

    Full Text Available The Journal Caminhando debuts with a new editorial format: eachmagazine will have a Dossier.In 2010 Christianity celebrated the centenary of Edinburgh. TheWorld Missionary Conference in Edinburgh in 1910 is regarded by manyas missiological watershed in the missionary and ecumenical movement.So the Faculty of Theology of the Methodist Church (FATEO decidedto organize a Wesleyan Week discussing the issue of mission. For anevent of this magnitude FATEO invited the Rev. Dr. Wesley Ariarajah,Methodist pastor and teacher of Sri Lanka with extensive experience inpastoral ministry in local churches and professor of History of Religionsand the New Testament at the Theological College of Lanka, maintainedby the Protestant Churches in Sri Lanka. In 1981 he was invited to jointhe World Council of Churches, where he presided for over ten years theCouncil of Interreligious Dialogue. From 1992 he served as Deputy GeneralSecretary of the WCC.The following texts are not the speeches of the Rev. Dr. WesleyAriarajah, for they will be published separately. Nevertheless, the journaldialogs with the celebrations of the centenary of Edinburgh, parting formthe intriguing theme: "Mission in the 21st century in Brazil". After all, howis it that mission takes place among us in personal, church, and communityactivities?Within the Dossier, as common to the journal, the textos are organizedas follows: Bible, Theology / History and Pastoral Care. Other items thatdo not fit within the Dossier, but, do articulate mission, can be found inthe section Declarations and Documents and Book Reviews.The authors of the Dossier have important considerations in buildinga contemporary missiological concept considering Brazilian reality.Anderson de Oliveira, in the Bible-Section, presents a significantexegeses of Matthew 26.6-13. What does it mean when Jesus is quotedwith the words: "For the poor always ye have with you, but me ye havenot always." Is this declaration challenging the gospels

  2. Nonabsorbable-Suture-Induced Osteomyelitis: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Cheng Hong Yeo

    2012-01-01

    Full Text Available We are reporting a case of nonabsorbable suture-induced osteomyelitis in patient who had an open rotator cuff repair with nonabsorbable Ethibond anchor suture. Patient in this case presented with very subtle clinical features of osteomyelitis of the left proximal humerus 15 years after initial rotator cuff repair surgery. Literature had shown that deep infection following rotator cuff repairs, although rare, can be easily missed and can cause severe complications. Absorbable suture had been demonstrated to be more superior, in terms of rate of deep infection, as compared to nonabsorbable suture when used in rotator cuff repair surgery. Both absorbable and nonabsorbable suture had been demonstrated to have similar mechanical properties by several different studies. The case demonstrated that initial presentation of deep infection can be subtle and easily missed by clinicians and leads to further complications.

  3. Normal skeletal development and imaging pitfalls of the calcaneal apophysis: MRI features

    Energy Technology Data Exchange (ETDEWEB)

    Rossi, Ignacio [Musculoskeletal Research Fellow at NYU Langone Medical Center, New York, NY (United States); Centro de Diagnostico Dr. Enrique Rossi, Buenos Aires (Argentina); Rosenberg, Zehava [NYU Langone Medical Center, New York, NY (United States); Zember, Jonathan [Albert Einstein College of Medicine Jacobi Medical Center, Bronx, NY (United States)

    2016-04-15

    Heel pain in children and secondary MR imaging (MRI) of the hindfoot have been increasing in incidence. Our purpose is to illustrate the, previously unreported, MRI stages in development of the posterior calcaneal apophysis, with attention to imaging pitfalls. This should aid in distinguishing normal growth from true disease. Consecutive ankle MRIs in children <18 years, from 2008-2014, were subdivided into 0≤5, 5≤10, 10≤15 and 15≤18 age groups and retrospectively reviewed for development of the calcaneal apophysis. 204 ankle MRI studies in 188 children were identified. 40 studies were excluded with final cohort of 164 studies in 154 patients (82 boys, 72 girls). The calcaneal apophysis was cartilaginous until age 5. Foci of decreased as well as increased signal were embedded in cartilage, prior to ossification. Early, secondary ossification centers appeared in plantar third of the apophysis in 100 % of children by age 7. Increased T2 signal in the ossifications was seen in 30 % of children. Apohyseal fusion began at 12 and was complete in 78 % of 14≤15 year olds and in 88 % of 15≤18 year olds. Curvilinear low signal in the ossification centers, paralleling, but distinguished from growth plate, and not be confused with fracture line, was common. Development of the posterior calcaneus follows a unique sequence. Apophyseal fusion occurs earlier than reported in the literature. Familiarity with this maturation pattern, in particular the apophyseal increased T2 signal and the linear low signal paralleling the growth plate, will avoid misinterpreting it for pathology. (orig.)

  4. Normal skeletal development and imaging pitfalls of the calcaneal apophysis: MRI features

    International Nuclear Information System (INIS)

    Heel pain in children and secondary MR imaging (MRI) of the hindfoot have been increasing in incidence. Our purpose is to illustrate the, previously unreported, MRI stages in development of the posterior calcaneal apophysis, with attention to imaging pitfalls. This should aid in distinguishing normal growth from true disease. Consecutive ankle MRIs in children <18 years, from 2008-2014, were subdivided into 0≤5, 5≤10, 10≤15 and 15≤18 age groups and retrospectively reviewed for development of the calcaneal apophysis. 204 ankle MRI studies in 188 children were identified. 40 studies were excluded with final cohort of 164 studies in 154 patients (82 boys, 72 girls). The calcaneal apophysis was cartilaginous until age 5. Foci of decreased as well as increased signal were embedded in cartilage, prior to ossification. Early, secondary ossification centers appeared in plantar third of the apophysis in 100 % of children by age 7. Increased T2 signal in the ossifications was seen in 30 % of children. Apohyseal fusion began at 12 and was complete in 78 % of 14≤15 year olds and in 88 % of 15≤18 year olds. Curvilinear low signal in the ossification centers, paralleling, but distinguished from growth plate, and not be confused with fracture line, was common. Development of the posterior calcaneus follows a unique sequence. Apophyseal fusion occurs earlier than reported in the literature. Familiarity with this maturation pattern, in particular the apophyseal increased T2 signal and the linear low signal paralleling the growth plate, will avoid misinterpreting it for pathology. (orig.)

  5. [Vascularization of the lateral heel in relation to extensive skin incisions in osteosynthesis of calcaneal fractures].

    Science.gov (United States)

    Rak, V; Matonoha, P; Otáhal, M; Masek, M M

    2007-09-01

    The aim of the study was to document soft tissue vascularization of the lateral heel on cadavers and, therefore, to indirectly demonstrate the importance to perform perfectly precise incisions, in order to prevent ischemic complications. Sections of 8 human lower limb cadavers were performed in cooperation with the Anatomical Institute of the MU Medical Faculty in Brno, according to current common standards for anatomical preparations. In successive steps, cutaneous and subcutanous covers of the lateral ankle, malleolar and heel regions were preparated. Final branches of the individual arteries were followed and the authors aimed to demonstrate their vascular arcade consisting of anastomosis of the lateral calcaneal artery--LCA (a branch of a. peronea)--which is a clinical term for rami calcaneares laterales, ventrolateral tarsal arteries--LTA (a branch of a. dorsalis pedis) and lateral malleolar artery branching off medially--LMA (a branch of a. tibialis ant.). The course of the arteries and their location is related to a reference point--a lateral tip of the lateral ankle. The investigators found out that all three arteries, as well as the arterial arch, had standard courses. The course of the arch defines the outline of the lateral extensive incision during osteosynthesis in calcaneal fractures, which lies fairly close to the lateral outline of this vascular arcade. Incorrect performance of the incision results, invitably, in serious ischemic complications. Open reduction and internal fixation of intraarticular calcaneal fractures has become a standard surgical method. Correct indication, good timing and saving open reduction, internal fixation using arthroscopy and early mobilization are the prerequisites to prevent further postoperative complications and to achieve complete healing of the fracture. Considering the demandingness of these fractures treatment and their rare incidence, their management should be centred in specialized traumatological clinics. PMID

  6. MRI findings of osteomyelitis of the mandible

    International Nuclear Information System (INIS)

    The purpose of this study was to evaluate the clinical significance of MRI findings of mandibular osteomyelitis. MR images of 24 patients with mandibular osteomyelitis (14 males and 10 females, average age of 49 years, range 16 to 80 years) were analyzed in relation to clinical findings and clinical outcome. The average duration of symptoms at the time of MR imaging was 17.2 months (range: 2 weeks to 12 years, median of 5 months). Seven patients (29%) were imaged within 1 month after the onset of symptoms. Patients were classified as ''cured'' and ''not cured'' based on the clinical outcome. Sixteen patients were ''cured'' and eight were ''not cured''. Characteristic MR findings were investigated on T1- weighted images (T1WI) and T2- weighted images with fat-suppression (T2WI). Characteristic MRI findings of mandibular osteomyelitis and the frequencies were signal changes in the bone marrow (low on T1WI and high on T2WI) in 24 patients (100%), defect of the cortical bone in 10 (42%), periosteal reaction in 8 (33%), widening of the bone width in 8 (33%), sequestrum in 1 (4%). Fourteen (58%) showed edematous change of surrounding muscles and seven (29%) showed abscess formation in the soft tissues. Six patients (25%) showed only signal changes in the bone marrow. Bone marrow signal change was categorized into 2 types. Fifteen (62.5%) showed homogenous signal changes on both T1WI and T2WI and the other 9 patients (37.5%) showed both high and low signal on T2WI in the area showing a low signal on T1WI (heterogeneous type). These patterns were correlated with the occurrence of bone width change. The non-cured group significantly more frequently showed the heterogeneous type of bone marrow signal change and widening of bone width. The bone marrow signal change pattern and the presence of widening of bone width are indicators of treatment-resistant osteomyelitis of the mandible. (author)

  7. Metastatic spinal abscesses from diabetic foot osteomyelitis.

    Science.gov (United States)

    Shaho, Shang; Khan, Shaila; Huda, M S Bobby; Chowdhury, Tahseen Ahmad

    2014-01-01

    A 66-year-old man with long-standing type 2 diabetes, nephropathy and neuropathy was admitted acutely with an infected left big toe neuropathic ulcer, with underlying osteomyelitis. His condition rapidly deteriorated with sepsis and right lobar pneumonia. Microbiology grew methicillin-sensitive Staphylococcus aureus. Shortly into his admission, he developed flaccid paraparesis, and an MRI showed multiple epidural abscesses with likely cord infarction, not amenable to surgical intervention. His sepsis resolved, but his paraparesis remained severe, requiring spinal rehabilitation. PMID:24920514

  8. Chronic recurrent multifocal osteomyelitis demonstrated by Tc-99m methylene diphosphonate bone scan

    DEFF Research Database (Denmark)

    Lise, Hobolt; Nemery, Michel; Albrectsen, Jens;

    2008-01-01

    A 12-year-old Middle Eastern girl presented with abdominal pain, weight loss, and intermittent pain in both thighs. She was initially suspected of Crohn disease, but this diagnosis was excluded after extensive gastromedical evaluation. Plain x-rays of the femora were normal, whereas the initial T...... osteomyelitis (CRMO). The patient's symptoms disappeared spontaneously, but reappeared 1.5 years later, which led to a new MDP bone scan that showed normal findings. Udgivelsesdato: 2008-Jan...

  9. Epidemic Assessment of Bacterial Agents in Osteomyelitis and Their Antibiotic Resistance Pattern Determination

    OpenAIRE

    Reza Mirnejad; Shahab Fallahi; Jalal Kiani; Farhad Jeddi; Mehdi Khoobdel; Nematollah Jonaidi; Farshid Alaeddini

    2008-01-01

    The aim of the present study was to determine the causative agents of osteomyelitis and specifying their antibiotic resistance pattern in patients referred to pediatrics ward of Imam Khomeini Hospital. This study has been performed in Tehran during January to December 2006. In this study, synovial fluid was taken from 90 patients who referred to pediatrics ward of Imam Khomeini. Samples were examined by direct test, culture and biochemical tests. In next step, antibiogram by disk diffusion me...

  10. Osteomyelitis and Discitis Following Translumbar Repair of a Type II Endoleak

    Energy Technology Data Exchange (ETDEWEB)

    Sella, David M., E-mail: Sella.david@mayo.edu; Frey, Gregory T., E-mail: Frey.gregory@mayo.edu; Giesbrandt, Kirk, E-mail: giesbrandt.kirk@mayo.edu [Mayo Clinic, Department of Radiology (United States)

    2016-03-15

    Here we present the case of an 80-year-old man who developed a type II endoleak following endovascular abdominal aortic aneurysm repair. Initial attempts at treating the endoleak via a transarterial approach were unsuccessful; therefore the patient underwent percutaneous translumbar endoleak embolization. Approximately 1 month following the translumbar procedure, he developed back pain, with subsequent workup revealing osteomyelitis and discitis as a complication following repair via the translumbar approach.

  11. Nuclear medicine for diagnostic evaluation of osteomyelitis in children

    International Nuclear Information System (INIS)

    Although skeletal scintiscanning has yielded results allowing an early diagnosis of osteomyelitis in children already at a stage prior to detection by X-ray radiography, reports have been published showing that there is quite a number of false negative findings obtained by nuclear medicine techniques, especially in newborns. The article here therefore reports a study on clinical validation of skeletal scintigraphy in case of suspected osteomyelitis in children. The results show that scintiscanning is a very sensitive method of detecting osteomyelitis in children, and also can be a very useful diagnostic tool for examination of newborns, provided the different anatomy of the skeleton in newborns is taken into account. (orig./MG)

  12. Osteomyelitis following extraction of lower third molar during pregnancy

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sang Bin; Huh, Kyung Hoe; Yi, Won Jin; Lee, Sam Sun [Department of Oral and Maxillofacial Radiology, and Dental Research Institute, School of Dentistry, Seoul National University, Seoul (Korea, Republic of); Kim, Mi Ja [Department of Dentistry, Hangang Sacred Heart Hospital, Hallym University, Seoul (Korea, Republic of)

    2008-09-15

    A 27-year-old female was referred to our hospital postpartum due to rapid aggravation of facial swelling. She was diagnosed with osteomyelitis on clinical, radiological, and histopathological examinations, but the possibility of malignancy was not excluded. Clinical signs and symptoms such as facial swelling and discomfort were improved with four months of antibiotics treatment. This is a case of an osteomyelitis progressed from infected extraction socket in a woman with physiological changes of pregnancy. Decreased immunological response, increased sex hormone and calcium regulatory hormones regulate the response of the bone infection. We report this case for helping the diagnosis of unusual form of osteomyelitis in pregnancy and postpartum.

  13. Clival osteomyelitis resulting from spread of infection through the fossa navicularis magna in a child

    Energy Technology Data Exchange (ETDEWEB)

    Prabhu, Sanjay P.; Zinkus, Timothy [Children' s Hospital Boston and Harvard Medical School, Division of Neuroradiology, Department of Pediatric Radiology, Boston, MA (United States); Cheng, Alan G. [Children' s Hospital Boston and Harvard Medical School, Department of Otolaryngology and Communication Enhancement, Boston, MA (United States); Stanford University School of Medicine, Department of Otolaryngology, Head and Neck Surgery, Stanford, CA (United States); Rahbar, Reza [Children' s Hospital Boston and Harvard Medical School, Department of Otolaryngology and Communication Enhancement, Boston, MA (United States)

    2009-09-15

    The fossa navicularis is a notch-like bone defect in the basiocciput that has been hitherto considered as an anatomical variant of the clivus and not previously described as a potential source of clival or skull base pathology. We report the imaging findings in a 5-year-old child who presented acutely with a retropharyngeal abscess and osteomyelitis of the clivus. Imaging after treatment revealed a ''notch-like'' defect in the anterior clivus consistent with a fossa navicularis. Based on these appearances, we postulate that the lymphoid tissue of the pharyngeal tonsil residing in the fossa navicularis served as a route through which infection spread and subsequently developed into clival osteomyelitis, which is a rare diagnosis. This case is unique, and we believe that the presence of this variant in young children may be important and is not merely an anatomical curiosity. (orig.)

  14. Acute osteomyelitis of the acetabulum induced by Staphylococcus capitis in a young athlete

    Directory of Open Access Journals (Sweden)

    Seiji Fukuda

    2010-03-01

    Full Text Available Acute hematogenous osteomyelitis (AHOM of the acetabulum is a rare condition in children and usually caused by Staphylococcus aureus. We present an 11-year-old soccer athlete who suffered from acute osteomyelitis involving the acetabulum caused by S. capitis, a normal flora of the human skin but never reported in this condition. The disease was associated with repetitive skin injuries of the knee and potential osseous microtrauma of the hip joint by frequent rigorous exercise. This unusual case suggests that osseous microtrauma of the acetabulum, in addition to repetitive skin injuries, allowed normal skin flora to colonize to the ipsilateral acetabulum, which served as a favorable niche and subsequently led to AHOM.

  15. Clival osteomyelitis resulting from spread of infection through the fossa navicularis magna in a child

    International Nuclear Information System (INIS)

    The fossa navicularis is a notch-like bone defect in the basiocciput that has been hitherto considered as an anatomical variant of the clivus and not previously described as a potential source of clival or skull base pathology. We report the imaging findings in a 5-year-old child who presented acutely with a retropharyngeal abscess and osteomyelitis of the clivus. Imaging after treatment revealed a ''notch-like'' defect in the anterior clivus consistent with a fossa navicularis. Based on these appearances, we postulate that the lymphoid tissue of the pharyngeal tonsil residing in the fossa navicularis served as a route through which infection spread and subsequently developed into clival osteomyelitis, which is a rare diagnosis. This case is unique, and we believe that the presence of this variant in young children may be important and is not merely an anatomical curiosity. (orig.)

  16. A CASE OF TIBIO - FIBULAR SCOLIOSIS FOLLOWING CH ILDHOOD OSTEOMYELITIS OF TIBIA: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Kali Varaprasad

    2015-03-01

    Full Text Available INTRODUCTION: Osteomyelitis of the long bones is not uncommon in children . The post infective sequelae are very much unpredictable . In this case report we would like to present a very rare complication of childhood Osteomyelitis i . e . gross deformity of distal 3 rd of Tibia and Fibula in patient of 19 year old male and tethering of the skin on concave side the Tibia . PROCEDURE: T he patient with the deformity of the both bones of leg on right s ide was thoroughly evaluated clinically and radiologically . The deformity was corrected gradually with the Ilizarov frame . The case was followed and the result was discussed in detail . CONCLUSIONS: The deformity of the Tibia was corrected by minimal incisi on corticotomy of the Tibia and the result was satisfying to the patient .

  17. Low back pain after a dental procedure: a case of Streptococcus viridans vertebral osteomyelitis.

    Science.gov (United States)

    Nazir, Salik; Lohani, Saroj; Tachamo, Niranjan; Rajagopalan, Priya

    2016-01-01

    Vertebral osteomyelitis due to Streptococcus viridans following a dental procedure is a rarely reported phenomenon. We discuss the case of a 67-year-old immunocompetent woman who presented with low back pain of 3 weeks duration associated with subjective fever and chills. On admission, the MRI of the lumbar spine showed L5-S1 vertebral osteomyelitis with associated paravertebral and epidural abscesses. Subsequently, detailed history was retaken and the patient reported having had a maxillary tooth extraction followed by a dental implant 2 months prior to the onset of her symptoms. Blood and abscess fluid cultures grew S. viridans Transthoracic echocardiogram showed no evidence of endocarditis. The patient was started on intravenous ceftriaxone but her treatment course was complicated by agranulocytosis requiring a switch to vancomycin. She required a total of 9 weeks of intravenous antibiotics for complete clinical cure. PMID:27268493

  18. Arthritis and Osteomyelitis due to Aspergillus fumigatus: A 17 years old boy with chronic granulomatous disease

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    Tabak Yalcın

    2003-01-01

    Full Text Available Abstract Background Invasive Aspergillus infections are frequently seen in immunocompromised patients but arthritis is a rare complication of Aspergillus infections in the absence of immune suppressive therapy, trauma or surgical intervention. Case presentation A 17 years old male patient with arthritis and patellar osteomyelitis of the left knee whose further investigations revealed chronic granulomatous disease as the underlying disease is followed. Aspergillus fumigatus was isolated from the synovial fluid and the tissue samples cultures. He was treated with Amphotericin B deoxicolate 0.7 mg/kg/day. Also surgical debridement was performed our patient. Amphotericin B nephrotoxicity developed and the therapy switched to itraconazole 400 mg/day. Itraconazole therapy were discontinued at the 6th month. He can perform all the activities of daily living including. Conclusion We think that, chronic granulomatous disease should be investigated in patients who have aspergillar arthritis and osteomyelitis.

  19. Treatment of radiation osteomyelitis of the mandible in a patient with acquired factor VIII inhibitor

    International Nuclear Information System (INIS)

    A case of radiation osteomyelitis of mandible in a 56-year-old man with acquired factor VIII inhibitor is presented. He had undergone radiation therapy for malignant lymphoma of the tonsilar region seven years earlier, and also had received steroids to treat acquired factor VIII inhibitor for a year. On initial examination, he was given a diagnosis of phlegmon of the cheek caused by pericoronitis of the left lower wisdom tooth. To prevent the recurrence of inflammation, the wisdom tooth was extracted carefully, but radiation osteomyelitis occurred in association with a pathological fracture of the condylar head. After mini-pulse therapy with methylpredonisolone, segmental mandibulectomy and reconstruction with a titanium metal plate were performed. The postoperative course was satisfactory with no complications such as bleeding or infection. (author)

  20. In-111 WBC scintigraphy in adult osteomyelitis

    International Nuclear Information System (INIS)

    Unlike pediatric bone infections, adult osteomyelitis is commonly related to trauma, surgery, or direct extension from an overlying soft tissue infection. Because of this, the findings on Tc-99m MDP bone scintigraphy tend to be nonspecific. Therefore the value of In-111 WBC scintigraphy in the diagnosis of adult osteomyelitis was evaluated. 52 scans were obtained on 51 adult patients who were consecutively referred to the authors' department with this provisional diagnosis. The diagnosis was confirmed by at least two of the following: positive culture, surgery, x-rays, laboratory results, and clinical response to antibiotics. Of the 52 scans studied the sensitivity was 84%, specificity was 82%, and the accuracy was 83%. False positive results occurred most frequently in patients with inflammatory arthritis. False negative examinations occurred in patients who had In-111 WBC concentration in overlying soft tissue obscuring the bony abnormality. Neither the chronicity of the infection, nor prior treatment with antibiotics created difficulty in scan interpretation. It was concluded that although somewhat less sensitive than TcMDP bone scanning, In-111 WBC scintigraphy is more specific than previously studied radiopharmaceuticals in the assessment of bone infections in the adult population

  1. In-111 WBC scintigraphy in adult osteomyelitis

    Energy Technology Data Exchange (ETDEWEB)

    Ehrlich, L.; Martin, R.H.; Saliken, J.

    1984-01-01

    Unlike pediatric bone infections, adult osteomyelitis is commonly related to trauma, surgery, or direct extension from an overlying soft tissue infection. Because of this, the findings on Tc-99m MDP bone scintigraphy tend to be nonspecific. Therefore the value of In-111 WBC scintigraphy in the diagnosis of adult osteomyelitis was evaluated. 52 scans were obtained on 51 adult patients who were consecutively referred to the authors' department with this provisional diagnosis. The diagnosis was confirmed by at least two of the following: positive culture, surgery, x-rays, laboratory results, and clinical response to antibiotics. Of the 52 scans studied the sensitivity was 84%, specificity was 82%, and the accuracy was 83%. False positive results occurred most frequently in patients with inflammatory arthritis. False negative examinations occurred in patients who had In-111 WBC concentration in overlying soft tissue obscuring the bony abnormality. Neither the chronicity of the infection, nor prior treatment with antibiotics created difficulty in scan interpretation. It was concluded that although somewhat less sensitive than TcMDP bone scanning, In-111 WBC scintigraphy is more specific than previously studied radiopharmaceuticals in the assessment of bone infections in the adult population.

  2. Vacuum-Assisted Closure Combined with a Myocutaneous Flap in the Management of Osteomyelitis in a Dog

    Directory of Open Access Journals (Sweden)

    Jeremy L. Shomper

    2013-01-01

    Full Text Available Case Description. A 2.5-year-old female spayed mixed breed dog presented to the Teaching Hospital for draining tracts on the left medial aspect of the tibia. Two years prior to presentation, the patient sustained a left tibial fracture, which was repaired with an intramedullary (IM pin and two cerclage wires. Multiple antimicrobials were utilized during this time. Clinical Findings. Radiographs were consistent with left tibial osteomyelitis. The implant was removed and the wound was debrided. Treatment and Outcome. A bone window on the medial aspect of the tibia was created in order to facilitate implant removal. The wound and associated bone window were treated with vacuum assisted closure (VAC in preparation for reconstructive surgery. Adjunctive VAC therapy was utilized following the caudal sartorius myocutaneous flap. Complications following this surgery included distal flap necrosis and donor site dehiscence. Clinical Relevance. This presents a difficult case of canine osteomyelitis with subsequent wound care in which VAC and a myocutaneous flap were useful adjunctive treatments for osteomyelitis. This is the first report of VAC in the management of canine osteomyelitis and management with a myocutaneous flap.

  3. Photodynamic Antimicrobial Chemotherapy (PACT) in osteomyelitis induced by Staphylococcus aureus: Microbiological and histological study.

    Science.gov (United States)

    Dos Reis, João Alves; Dos Santos, Jean Nunes; Barreto, Brunna Santos; de Assis, Patrícia Nascimento; Almeida, Paulo Fernando; Pinheiro, Antônio Luiz Barbosa

    2015-08-01

    Osteomyelitis is an inflammation either of medullar spaces or of the surface of cortical bones, which represents a bacterial infection. Photodynamic Antimicrobial Chemotherapy (PACT) is a treatment based on a cytotoxic photochemical reaction that induces a series of metabolic reactions and culminates in bacterial suppression. Such effect led to the idea that it could be used as a treatment of osteomyelitis. Following approval by the Animal Experimentation Committee of the School of Dentistry of the Federal University of Bahia, the present randomized study used eighty Wistar rats with the aim to evaluate, by microbiological and histological analysis, the effects of Photodynamic Antimicrobial Chemotherapy - PACT on tibial surgical bone defects in rats infected by Staphylococcus aureus. The animals were divided in groups: Control (non-infected); Control Osteomyelitis Induction; Saline solution; Photosensitizer; Red Laser and PACT - on this group, a diode laser (40mW; λ660nm ∅=0.04cm(2), CW, 10J/cm(2)) was used in combination with 5μg/ml of toluidine blue as the photosensitizer. On the microbiological study, immediately after treatment, the PACT group presented a bacterial reduction of 97.4% (pbone sequestration and micro-abscesses. The PACT using toluidine blue was effective in reducing the number of S. aureus enabling a better quality bone repair. PMID:26111990

  4. Preliminary screening of osteoporosis and osteopenia in middle aged urban women from Hyderabad (INDIA using calcaneal QUS

    Directory of Open Access Journals (Sweden)

    Ashwin Kasturi

    2015-08-01

    Conclusions: A substantial female population was screened for osteoporosis and osteopenia using calcaneal QUS method utilizing same WHO T score criteria that otherwise shall remain undiagnosed and face the complications and menace of osteoporosis. [Int J Res Med Sci 2015; 3(8.000: 2029-2033

  5. An outcomes assessment of intra-articular calcaneal fractures, using patient and physician's assessment profiles.

    LENUS (Irish Health Repository)

    Kennedy, J G

    2012-02-03

    Thirty-six patients with intra-articular displaced calcaneal fractures were examined to determine both physician- and patient-based outcomes. Three groups were selected. Group A was treated with open reduction and internal fixation, group B was treated with open reduction internal fixation and supplemental bone graft augmentation and the patients in group C were treated with plaster cast immobilisation and no formal operative treatment. All cohorts were well matched for age, sex and severity of injury. Patients were evaluated using both the American Foot and Ankle Society Scoring System (AFASS) and the short form 36 (SF-36). Minimum time to follow up was 4 years. No significant difference was observed between the three groups with regards to pain and functional outcomes using the AFASS score (P>0.05). No difference was observed between the three groups using the SF-36 score (P>0.1). A statistically significant difference was observed, using radiological criteria, between both groups A and B when compared to the non-operative group C. The rate of wound infection in groups A and B was 31.5%. No correlation was found between the SF-36 score and the AFASS score. No correlation was found between the radiological score and either the SF-36 or the AFASS score. This study has found that the conservative treatment of calcaneal fractures can produce satisfactory outcomes with lower morbidity than surgically treated fractures.

  6. Diagnosis of osteomyelitis in the presence of soft-tissue infection and radiologic evidence of osseous abnormalities: Value of leukocyte scintigraphy

    International Nuclear Information System (INIS)

    To evaluate the usefulness of 111In-leukocyte scintigraphy for identifying osteomyelitis in the presence of soft-tissue infection, the author prospectively studied 45 bone sites adjacent to soft-tissue infection in patients with abnormal findings on radiographs and 99mTc bone scans that were suggestive of osteomyelitis. 111In-leukocyte scans were analyzed in terms of the intensity of abnormal uptake and its location relative to bone. The diagnosis of osteomyelitis was established from results of percutaneous bone biopsy culture (n = 35), histologic examination of surgical specimens (n = 8), and clinical follow-up (n = 2). Osteomyelitis was present at 22 sites, including 16 of 18 sites with increased leukocyte uptake in bone, resulting in a sensitivity of 73%, specificity of 91%, and positive predictive value of 89% for this finding. Osteomyelitis was present at four of 17 sites with predominantly soft-tissue localization of leukocyte activity in the region of bone, none of seven sites with normal leukocyte scans, and two of three sites with diminished leukocyte uptake in bone. Although not helpful in distinguishing infectious from noninfectious bone abnormalities, 3- and especially 24-hr bone scans viewed in conjunction with leukocyte studies provided important correlation to aid in estimating the location of focal abnormal leukocyte uptake. The finding of soft-tissue infection with increased uptake of labeled leukocytes that extends to involve adjacent bone strongly suggests concurrent osteomyelitis. When the presence of abnormal leukocyte uptake in bone is uncertain, additional imaging and possibly biopsy may be required to establish or exclude the diagnosis of osteomyelitis

  7. Early diagnosis of osteomyelitis occurred in the jaws

    International Nuclear Information System (INIS)

    Early diagnosis and treatment of osteomyelitis provide good prognosis and prevent severe complications. Therefore, it is important to early diagnose and treat before the bony changes are observed in conventional radiograms. Authors experienced three cases of early osteomyelitis, and scintigrams were useful to differentiate them from other diseases. The purpose of this report was to aid in the early diagnosis and treatment of osteomyelitis occurred in the jaws. The characteristic features were as follows: 1. In clinical examination, the patients complained mild pain and localized swelling in the jaws. 2. In radiographic findings, the conventional radiograms showed relatively mild bony change in the jaws. 3. The more severe periosteal reactions were observed in radiograms in children than in adult patient. 4. It showed marked increased uptake of radioisotopes in all scintigrams. 5. The three phase bone scanning were helpful to differentiate osteomyelitis from soft tissue diseases.

  8. Congenital multifocal osteomyelitis at 24 weeks' gestation

    Energy Technology Data Exchange (ETDEWEB)

    Raupp, Peter; Shubbar, Adil; Baichoo, Vijaymani; Samson, Gregory [Al Corniche Hospital, Department of Neonatology, P.O. Box 3788, Abu Dhabi (United Arab Emirates)

    2007-12-15

    We report an extremely rare case of congenital nonsyphilitic osteomyelitis in a very preterm infant, providing a unique illustration of the radiological appearances at birth, which may serve as a reference to facilitate diagnosis. (orig.)

  9. A Case of Pediatric Q Fever Osteomyelitis Managed Without Antibiotics.

    Science.gov (United States)

    Khatami, Ameneh; Sparks, Rebecca T; Marais, Ben J

    2015-12-01

    Q fever osteomyelitis, caused by infection with Coxiella burnetti, is rare but should be included in the differential diagnosis of children with culture-negative osteomyelitis, particularly if there is a history of contact with farm animals, and/or granulomatous change on histologic examination of a bone biopsy specimen. We describe a case of Q fever osteomyelitis in a 6-year-old boy in which a decision was made not to treat the patient with combination antimicrobial agents, balancing possible risks of recurrence against potential side effects of prolonged antibiotic treatment. The patient had undergone surgical debridement of a single lesion and was completely asymptomatic after recovery from surgery. This case suggests that a conservative approach of watchful waiting in an asymptomatic patient with chronic Q fever osteomyelitis may be warranted in select cases when close follow-up is possible. PMID:26574586

  10. Effects of Implant-Associated Osteomyelitis on Cefuroxime Bone Pharmacokinetics

    DEFF Research Database (Denmark)

    Tøttrup, Mikkel; Bue, Mats; Koch, Janne;

    2016-01-01

    Background: The prolonged antibiotic therapy that is often needed for successful management of osteomyelitis may be related to incomplete penetration of antibiotics into the target site. The objective of this study was to assess the effects of implant-associated osteomyelitis on cefuroxime...... penetration into bone. Methods: Implant-associated osteomyelitis using a Staphylococcus aureus strain was induced in the right tibia in ten pigs. After five days and following administration of 1500 mg of cefuroxime, measurements of cefuroxime were obtained using microdialysis for eight hours in the implant...... cavity up to MICs of 2 mg/L compared with the other tissues, but the time was shorter for higher MICs. Conclusions: Cefuroxime penetration into infected cancellous bone was incomplete but comparable with that in healthy bone. The destructive bone processes associated with acute osteomyelitis reduced...

  11. Clinical and radiological diagnosis of the osteomyelitis in children

    International Nuclear Information System (INIS)

    The authors explain the pathogenesis as well as the clinical and the in vitro chemical data obtained in the case of acute, hematogenic osteomyelitis which is the type most frequently occurring in childhood. X-ray radiography still is the imaging method of choice for diagnostic evaluation, and typical findings are explained. It is recommended to start treatment with antibiotics as early as possible, also in case of suspected osteomyelitis. (MG)

  12. Intravenous Versus Oral Outpatient Antibiotic Therapy for Pediatric Acute Osteomyelitis

    OpenAIRE

    Liu, Raymond W.; Abaza, Hadeel; Mehta, Priyesh; Bauer, Jennifer; Cooperman, Daniel R.; Gilmore, Allison

    2013-01-01

    The optimal route (oral versus intravenous) of antibiotic administration for pediatric acute osteomyelitis is not well established. Seventy-eight children from our university hospital and 17 children at our county hospital were treated for acute osteomyelitis. The rates of intravenous antibiotics upon discharge were 95% versus 65% (P=0.002), respectively. The recurrence rate and line complication rates were 10% and 24% at the university hospital, compared to 0% (P=0.34) and 6% (P=0.29) at the...

  13. Selection of treatment modalities in children with chronic osteomyelitis

    OpenAIRE

    Unal, Vuslat Sema; Dayican, Avni; Demirel, Murat; Portakal, Suleyman; Ozkan, Guray; Ucaner, Ahmet

    2004-01-01

    Objectives: We evaluated clinical and follow-up findings and treatment methods of pediatric patients with chronic osteomyelitis. Methods: The study included 22 children (14 boys, 8 girls; mean age 8±7 years) who were treated for chronic osteomyelitis. Infection sites were the femur, tibia, ulna, and radius in 11, 8, 1, and 2 patients, respectively. Sixteen patients had a history of trauma. Fourteen patients had fractures, nine of which were associated with segmentary bone defects. All the ...

  14. Radio-isotope bone scanning in suspected osteomyelitis in children

    International Nuclear Information System (INIS)

    The usefulness of radio-isotope bone scanning in suspected osteomyelitis has been widely acclaimed. Fourteen children had rectilinear bone scans performed three hours after injection of Tcsup(99m) methylene diphosphonate. A diagnostic accuracy of 56% was achieved, which is lower than in other series. The reasons for this are discussed and the value of bone scanning in the evaluation of osteomyelitis is questioned. (orig.)

  15. Primary tuberculous osteomyelitis of the mandible- A Rare Case Report-

    Directory of Open Access Journals (Sweden)

    Ashalata

    2011-01-01

    Full Text Available Tuberculous osteomyelitis of mandible is an extremely rare condition, particularly in comparison to pyogenic infections andneoplastic diseases involving the mandible. Although a rare occurrence, the differential diagnosis of tuberculous osteomyelitismust always keep in dentist’s mind when the routine therapy fails to respond. Here, we report an unusual case of primarytubercular osteomyelitis of the mandible where the biopsy of the lesion alone has lead to near final diagnosis of the case andthere after antitubercular therapy subsided the swelling.

  16. Phage therapy of staphylococcal chronic osteomyelitis in experimental animal model

    OpenAIRE

    Chandan Kishor; Raghvendra Raman Mishra; Saraf, Shyam K.; Mohan Kumar; Arvind K Srivastav; Gopal Nath

    2016-01-01

    Background & objectives: Methicillin resistant Staphylococcus aureus (MRSA) are the commonest cause of osteomyelitis. The aim of this study was to evaluate the role of an alternative therapy i.e. application of S. aureus specific bacteriophages in cases of osteomyelitis caused by MRSA in animal model. Methods: Twenty two rabbits were included in this study. The first two rabbits were used to test the safety of phage cocktail while the remaining 20 rabbits were divided into three groups; g...

  17. A case of osteomyelitis of mandibular bone in Kimura's disease

    International Nuclear Information System (INIS)

    We experienced a case of osteomyelitis of mandibular bone in Kimura's disease. The patient received radiation therapy to head and neck area against the same disease. Bone tissue which received radiation therapy had developed malnutrition as side effect of radiation, and osteomyelitis was induced by infection from the teeth. Even in the benign soft tissue disease like Kimura's disease, especially after radiation therapy, pathologic fracture of bone may happen due to bone damage caused by radiation. (author)

  18. Hodgkin's lymphoma masquerading as vertebral osteomyelitis in a man with diabetes: a case report

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    Sohani Aliyah R

    2010-04-01

    Full Text Available Abstract Introduction Infection and malignancy often have common characteristics which render the differential diagnosis for a prolonged fever difficult. Imaging and tissue biopsy are crucial in making a correct diagnosis, though differentiating between chronic osteomyelitis and malignancy is not always straightforward as they possess many overlapping features. Case Presentation A 52-year-old Caucasian man was treated with antibiotics for his diabetic foot infection after a superficial culture showed Staphylococcus aureus. He had persistent fevers for several weeks and later developed acute onset of back pain which was treated with several courses of antibiotics. Radiographic and pathological findings were atypical, and a diagnosis of Hodgkin's lymphoma was made 12 weeks later. Conclusion Clinicians should maintain a suspicion for Hodgkin's lymphoma or other occult malignancy when features of presumed osteomyelitis are atypical. Chronic vertebral osteomyelitis in particular often lacks features common to acute infectious disease processes, and the chronic lymphocytic infiltrates seen on histopathology have very similar features to Hodgkin's lymphoma, highlighting a similar inflammatory microenvironment sustained by both processes.

  19. Photopenic defects in marrow-containing skeleton on indium-111 leucocyte scintigraphy: Prevalence at sites suspected of osteomyelitis and as an incidental finding

    International Nuclear Information System (INIS)

    The skeletal distribution of red marrow-containing sites with a decreased uptake of indium-111-labelled leucocytes was examined as part of a retrospective review of 128 consecutive scans in 113 patients. The prevalence of photopenic defects was determined for sites of suspected osteomyelitis and for other skeletal locations included as part of limited or total-body surveys. Of 52 sites suspected of osteomyelitis based upon radiological and clinical data, 21 (40%) demonstrated a decreased leucocyte uptake. The prevalence of photopenia ranged from 79% (11/14) in the spine and 63% (5/8) in the pelvis to 25% (4/16) in the proximal femur and 0% elsewhere in the extremities (0/9) and in the skull (0/3). Fourteen of these 21 defects (67%) were due to active (n=9) or healed (n=5) osteomyelitis/discitis. All sites of active osteomyelitis showed destructive changes on correlative radiographs and were associated with infectious processes of more than 1 months duration. Thirty-seven photopenic defects were observed as incidental findings. The prevalence of photopenia as an incidental finding ranged from 0% in the skyll, neck and chest to 3%-4% in the thoracolumbar spine and pelvis and 14% in the femoral heads, the latter reflecting primarily bilateral loss of femoral head marrow. No incidentally found photopenic defect reflected active osteomyelitis. At sites in the spine and pelvis with radiologic evidence of bone destruction suggestive of osteomyelitis, an absence of normal red marrow uptake of labelled leucocytes often reflects a variant presentation for active chronic infection. In contrast, incidental photopenia is uncommon at all skeletal sites except the femoral heads, and should not raise concern over unsuspected active osteomyelitis. (orig.)

  20. Pediatric pyogenic sacroiliitis and osteomyelitis

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    Sushant Srinivasan

    2012-03-01

    Full Text Available Pyogenic sacroiliitis for 1-2% of all cases of septic arthritis with less than 200 cases reported in the English literature since the beginning of the twentieth century. Cultures of joint fluid usually grow Staphylococcus aureus. Prognosis is excellent; however, diagnosis may be difficult due to rarity of disease and non-specific signs, symptoms, and physical findings. Magnetic resonance imaging has been found to be the most useful imaging modality in diagnosis. Most reported cases required prolonged antimicrobial therapy of six to nine weeks. Presented here are two children with pyogenic sacroiliitis managed at a tertiary-care, university hospital and review of the literature on this relatively rare diagnosis.

  1. Chronic mandibular osteomyelitis with suspected underlying synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO syndrome: a case report

    Directory of Open Access Journals (Sweden)

    Osako T

    2012-02-01

    Full Text Available Yumi Mochizuki, Ken Omura, Hideaki Hirai, Takuma Kugimoto, Toshimitu Osako, Takahide TaguchiDepartment of Oral and Maxillofacial Surgery, Oral Restitution, Division of Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, JapanAbstract: Chronic mandibular osteomyelitis is an intractable disease. In recent years, some case reports have related this disease process to synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO syndrome, which is chronic with frequent remissions and exacerbations. This report describes a case of chronic mandibular osteomyelitis suspected to be SAPHO syndrome. A 68-year-old woman presented with pain on the left side of the mandible. On the basis of clinical and radiological findings, chronic mandibular diffuse sclerosing osteomyelitis was initially diagnosed. We administrated oral clarithromycin (400 mg daily and levofloxacin (500 mg daily, and her pain subsequently resolved. On 99mTc-labeled methylene diphosphonate scintigraphy, tracer uptake in the asymptomatic mandible was unchanged, but there was increasing tracer uptake in the sternocostal and sternoclavicular joints, compared with 99mTc-labeled methylene diphosphonate scintigraphic findings of the first visit. We diagnosed SAPHO syndrome and administrated oral sodium risedronate hydrate (2.5 mg daily. Although there has been no pain or swelling in the area of the left mandibular lesion, we have followed up on other skin and osteoarticular manifestations in conjunction with other medical departments.Keywords: SAPHO syndrome, diffuse sclerosing osteomyelitis, 14-membered ring macrolide antibiotics, new quinolone antibiotics, bisphosphonates

  2. Osteomyelitis of the base of the skull

    Energy Technology Data Exchange (ETDEWEB)

    Chandler, J.R.; Grobman, L.; Quencer, R.; Serafini, A.

    1986-03-01

    Infection in the marrow of the temporal, occipital, and sphenoid bones is an uncommon, but increasing occurrence. It is usually secondary to infections beginning in the external auditory canal and is caused almost uniformly by the gram negative Pseudomonas aeruginosa bacteria. Technetium and gallium scintigraphy help in the early detection of such infections while CT scans demonstrate dissolution of bone in well-developed cases. Headache is the predominant symptom. Dysphagia, hoarseness, and aspiration herald the inevitable march of cranial nerves. We have diagnosed and treated 17 cases of osteomyelitis of the skull base. Although the total mortality rate is 53%, it is now a curable disease. Six of our last 8 patients remain alive, although 1 is still under treatment. Treatment is medical and requires the long-term concomitant intravenous administration of an aminoglycoside and a broad spectrum semisynthetic penicillin effective against the causative organism.

  3. Osteomyelitis of the base of the skull

    International Nuclear Information System (INIS)

    Infection in the marrow of the temporal, occipital, and sphenoid bones is an uncommon, but increasing occurrence. It is usually secondary to infections beginning in the external auditory canal and is caused almost uniformly by the gram negative Pseudomonas aeruginosa bacteria. Technetium and gallium scintigraphy help in the early detection of such infections while CT scans demonstrate dissolution of bone in well-developed cases. Headache is the predominant symptom. Dysphagia, hoarseness, and aspiration herald the inevitable march of cranial nerves. We have diagnosed and treated 17 cases of osteomyelitis of the skull base. Although the total mortality rate is 53%, it is now a curable disease. Six of our last 8 patients remain alive, although 1 is still under treatment. Treatment is medical and requires the long-term concomitant intravenous administration of an aminoglycoside and a broad spectrum semisynthetic penicillin effective against the causative organism

  4. BOHLER'S ANGLE: CORRELATION WITH OUTCOME IN DISPLACED INTRA-ARTICULAR CALCANEAL FRACTURES TREATED WITH LOCKING COMPRESSION PLATE FIXATION WITH AND WITHOUT BONE GRAFTING

    OpenAIRE

    Deepak P; Eknath D; Vijayanand; Satish

    2014-01-01

    BOHLER'S ANGLE: correlation with outcome in displaced intra-articular calcaneal fractures Treated with locking compression Plate Fixation with and without bone grafting. AIMS: The aim is an accurate reduction of the fracture with reconstruction of Bohler’s angle, length and axis and sub talar joint surface. To determine whether autologous bone graft supplementation is beneficial in achieving and maintaining restoration of Calcaneal height and anatomic reduction. SETTINGS AND ...

  5. Case report:Calcaneal fractures in a cat

    OpenAIRE

    Longley, Mark J; Hannes, Bergmann,; Langley-Hobbs, Sorrel J.

    2016-01-01

    A one year four month old male neutered domestic shorthair cat was presented for sudden onset, left pelvic limb lameness. Upon clinical examination, pain was localised to the hock region and the cat was found to have persistent deciduous teeth. No evidence of trauma was apparent. Radiographs revealed a transverse fracture at the base of the calcaneus. The fracture was stabilised with a Steinmann pin and tension band wire. Eleven weeks after fixation of the fracture, the cat presented with lam...

  6. Acute hematogenous osteomyelitis - exclusion by means of turbo-STIR sequence?; Akute haematogene Osteomyelitis - Ausschluss mit Turbo-STIR-Sequenz?

    Energy Technology Data Exchange (ETDEWEB)

    Wunsch, R.; Darge, K.; Rohrschneider, W.; Zieger, B.; Troeger, J. [Heidelberg Univ. (Germany). Paediatrische Radiologie

    2001-05-01

    The timely diagnosis and early initiation of antibiotic therapy determine the clinical course of an acute hematogenous osteomyelitis. Consequently, a fast and efficient MRI examination protocol is crucial. We retrospectively evaluated various MR sequences used in the examination of 8 children having osteomyelitis. The examinations were conducted using a 0.5 T MR machine. All patients had a high signal intensity of the lesion in the IR sequence with fat suppression (turbo-STIR). An acute osteomyelitis can be excluded in the absence of signal intensity increase in the turbo-STIR sequence without the necessity of having to perform additional sequences. (orig.) [German] Eine schnelle effiziente Diagnostik ist bei der Frage nach einer akuten haematogenen Osteomyelitis besonders wichtig, da der klinische Verlauf vorwiegend durch eine fruehzeitige Diagnose und einen baldmoeglichen Behandlungsbeginn bestimmt wird. Um den Stellenwert der Sequenzen einer magnetresonanztomographischen Untersuchung zu ermitteln, evaluierten wir in einer retrospektiven Studie die Bilder von 8 Kindern mit akuter juveniler Osteomyelitis, welche eine Untersuchung an einem 0,5-Tesla-Geraet erhalten hatten. Auf allen Bildern zeigte sich eine Intensitaetserhoehung in der Turbo-STIR-Sequenz, in 7 von 8 Faellen war ein Kontrastmittelenhancement in einer T1-gewichteten Sequenz mit Fettunterdrueckung nachweisbar. Die Turbo-STIR-Sequenz stellte sich als sensitivste Sequenz heraus. Ist in der Turbo-STIR-Sequenz kein hyperintenses Signal zu erkennen, kann eine akute Osteomyelitis ohne Durchfuehrung weiterer Sequenzen ausgeschlossen werden. (orig.)

  7. Sternal Tuberculosis: An Uncommon Presentation

    OpenAIRE

    Manish Narang; Archana Dwivedi; Shiva Narang; Gopesh Mehrotra

    2011-01-01

    Primary tubercular osteomyelitis of sternum presenting as an acute swelling over chest is an extremely rare presentation in pediatric population. We herein report such a case which was diagnosed by CT scan showing lytic lesion and aspiration revealed positive culture for Mycobacterium tuberculosis. Child improved with antitubercular treatment.

  8. Sternal Tuberculosis: An Uncommon Presentation

    Directory of Open Access Journals (Sweden)

    Manish Narang

    2011-12-01

    Full Text Available Primary tubercular osteomyelitis of sternum presenting as an acute swelling over chest is an extremely rare presentation in pediatric population. We herein report such a case which was diagnosed by CT scan showing lytic lesion and aspiration revealed positive culture for Mycobacterium tuberculosis. Child improved with antitubercular treatment.

  9. Chronic recurrent multifocal osteomyelitis: an evolving clinical and radiological spectrum

    International Nuclear Information System (INIS)

    Based on radiographic and microscopic findings, three patients were prospectively diagnosed as having chronic recurrent multifocal osteomyelitis (CRMO). They form the basis of this report because of either the unusualness of the clinical presentation, hitherto undescribed associated diseases or the unusual age of presentation and sites of lesions. One patient developed pyoderma gangrenosum at the site of one of the skeletal lesions and then went on the develop ulcerative proctitis. A second patient presented with a soft tissue mass, which on MRI mimicked a sarcoma. The final patient presented with lesions in the wrist and phalanges of the toes at the unusual age of 38. None of the patients was treated with steroids or antibiotics for the skeletal lesions. Steroids were administered to one patient for treatment of pyoderma gangrenosum. The pattern and distribution of skeletal lesions in CRMO are well recognized in the pediatric age group. The unusual clinical and/or radiological features discussed herein suggests that this is a disease that continues to evolve with a broader spectrum of features than recognized. (orig./MG)

  10. Chronic recurrent multifocal osteomyelitis: an evolving clinical and radiological spectrum

    Energy Technology Data Exchange (ETDEWEB)

    Sundaram, M. [Dept. of Radiology, St. Louis Univ. Medical Center, MO (United States); McDonald, D. [Dept. of Orthopedic Surgery, St. Louis Univ. Medical Center, MO (United States); Engel, E. [Dept. of Orthopedic Surgery, St. Louis Univ. Medical Center, MO (United States); Rotman, M. [Dept. of Orthopedic Surgery, St. Louis Univ. Medical Center, MO (United States); Siegfried, E.C. [Dept. of Internal Medicine, Dermatology Div., St. Louis Univ. Medical Center, MO (United States)

    1996-05-01

    Based on radiographic and microscopic findings, three patients were prospectively diagnosed as having chronic recurrent multifocal osteomyelitis (CRMO). They form the basis of this report because of either the unusualness of the clinical presentation, hitherto undescribed associated diseases or the unusual age of presentation and sites of lesions. One patient developed pyoderma gangrenosum at the site of one of the skeletal lesions and then went on the develop ulcerative proctitis. A second patient presented with a soft tissue mass, which on MRI mimicked a sarcoma. The final patient presented with lesions in the wrist and phalanges of the toes at the unusual age of 38. None of the patients was treated with steroids or antibiotics for the skeletal lesions. Steroids were administered to one patient for treatment of pyoderma gangrenosum. The pattern and distribution of skeletal lesions in CRMO are well recognized in the pediatric age group. The unusual clinical and/or radiological features discussed herein suggests that this is a disease that continues to evolve with a broader spectrum of features than recognized. (orig./MG)

  11. An initial assessment of therapeutic value of strontium 85 isotope in treatment of chronic osteomyelitis in adults; Wstepna ocena wartosci terapeutycznej izotopu strontu 85 w leczeniu przewleklego zapalenia kosci u doroslych

    Energy Technology Data Exchange (ETDEWEB)

    Wieczorek, M.; Pizio, Z.; Kotarska-Kurp, D. [Szpital MSW, Opole (Poland)]|[Wojewodzki Szpital Zespolony, Opole (Poland)

    1993-12-31

    An initial assessment of treatment of chronic osteomyelitis in 16 adults with strontium 85 is presented. A dose 3.5-5 times greater than standard scintigraphic one was administered. In 3 cases the dose has been repeated because of the persistence of infection. The radionuclide was well tolerated. In 14 cases ceasing of osteomyelitis have been achieved. Laboratory tests showed no abnormalities. (author). 6 refs, 3 figs.

  12. Comparison of radionuclide scintigraphy and radiography for the evaluation of diabetic osteomyelitis

    International Nuclear Information System (INIS)

    Radionuclide scintigraphy using Tc-99m and radiography were compared in the evaluation of diabetic osteomyelitis in 11 patients. Of the eleven patients, nine showed findings highly suggestive of osteomyelitis by bone scan. Of these nine patients, however, six were considered negative for osteomyelitis based on radiography. Bone imaging appears to be more sensitive diagnostic procedure in determining osteomyelitis than X-rays. (Auth.). 9 refs., 5 tabs

  13. Differences in the Clinical Outcome of Osteomyelitis by Treating Specialty: Orthopedics or Infectology.

    Directory of Open Access Journals (Sweden)

    Carolina Arias Arias

    Full Text Available Osteomyelitis is a heterogeneous infection with regard to etiology and treatment, and currently no single management protocol exists. Management of the condition is typically an interdisciplinary approach between orthopedics and infectious disease; however, the orthopedist is often the person who manages treatment. The aim of the study was to determine differences in the outcome of osteomyelitis according to its treating specialty and to identify factors associated with the recurrence of the disease. An ambispective cohort study of 129 patients with osteomyelitis was conducted and the proportions for qualitative variables and central tendency and dispersion measures for quantitative variables were calculated; the latter were tested for normality using the Shapiro-Wilk test. A bivariate analysis was conducted with measures of association based on the chi square test and crude relative risk. A logistic regression model was applied and statistical significance was set at p < 0.05, including the model of relevant clinical variables that fit the Hosmer-Lemeshow test. We found that 70% of patients were treated either by orthopedics or infectious disease. Patients who were treated by an orthopedist alone presented a greater risk of relapse or reinfection (RR = 4.6; 95% CI 2.3;8.9. Risk factors of osteomyelitis recurrence as determined in the regression model included the following: age of 57 years or older (RR = 1.3; 95% 0.3;5.2, long bones (RR = 1.9; 95% CI 0.5;7.1, fracture (RR = 5.0; 95% CI 0.4;51.4, monotherapy (RR = 3.0; 95% CI 0.6;14.5, receiving less than 4 weeks of antibiotics (RR = 1.5; 95% CI 0.2;10.1, inadequate treatment (RR = 3.1; 95% CI 0.4;20.1, and receiving orthopedics treatment (RR = 5.5; 95% CI 1.6;18.2. Most patients evaluated jointly by orthopedics and infectious disease received adequate treatment for osteomyelitis and had fewer relapses.

  14. MR imaging of the osteomyelitis of the extremities

    International Nuclear Information System (INIS)

    To evaluate the characteristics of MR findings in osteomyelitis, retrospective MR image interpretations were made in 18 patients with osteomyelitis proved either by surgery(n=17) or clinical course(n=1). Osteomyelitis was acute in five patients, subacute in five, chronic in seven, and healed in one. Area of active inflammation had low marrow signal intensity on T1-weighted images, high signal intensity on T2-weighted images inhomogeneously. It has been said that morphologic characteristics of osteomyelitis in MR improved the accuracy in diagnosis of osteomyelitis and that gadolinium enhanced MR images further assisted in the planning of surgery. Our study was performed to observe the signal intensity change or morphologic change of bone marrow, cortex, periosteal reaction, and soft tissue which are specific for osteomyelitis. Multiple inhomogeneous round marrow lesions were noted with central high signal intensity and peripheral low signal intensity on T1-weighted images, and central low signal intensity and peripheral high signal intensity on T2-weighted images in two patients. Intra and extraosseous abscesses showed rim enhancement after gadopentetate dimeglumine injection. The signal intensity of the rim was relatively higher than the internal area of the abscess on T1-weighted images. Cortical bone destruction showed high signal intensities T2-weighted images with destruction patterns of fine radial, circumferential, vertical or wedge shaped. MR imaging, by displaying specific signal intensities and morphological changes of bone marrow, cortex, periosteal reaction and soft tissue, would be an aid in early diagnosis and in planning for appropriate conservative and operative therapeutic procedures for osteomyelitis

  15. Combined protocol of 99mTc-Ciprofloxalina and 99mTc-MDP in the diagnosis of complicated osteomyelitis and infected prosthesis

    International Nuclear Information System (INIS)

    Introduction: Bone scintigraphy with 99mTc-MDP is a useful technique in the diagnosis of osteomyelitis, however, has limited specificity in the presence of previous bone pathology (complicated osteomyelitis). 99mTc-ciprofloxacin is one of the most widely used radiotracers for the detection of bone infection, although controversies persist on its diagnostic performance. Objective: To determine the clinical value of 99mTc-ciprofloxacin/99mTc-MDP combined protocol in the diagnosis of complicated osteomyelitis and infected joint prosthesis. Materials and methods: 37 patients with clinically suspected complicated osteomyelitis or infected prosthesis were studied with 99mTc-ciprofloxacin and 99mTc-MDP scintigraphy. 26/37 patients had previous fractures, 7 had knee replacements and 4 had hip replacements. All of the patients underwent clinical and bacteriological follow-up. Results: The method presented sensitivity of 94%, 79% specificity, 81% positive predictive value and 94% negative predictive value, with an accuracy of 86%. Conclusions: The combined protocol using 99mTc-ciprofloxacin/99mTc-MDP showed high diagnostic performance in complicated osteomyelitis and infected joint prosthesis

  16. Previous physical exercise slows down the complications from experimental diabetes in the calcaneal tendon

    Science.gov (United States)

    Bezerra, Márcio Almeida; da Silva Nery, Cybelle; de Castro Silveira, Patrícia Verçoza; de Mesquita, Gabriel Nunes; de Gomes Figueiredo, Thainá; Teixeira, Magno Felipe Holanda Barboza Inácio; de Moraes, Silvia Regina Arruda

    2016-01-01

    Summary Background the complications caused by diabetes increase fragility in the muscle-tendon system, resulting in degeneration and easier rupture. To avoid this issue, therapies that increase the metabolism of glucose by the body, with physical activity, have been used after the confirmation of diabetes. We evaluate the biomechanical behavior of the calcaneal tendon and the metabolic parameters in rats induced to experimental diabetes and submitted to pre- and post-induction exercise. Methods 54-male-Wistar rats were randomly divided into four groups: Control Group (CG), Swimming Group (SG), Diabetic Group (DG), and Diabetic Swimming Group (DSG). The trained groups were submitted to swimming exercise, while unexercised groups remained restricted to the cages. Metabolic and biomechanical parameters were assessed. Results the clinical parameters of DSG showed no change due to exercise protocol. The tendon analysis of the DSG showed increased values for the elastic modulus (ptendinopathy process, but prevent the progress of degeneration. PMID:27331036

  17. Ultrasound parameters of calcaneal bone density in girls with anorexia nervosa.

    Science.gov (United States)

    Kutílek, S; Bayer, M

    2001-12-01

    Osteoporosis is common in patients with anorexia nervosa (AN), but ultrasound has so far been scarcely used to detect it We measured calcaneal broadband ultrasound attenuation (BUA) and velocity of sound (VOS) in 26 AN girls (mean age 15.1+/- 1.5 years) using a Cuba Clinical device (McCue Ultrasonics, UK). Basic anthropometric (body weight, height and body mass index--BMI) and clinical data (mean duration of AN, number of absent cycles, weight loss) were collected. All of the girls reported that they did at least one hour's vigorous exercise a day. BUA was significantly lower (pmeasurements were significantly lower than the reference data (pphysical activity may lead to the increase in VOS. In conclusion, girls with AN have low BUA and high VOS values, neither of which correlate with the duration of AN or the number of missed cycles. PMID:11808818

  18. Ligamentotaxis for complex calcaneal fractures using Joshi′s external stabilization system

    Directory of Open Access Journals (Sweden)

    Singh Ajai

    2008-01-01

    Full Text Available Background: Controversies exist in the literature regarding the management of complex fractures of the calcaneum. We evaluated a series of complex fractures of the calcaneum managed by ligamentotaxis using Joshi′s external stabilization system (JESS for its efficacy. Materials and Methods: Forty-five patients having complex (comminuted, intra-articular fracture with compromised soft tissue condition fractures of the calcaneum, who were treated by external fixator (JESS based on the principle of ligamentotaxis. The gradual distraction was done to bring the articular margins together to maintain both alpha and beta angles to near normal range. Thirteen (28.9% patients underwent additional corticocancellous bone grafting with elevation of posterior facet. All patients were evaluated for their functional outcomes by American Orthopedic Foot and Ankle society (AOFAS Score for the ankle and hind foot. Mean duration of follow-up was 20.5 months. Results: Forty-two (93.4% of our patients did well with the ligamentotaxis. On evaluating final outcomes by AOFAS, approximately 71% of cases showed good results. Eleven patients (24.4% complained of persistent heel pain in the long-term follow-up. Out of these, eight (17.8% patients were those who had severe comminution with almost total loss of calcaneal height. The origin of heel pain was not the subtalar joint in all of these patients. On long-term follow-up none of these patients suffered from such severe pain so as to compel them to change the nature of their activity. Conclusion: We conclude that ligamentotaxis by JESS provides a viable and user-friendly alternative method of management of these complex calcaneal fractures.

  19. The value of calcaneal bone mass measurement using a dual X-ray laser calscan device in risk screening for osteoporosis

    Directory of Open Access Journals (Sweden)

    Gulseren Kayalar

    2009-01-01

    Full Text Available OBJECTIVE: To evaluate how bone mineral density in the calcaneus measured by a dual energy X-ray laser (DXL correlates with bone mineral density in the spine and hip in Turkish women over 40 years of age and to determine whether calcaneal dual energy X-ray laser variables are associated with clinical risk factors to the same extent as axial bone mineral density measurements obtained using dual energy x-ray absorbtiometry (DXA. MATERIALS AND METHODS: A total of 2,884 Turkish women, aged 40-90 years, living in Ankara were randomly selected. Calcaneal bone mineral density was evaluated using a dual energy X-ray laser Calscan device. Subjects exhibiting a calcaneal dual energy X-ray laser T- score <-2.5 received a referral for DXA of the spine and hip. Besides dual energy X-ray laser measurements, all subjects were questioned about their medical history and the most relevant risk factors for osteoporosis. RESULTS: Using a T-score threshold of -2.5, which is recommended by the World Health Organization (WHO, dual energy X-ray laser calcaneal measurements showed that 13% of the subjects had osteoporosis, while another 56% had osteopenia. The mean calcaneal dual energy X-ray laser T-score of postmenopausal subjects who were smokers with a positive history of fracture, hormone replacement therapy (HRT, covered dressing style, lower educational level, no regular exercise habits, and low tea consumption was significantly lower than that obtained for the other group (p<0.05. A significant correlation was observed between the calcaneal dual energy X-ray laser T-score and age (r=-0.465, p=0.001, body mass index (BMI (r=0.223, p=0.001, number of live births (r=-0.229, p=0.001, breast feeding time (r=-0.064, p=0.001, and age at menarche (r=-0.050, p=0.008. The correlations between calcaneal DXL and DXA T-scores (r=0.340, p=0.001 and calcaneal DXL and DXA Z-scores (r=0.360, p=0.001 at the spine, and calcaneal DXL and DXA T- scores (r=0.28, p=0.001 and calcaneal

  20. Imaging of chronic osteomyelitis; Chronische Infektionen des Skelettsystems. Bildgebende Diagnostik

    Energy Technology Data Exchange (ETDEWEB)

    Glaser, C.; Matzko, M.; Reiser, M. [Klinikum Grosshadern, Muenchen (Germany). Inst. fuer Radiologische Diagnostik

    2000-06-01

    The diagnosis of chronic osteomyelitis is made on the basis of clinical, radiologic and histologic findings. The role of imaging in patients with known chronic osteomyelitis is to detect and to delineate areas of active infection. To correctly interpret the imaging findings, it is essential to take both the individual clinical findings and previous imaging studies into account. Reliable signs of active infection are bone marrow abscess, sequestra and sinus tract formation. Only the combined evaluation of bony changes together with alterations of the adjacent soft tissues provides good diagnostic accuracy. Projection radiography gives an overview of the condition of the bone, which provides the basis for follow-up and the selection of further imaging modalities. Computed tomography can be used to evaluate even discrete or complex bony alterations and to guide percutaneous biopsy or drainage. Magnetic resonance imaging achieves the best diagnostic sensitivity and specificity and provides superior contrast as well as anatomical resolution in both bone marrow and soft tissues. In this paper the features and clinical relevance of imaging in primary chronic osteomyelitis, posttraumatic osteomyelitis, tuberculous spondylitis and osteomyelitis of the diabetic foot are reviewed, with particular respect to MRI. (orig.) [German] Die Diagnose der chronischen Osteomyelitis wird durch Klinik, Bildgebung und Histologie gestellt. Bei bekannter chronischer Osteomyelitis soll die Bildgebung einen floriden Prozess und die betroffenen Kompartimente herausarbeiten. Die Klinik des Patienten, seine individuelle Krankheitskonstellation und die Verlaufsbeobachtung sind essentiell fuer die Befundinterpretation. Erst die kombinierte Beurteilung der Veraenderungen am Knochen selbst sowie die der umgebenden Weichteile fuehrt zu einer validen Aussage. Sichere Zeichen einer floriden Osteomyelitis sind lediglich (Knochenmarks)abzess, Sequester und Fistelgang. Die Projektionsradiographie gibt

  1. Bone and Joint Infections in Children: Acute Hematogenous Osteomyelitis.

    Science.gov (United States)

    Agarwal, Anil; Aggarwal, Aditya N

    2016-08-01

    Acute hematogenous osteomyelitis (AHO) is one of the commonest bone infection in childhood. Staphylococcus aureus is the commonest organism causing AHO. With use of advanced diagnostic methods, fastidious Kingella kingae is increasingly becoming an important organism in etiology of osteoarticular infections in children under the age of 3 y. The diagnosis of AHO is primarily clinical. The main clinical symptom and sign in AHO is pain and tenderness over the affected bone especially in the metaphyseal region. However, in a neonate the clinical presentation may be subtle and misleading. Laboratory and radiological investigations supplement the clinical findings. The acute phase reactants such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are frequently elevated. Ultrasonography and MRI are key imaging modalities for early detection of AHO. Determination of infecting organism in AHO is the key to the correct antibiotic choice, treatment duration and overall management and therefore, organism isolation using blood cultures and site aspiration should be attempted. Several effective antibiotics regimes are available for managing AHO in children. The choice of antibiotic and its duration and mode of delivery requires individualization depending upon severity of infection, causative organism, regional sensitivity patterns, time elapsed between onset of symptoms and child's presentation and the clinical and laboratory response to the treatment. If pus has been evidenced in the soft tissues or bone region, surgical decompression of abscess is mandatory. PMID:26096866

  2. Osteomyelitis of Myositis Ossificans in Arm – First Case Report

    Science.gov (United States)

    Mishra, Pankaj Kumar; Singhal, Prakhar; Shukla, Jiten; Maravi, Deepak Singh

    2014-01-01

    Introduction: Myositis ossificans [MO] is a benign heterotropic bone forming (often- self resolving) pathology of bone and soft tissue. Here we are reporting the first time in literature for osteomyelitis of myositis ossificans in arm of a male due to trauma as a perusal of rare entity. Case Report: It is a case report of a 25 years old male presented to us in out-patient department with chief complaint of discharging wounds over mid part of left arm since six months. Clinically provisional diagnosis of chronic osteomylitis of left humerus made and his x-ray sought. X- Ray showed geographic appearance of myositis ossificans around the upper two third of left arm. Sinuses curetted and infected bone (part of myositis ossificans) removed and sent for biopsy. Now the patient is discharge and sinus free, and has resumed his work. Conclusion: Osteomyleitis of myositis ossificans should be recognized as a possible differential diagnosis chronic discharging sinus. This type of presentation of myositis ossificans is rarest. PMID:27299005

  3. Microbiota associated with chronic osteomyelitis of the jaws

    Science.gov (United States)

    Gaetti-Jardim Júnior, Elerson; Fardin, Angélica Cristiane; Gaetti-Jardim, Ellen Cristina; de Castro, Alvimar Lima; Schweitzer, Christiane Marie; Avila-Campos, Mario Julio

    2010-01-01

    Chronic osteomyelitis of maxilla and mandible is rare in industrialized countries and its occurrence in developing countries is associated with trauma and surgery, and its microbial etiology has not been studied thoroughly. The aim of this investigation was to evaluate the microbiota associated with osteomyelitis of mandible or maxilla from some Brazilian patients. After clinical and radiographic evaluation, samples of bone sequestra, purulent secretion, and biopsies of granulomatous tissues from twenty-two patients with chronic osteomyelitis of mandible and maxilla were cultivated and submitted for pathogen detection by using a PCR method. Each patient harbored a single lesion. Bacterial isolation was performed on fastidious anaerobe agar supplemented with hemin, menadione and horse blood for anaerobes; and on tryptic soy agar supplemented with yeast extract and horse blood for facultative bacteria and aerobes. Plates were incubated in anaerobiosis and aerobiosis, at 37oC for 14 and 3 days, respectively. Bacteria were cultivated from twelve patient samples; and genera Actinomyces, Fusobacterium, Parvimonas, and Staphylococcus were the most frequent. By PCR, bacterial DNA was detected from sixteen patient samples. The results suggest that cases of chronic osteomyelitis of the jaws are usually mixed anaerobic infections, reinforcing the concept that osteomyelitis of the jaws are mainly related to microorganisms from the oral environment, and periapical and periodontal infections may act as predisposing factors. PMID:24031586

  4. Microbiota associated with chronic osteomyelitis of the jaws

    Directory of Open Access Journals (Sweden)

    Elerson Gaetti-Jardim Júnior

    2010-12-01

    Full Text Available Chronic osteomyelitis of maxilla and mandible is rare in industrialized countries and its occurrence in developing countries is associated with trauma and surgery, and its microbial etiology has not been studied thoroughly. The aim of this investigation was to evaluate the microbiota associated with osteomyelitis of mandible or maxilla from some Brazilian patients. After clinical and radiographic evaluation, samples of bone sequestra, purulent secretion, and biopsies of granulomatous tissues from twenty-two patients with chronic osteomyelitis of mandible and maxilla were cultivated and submitted for pathogen detection by using a PCR method. Each patient harbored a single lesion. Bacterial isolation was performed on fastidious anaerobe agar supplemented with hemin, menadione and horse blood for anaerobes; and on tryptic soy agar supplemented with yeast extract and horse blood for facultative bacteria and aerobes. Plates were incubated in anaerobiosis and aerobiosis, at 37ºC for 14 and 3 days, respectively. Bacteria were cultivated from twelve patient samples; and genera Actinomyces, Fusobacterium, Parvimonas, and Staphylococcus were the most frequent. By PCR, bacterial DNA was detected from sixteen patient samples. The results suggest that cases of chronic osteomyelitis of the jaws are usually mixed anaerobic infections, reinforcing the concept that osteomyelitis of the jaws are mainly related to microorganisms from the oral environment, and periapical and periodontal infections may act as predisposing factors.

  5. Non-union of calcaneum - A rare complication of calcaneal fracture - A case report with brief review of literature.

    Science.gov (United States)

    Kumar, Narinder

    2015-09-01

    Intra-articular fractures of calcaneum are known to be difficult to manage and lead to multiple complications including subtalar arthritis and malunion. However, non-union of calcaneum is rarely encountered. Only a total of six studies reporting on 12 patients could be found on reviewing the available literature (English language only). One such case of non-union of calcaneal fracture and its successful management is being reported in this case report. In addition, extremely limited literature available on calcaneal non-union is also briefly reviewed. Role of subtalar arthrodesis with internal fixation of fracture and bone grafting for successful management of this rare complication is highlighted along with the possibility of under-reporting of this relatively unknown complication. PMID:26155055

  6. Discordance between MRI and bone scan findings in a child with acute complicated osteomyelitis: scintigraphic features that contribute to the early diagnosis.

    Science.gov (United States)

    Mpalaris, V; Arsos, G; Iakovou, I; Dalpa, E; Karatzas, N

    2014-01-01

    Early diagnosis and prompt treatment of acute osteomyelitis are of paramount importance in children because they can prevent irreversible bone damage. Magnetic resonance imaging (MRI) with its superior spatial resolution and lack of ionizing radiation is routinely preferred over bone scan for this purpose. Increased blood flow, hyperemia and focally increased tracer uptake shown by "three phase" bone scan are the typical scintigraphic findings of acute osteomyelitis. In addition, diffuse uptake along the shaft of long bones and focal "cold" lesions are two special features that may be highly suggestive of infective periostitis, soft tissue sepsis and subperiosteal abscess formation, due to the loose attachment of periosteum to bone during childhood. We present a case of complicated osteomyelitis in a child with inconclusive MRI correctly diagnosed on the basis of these special scintigraphic findings resulting in treatment change from double i.v. Vancomycin--Ceftriaxone scheme to surgical intervention. PMID:23938190

  7. Successful Treatment of Fungal Osteomyelitis with Voriconazole in a Patient with CGD

    Directory of Open Access Journals (Sweden)

    Masoud Mohammadpour

    2010-12-01

    Full Text Available Background:Chronic granulomatous disease (CGD is an immunodeficiency affecting phagocytic leukocytes. Defective respiratory burst mechanism renders the affected patients to be susceptible to catalase positive microorganisms. With the great successes in antibacterial prophylaxis and therapy, fungal infections are a persistent problem. Invasive aspergillosis is the most important cause of mortality in CGD. Case Presentation: We describe a nine year-old boy with CGD who presented with aspergillus induced skull osteomyelitis. He was successfully treated with voriconazole after initial failure of amphotericin B therapy.Conclusion: Currently, newer triazoles are recommended as initial therapy for invasive aspergillosis in immunodeficiency states such as CGD.

  8. Successful Treatment of Fungal Osteomyelitis with Voriconazole in a Patient with CGD

    Directory of Open Access Journals (Sweden)

    Mahsa Oaji

    2010-12-01

    Full Text Available Background:Chronic granulomatous disease (CGD is an immunodeficiency affecting phagocytic leukocytes. Defective respiratory burst mechanism renders the affected patients to be susceptible to catalase positive microorganisms. With the great successes in antibacterial prophylaxis and therapy, fungal infections are a persistent problem. Invasive aspergillosis is the most important cause of mortality in CGD. Case Presentation: We describe a nine year-old boy with CGD who presented with aspergillus induced skull osteomyelitis. He was successfully treated with voriconazole after initial failure of amphotericin B therapy. Conclusion: Currently, newer triazoles are recommended as initial therapy for invasive aspergillosis in immunodeficiency states such as CGD.

  9. Garre's chronic diffuse sclerosing osteomyelitis of the sacrum: a rare condition mimicking malignancy.

    LENUS (Irish Health Repository)

    Nasir, N

    2012-02-03

    Garre\\'s chronic diffuse sclerosing osteomyelitis (DSOM) is a rare disease that occurs most commonly in the mandible. We present a case of sacral DSOM that simulated an expanding destructive sacral tumour. Treatment was conducted on the basis of the available experience with the mandibular form of the disease, with partial symptomatic relief, but progressive sclerosis of the sacral lesion. To the best of our knowledge, this is the first case initially presenting in the sacrum. As an osteolytic expanding lesion simulating malignancy, it is important to recognize this entity in the sacrum.

  10. Neuspešno primarno zdravljenje zloma petnice: Failed primary treatment of calcaneal fracture: kaj storiti?: what to do?:

    OpenAIRE

    Andoljšek, Matej

    2008-01-01

    Many patients are seriously disabled after failed primary treatment of calcaneal fracture. They complain about pain, swelling of the foot and ankle, stiffness and/or limping. They have problems with walking the uneven ground, standing on their toes or climbing ladders. Complains are related to injuries of the soft tissues (not discussed in this paper) and/or injures of the bones and joints. A decreased Boehler's angle resulting in flatfoot is not always aserious defect, and most patients with...

  11. Assessment of the bone quality of black male athletes using calcaneal ultrasound: a cross-sectional study

    OpenAIRE

    Sendeht Ayuba J; Obadofin Michael O; VanderJagt Dorothy J; Laabes Emmanuel P; Glew Robert H

    2008-01-01

    Abstract Background Lifestyle, genetics and environmental factors are established determinants of bone density. We aimed to describe the bone characteristics of competitive top-ranked Nigerian male athletes using calcaneal ultrasound and to assess whether intensive training promotes higher bone density in an environment with reportedly low calcium intake; to compare the bone characteristics of footballers with runners and other sportsmen; and to assess the correlation of stiffness index (SI) ...

  12. Normative calcaneal quantitative ultrasound data for the indigenous Shuar and non-Shuar Colonos of the Ecuadorian Amazon

    OpenAIRE

    Madimenos, FC; Snodgrass, JJ; Blackwell, AD; Liebert, MA; Cepon, TJ; Sugiyama, LS

    2011-01-01

    Summary Minimal data on bone mineral density changes are available from populations in developing countries. Using calcaneal quantitative ultrasound (QUS) techniques, the current study contributes to remedying this gap in the literature by establishing a normative data set on the indigenous Shuar and non-Shuar Colonos of the Ecuadorian Amazon. Purpose The paucity of bone mineral density (BMD) data from populations in developing countries partially reflects the lack of diagnostic resources in ...

  13. Treatment of ipsilateral high energy tibial plateau and calcaneal fractures by a circular wire fixator: a case report

    OpenAIRE

    Dhar, Shabir Ahmed; Butt, Mohammed Farooq; Ali, Murtaza Fazal; Mir, Mohammed Ramzan; Kawoosa, Altaf Ahmed

    2009-01-01

    Introduction High energy tibial plateau fractures along with calcaneal fractures individually produce several challenges for the orthopaedic surgeon. The principles of bony reconstruction include anatomic reduction and rigid internal fixation of intra-articular fractures and accurate restoration of the coronal, sagittal and transverse mechanical axes. Due to the tenuous nature of the soft tissue and devitalisation of the comminuted fragments with open reduction, external fixation of type 6 ti...

  14. Gallium and Indium: which to use when 2. Nuclear medicine imaging of osteomyelitis

    International Nuclear Information System (INIS)

    Nuclear medicine studies have become increasingly clinically utilized in the diagnostic approach to suspected osteomyelitis. The technetium-99m phosphonate bone scan, with the three- or four-phase modification designed to distinguish between osteomyelitis and cellulitis, the gallium-67 citrate scan, and the indium-111 leukocyte scan. have demonstrated utility in diagnosing acute osteomyelitis or exacerbation of chronic osteomyelitis and monitoring the response to therapy in those patients. Computed tomography and magnetic resonance imaging of suspected osteomyelitis continue to be evaluated, but available data indicate that these modalities play a supporting role to radionuclide studies. 34 refs., 3 figs

  15. Cold defects in In-111 leukocyte imaging of osteomyelitis in the axial skeleton

    International Nuclear Information System (INIS)

    The authors retrospectively reviewed 61 In-111 leukocyte scans obtained in areas of normal red marrow (the axial skeleton and proximal long bones) to exclude osteomyelitis. Eight cold defects were identified at sites of suspected osteomyelitis. Five of these represented surgically proved osteomyelitis. Overall, five of 26 (19%) cases of osteomyelitis in these areas manifested as cold defects. They found the prevalence of skeletal photopenic defects with In-111 leukocyte imaging to be higher than previously recorded. The possibility of osteomyelitis should be considered when a cold defect is identified

  16. Case Report: Rare occurrence of Pseudomonas aeruginosa osteomyelitis of the right clavicle in a patient with IgA nephropathy

    OpenAIRE

    Damodaran, Aishwarya; Rohit, Anusha; Abraham, Georgi; Nair, Sanjeev; Yuvaraj, Anand; Prasad, Kashi Nath; Dakshinamurthy, K. V.

    2014-01-01

    We describe the case of a 47 year old patient with proven primary IgA nephropathy who presented with osteomyelitis of the medial end of the right clavicle. The patient was not on immunosuppressive medications. He underwent aspiration curettage and CT scan of the clavicle which yielded pus that grew Pseudomonas aeruginosa. Following treatment with appropriate antibiotic therapy the patient presented a complete recovery of the lesion with no loss of renal function. This case highlights the impo...

  17. Urinary Mineral Concentrations in European Pre-Adolescent Children and Their Association with Calcaneal Bone Quantitative Ultrasound Measurements †

    Science.gov (United States)

    Van den Bussche, Karen; Herrmann, Diana; De Henauw, Stefaan; Kourides, Yiannis A.; Lauria, Fabio; Marild, Staffan; Molnár, Dénes; Moreno, Luis A.; Veidebaum, Toomas; Ahrens, Wolfgang; Sioen, Isabelle

    2016-01-01

    This study investigates differences and associations between urinary mineral concentrations and calcaneal bone measures assessed by quantitative ultrasonography (QUS) in 4322 children (3.1–11.9 years, 50.6% boys) from seven European countries. Urinary mineral concentrations and calcaneal QUS parameters differed significantly across countries. Clustering revealed a lower stiffness index (SI) in children with low and medium urinary mineral concentrations, and a higher SI in children with high urinary mineral concentrations. Urinary sodium (uNa) was positively correlated with urinary calcium (uCa), and was positively associated with broadband ultrasound attenuation and SI after adjustment for age, sex and fat-free mass. Urinary potassium (uK) was negatively correlated with uCa but positively associated with speed of sound after adjustment. No association was found between uCa and QUS parameters after adjustment, but when additionally adjusting for uNa, uCa was negatively associated with SI. Our findings suggest that urinary mineral concentrations are associated with calcaneal QUS parameters and may therefore implicate bone properties. These findings should be confirmed in longitudinal studies that include the food intake and repeated measurement of urinary mineral concentrations to better estimate usual intake and minimize bias. PMID:27164120

  18. Childhood osteomyelitis-incidence and differentiation from other acute onset musculoskeletal features in a population-based study

    Directory of Open Access Journals (Sweden)

    Reiseter Tor

    2008-10-01

    Full Text Available Abstract Background Osteomyelitis can be difficult to diagnose and there has previously not been a prospective approach to identify all children in a defined geographic area. The aim of this study was to assess the annual incidence of osteomyelitis in children, describe the patient and disease characteristics in those with acute ( Methods In a population-based Norwegian study physicians were asked to refer all children with suspected osteomyelitis. Children with osteomyelitis received follow-up at six weeks, six months and thereafter as long as clinically needed. Results The total annual incidence rate of osteomyelitis was 13 per 100 000 (acute osteomyelitis 8 and subacute osteomyelitis 5 per 100 000. The incidence was higher in patients under the age of 3 than in older children (OR 2.9, 95%: CI 2.3–3.7. The incidence of non-vertebral osteomyelitis was higher than the incidence of vertebral osteomyelitis (10 vs. 3 per 100 000; p = .002. Vertebral osteomyelitis was more frequent in girls than in boys (OR 7.0, 95%: CI 3.3–14.7. ESR ≥ 40 mm/hr had the highest positive predictive laboratory value to identify osteomyelitis patients at 26% and MRI had a positive predictive value of 85%. Long-bone infection was found in 16 (43% patients. ESR, CRP, white blood cell count, neutrophils and platelet count were higher for patients with acute osteomyelitis than for patients with subacute osteomyelitis. Subacute findings on MRI and doctor's delay were more common in subacute osteomyelitis than in acute osteomyelitis patients. Blood culture was positive in 26% of the acute osteomyelitis patients and was negative in all the subacute osteomyelitis patients. Conclusion The annual incidence of osteomyelitis in Norway remains high. ESR values and MRI scan may help to identify osteomyelitis patients and differentiate acute and subacute osteomyelitis.

  19. Chronic recurrent multifocal osteomyelitis: how to suggest this diagnosis?

    International Nuclear Information System (INIS)

    Chronic recurrent multifocal osteomyelitis is a rare disorder that affects children and teenagers. Clinically, it is characterized by insidious onset of local swelling and pain in several metaphyses. A symmetric, recurrent and multifocal pattern is usual. Spinal involvement is possible. Inconstant association with a cutaneous affection (palmo-plantar pustulosis, acne fulminans, psoriasis), or less frequently with an inflammatory chronic gut disorder is described. Pathogenesis usually recognized is an enthesopathy. Enthesitis may progress to the osseous part of the enthese and produce an aseptic chronic osteomyelitis. Biopsy specimen with culture is certainly necessary to rule out bacterial osteomyelitis and bone tumor. It is particularly true when the bone lesion is isolated. Disease course is benign and self-limited. The clinical course is characterized by recurrences and remissions occurring for 6 to 10 years. Treatment based on non steroid anti-inflammatory drugs is usually effective. (authors)

  20. SPECT/CT in the Diagnosis of Skull Base Osteomyelitis

    Energy Technology Data Exchange (ETDEWEB)

    Damle, Nishikant Avinash; Kumar, Rakesh; Kumar, Praveen; Jaganthan, Sriram; Patnecha, Manish; Bal, Chandrasekhar; Bandopadhyaya, Gurupad; Malhotra, Arun [All India Institute of Medical Sciences, New Delhi (India)

    2011-09-15

    Skull base osteomyelitis is a potentially fatal disease. We demonstrate here the utility of SPECT/CT in diagnosing this entity, which was not obvious on a planar bone scan. A {sup 99mT}c MDP bone scan with SPECT/CT was carried out on a patient with clinically suspected skull base osteomyelitis. Findings were correlated with contrast enhanced CT (CECT) and MRI. Planar images were equivocal, but SPECT/CT showed intense uptake in the body of sphenoid and petrous temporal bone as well as the atlas corresponding to irregular bone destruction on CT and MRI. These findings indicate that SPECT/CT may have an additional role beyond planar imaging in the detection of skull base osteomyelitis.

  1. [Chronic recurrent multifocal osteomyelitis of the spine : Children and adolescent].

    Science.gov (United States)

    von der Höh, N H; Völker, A; Jeszenszky, D; Heyde, C-E

    2016-06-01

    Chronic non-bacterial osteomyelitis (CNO) in childhood and adolescence is a non-infectious autoinflammatory disease of the bone with partial involvement of adjacent joints and soft tissue. The etiology is unknown. The disease can occur singular or recurrent. Individual bones can be affected and multiple lesions can occur. Chronic recurrent multifocal osteomyelitis (CRMO) shows the whole picture of CNO. Accompanying but temporally independent of the bouts of osteomyelitis, some patients show manifestations in the skin, eyes, lungs and the gastrointestinal tract. The article gives an overview of the clinical manifestations, diagnostic procedures, and treatment options for CRMO involvement of the spine based on the current literature and our own cases. PMID:27221306

  2. SPECT/CT in the Diagnosis of Skull Base Osteomyelitis

    International Nuclear Information System (INIS)

    Skull base osteomyelitis is a potentially fatal disease. We demonstrate here the utility of SPECT/CT in diagnosing this entity, which was not obvious on a planar bone scan. A 99mTc MDP bone scan with SPECT/CT was carried out on a patient with clinically suspected skull base osteomyelitis. Findings were correlated with contrast enhanced CT (CECT) and MRI. Planar images were equivocal, but SPECT/CT showed intense uptake in the body of sphenoid and petrous temporal bone as well as the atlas corresponding to irregular bone destruction on CT and MRI. These findings indicate that SPECT/CT may have an additional role beyond planar imaging in the detection of skull base osteomyelitis.

  3. Staphylococcal diaphyseal subacute osteomyelitis of the ulna in a child: an unusual cause of post-traumatic forearm swelling.

    LENUS (Irish Health Repository)

    Kearns, S R

    2004-01-01

    Paediatric subacute osteomyelitis (SAO) presents a diagnostic and therapeutic challenge to clinicians. Typically located in the metaphysis of long bones, diaphyseal SAO of the upper limb is rare. We present the case of a three-year-old girl referred to our fracture clinic as an occult fracture following trauma to her forearm with normal initial radiographs. Follow-up radiographs one week later showed cortical erosion of the distal ulna, while a subsequent MRI scan showed soft tissue swelling with an area of high signal in the distal ulna. A limited biopsy diagnosed staphylococcal subacute osteomyelitis of the ulna. The patient responded to high dose antibiotic therapy and made a full recovery. We present this case to highlight the high index of suspicion required to diagnose and appropriately manage this insidious condition, which may easily be confused with any number of benign and malignant bony lesions and provide a review of the relevant literature.

  4. Posterior-Only Circumferential Decompression and Reconstruction in the Surgical Management of Lumbar Vertebral Osteomyelitis.

    Science.gov (United States)

    Skovrlj, Branko; Guzman, Javier Z; Caridi, John; Cho, Samuel K

    2016-02-01

    Study Design Case report. Objective The purpose of this report is to discuss the surgical management of lumbar vertebral osteomyelitis with a spinal epidural abscess (SEA) and present a single-stage, posterior-only circumferential decompression and reconstruction with instrumentation using an expandable titanium cage and without segmental nerve root sacrifice as an option in the treatment of this disease process. Methods We report a 42-year-old man who presented with 3 days of low back pain and chills who rapidly decompensated with severe sepsis following admission. Magnetic resonance imaging of his lumbosacral spine revealed intramuscular abscesses of the left paraspinal musculature and iliopsoas with SEA and L4 vertebral body involvement. The patient failed maximal medical treatment, which necessitated surgical treatment as a last resort for infectious source control. He underwent a previously undescribed procedure in the setting of SEA: a single-stage, posterior-only approach for circumferential decompression and reconstruction of the L4 vertebral body with posterior segmental instrumented fixation. Results After the surgery, the patient's condition gradually improved; however, he suffered a wound dehiscence necessitating a surgical exploration and deep wound debridement. Six months after the surgery, the patient underwent a revision surgery for adjacent-level pseudarthrosis. At 1-year follow-up, the patient was pain-free and off narcotic pain medication and had returned to full activity. Conclusion This patient is the first reported case of lumbar osteomyelitis with SEA treated surgically with a single-stage, posterior-only circumferential decompression and reconstruction with posterior instrumentation. Although this approach is more technically challenging, it presents another viable option for the treatment of lumbar vertebral osteomyelitis that may reduce the morbidity associated with an anterior approach. PMID:26835214

  5. Update: Cytokine Dysregulation in Chronic Nonbacterial Osteomyelitis (CNO

    Directory of Open Access Journals (Sweden)

    Sigrun R. Hofmann

    2012-01-01

    Full Text Available Chronic nonbacterial osteomyelitis (CNO with its most severe form chronic recurrent multifocal osteomyelitis (CRMO is a non-bacterial osteitis of yet unknown origin. Secondary to the absence of both high-titer autoantibodies and autoreactive T lymphocytes, and the association with other autoimmune diseases, it was recently reclassified as an autoinflammatory disorder of the musculoskeletal system. Since its etiology is largely unknown, the diagnosis is based on clinical criteria, and treatment is empiric and not always successful. In this paper, we summarize recent advances in the understanding of possible etiopathogenetic mechanisms in CNO.

  6. Technetium bone scintigraphy in the diagnosis of osteomyelitis in children

    International Nuclear Information System (INIS)

    In a 5 1/2-year retrospective study of hospitalized children with osteomyelitis who had technetium bone scans, we found that 32 of 38 (84%) had increased radionuclide uptake, 4 (11%) had normal uptake and 2 (5%) had decreased uptake. The two patients with decreased uptake had a stormy course with extensive bone destruction and pathologic fractures in spite of prolonged courses of antibiotic therapy. Decreased uptake on bone scan in patients with clinical evidence of osteomyelitis could indicate a poor prognosis and early surgical drainage is indicated in order to decrease morbidity

  7. Role of radionuclide imaging in the diagnosis of acute osteomyelitis

    International Nuclear Information System (INIS)

    Over the last decade, the role of nuclear medicine studies in the diagnosis of acute osteomyelitis has been discussed in depth in the literature. Yet, the respective roles played in this setting by each of the commonly used radionuclide studies often are confusing. In an attempt to develop a cogent diagnostic strategy, we reviewed the literature published within the last 12 years pertaining to the use of radiophosphate bone scintigraphy as well as gallium and indium WBC imaging in the diagnosis of this condition. Based on our findings, we propose an alternative approach to the evaluation of a patient with suspected acute osteomyelitis. 63 references

  8. Inflammatory Metastatic Carcinoma of Sternum Mimicking Sternal Osteomyelitis with Gas Gangrene

    Energy Technology Data Exchange (ETDEWEB)

    Choo, Ji Yung; Je, Bo Kyung; Lee, Ki Yeol; Kim, Baek Hyun [Dept. of Radiology, Korea University College of Medicine, Ansan Hospital, Ansan (Korea, Republic of); Kim, Sung Bum [Dept. of Internal Medicine, Dongshin Hospital, Seoul (Korea, Republic of)

    2013-03-15

    Inflammatory metastasis is a metastatic tumor associated with fever, skin changes, soft tissue inflammation, and laboratory abnormalities, suggesting an inflammation that obscures the underlying malignancy. We report a 69-year-old male with inflammatory metastatic carcinoma of sternum. He presented with clinical findings mimicking osteomyelitis of the sternum. The chest CT scan showed the parasternal soft tissue masses and cortical disruption of sternum which was continuous with air bubbles spreading through the pectoralis muscles. He was diagnosed as poorly-differentiated carcinoma with unknown origin.

  9. Serendipitous diagnosis of childhood xanthogranulomatous pyelonephritis: In a child with osteomyelitis

    International Nuclear Information System (INIS)

    Xanthogranulomatous pyelonephritis (XGP), a rare chronic renal infection in children, usually presents as high fever, pyuria and an abdominal mass. This child with clinical and radiologic evidence of osteomyelitis was not suspected of renal disease until a non-functioning kidney was discovered during a bone scan. The pathologic proven diagnosis of XGP could have been made by correlative imaging using renal ultrasound, a renal scan and a gallium scan. Computed tomography and avoiding cystourethrography provided additional information as to the nature and extent of the disease process. (orig.)

  10. Unusual Case of Occult Brucella Osteomyelitis in the Skull Detected by Bone Scintigraphy

    International Nuclear Information System (INIS)

    Brucellosis is a worldwide infectious disease of animals that can be transmitted to humans. Osteoarticular involvement is the most common complication of brucellosis. A 47-year-old man, who was a stock breeder, complained of myalgia with fever and chills for 2 weeks. The serology titers and blood cultures for brucellosis were positive. Bone scintigraphy demonstrated a focally increased uptake in the left supra orbital area. Plain radiographs showed an osteolytic lesion, and an MRI revealed signal abnormalities in the corresponding site. We present an unusual case of occult Brucella osteomyelitis in the frontal bone of the skull detected by done scintigraphy.

  11. A Pathological Fracture of the Mandible due to Osteomyelitis following a Full Dental Clearance.

    Science.gov (United States)

    Jauhar, Preeti; Handley, Thomas; Hammersley, Nicholas

    2016-03-01

    Orofacial infections following dental extractions are a common referral to an oral and maxillofacial department as an emergency, especially when combined with swelling and limited mouth opening. The case presented demonstrates a rare complication of chronic suppurative osteomyelitis with bilateral pathological fractures of the mandible, which occurred following a staged dental clearance. CPD/Clinical Relevance: Dental extractions are one of the most common treatments carried out by oral surgeons and general dental practitioners. This case highlights a rare but encountered complication of routine oral surgery and demonstrates when it is necessary to make an immediate referral to the local oral and maxillofacial surgery unit. PMID:27188132

  12. Chronic Q-Fever (Coxiella burnetii) Causing Abdominal Aortic Aneurysm and Lumbar Osteomyelitis: A Case Report.

    Science.gov (United States)

    Leahey, P Alexander; Tahan, Steven R; Kasper, Ekkehard M; Albrecht, Mary

    2016-01-01

    Coxiella burnetii is a rare cause of chronic infection that most frequently presents as endocarditis. We report a case of C burnetii causing an infected abdominal aortic aneurysm with contiguous lumbar osteomyelitis resulting in spinal cord compromise. The diagnosis was established by serologic studies consistent with chronic Q-fever (ratio of C burnetii immunoglobulin [Ig]G phase II titer to IgG phase I titer <1) and was confirmed by positive C burnetii polymerase chain reaction of vertebral tissue in addition to pathology of vertebral bone showing intracellular Gram-negative coccobacillary bacteria. The patient clinically improved after surgical decompression and prolonged treatment with doxycycline and hydroxychloroquine. PMID:26730393

  13. Unusual Case of Occult Brucella Osteomyelitis in the Skull Detected by Bone Scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Sohn, Myung Hee; Lim, Seok Tae; Jeong, Young Jin; Kim, Dong Wook; Jeong, Hwan Jeong; Lee, Chang Seob [Chonbuk National University Medical School, Jeonju (Korea, Republic of)

    2010-06-15

    Brucellosis is a worldwide infectious disease of animals that can be transmitted to humans. Osteoarticular involvement is the most common complication of brucellosis. A 47-year-old man, who was a stock breeder, complained of myalgia with fever and chills for 2 weeks. The serology titers and blood cultures for brucellosis were positive. Bone scintigraphy demonstrated a focally increased uptake in the left supra orbital area. Plain radiographs showed an osteolytic lesion, and an MRI revealed signal abnormalities in the corresponding site. We present an unusual case of occult Brucella osteomyelitis in the frontal bone of the skull detected by done scintigraphy.

  14. Osteomyelitis in the neonate. Clinical aspects and the role of radiography and scintigraphy in diagnosis and management

    International Nuclear Information System (INIS)

    Based on experience with 22 cases of neonatal osteomyelitis in 10 years, the authors suggest these patients can be divided into two groups depending on severity of disease. Premature infants requiring umbilical catheterization and severely ill full-term infants constitute a high-risk group; signs are more overt, multifocal infection and joint involvement more frequent, and severe skeletal deformities more common. The patients in the low-risk group had much milder disease but also presented more difficulty in diagnosis because of the vagueness of the presenting signs. Radiographic examination is essential for diagnosis and follow-up of osteomyelitis, particularly limb deformities. Bone scans should be reserved for situations in which the clinical and radiographic findings are equivocal

  15. Paucity of bone scan abnormalities in a child with multifocal osteomyelitis and disseminated sepsis

    International Nuclear Information System (INIS)

    Full text: We present an unusual case of multifocal osteomyelitis with minimal bone scan abnormalities and markedly discordant findings on Magnetic Resonance Imaging(MRI) and gallium scans. A seven-year-old female presented with left leg, right elbow pain and fever. A bone scan was performed. Mild increased vascularity was demonstrated on the dynamic and blood pool phases of the study in the area of the right elbow. In the delayed images there was a photopenic lesion in the left distal femoral metadiaphysis and also irregular uptake in the metaphyseal regions of the long bones. Low grade soft tissue tracer uptake was seen in the left thigh and right forearm. The patient deteriorated clinically and underwent further investigations with MRI and gallium scans. The MRI showed extensive abnormalities with mulitlocular fluid collection seen throughout most of the muscle groups of both thighs suggesting myositis with an associated cellulitis and osteomyelitis of the left femur. The gallium study was markedly abnormal with increased uptake in the distal 2/3rds of the left femur, proximal 1/2 of the right femur, right proximal forearm (mid forearm extending to mid upper arm), left proximal humerus and right hemithorax especially the lower zones. Staphylococcal aureus was cultured. The patient required intensive care management and slowly responded to antibiotic therapy and surgery to drain abscesses in the thighs. A bone marrow biopsy was normal and immunological tests were performed but a result has yet to be determined. The lack of increased bone uptake in the demonstrated areas of osteomyelitis maybe explained on the basis of an overwhelming infective process inhibiting the patient's healing response. Copyright (2000) The Australian and New Zealand Society of Nuclear Medicine Inc

  16. Acute haematogenous community-acquired methicillin-resistant Staphylococcus aureus osteomyelitis in an adult: Case report and review of literature

    OpenAIRE

    Dhanoa Amreeta; Singh Vivek; Mansor Azura; Yusof Mohd; Lim King-Ting; Thong Kwai-Lin

    2012-01-01

    Abstract Background Methicillin-resistant Staphylococcus aureus (MRSA) has of late emerged as a cause of community-acquired infections among immunocompetent adults without risk factors. Skin and soft tissue infections represent the majority of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) clinical presentations, whilst invasive and life-threatening illness like necrotizing pneumonia, necrotizing fasciitis, pyomyositis, osteomyelitis and sepsis syndrome are less comm...

  17. Multiresistant-MRSA tricuspid valve infective endocarditis with ancient osteomyelitis locus

    Directory of Open Access Journals (Sweden)

    Gambarati Gianpaolo

    2006-07-01

    Full Text Available Abstract Background Methicillin-resistant S. aureus (MRSA with low susceptibility to glycopeptides is uncommon. Case presentation The case of a 50-year-old non-drug addict patient presenting with tricuspid valve infective endocarditis (IE by MRSA resistant to vancomycin and linezolid is presented. There was response only to quinupristin/dalfopristin. He had a motorcycling accident four years before undergoing right above-the-knee amputation and orthopaedic fixation of the left limb. There were multiple episodes of left MRSA-osteomyelitis controlled after surgery and vancomycin therapy. MRSA isolated from the blood at the time of IE presented with the same profile than the isolated four years earlier. Sequential treatment with teicoplanin-cotrimoxazole and Linezolid associated to vancomycin – rifampicin – cotrimoxazole had no improvement. Infection was controlled after 28 days of therapy with quinupristin/dalfopristin. Conclusion The literature presents only a few cases of MRSA IE not susceptible to glycopeptides in not drug addicted patients. This case shows the comparison of a highly-resistant MRSA after previous S. aureus osteomyelitis treated with glycopeptides. This is the first description of successful treatment of resistant-MRSA IE of the tricuspid valve complicated by multiple pulmonary septic infarction with quinupristin/dalfopristin

  18. Metaphyseal osteomyelitis in children: how often does MRI-documented joint effusion or epiphyseal extension of edema indicate coexisting septic arthritis?

    International Nuclear Information System (INIS)

    Joint effusions identified by MRI may accompany osteomyelitis and determining whether the joint effusion is septic or reactive has important implications on patient care. Determine the incidence of epiphyseal marrow edema, joint effusions, perisynovial edema and epiphyseal non-enhancement in the setting of pediatric metaphyseal osteomyelitis and whether this may be used to predict coexisting septic arthritis. Following IRB approval, we retrospectively evaluated children who underwent MRI and orthopedic surgical consultation for suspected musculoskeletal infection between January 2011 and September 2013. Criteria for inclusion in the study were microbiologically/pathologically proven infection, MRI prior to surgical intervention, long bone involvement and age 0-18 years. MRI exams were independently reviewed by two faculty pediatric radiologists to confirm the presence of appendicular metaphyseal osteomyelitis, to evaluate extent of edema, to determine subjective presence of a joint effusion and to assess perisynovial edema and epiphyseal non-enhancement. Any discrepant readings were reviewed in consensus. Charts and operative notes were reviewed to confirm the diagnosis of osteomyelitis and septic arthritis. One hundred and three joints with metaphyseal osteomyelitis were identified (mean age: 7.1 years; M:F 1.3:1), of whom 53% (55/103) had joint effusions, and of those, 75% (41/55) had surgically confirmed septic arthritis. The incidence of coexisting septic arthritis was 40% in the setting of epiphyseal edema, 74% in epiphyseal edema and effusion, 75% with perisynovial edema, 76% with epiphyseal non-enhancement and 77% when all four variables were present. Of these, the only statistically significant variable, however, was the presence of a joint effusion with a P-value of <0.0001 via Fisher exact test. Statistical significance for coexisting septic arthritis was also encountered when cases were subdivided into intra-articular vs. extra-articular metaphyses (P

  19. Metaphyseal osteomyelitis in children: how often does MRI-documented joint effusion or epiphyseal extension of edema indicate coexisting septic arthritis?

    Energy Technology Data Exchange (ETDEWEB)

    Schallert, Erica K.; Kan, J.H.; Monsalve, Johanna; Zhang, Wei; Bisset, George S. [Texas Children' s Hospital, Department of Pediatric Radiology, Houston, TX (United States); Rosenfeld, Scott [Texas Children' s Hospital, Department of Pediatric Orthopedic Surgery, Houston, TX (United States)

    2015-08-15

    Joint effusions identified by MRI may accompany osteomyelitis and determining whether the joint effusion is septic or reactive has important implications on patient care. Determine the incidence of epiphyseal marrow edema, joint effusions, perisynovial edema and epiphyseal non-enhancement in the setting of pediatric metaphyseal osteomyelitis and whether this may be used to predict coexisting septic arthritis. Following IRB approval, we retrospectively evaluated children who underwent MRI and orthopedic surgical consultation for suspected musculoskeletal infection between January 2011 and September 2013. Criteria for inclusion in the study were microbiologically/pathologically proven infection, MRI prior to surgical intervention, long bone involvement and age 0-18 years. MRI exams were independently reviewed by two faculty pediatric radiologists to confirm the presence of appendicular metaphyseal osteomyelitis, to evaluate extent of edema, to determine subjective presence of a joint effusion and to assess perisynovial edema and epiphyseal non-enhancement. Any discrepant readings were reviewed in consensus. Charts and operative notes were reviewed to confirm the diagnosis of osteomyelitis and septic arthritis. One hundred and three joints with metaphyseal osteomyelitis were identified (mean age: 7.1 years; M:F 1.3:1), of whom 53% (55/103) had joint effusions, and of those, 75% (41/55) had surgically confirmed septic arthritis. The incidence of coexisting septic arthritis was 40% in the setting of epiphyseal edema, 74% in epiphyseal edema and effusion, 75% with perisynovial edema, 76% with epiphyseal non-enhancement and 77% when all four variables were present. Of these, the only statistically significant variable, however, was the presence of a joint effusion with a P-value of <0.0001 via Fisher exact test. Statistical significance for coexisting septic arthritis was also encountered when cases were subdivided into intra-articular vs. extra-articular metaphyses (P

  20. Vertebral body osteomyelitis in the horse

    International Nuclear Information System (INIS)

    The clinical signs, laboratory data, results of nuclear scintigraphy and radiographic examination of five horses with vertebral body osteomyelitis are described together with response to treatment. Three horses were less than five months of age. Four horses demonstrated hindlimb paresis and in three a focus of pain in the thoracolumbar region could be identified. An umbilical abscess, a caudal lobe lung abscess and a patent urachus were considered primary niduses of infection in each of three horses. Leucocytosis, neutrophilia, anaemia and elevated fibrinogen were the most consistent laboratory abnormalities. Nuclear scintigraphy was performed in three horses and identified the site of the vertebral lesion which was subsequently evaluated radiographically. In the other two horses radiographic examination in the region of areas of focal pain identified a lesion. Radiographic abnormalities included compression fractures of vertebral bodies (two), proliferative new bone (three) and soft tissue swelling ventral to a vertebral body (one). Two horses, including one with a compression fracture of the second lumbar vertebra, received parenteral antimicrobial therapy for 40 and 74 days, respectively. When re-examined six months later they showed no neurological abnormalities. The other three horses failed to respond to antimicrobial treatment and were humanely destroyed. The horse with a lung abscess also had an abscess cranial to the right tuber coxae which extended into the vertebral bodies of the third and fourth lumbar vertebrae from which Streptococcus zooepidemicus was cultured. A horse with proliferative new bone on the ventral aspect of the fifth and sixth thoracic vertebrae had a mediastinal mass associated with these vertebrae and fungal granulomas, from which Aspergillus species was cultured, in the heart and aorta, trachea, spleen and kidney. The horse with a patent urachus and soft tissue swelling ventral to the vertebral body of the 12th thoracic vertebra

  1. Osteomyelitis: a review of currently used imaging techniques

    International Nuclear Information System (INIS)

    Conventional radiographs remain the initial imaging modality involved in the diagnosis of osteomyelitis. Bone scintigraphy and its specific agents did not only eliminate the problems of inherent low sensitivity of conventional radiographs, but also increased the specificity to higher degrees. Spiral CT, on the other hand, has solved several diagnostic problems, such as osteomyelitis of the sterno-clavicular junction and hidden areas in the pelvic bones. Magnetic resonance imaging with its multiplanar capability, greater anatomic details and excellent soft tissue bone marrow contrast resolution has a significant role in surgical planning and limb preservation. Ultrasound and US-guided aspiration has recently been involved in the diagnosis and management of osteomyelitis with several advantages particularly in children. Our goal in this review is to outline the ability of various imaging techniques by comparing their strengths and weaknesses in the diagnosis of osteomyelitis. Finally, we suggest various imaging algorithms for specific clinical scenarios. Spondylitis and septic arthritis are not discussed in this review. (orig.)

  2. The MRI appearances of early vertebral osteomyelitis and discitis

    Energy Technology Data Exchange (ETDEWEB)

    Dunbar, J.A.T.; Sandoe, J.A.T. [Department of Microbiology, Leeds General Infirmary, Leeds LS1 3EX (United Kingdom); Rao, A.S. [Department of Orthopaedics, Leeds General Infirmary, Leeds LS1 3EX (United Kingdom); Crimmins, D.W. [Department of Neurosurgery, Leeds General Infirmary, Leeds LS1 3EX (United Kingdom); Baig, W. [Department of Cardiology, Leeds General Infirmary, Leeds LS1 3EX (United Kingdom); Rankine, J.J., E-mail: james.rankine@leedsth.nhs.u [Department of Radiology, Leeds General Infirmary, Leeds LS1 3EX (United Kingdom); Leeds Musculoskeletal Biomedical Research Unit, Leeds (United Kingdom)

    2010-12-15

    Aim: To describe the magnetic resonance imaging (MRI) appearances in patients with a clinical history suggestive of vertebral osteomyelitis and discitis who underwent MRI very early in their clinical course. Materials and methods: A retrospective review of the database of spinal infections from a spinal microbiological liaison team was performed over a 2 year period to identify cases with clinical features suggestive of spinal infection and an MRI that did not show features typical of vertebral osteomyelitis and discitis. All patients had positive microbiology and a follow up MRI showing typical features of spinal infection. Results: In four cases the features typical of spinal infection were not evident at the initial MRI. In three cases there was very subtle endplate oedema associated with disc degeneration, which was interpreted as Modic type I degenerative endplate change. Intravenous antibiotic therapy was continued prior to repeat MRI examinations. The mean time to the repeat examination was 17 days with a range of 8-22 days. The second examinations clearly demonstrated vertebral osteomyelitis and discitis. Conclusion: Although MRI is the imaging method of choice for vertebral osteomyelitis and discitis in the early stages, it may show subtle, non-specific endplate subchondral changes; a repeat examination may be required to show the typical features.

  3. The importance of skeletal scintigraphy for diagnosis of infant osteomyelitis

    International Nuclear Information System (INIS)

    As the prognosis of osteomyelitis critically depends on early treatment, early detection of the condition is of paramount importance. While bone scans are known to suggest the diagnosis in children before X-rays show structural changes, a major proportion of radionuclide studies, particularly in patients with neonatal osteomyelitis, has repeatedly been reported to be negative. This prompted us to compare clinical signs and symptoms, laboratory parameters, microbiologic and histologic data with the results of X-ray films and bone scans in a retrospective study involving 160 children aged between 9 days and 16 years. Of the 43 children with verified osteomyelitis, only 3 had negative X-rays and bone scans. Negative scans in the presence of X-ray abnormalities were neither seen in newborns and infants nor in older children. But in 8 children bone scans correctly detected the condition at a time at which X-rays were still normal. Of the 117 children in whom suspected osteomyelitis was not confirmed none had positive bone scans. (Author)

  4. Treatment of chronic osteomyelitis with one-stage allograft

    Institute of Scientific and Technical Information of China (English)

    LU Wei-ju; LI Bin; BAO Ni-rong; QIAN Hong-bo; ZENG Xiao-feng; XU Bin; CHEN Yong; ZHAO Jian-ning

    2006-01-01

    Objective: To avoid disadvantages of two-stage cancellus bone autograft, we investigated the feasibility of one-stage allograft for reconstructing the bone defect resulting from debridement of chronic osteomyelitis in limbs.Methods: Between Feb. 1999 and Apr. 2004, 35 cases of chronic osteomyelitis (8 cases of nonunion )underwent one-stage allograft after debridement in our hospital.Results: Thirty-five cases were followed up for an average period of 28 months (range, 13 to 55 months), in which 32 cases (91.43%) were found no infection, and 3cases (8.57 %) were confirmed recurrence of infection.Four out of 8 cases of bone nonunion healed in 9.5 months on average (range, 3 to 12 months), and another case also acquired union after redebridement and autograft of ilium due to infection recurrence 35 days after surgery.Renonunion occurred in 3 cases, 2 out of whom healed after secondary operation with autograft. One case of renonunion and 2 cases of infection recurrence refused further treatment.Conclusions: A high rate of infection arrest can be attained when one-stage allograft is used to reconstruct the bone defect of chronic osteomyelitis after debridement in limbs. Therefore, chronic osteomyelitis should not be regarded as a contraindication to one-stage allogeneic bone grafting. Renonuion, however, achieves a relatively high rate, especially in cases of segmental bone defect.

  5. A case of radiation ulcer of chest wall with osteomyelitis

    International Nuclear Information System (INIS)

    We report a case of anterior chest skin ulcer with rib and sternum osteomyelitis following radiation therapy for post operative mammary carcinoma. Operation was performed six times including debridement with sternum and rib resection reconstruction and skin grafting. It took about one and a half years after first operation to heal the ulcer with osteomyelitis. Principle of treatment for radiation ulcer accompanied by osteomyelitis is complete resection of the damaged lesion. However, it is difficult to evaluate the exact area of the damaged lesion. Therefore it is not rare to repeat its recurrence and have trouble with its treatment. In this case, it was considered that the resected area was insufficient on the initial operation. In order to treat for radiation ulcers accompanied by osteomyelitis, enough resection of the damaged lesion in the initial operation is necessary. Ultimately, in our case, the resection of all sternum, part of the right second to fifth rib and part of left second to seventh rib was necessary. It is generally said that reconstructing bone structure is required in the case of wide defect of chest wall. Though, we did not perform reconstruction of the bone structures, there is no problem in the condition of respiratory system. The surrounding soft tissues changed to hard enough to avoid paradoxical breathing. (author)

  6. The MRI appearances of early vertebral osteomyelitis and discitis

    International Nuclear Information System (INIS)

    Aim: To describe the magnetic resonance imaging (MRI) appearances in patients with a clinical history suggestive of vertebral osteomyelitis and discitis who underwent MRI very early in their clinical course. Materials and methods: A retrospective review of the database of spinal infections from a spinal microbiological liaison team was performed over a 2 year period to identify cases with clinical features suggestive of spinal infection and an MRI that did not show features typical of vertebral osteomyelitis and discitis. All patients had positive microbiology and a follow up MRI showing typical features of spinal infection. Results: In four cases the features typical of spinal infection were not evident at the initial MRI. In three cases there was very subtle endplate oedema associated with disc degeneration, which was interpreted as Modic type I degenerative endplate change. Intravenous antibiotic therapy was continued prior to repeat MRI examinations. The mean time to the repeat examination was 17 days with a range of 8-22 days. The second examinations clearly demonstrated vertebral osteomyelitis and discitis. Conclusion: Although MRI is the imaging method of choice for vertebral osteomyelitis and discitis in the early stages, it may show subtle, non-specific endplate subchondral changes; a repeat examination may be required to show the typical features.

  7. Complications of Candidemia in ICU Patients: Endophthalmitis, Osteomyelitis, Endocarditis.

    Science.gov (United States)

    Kauffman, Carol A

    2015-10-01

    Bloodstream infection with Candida species is not uncommon in the intensive care unit setting and has the potential to distribute organisms to many different organ systems causing secondary infections, such as endophthalmitis, osteomyelitis, and endocarditis. In some patients, these types of infections become manifested shortly after the episode of candidemia. In others, especially vertebral osteomyelitis, weeks pass before the diagnosis is entertained. Endophthalmitis should be sought by a retinal examination in all patients early after an episode of candidemia. Both osteomyelitis and endocarditis are less common complications of candidemia than endophthalmitis. In patients who manifest symptoms or signs suggesting these infections, magnetic resonance imaging and transesophageal echocardiography, respectively, are extremely helpful diagnostic tests. Newer approaches to the treatment of these infections allow the use of better tolerated, safer antifungal agents. Endophthalmitis is often treated with fluconazole or voriconazole, and the echinocandins are increasingly used, instead of amphotericin B, as initial therapy for osteomyelitis and endocarditis before step-down therapy to oral azole agents. PMID:26398531

  8. Candida osteomyelitis and disc space infection of the lumbar spine

    International Nuclear Information System (INIS)

    Candida osteomyelitis is an uncommon complication of immunosuppressive therapy. Its radiographic manifestations are similar to those of other relatively indolent infectious agents. We report the CT and MR findings in a patient who developed this condition following treatment for acute myelogenous leukemia, and review the imaging literature covering similar cases. (orig.). With 7 figs

  9. Candida osteomyelitis and disc space infection of the lumbar spine

    Energy Technology Data Exchange (ETDEWEB)

    Munk, P.L. [British Columbia Cancer Agency - Vancouver Center, University of British Columbia, Vancouver, BC (Canada)]|[British Columbia Cancer Agency, Vancouver, BC (Canada); Lee, M.J. [British Columbia Cancer Agency - Vancouver Center, University of British Columbia, Vancouver, BC (Canada); Poon, P.Y. [British Columbia Cancer Agency - Vancouver Center, University of British Columbia, Vancouver, BC (Canada); O`Connell, J.X. [Department of Pathology, Vancouver Hospital and Health Sciences Center, and University of British Columbia, Vancouver, BC (Canada); Coupland, D.B. [Department of Radiology, Vancouver Hospital and Health Sciences Center, and University of British Columbia, Vancouver, BC (Canada); Janzen, D.L. [Department of Radiology, Vancouver Hospital and Health Sciences Center, and University of British Columbia, Vancouver, BC (Canada); Logan, P.M. [Department of Radiology, Vancouver Hospital and Health Sciences Center, and University of British Columbia, Vancouver, BC (Canada); Dvorak, M.F. [Department of Orthopedic Surgery, Vancouver Hospital and Health Sciences Center, and University of British Columbia, Vancouver, BC (Canada)

    1997-01-01

    Candida osteomyelitis is an uncommon complication of immunosuppressive therapy. Its radiographic manifestations are similar to those of other relatively indolent infectious agents. We report the CT and MR findings in a patient who developed this condition following treatment for acute myelogenous leukemia, and review the imaging literature covering similar cases. (orig.). With 7 figs.

  10. First Case of Osteomyelitis Due to Shewanella algae

    OpenAIRE

    Botelho-Nevers, E.; Gouriet, F.; Rovery, C.; Paris, P.; Roux, V.; Raoult, D.; Brouqui, P.

    2005-01-01

    Shewanella spp. are infrequently recovered from clinical specimens. We report here on the first case of osteomyelitis due to Shewanella algae. This bacterium, at first misidentified by phenotypic tests as Shewanella putrefaciens, was subsequently identified correctly as S. algae by 16S rRNA gene sequence analysis.

  11. Calcaneal Quantitative Ultrasound Indicates Reduced Bone Status Among Physically Active Adult Forager-Horticulturalists.

    Science.gov (United States)

    Stieglitz, Jonathan; Madimenos, Felicia; Kaplan, Hillard; Gurven, Michael

    2016-03-01

    Sedentary lifestyle contributes to osteoporosis and fragility fracture risks among modern humans, but whether such risks are prevalent in physically active preindustrial societies with lower life expectancies is unclear. Osteoporosis should be readily observable in preindustrial societies if it was regularly experienced over human history. In this study of 142 older adult Tsimane forager-horticulturalists (mean age ± SD, 62.1 ± 8.6 years; range, 50 to 85 years; 51% female) we used calcaneal quantitative ultrasonography (qUS) to assess bone status, document prevalence of adults with reduced bone status, and identify factors (demographic, anthropometric, immunological, kinesthetic) associated with reduced bone status. Men (23%) are as likely as women (25%) to have reduced bone status, although age-related decline in qUS parameters is attenuated for men. Adiposity and fat-free mass positively co-vary with qUS parameters for women but not men. Leukocyte count is inversely associated with qUS parameters controlling for potential confounders; leukocyte count is positively correlated within adults over time, and adults with persistently low counts have higher adjusted qUS parameters (6% to 8%) than adults with a high count. Reduced bone status characteristic of osteoporosis is common among active Tsimane with minimal exposure to osteoporosis risk factors found in industrialized societies, but with energetic constraints and high pathogen burden. © 2015 American Society for Bone and Mineral Research. PMID:26460548

  12. Macrophage imaging by USPIO-enhanced MR for the differentiation of infectious osteomyelitis and aseptic vertebral inflammation

    Energy Technology Data Exchange (ETDEWEB)

    Bierry, Guillaume [University Hospital, Department of Radiology, Strasbourg (France); University Louis Pasteur, EA 3432, Strasbourg (France); Jehl, Francois [University Hospital of Strasbourg, Department of Bacteriology, Strasbourg (France); University Louis Pasteur, EA 3432, Strasbourg (France); Boehm, Nelly [University Louis Pasteur, Institute of Histology, Faculty of Medicine, Strasbourg (France); University Louis Pasteur, INSERM U666, Strasbourg (France); Robert, Philippe [Guerbet Research, Roissy (France); Dietemann, Jean-Louis; Kremer, Stephane [University Hospital, Department of Radiology, Strasbourg (France)

    2009-07-15

    The purpose of this study was to prospectively evaluate USPIO-enhanced MR imaging for the differentiation of vertebral infectious osteomyelitis and sterile inflammation. Vertebral osteomyelitis and sterile vertebral inflammation were induced in two groups of six rabbits each. MRI examinations were performed including unenhanced and gadolinium-enhanced fat-saturated SE T1w sequences. Once endplate enhancement was observed on the T1 gadolinium-enhanced MR sequence, a second MRI examination (SE T1w sequence) was performed 24 h after USPIO administration (45 {mu}mol Fe/kg). MR imaging was correlated with histopathological findings (macrophage immunostaining and Perls Prussian blue staining). On gadolinium-enhanced T1 sequences, a significant SNR increase in vertebral endplates was present in both groups without significant difference between the two groups (P = 0.26). On USPIO-enhanced T1 sequences, a significant SNR increase was only observed in the infection group (P = 0.03) with a significant difference in SNR between the infection and the sterile-inflammation groups (P = 0.002). Infected areas presented replacement of bone marrow by an intense macrophage infiltration, some being iron-loaded. Sterile inflammation showed a replacement of bone marrow by inflammatory tissue with only rare macrophages without any Perls blue staining. USPIO-enhanced MR imaging can distinguish infectious osteomyelitis from sterile vertebral inflammation due to different macrophage distributions in the two lesions. (orig.)

  13. Macrophage imaging by USPIO-enhanced MR for the differentiation of infectious osteomyelitis and aseptic vertebral inflammation

    International Nuclear Information System (INIS)

    The purpose of this study was to prospectively evaluate USPIO-enhanced MR imaging for the differentiation of vertebral infectious osteomyelitis and sterile inflammation. Vertebral osteomyelitis and sterile vertebral inflammation were induced in two groups of six rabbits each. MRI examinations were performed including unenhanced and gadolinium-enhanced fat-saturated SE T1w sequences. Once endplate enhancement was observed on the T1 gadolinium-enhanced MR sequence, a second MRI examination (SE T1w sequence) was performed 24 h after USPIO administration (45 μmol Fe/kg). MR imaging was correlated with histopathological findings (macrophage immunostaining and Perls Prussian blue staining). On gadolinium-enhanced T1 sequences, a significant SNR increase in vertebral endplates was present in both groups without significant difference between the two groups (P = 0.26). On USPIO-enhanced T1 sequences, a significant SNR increase was only observed in the infection group (P = 0.03) with a significant difference in SNR between the infection and the sterile-inflammation groups (P = 0.002). Infected areas presented replacement of bone marrow by an intense macrophage infiltration, some being iron-loaded. Sterile inflammation showed a replacement of bone marrow by inflammatory tissue with only rare macrophages without any Perls blue staining. USPIO-enhanced MR imaging can distinguish infectious osteomyelitis from sterile vertebral inflammation due to different macrophage distributions in the two lesions. (orig.)

  14. Etiology and Antimicrobial Susceptibility of Bace­rial Septic Arthritis and Osteomyelitis

    Directory of Open Access Journals (Sweden)

    N Kalantari

    2007-09-01

    Full Text Available Background: To assess the distribution and resistance of the pathogens responsible for septic arthritis and osteomyelitis over a 10 years period in children admitted to Children's Medical Center Hospital, Tehran, Iran.Methods: Microbiologic and clinical presentation reports from 145 cases of septic arthritis and osteomyelitis from March 1995 to February 2005 were retrospectively reviewed. Results: Of 145 cases, 71(49% had positive culture: 71.8%(51/71 of organisms were isolated from synovial fluid alone, 8.4%(6/71 from blood culture alone and 19.7% (14/71 from both synovial fluids and blood cultures. Staphylococcus aureus was the most common pathogen isolated, making up 60.5% of all positive cultures, followed by Klebsiella spp. (14% and coagulase-negative staphylococci (8.4%. Thirty eight percent of S. aureus and 84% of coagulase-negative staphylo­cocci isolates were resistant to cloxacillin. All isolates of S. aureus were susceptible to clindamycin and also, 89% were susceptible to vancomycin. Among Klebsiella spp., amikacin was shown to be very effective, with susceptibility rates of 100%. Haemophilus influenzae was identified in only 2% of all patients.Conclusion: The present study highlights the importance of characterizing the etiology and antibiotic susceptibility of organ­isms causing septic arthritis or osteomylitis in children.

  15. Bacterial chondronecrosis with osteomyelitis and lameness in broilers: a review.

    Science.gov (United States)

    Wideman, Robert F

    2016-02-01

    This review focuses on a specific cause of lameness known as bacterial chondronecrosis with osteomyelitis (BCO) in broilers. Rapid increases in body weight impose excessive torque and shear stress on structurally immature epiphyseal and physeal cartilage, primarily in the proximal femora, proximal tibiae, and flexible thoracic vertebrae. Excessive mechanical stress creates osteochondrotic clefts among the chondrocytes of susceptible growth plates. These wound sites are colonized by hematogenously distributed opportunistic bacteria, culminating in the gross abscesses and necrotic voids that are pathognomonic for terminal BCO. Lameness attributable to characteristic BCO lesions can be reproduced by rearing broilers on wire flooring to create persistent footing instability and physiological stress, without the need to inoculate the birds with pathogenic bacteria that presumably are present but quiescent within the bird's microbial communities or in the environment. Experiments using the wire-flooring model revealed innate differences in the susceptibility of broiler lines to BCO, and demonstrated that BCO incidences can be reduced by prophylactically providing probiotics in the feed, by prophylactically adding 25-hydroxy vitamin D3 to the drinking water, or by therapeutically adding the antibiotic enrofloxacin to the drinking water. Hatchery and chick quality issues clearly influence the susceptibility of broilers to BCO. When broilers remain in a sitting posture for prolonged periods, the major arteries supplying their legs may be compressed. These episodes of inadequate blood flow may prevent chondrocyte maturation and trigger focal necrosis, thereby making the epiphyseal and physeal cartilage highly susceptible to osteochondrosis and BCO. Much remains to be revealed regarding the pathogenesis of BCO. Further revelations will be facilitated by the availability of the now-validated wire-flooring models that consistently trigger high incidences of BCO in experimental

  16. Chronic Osteomyelitis of Clavicle in a Neonate: Report of Morbid Complication of Adjoining MRSA Abscess.

    Science.gov (United States)

    Suranigi, Shishir Murugharaj; Joshi, Manoj; Deniese, Pascal Noel; Rangasamy, Kanagasabai; Najimudeen, Syed; Gnanadoss, James J

    2016-01-01

    Osteomyelitis of clavicle is rare in neonates. Acute osteomyelitis of clavicle accounts for less than 3% of all osteomyelitis cases. It may occur due to contiguous spread, due to hematogenous spread, or secondary to subclavian catheterization. Chronic osteomyelitis may occur as a complication of residual adjoining abscess due to methicillin resistant staphylococcus aureus (MRSA) sepsis. We report a newborn female with right shoulder abscess that developed chronic clavicular osteomyelitis in follow-up period after drainage. She required multiple drainage procedures and was later successfully managed with bone curettage and debridement. We report this case to highlight that a MRSA abscess may recur due to residual infection from a chronic osteomyelitis sinus. It may be misdiagnosed as hypergranulation tissue of nonhealing wound leading to inappropriate delay in treatment. High index of suspicion, aggressive initial management, and regular follow-up are imperative to prevent this morbid complication. PMID:27051549

  17. Chronic Osteomyelitis of Clavicle in a Neonate: Report of Morbid Complication of Adjoining MRSA Abscess

    Directory of Open Access Journals (Sweden)

    Shishir Murugharaj Suranigi

    2016-01-01

    Full Text Available Osteomyelitis of clavicle is rare in neonates. Acute osteomyelitis of clavicle accounts for less than 3% of all osteomyelitis cases. It may occur due to contiguous spread, due to hematogenous spread, or secondary to subclavian catheterization. Chronic osteomyelitis may occur as a complication of residual adjoining abscess due to methicillin resistant staphylococcus aureus (MRSA sepsis. We report a newborn female with right shoulder abscess that developed chronic clavicular osteomyelitis in follow-up period after drainage. She required multiple drainage procedures and was later successfully managed with bone curettage and debridement. We report this case to highlight that a MRSA abscess may recur due to residual infection from a chronic osteomyelitis sinus. It may be misdiagnosed as hypergranulation tissue of nonhealing wound leading to inappropriate delay in treatment. High index of suspicion, aggressive initial management, and regular follow-up are imperative to prevent this morbid complication.

  18. Role of MRI in the diagnosis and treatment of osteomyelitis in pediatric patients

    Institute of Scientific and Technical Information of China (English)

    Brian; S; Pugmire; Randheer; Shailam; Michael; S; Gee

    2014-01-01

    Osteomyelitis is a significant cause of morbidity in children throughout the world. Multiple imaging modalities can be used to evaluate for suspected osteomyelitis, however magnetic resonance imaging(MRI) has distinct advantages over other modalities given its ability to detect early changes related to osteomyelitis, evaluate the true extent of disease, depict extraosseous spread of infection, and help guide surgical manage-ment. MRI has assumed a greater role in the evaluation of osteomyelitis with the increase in musculoskeletal infections caused by methicillin-resistant Staphylococ-cus aureus which have unique imaging features that are well-demonstrated with MRI. This review focuses primarily on the use of MRI in the evaluation of osteo-myelitis in children and will include a discussion of the clinically important and characteristic findings on MRI of acute bacterial osteomyelitis and related conditions.

  19. Antimicrobial photodynamic therapy in chronic osteomyelitis induced by Staphylococcus aureus: An in vitro and in vivo study

    Science.gov (United States)

    dos Reis Júnior, João Alves; de Assis, Patrícia Nascimento; Paraguassú, Gardênia Matos; de Vieira de Castro, Isabele Cardoso; Trindade, Renan Ferreira; Marques, Aparecida Maria Cordeiro; Almeida, Paulo Fernando; Pinheiro, Antônio Luiz Barbosa

    2012-09-01

    Osteomyelitis it is an acute or chronic inflammation in the marrow spaces in the superficial or cortical bone, and associated to bacterial infection. Chronic osteomyelitis represents a major health problem due to its difficult treatment and increased morbidity. Antimicrobial photodynamic therapy (APT) by laser is a treatment based on a cytotoxic photochemical reaction in which, a bright light produced by a laser system and an active photosensitizer absorbed by cells leads an activation that induces a series of metabolic reactions that culminates a bacterial killing. The aim of this study was to assess, both in vitro and in vivo, the effect of lethal laser photosensitization on osteomyelitis. On the in vitro study a diode laser (λ660nm; 40mW; o/ = 0.4 cm2; 5 or 10 J/cm2) and 5, 10 and 15μg/mL toluidine blue (TB) were tested and the best parameter chosen for the in vivo study. The concentration of 5μg/mL was selected to perform the decontamination of infected by Staphylococcus aureus tibial bone defects in rats. The results were performed by ANOVA test. On the in vitro studies all PDTs groups in the different concentrations reduced significantly (p<0,001) the amount of bacteria. On the in vivo study PDT group presented a bacterial reduction of 97,4% (P<0,001). The photodynamic therapy using toluidine blue was effective in reducing the staphiloccocus aureus in both in vitro and in vivo studies.

  20. Role of MRI in the diagnosis and treatment of osteomyelitis in pediatric patients

    OpenAIRE

    Pugmire, Brian S; Shailam, Randheer; Gee, Michael S.

    2014-01-01

    Osteomyelitis is a significant cause of morbidity in children throughout the world. Multiple imaging modalities can be used to evaluate for suspected osteomyelitis, however magnetic resonance imaging (MRI) has distinct advantages over other modalities given its ability to detect early changes related to osteomyelitis, evaluate the true extent of disease, depict extraosseous spread of infection, and help guide surgical management. MRI has assumed a greater role in the evaluation of osteomyelit...

  1. Radionuclide imaging in early detection of childhood osteomyelitis and its differentiation from cellulitis and bone infarction

    International Nuclear Information System (INIS)

    In children, radionuclide skeletal imaging with sup(99m)Tc-phosphate compounds is significantly more sensitive than roentgenographic studies in the early detection of osteomyelitis and septic arthritis. The scintigraphic patterns are usually characteristic. Cellulitis and some cases of early infarction are easily differentiated from osteomyelitis. However, some cases of infarction are indistinguishable from osteomyelitis on sup(99m)Tc-phosphate scan. In these cases 67Ga-citrate may prove helpful

  2. Alterations to Bone Mineral Composition as an Early Indication of Osteomyelitis in the Diabetic Foot

    OpenAIRE

    Esmonde-White, Karen A.; Esmonde-White, Francis W. L.; Holmes, Crystal M.; Morris, Michael D.; Roessler, Blake J.

    2013-01-01

    OBJECTIVE Osteomyelitis in the diabetic foot is a major risk factor for amputation, but there is a limited understanding of early-stage infection, impeding limb-preserving diagnoses. We hypothesized that bone composition measurements provide insight into the early pathophysiology of diabetic osteomyelitis. RESEARCH DESIGN AND METHODS Compositional analysis by Raman spectroscopy was performed on bone specimens from patients with a clinical diagnosis of osteomyelitis in the foot requiring surgi...

  3. 骶椎隐球菌骨髓炎一例报告%Cryptococcus neoformans osteomyelitis of the sacral vertebrae:a case report

    Institute of Scientific and Technical Information of China (English)

    陈志源; 丁焕文; 涂强; 沈健坚; 刘辉亮; 王虹; 滕强; 贾军锋; 庾广文

    2014-01-01

    Objective To report a case of cryptococcus neoformans osteomyelitis of the sacral vertebrae and to analyze the cause of misdiagnosis. Methods The clinical data of a patient with cryptococcus neoformans osteomyelitis of the sacral vertebrae who was adopted in 2012 were retrospectively analyzed. Results Intermittent pain in the sacrum occurred to the patient without any obvious precipitating factors, which became worse at night. And meanwhile, the patient had low-grade fever. Whole body bone scan and single photon emission computed tomography ( SPECT )/CT showed abnormally active metabolism in the sacrum and bony defects and changes in the right margin. Therefore, bone tumors were considered. Sacral metastases was conifrmed using CT-guided needle aspiration biopsy. Debridement was performed after multidisciplinary consultation. The intraoperative frozen pathology presented fungal infections. The postoperative routine pathological examination showed pyogenic and inlfammatory granulomas and there were fungal spores in the histocytes. At last, sacral cryptococcus infections was diagnosed. Conclusions The partial performance of cryptococcus neoformans osteomyelitis of the sacral vertebrae is similar to that of malignant tumors of the sacral vertebrae. So clinical doctors should raise the awareness of the disease. It is necessary to ifrst rule out the possibility of cryptococcus neoformans osteomyelitis of the sacral vertebrae before making the diagnosis of malignant tumors of the sacral vertebrae.

  4. Chronic Osteomyelitis in Sternum Mimicking Bone Metastasis of Lung Cancer Patient

    International Nuclear Information System (INIS)

    Primary sternal osteomyelitis without predisposing factors is a rare condition, and it is hardly differentiated from metastatic bone tumor especially in patient with the history of primary malignancy because osteomyelitis shares frequently common findings with metastatic bone lesion on 18F-FDG PET and bone scan. Although there have been several publications of primary osteomyelitis mimicking bone metastasis in the spine or extremities, we report a case of primary sternal osteomyelitis in the patient with lung cancer, which has, to our knowledge, not been reported before

  5. Chronic Osteomyelitis in Sternum Mimicking Bone Metastasis of Lung Cancer Patient

    Energy Technology Data Exchange (ETDEWEB)

    Im, Hyung Jun; Kim, Yu Keong; Lee, Sang Mi; Lee, Won Woo; Kim, Sang Eun [Seoul National University Bundang Hospital, Seoul (Korea, Republic of)

    2009-06-15

    Primary sternal osteomyelitis without predisposing factors is a rare condition, and it is hardly differentiated from metastatic bone tumor especially in patient with the history of primary malignancy because osteomyelitis shares frequently common findings with metastatic bone lesion on {sup 18}F-FDG PET and bone scan. Although there have been several publications of primary osteomyelitis mimicking bone metastasis in the spine or extremities, we report a case of primary sternal osteomyelitis in the patient with lung cancer, which has, to our knowledge, not been reported before.

  6. Dual functioning microspheres embedded crosslinked gelatin cryogels for therapeutic intervention in osteomyelitis and associated bone loss.

    Science.gov (United States)

    Pandey, Gitu; Mittapelly, Naresh; Pant, Anamika; Sharma, Shweta; Singh, Pratiksha; Banala, Venkatesh Teja; Trivedi, Ritu; Shukla, P K; Mishra, P R

    2016-08-25

    In the present research,we simultaneously addressed the condition of osteomyelitis and osteoporosis by developing a gelatin based chemically cross linked cryogel system embedded with CaCO3 microspheres and ciprofloxacin hydrochloride was incorporated in both the microspheres and the 3D matrix of cryogel. The fabricated cryogel was characterized for the swelling ratio, swelling kinetics, porosity, pore volume, compression strength and in vitro rate of degradation which were found to be dependent on the concentration of gelatin, duration of freezing and number of freeze-thaw cycles. The sustained release of drug was obtained up to 21days after the initial burst, and the concentration was maintained above the MIC for the entire duration of the study. The in vitro antibacterial study in Staphylococcus aureus and Escherichia coli exhibited 33mm, 30mm, 28mm, 27mm and 43mm, 37mm, 37mm, and 36mm zone of inhibition respectively at day 1, 3, 5 and 7. The cell viability, number of cells in the growth phase and alkaline phosphatase levels were found to be significantly higher in rat osteoblasts cultured in cryogel as compared to 2D surface. All these results demonstrate the propitious potential of this microsphere incorporated, ciprofloxacin-loaded, industrially scalable cryogel system for therapeutic intervention in osteoporosis and associated osteomyelitis. PMID:27287423

  7. Bilateral mandibular osteomyelitis mimicking periapical cysts in a patient with sickle cell anemia

    Science.gov (United States)

    Araújo, Juliane Pirágine; Cadavid, Ana Maria Hoyos; Lemos, Celso Augusto; Trierveiler, Marilia

    2015-01-01

    Sickle cell anemia (SCA) is a hemoglobin disorder that occurs more commonly among Afro-descendants. The authors report the case of a 28-year-old Afro-descendent male patient with the diagnosis of homozygotic sickle cell disease (SCD) referred for evaluation of mandibular lesions. The patient’s main complaints included pain and bilateral teeth mobility. An intraoral examination revealed gingiva recession affecting the lower molars with extensive root exposure. A panoramic x-ray showed two radiolucent symmetrical periapical lesions evolving both the first and the second lower molars, bilaterally. The diagnostic hypotheses comprised odontogenic infection, among others. Besides antimicrobial therapy, the two molars of both sides were extracted and bone was collected for histopathological and microbiological analyses. Osteomyelitis was diagnosed, and Streptococcus viridans was recovered from the culture media. Mandibular osteomyelitis should be considered as a diagnosis in patients with SCD. The present case offers an alert to clinicians about the importance of knowing jaw lesions related to SCA. PMID:26558249

  8. Pitfalls and limitations of magnetic resonance imaging in chronic posttraumatic osteomyelitis

    International Nuclear Information System (INIS)

    The aim of this study was to evaluate pitfalls and technical limitations of MR imaging in diagnosing relapse of chronic posttraumatic osteomyelitis of the lower extremities. Retrospective analysis of MR examinations in 15 patients (17 body areas) with suspected relapse of chronic posttraumatic osteomyelitis (at least 1.5 years duration/mean number of surgical procedures per patient: 5.8). The MRI findings were compared with postoperative bacteriology (n = 11) and clinical follow-up (n = 4). Five patients had additional CT examination. Magnetic resonance imaging identified all infected areas correctly, but five uninfected regions were diagnosed false positive due to postoperative scarring/oedema in bone defects (n = 4) and soft tissue (n = 1). Specificity of MRI in diagnosing active bone infection was 63 % and sensitivity 100 %. Additional CT was preoperatively necessary in 5 patients (33 %) to further examine osteomyelitic and reparative bone remodeling. Metal artefacts were present in 11 patients, rendering complete evaluation impossible (n = 2) or considerably more difficult (n = 4). Scarring/oedema in postoperative bone defects occurs up to 13 months postoperatively and represents a major pitfall leading to low specificity. Definitive evaluation of suspected fistula, bony fragments and mineralization by MRI may be limited in this special patient group and requires additional CT in one third of patients. Metal artefacts occur in most patients and may impair or even prevent correct film evaluation in 23 and 11 %, respectively. (orig.)

  9. Lateral Calcaneal Artery Flaps in Atherosclerosis: Cadaveric Study, Vascular Assessment and Clinical Applications

    Science.gov (United States)

    Tanthanatip, Pattaya; Kuhaphensaeng, Paiboon; Ruamthanthong, Anuchit; Pitiseree, Anont; Suwantemee, Chaichoompol

    2015-01-01

    Background: Soft tissue defects of the lateral malleolus (LM) and Achilles tendon pose difficult reconstructive problems due to the bony prominence and limited local tissue available. The objectives were to study the anatomical landmarks of the lateral calcaneal artery (LCA) and patency of LCA in atherosclerotic patients. Methods: Part I: Thirty-four cadaveric feet were dissected to identify the LCA. The distance between the LCA and the most prominent point of the LM was measured horizontally (LCAa-LM), obliquely (LCAb-LM), and vertically (LCAc-LM). Part II: Thirty-two patients were divided in 2 groups as nonatherosclerotic and atherosclerotic groups. The LCA was assessed by both Doppler ultrasonography and computed tomographic angiography (CTA). Part III: Clinical applications were demonstrated. Results: Part I: Mean distances of LCAa-LM, LCAb-LM, and LCAc-LM were 24.76, 33.68, and 35.03 mm, respectively. The LCA originated 94.12% from the peroneal artery. Part II: Doppler ultrasonography detected the LCA at 90.62% and 87.50% in nonatherosclerotic and atherosclerotic groups, respectively, whereas 100.00% and 93.75%, respectively, were detected by CTA. No statistically significant difference was found in the patency of the LCA between nonatherosclerotic and atherosclerotic patients. Part III: Clinical applications were performed in atherosclerotic patients. Conclusions: The LM is a reliable point to identify the LCA, and the LCA flap can be raised safely in atherosclerotic patients. Preoperative CTA should be performed in severely atherosclerotic patients or cases of major lower extremity vascular injuries. PMID:26495230

  10. The lateral calcaneal artery: Anatomic basis for planning safe surgical approaches.

    Science.gov (United States)

    Elsaidy, Mohamed A; El-Shafey, Khaled

    2009-10-01

    The proximity of the lateral calcaneal artery (LCA) to surgical incisions applied to the lateral hindfoot makes it vulnerable to iatrogenic injury and subsequent postoperative skin necrosis. This study aimed to investigate the course of the LCA and to define anatomical points that can be used by surgeons during lateral approaches to the calcaneus. Thirteen leg-ankle-foot specimens were dissected and the superficial course of the LCA was outlined by three anatomic points: (a) tip of lateral malleolus, (b) the point where it pierces the deep fascia, and (c) the point where it crosses the line connecting the lateral malleolus with the insertion of Achilles tendon. Fifteen healthy volunteers were investigated by color Doppler ultrasound where the diameter and depth of LCA were measured. The LCA pierced the deep fascia at a maximum height of 4.5 cm (mean 3.78) above the midpoint of a line extending from the lateral malleolus to the insertion of Achilles tendon. It crossed the previous line at a maximum distance of 3 cm (mean 2.6) posterior to lateral malleolus. At this point, its mean diameter was 1.75 mm on the right and 1.73 mm on the left sides, while its mean depth was 7.73 mm on the right and 8.0 mm on the left sides. A dangerous triangle that contained the superficial course of the artery was mapped out in the lower lateral part of the leg. This triangle should be considered during surgical approaches applied to the lateral hindfoot to avoid damage of the LCA. PMID:19637301

  11. The effect of fracture type and angular deterioration on the functional outcome of calcaneal fractures

    Directory of Open Access Journals (Sweden)

    Atilla Polat

    2011-03-01

    Full Text Available The aim of this study was to determine the effect of fracture type and angular deterioration on the outcome of calcaneal fractures.Materials and methods: Thirty-two patients (23 males, 9 females; mean age 45 years with calcaneus fractures retrospectively reviewed. Twenty-four fractures were closed, and eight fractures were open. Böhler and Gissane angles were measured using patient’s before, and after reduction X-ray films. According to the Essex-Lopresti classification there were three type I, 14 type II, and 15 type III fractures. Five patients were treated with casting (Group I, 19 patients with closed reduction K-wire application (Group II, and 8 patients with plate fixation. Final clinical outcome were assessed by Maryland Foot Score. Mean follow-up period was 109 weeks.Results: Mean Böhler and Gissane angles were 7°, 85° before reduction, and 20°, 100° after reduction, respectively. The mean Maryland Foot Score was 62 (range 55-72 in Group I, 68 (range 40-90, and 66 (range 58-79 in group II.The Maryland Foot score in Type I fracture was higher than Type III (p=0.025, and Typ II (p=0.094, respectively. In terms of last radiologic examination, the Maryland Foot Score was higher in those angle’s were in normal border than whose angle’s were abnormal (p=0.027 and p=0.02, respectively. Mean correction of angles in Group III were more than Group I, and Gruop II (p<0.05.Conclusion: Severe calcaneus fracture was related to poor functional outcome. Böhler and Gissane angle can be more corrected with plate fixation method, but has similar functional outcome.

  12. Chronic recurrent multifocal osteomyelitis with MR correlation: a case report

    International Nuclear Information System (INIS)

    Chronic recurrent multifocal osteomyelitis (CRMO) is a rare disorder of unknown etiology. The main characteristics on plain X-rays are a lytic destruction in the metaphyseal region of the long bones followed by progressive sclerosis. CRMO of the tibial and fibular bones is described in a 14-year-old girl, who suffered from pain and soft tissue swelling in both ankles. Initial plain X-rays and laboratory findings were normal. After relapsing clinically, progressive sclerosis of both fibular bones occurred. The diagnostics of CRMO was suggested based on CT and MRI findings. CRMO was confirmed after curettage and bone biopsy. Histopathological findings were consistent with active chronic osteomyelitis. (orig./DG)

  13. Chronic recurrent multifocal osteomyelitis with MR correlation: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Machiels, F. (Dept. of Radiology, Middelheim Hospital, Antwerp (Belgium)); Seynaeve, P. (Dept. of Radiology, Middelheim Hospital, Antwerp (Belgium)); Lagey, C. (Dept. of Orthopaedic Surgery, Children' s Hospital, Antwerp (Belgium)); Mortelmans, L.L. (Dept. of Radiology, Middelheim Hospital, Antwerp (Belgium))

    1992-11-01

    Chronic recurrent multifocal osteomyelitis (CRMO) is a rare disorder of unknown etiology. The main characteristics on plain X-rays are a lytic destruction in the metaphyseal region of the long bones followed by progressive sclerosis. CRMO of the tibial and fibular bones is described in a 14-year-old girl, who suffered from pain and soft tissue swelling in both ankles. Initial plain X-rays and laboratory findings were normal. After relapsing clinically, progressive sclerosis of both fibular bones occurred. The diagnostics of CRMO was suggested based on CT and MRI findings. CRMO was confirmed after curettage and bone biopsy. Histopathological findings were consistent with active chronic osteomyelitis. (orig./DG)

  14. Lumbosacral Osteomyelitis and Discitis with Phlegmon Following Laparoscopic Sacral Colpopexy.

    Science.gov (United States)

    Jenson M D, Amanda V; Scranton, Robert; Antosh, Danielle D; Simpson, Richard K

    2016-01-01

    Lumbosacral osteomyelitis and discitis are usually a result of hematogenous spread; rarely it can result from direct inoculation during a surgical procedure. Bacteria may also track along implanted devices to a different location. This is a rare complication seen from pelvic organ prolapse surgery with sacral colpopexy. A 67-year-old female developed increasing lower back pain four months following a laparoscopic sacral colpopexy. Imaging revealed lumbar 5-sacral 1 (L5-S1) osteomyelitis and discitis with associated phlegmon confirmed by percutaneous biopsy and culture. The patient was treated conservatively with antibiotics, but required laparoscopic removal of the pelvic and vaginal mesh followed by twelve weeks of intravenous antibiotics. The patient has experienced clinical improvement of her back pain. This is an uncommon complication of sacral colpopexy, but physicians must be vigilant and manage aggressively to avoid more serious complications and permanent deficit. PMID:27551651

  15. Prophylaxis of radiogenic osteomyelitis of the jaw by thyrocalcitonine

    International Nuclear Information System (INIS)

    The influence of exogenous thyrocalcitonine (TC) on the result of a fractionated gamma irradiation of the system of teeth and jaws of dogs with a total dose of 60 Gy (756 ret) with a functional overload of their parodontium (FOP) was studied. The FOP was found to intensify radiation injuries, even an osteomyelitis of the jaw may develop. A prophylactic 30-day treatment with parenteral administration of TC in an amount of 1 MRC unit per 1 kg body weight decreased the extent of radiation injuries to the structures of the dental bed, normalized the metabolism of tissues of the region studied and prevented osteomyelitis of the jaw. A repeated prophylactic treatment further improved the results. It is concluded that TC can be recommended as an agent for the prophylaxis of a radioosteomyelitis. (author)

  16. Successful Daptomycin Use in a Pediatric Patient With Acute, Bilateral Osteomyelitis Caused by Methicillin-Resistant Staphylococcus aureus

    OpenAIRE

    Billups, Kelsey L.; Stultz, Jeremy S

    2015-01-01

    Staphylococcus aureus is the most common bacteria associated with the development of osteomyelitis in pediatric patients. Osteomyelitis caused by methicillin-resistant Staphylococcus aureus (MRSA) can be difficult to safely and effectively treat. Vancomycin, linezolid, and clindamycin are commonly used to treat osteomyelitis caused by MRSA. While adult studies suggest intravenous (IV) daptomycin may by beneficial for the treatment of MRSA osteomyelitis, it is not Food and Drug Administration ...

  17. Three Phase Bone Scintigraphy in Active and Inactive Osteomyelitis

    International Nuclear Information System (INIS)

    To Appreciate the value of bone scintigraphy in determination of the bony infection, we performed three phase bone scintigraphy in 34 cases of osteomyelitis of extremities prospectively. They were clinically inactive in 11 and active in 23 cases. We confirmed the active osteomyelitis by operation or aspiration within one week after scintigraphy. Perfusion, blood pool and delayed images were analyzed respectively and compared with the plain roentgenograms. All 23 active lesions showed diffusely increased perfusion in affected limbs. The areas of the increased activities on blood pool images were larger than or similar to those on delayed images in 17 cases (73.9%) with active osteomyelitis and smaller in 6 cases (26.1%). 5 of the latter 6 cases showed definite soft tissue activities on blood pool images. In inactive cases bone scintigrams were completely normal in 4 cases. Two of those were normal on plain films and remaining two showed mild focal bony sclerosis. Among 7 inactive lesions, perfusion was normal in 2 cases, diffusely increased in 4 cases and diffusely decreased in 1 case. 6 of these 7 cases showed increased activities both on blood pool and delayed images and the areas of increased activities on blood pool images didn't exceed those on delayed images. Bony sclerosis was noted on plain films in those 7 inactive lesions and the extent of the sclerosis correlated well to delayed images. Large blood pool activity was characteristics of active osteomyelitis. Normal three phase bone scintigram may indicate the time to terminate the treatment, but increased activity on perfusion and blood pool scans is not absolute indication of active lesion if the extent of the lesion on the blood pool image is smaller than that on delayed image and if no definite soft tissue activity is noted on perfusion and blood pool images in clinically inactive patient.

  18. Primary subacute hematogenous osteomyelitis in children: a clearer bacteriological etiology

    OpenAIRE

    Spyropoulou, Vasiliki; Dhouib Chargui, Amira; Merlini, Laura; Samara, Eleftheria; Valaikaite, Raimonda; Kampouroglou, Georgios; Ceroni, Dimitri

    2016-01-01

    Background This study aimed to describe the spectrum of pediatric primary subacute hematogenous osteomyelitis (PSAHO) and to investigate its bacterial etiology. Methods Sixty-five consecutive cases of PSAHO admitted to our institution over a 16-year period (2000–2015) were retrospectively reviewed to assess their laboratory and radiographic imaging features, as well as their bacteriological etiology. Results On evaluation, white blood cell count and C-reactive protein were normal in 53 (81.5 ...

  19. Cefoperazone Sodium Impregnated Polycaprolactone Composite Implant for Osteomyelitis

    OpenAIRE

    Anand A.; Pundir R; Pandian C; Saraf S; Gupta H

    2009-01-01

    The use of local antibiotics from a biodegradable implant for chronic osteomyelitis is an attractive alternative. The implant delivers high antibiotic concentration at tissue levels, obliterates dead space, aids bone repair and does not need to be removed. The purpose of this paper is to develop and evaluate a calcium sulphate and polycaprolactone based composite biodegradable implantable delivery system of cefoperazone sodium. Implants were prepared by modified fabrication technique to avoid...

  20. Chronic Suppurative Osteomyelitis of Subcondylar Region: A Case Report

    OpenAIRE

    Kumar, G Ravi; Syed, Basheer Ahmed; Prasad, N.; Praveen, SP

    2013-01-01

    ABSTRACT Chronic suppurative osteomyelitis (CSO) of the maxillofacial region is primarily caused by infections of odontogenic microorganisms. It may also arise as a complication of dental extractions, maxillofacial trauma, inadequate treatment of a fracture and irradiation to the mandible. This condition is characterized by areas of devitalized bone (sequestra) which serves as a nidus for recurrent episodes of infection. This case report describes a case of CSO in an untreated right subcondyl...

  1. A systematic review of animal models for Staphylococcus aureus osteomyelitis

    Directory of Open Access Journals (Sweden)

    W Reizner

    2014-03-01

    Full Text Available Staphylococcus aureus (S. aureus osteomyelitis is a significant complication for orthopaedic patients undergoing surgery, particularly with fracture fixation and arthroplasty. Given the difficulty in studying S. aureus infections in human subjects, animal models serve an integral role in exploring the pathogenesis of osteomyelitis, and aid in determining the efficacy of prophylactic and therapeutic treatments. Animal models should mimic the clinical scenarios seen in patients as closely as possible to permit the experimental results to be translated to the corresponding clinical care. To help understand existing animal models of S. aureus, we conducted a systematic search of PubMed and Ovid MEDLINE to identify in vivo animal experiments that have investigated the management of S. aureus osteomyelitis in the context of fractures and metallic implants. In this review, experimental studies are categorised by animal species and are further classified by the setting of the infection. Study methods are summarised and the relevant advantages and disadvantages of each species and model are discussed. While no ideal animal model exists, the understanding of a model’s strengths and limitations should assist clinicians and researchers to appropriately select an animal model to translate the conclusions to the clinical setting.

  2. Clinical value of imaging techniques in childhood osteomyelitis

    International Nuclear Information System (INIS)

    Purpose: The traditional approach to investigating suspected osteomyelitis in children includes conventional radiography and bone scintigraphy. The roles of US, CT and MR imaging are controversial. Our objective was to determine whether the additional use of these modalities would yield information likely to lead to treatment modification. Material and Methods: Sixty-five children with clinically suspected osteomyelitis took part in a prospective study. All patients underwent conventional radiography and bone scintigraphy. In addition to this, US, CT and MR imaging were all performed in 33 patients; the remaining 32 patients were examined with various combinations of these three modalities. The value of the additional information obtained was estimated retrospectively by a pediatric orthopedic surgeon in terms of possible modification of treatment. Results: MR imaging was the modality with the highest sensitivity and specificity for detecting osteomyelitis. MR yielded information likely to influence treatment in the greatest proportion of patients (45%) followed by US (30%). Conclusion: The standard investigation protocol with the addition of US (because of its ability to detect subperiosteal abscesses early and simply) is adequate in uncomplicated cases. When additional imaging is required to outline a lesion, or in complicated cases, and when bone scintigraphy is inconclusive, MR imaging should also be performed. CT should be considered when MR investigation is not available or when anesthesia is required but cannot be provided. (orig.)

  3. Clinical value of imaging techniques in childhood osteomyelitis

    Energy Technology Data Exchange (ETDEWEB)

    Kaiser, S.; Jorulf, H. [Karolinska Hospital, Astrid Lindgren Children`s Hospital, Dept. of Pediatric Radiology, Stockholm (Sweden); Hirsch, G. [Karolinska Hospital, Astrid Lindgren Children`s Hospital, Dept. of Pediatric Surgery, Stockholm (Sweden)

    1998-09-01

    Purpose: The traditional approach to investigating suspected osteomyelitis in children includes conventional radiography and bone scintigraphy. The roles of US, CT and MR imaging are controversial. Our objective was to determine whether the additional use of these modalities would yield information likely to lead to treatment modification. Material and Methods: Sixty-five children with clinically suspected osteomyelitis took part in a prospective study. All patients underwent conventional radiography and bone scintigraphy. In addition to this, US, CT and MR imaging were all performed in 33 patients; the remaining 32 patients were examined with various combinations of these three modalities. The value of the additional information obtained was estimated retrospectively by a pediatric orthopedic surgeon in terms of possible modification of treatment. Results: MR imaging was the modality with the highest sensitivity and specificity for detecting osteomyelitis. MR yielded information likely to influence treatment in the greatest proportion of patients (45%) followed by US (30%). Conclusion: The standard investigation protocol with the addition of US (because of its ability to detect subperiosteal abscesses early and simply) is adequate in uncomplicated cases. When additional imaging is required to outline a lesion, or in complicated cases, and when bone scintigraphy is inconclusive, MR imaging should also be performed. CT should be considered when MR investigation is not available or when anesthesia is required but cannot be provided. (orig.)

  4. Ultrasonographic findings of septic arthritis and osteomyelitis in neonatal hip

    International Nuclear Information System (INIS)

    To evaluate ultrasonographic findings of neonatal patients who confirmed and treated as hip joint septic arthritis and osteomyelitis. We retrospectively examined clinical feature and radiologic findings of 7 neonatal patients ranging from 8 to 28 days of age who were examined from January 1966 to December 1998 at nursery and were confirmed and treated on the diagnosis of septic arthritis and osteomyelitis. Clinical features of the patients were comparatively analyzed with radiologic findings including plain radiographs, ultrasonography, bone scan and MRI. We emphasized importance of ultrasonographic findings of these patients. Ultrasonography was performed first of all in all cases after the symptom onset. Other examinations were performed on the same day or a few days later after ultrasonography. Ultrasonography revealed abnormal finding in 85.7% (6/7) of all cases. Plain radiographs revealed abnormal findings in 28.6% (2/7). Bone scan revealed decreased uptake in 66.7%(2/3). MRI revealed abnormal signal intensity in 100%(3/3). Ultrasonographic findings of the patients were deep soft swelling in 85.7% (6/7) of all cases, periosteal elevation in 57.1% (4/7), synovial thickening in 42.8% (3/7), synovial effusion in 42.8%(3/7), echogenic debris or clot in 28.5% (2/7), cortical erosion in 28.5% (2/7), and subperiosteal abscess in 14.2% (1/7). Ultrasonography is a useful modality to diagnose septic arthritis and osteomyelitis in neonatal hip.

  5. Osteomyelitis in the diabetic foot: diagnosis and management.

    Science.gov (United States)

    Game, Frances L

    2013-09-01

    Although osteomyelitis of the foot in diabetes remains common in specialist foot clinics across the world, the quality of published work to guide clinicians in the diagnosis and management is generally poor. Diagnosis should be based primarily on clinical signs supported by results of pathologic and radiologic investigations. Although the gold standard comes from the histologic and microbiological examination of bone, clinicians should be aware of the problems of sampling error. This lack of standardization of diagnostic criteria and of consensus on the choice of outcome measures poses further difficulties when seeking evidence to support management decisions. Experts have traditionally recommended surgical removal of infected bone but available evidence suggests that in many cases (excepting those in whom immediate surgery is required to save life or limb) a nonsurgical approach to management of osteomyelitis may be effective for many, if not most, patients with osteomyelitis of the diabetic foot. The benefits and limitations of both approaches need, however, to be established in prospective trials so that appropriate therapy can be offered to appropriate patients at the appropriate time, with the patients' views taken fully into account. PMID:23992902

  6. Invasive aspergillosis osteomyelitis in children - a case report and review of the literature

    International Nuclear Information System (INIS)

    Immunocompromised patients are at high risk of secondary infection associated with high morbidity. In children these complications include fungal osteomyelitis due to continuous infiltration or hematogenous spread. The case of a 4-year-old boy is presented who developed lumbalgia and thigh pain during ongoing chemotherapy for acute lymphatic leukemia. MRI revealed infarct-like lesions in the femur and L5 vertebra, which were biopsied. The histologic diagnosis was consistent with angioinvasive aspergillosis. A multifocal osseous presentation has rarely been described in children and an overview of the literature is presented. Invasive aspergillosis is a rare complication to be considered in children with MRI-detected bony lesions of infarct-like appearance. (orig.)

  7. Invasive aspergillosis osteomyelitis in children - a case report and review of the literature

    Energy Technology Data Exchange (ETDEWEB)

    Winterstein, Anton R.; Bohndorf, Klaus; Vollert, Kurt [Klinikum Augsburg, Department of Radiology, Augsburg (Germany); Wagner, Theodor [Klinikum Augsburg, Department of Pathology, Augsburg (Germany); Gnekow, Astrid [Klinikum Augsburg, Department of Pediatrics, Augsburg (Germany); Roemer, Frank W. [Klinikum Augsburg, Department of Radiology, Augsburg (Germany); Boston University School of Medicine, Department of Radiology, Boston, MA (United States)

    2010-08-15

    Immunocompromised patients are at high risk of secondary infection associated with high morbidity. In children these complications include fungal osteomyelitis due to continuous infiltration or hematogenous spread. The case of a 4-year-old boy is presented who developed lumbalgia and thigh pain during ongoing chemotherapy for acute lymphatic leukemia. MRI revealed infarct-like lesions in the femur and L5 vertebra, which were biopsied. The histologic diagnosis was consistent with angioinvasive aspergillosis. A multifocal osseous presentation has rarely been described in children and an overview of the literature is presented. Invasive aspergillosis is a rare complication to be considered in children with MRI-detected bony lesions of infarct-like appearance. (orig.)

  8. Case Report: Rare occurrence of Pseudomonas aeruginosa osteomyelitis of the right clavicle in a patient with IgA nephropathy [v1; ref status: indexed, http://f1000r.es/37r

    Directory of Open Access Journals (Sweden)

    Aishwarya Damodaran

    2014-11-01

    Full Text Available We describe the case of a 47 year old patient with proven primary IgA nephropathy who presented with osteomyelitis of the medial end of the right clavicle. The patient was not on immunosuppressive medications. He underwent aspiration curettage and CT scan of the clavicle which yielded pus that grew Pseudomonas aeruginosa. Following treatment with appropriate antibiotic therapy the patient presented a complete recovery of the lesion with no loss of renal function. This case highlights the importance of positive cultures in the choice of the appropriate therapy in an extremely rare case of an immunocompetent patient with osteomyelitis of the clavicle.

  9. Brucellosis: unusual presentations in two adolescent boys

    International Nuclear Information System (INIS)

    Two boys presented with variable signs and symptoms of infectious disease that challenged diagnosis. One of the two patients had aortic valve vegetations and lower extremity aneurysms, and the other had calvarial osteomyelitis, epidural abscess, pleural effusions, and pulmonary nodules. Only after a battery of bacterial and fungal agglutination tests was the unsuspected diagnosis made in each of brucellosis from Brucella canis. (orig.)

  10. Brucellosis: unusual presentations in two adolescent boys

    Energy Technology Data Exchange (ETDEWEB)

    Piampiano, P.; McLeary, M.; Young, L.W. [Dept. of Radiology, Division of Pediatric Radiology, Loma Linda University Children' s Hospital, Loma Linda, CA (United States); Janner, D. [Div. of Pediatric Infectious Disease, Loma Linda University Medical Center and Children' s Hospital, Loma Linda, CA (United States)

    2000-05-01

    Two boys presented with variable signs and symptoms of infectious disease that challenged diagnosis. One of the two patients had aortic valve vegetations and lower extremity aneurysms, and the other had calvarial osteomyelitis, epidural abscess, pleural effusions, and pulmonary nodules. Only after a battery of bacterial and fungal agglutination tests was the unsuspected diagnosis made in each of brucellosis from Brucella canis. (orig.)

  11. A Prospective Study on Radiological and Functional Outcome of Displaced Tongue Type Intra-Articular Calcaneal Fractures Treated by Percutaneous Screw Fixation

    Science.gov (United States)

    Hegde, Anoop; Mathias, Lawrence John; Shetty, Vikram; Shetty, Ashwin

    2016-01-01

    Introduction Calcaneal fractures have posed a challenge to orthopaedic surgeon for many years. The major problem is to reconstruct the fracture and improve healing of the fracture and also the surrounding tissues. Anatomic restoration of the three-dimensional anatomy of the calcaneum is the goal of surgical management of calcaneal fractures. Over the years, various techniques have been developed to accomplish this goal. Aim To determine the functional outcome in displaced tongue-type calcaneal fracture treated by percutaneous screw fixation. Materials and Methods A prospective study was conducted from October 2012 and September 2014. A total of 23 patients with intra-articular ‘tongue type’ calcaneal fractures were included in the study. Complete clinical and radiological evaluation was done. The surgical procedure encompassed closed reduction and fixation with two criss-cross 6.5 mm cannulated cancellous across the fracture site under fluoroscopic guidance. Postoperatively, on day three ankle and toe mobilization was begun. Non-weight bearing crutch mobilization was begun on postoperative day three. Reviews were done at 6 weeks, 12 weeks and 24 weeks postoperatively. At 6 weeks partial weight bearing mobilization was started. Full weight bearing was begun at 12 weeks. The patient was finally reviewed at 24 weeks and assessment of ankle function was done as per the Maryland foot scoring system. Radiographs were compared and preoperative and postoperative Gissane’s and Bohler’s angles were also compared. The results were analysed as per descriptive statistics (frequency, percentage). The complications noted were documented. Results Of the 23 patients under the study, three had excellent results with mean score of 90, 17 had good results with mean score of 82.94 and three had fair results with mean score of 74. Only one patient had subtalar arthritis as a complication. No other complications were seen. Conclusion Percutaneous screw fixation of tongue type

  12. BOHLER'S ANGLE: CORRELATION WITH OUTCOME IN DISPLACED INTRA-ARTICULAR CALCANEAL FRACTURES TREATED WITH LOCKING COMPRESSION PLATE FIXATION WITH AND WITHOUT BONE GRAFTING

    Directory of Open Access Journals (Sweden)

    Deepak P

    2014-09-01

    Full Text Available BOHLER'S ANGLE: correlation with outcome in displaced intra-articular calcaneal fractures Treated with locking compression Plate Fixation with and without bone grafting. AIMS: The aim is an accurate reduction of the fracture with reconstruction of Bohler’s angle, length and axis and sub talar joint surface. To determine whether autologous bone graft supplementation is beneficial in achieving and maintaining restoration of Calcaneal height and anatomic reduction. SETTINGS AND DESIGN: Level 1 trauma center, Prospective, randomized. METHODS AND MATERIAL: Consecutive 46 patients who had fracture calcaneum were treated by open reduction and internal fixation by locking plate with and without bone graft during the period from November 2009 to April 2012. STATISTICAL ANALYSIS USED: AOFAS-Ankle-Hind foot Scale, t Test. RESULTS: Fewer complications and statistically significant better results related to treatment with locking plates with bone grafting confirmed in comparison to without bone grafting ones were noted for intra-articular calcaneal fractures. In Group A the mean time for union was 10.39wks. The results were good and excellent in 86.95%, 8.69 % had fair result and 4.34% had poor results. In Group B the mean time for union was 11.95 wks. The overall results were good and excellent in 73.91%, 13.04 % had fair result and 13.04 % had poor results. CONCLUSIONS: The operative treatment of intra-articular calcaneal fractures could restore Böhler's angle better and the patient could return to full weight bearing earlier. We confirmed that autologous bone graft supplementation is beneficial in achieving and maintaining restoration of calcaneal height and anatomic reduction.

  13. Acute osteomyelitis in children: combined Tc-99m and Ga-67 imaging

    International Nuclear Information System (INIS)

    This retrospective study was done to determine the value of combined bone (technetium-99m methylene-diphosphonate) and gallium-67 citrate imaging in selected children with complicated clinical situations. Thirty-one children were evaluated for suspected osteomyelitis by bone scan followed within 4 days by a gallium scan. These 31 children represented a subpopulation in whom the Tc-99m scan is known to be potentially unreliable in diagnosing acute osteomyelitis. Eight children had acute osteomyelitis by strict criteria, while 23 did not. The bone scan successfully identified five of the eight with osteomyelitis but was positive in ten of the other 23. The gallium scan correctly identified all eight with osteomyelitis but was positive in seven of the other 23. The gallium scan was significantly less specific when the suspected lesion was in the extremities compared with central locations; causes of false-positive gallium scans included fracture and juvenile rheumatoid arthritis. Combined gallium and bone scanning increased accuracy of the scintigraphic diagnosis of acute osteomyelitis. Both tests may, however, be abnormal in conditions other than osteomyelitis. These findings emphasize the importance of correlating all imaging studies in detection of osteomyelitis

  14. Autoinflammatory bone disorders with special focus on chronic recurrent multifocal osteomyelitis (CRMO)

    OpenAIRE

    Hedrich, Christian M.; Hofmann, Sigrun R.; Pablik, Jessica; Morbach, Henner; Girschick, Hermann J.

    2016-01-01

    Sterile bone inflammation is the hallmark of autoinflammatory bone disorders, including chronic nonbacterial osteomyelitis (CNO) with its most severe form chronic recurrent multifocal osteomyelitis (CRMO). Autoinflammatory osteopathies are the result of a dysregulated innate immune system, resulting in immune cell infiltration of the bone and subsequent osteoclast differentiation and activation. Interestingly, autoinflammatory bone disorders are associated with inflammation of the skin and/or...

  15. MR imaging fails to detect bone marrow oedema in osteomyelitis: report of two cases

    International Nuclear Information System (INIS)

    Bone marrow oedema is the earliest and most sensitive sign in diagnostic imaging of osteomyelitis. In the two demonstrated cases of acute and chronic osteomyelitis, MRI was not able to detect bone marrow oedema due to accompanying haemosiderosis and sclerosis surrounding a bone abscess. (orig.)

  16. Role of computed tomography and radionuclide scintigraphy in the localization of osteomyelitis in flat bones

    International Nuclear Information System (INIS)

    The combined use of radionuclide scintigraphy and computed tomography is recommended for evaluating children with laboratory and clinical data suggestive of flat bone osteomyelitis despite normal conventional radiographs. In addition, computed tomography may be helpful in the presence of abnormal radiographs in determining the exact location of the focus of osteomyelitis and the most suitable route for appropriate drainage or to obtain culture material

  17. MR imaging fails to detect bone marrow oedema in osteomyelitis: report of two cases

    Energy Technology Data Exchange (ETDEWEB)

    Wingen, M.; Alzen, G.; Guenther, R.W. [Technische Hochschule Aachen (Germany). Dept. of Diagnostic Radiology

    1998-03-01

    Bone marrow oedema is the earliest and most sensitive sign in diagnostic imaging of osteomyelitis. In the two demonstrated cases of acute and chronic osteomyelitis, MRI was not able to detect bone marrow oedema due to accompanying haemosiderosis and sclerosis surrounding a bone abscess. (orig.)

  18. Case report 558: Multicentric Klebsiella pneumoniae (Friedlaenders bacillus) osteomyelitis in sickle cell anemia

    International Nuclear Information System (INIS)

    This patient represents a unique combination of multicentric osteomyelitis due to Klebsiella pneumoniae, lesions in the skull, pathological fracture of a long bone and no evidence of pulmonary disease. That Klebsiella pneumoniae osteomyelitis can occur in sickle cell anemia should be considered when such bone changes are seen. The remarkable resolution on conservative management also needs to be noted. (orig./GDG)

  19. Low-cost antibiotic delivery system for the treatment of osteomyelitis in developing countries

    NARCIS (Netherlands)

    Rasyid, Hermawan Nagar

    2009-01-01

    Although application of biomaterials has been one of the major assets in modern medicine to improve the quality of life of patients, occurrence of a chronic osteomyelitis is still a serious health threat to the individual patient. Chronic osteomyelitis can result in morbidity affecting the viability

  20. An update on the evaluation and management of plantar puncture wounds and Pseudomonas osteomyelitis.

    Science.gov (United States)

    Inaba, A S; Zukin, D D; Perro, M

    1992-02-01

    The management of children who present to the ED with plantar puncture wounds is dependent upon the nature of the injury, the examination of the puncture site, and the potential risk of a retained foreign body. Not all patients will require wound enlargement and a search for a retained foreign body. Close follow-up of all children who are being treated as outpatients is of vital importance in detecting an early development of an infectious complication. Pseudomonas osteomyelitis should be suspected in all patients who present with foot pain, swelling, and a decreased ability to bear weight after sustaining a nail puncture through a sneaker. The current consensus favors open surgical débridement followed by a course of intravenous antibiotics. The exact duration of the postoperative antibiotic course is still being debated. PMID:1603689

  1. Computerized tomography of pelvic osteomyelitis in patients with spinal cord injuries

    International Nuclear Information System (INIS)

    Computerized tomography (CT) was performed in 19 patients with spinal cord injury (SCI) who had large pressure sores and in whom other complications were suspected. CT detected the depth, extent, and degree of undermining of the edges of the pressure sores in 19 of 27 lesions. Conventional radiography detected four cases of pelvic osteomyelitis. CT detected eight additional cases of pelvic osteomyelitis, as well as eight clinically unsuspected peripelvic and intrapelvic abscesses. Technetium-99m bone scanning was not very helpful because of localization in chronic proliferative changes of bone and widespread foci of myositis ossificans, as well as in osteomyelitis. Gallium-67 scanning detected only one of six abscesses. It was not very helpful because of confusion of abscess and osteomyelitis with intense soft tissue swelling and cellulitis, which are often associated with pressure sores in patients with chronic SCI. CT was found to be, by far, the modality of choice for detection of pelvic osteomyelitis and abscess in patients with SCI

  2. Early Diagnosis of Acute Osteomyelitis by 99mTc Pyrophosphate Bone Imaging

    International Nuclear Information System (INIS)

    The radiographic diagnosis of osteomyelitis can be suspected early with deep soft tissue swelling, but the actual bone changes of osteomyelitis may be delayed as long as 10 to 14 days after onset or may be totally aborted by antibiotic therapy. Recognition of osteomyelitis by bone imaging is far more rapid than by conventional radiographic examination and can be used on admission to establish the diagnosis. Ten patients suspected of having early, acute osteomyelitis were studied by 99mTc Pyrophosphate bone imaging. Radiographs taken at the same time were all negative. Of these 9 patients showed positive bone images. The bone imaging provides a safe, accurate, noninvasive technique for the early diagnosis of osteomyelitis.

  3. Efficacy of clindamycin in the treatment of Staphylococcus aureus osteomyelitis in dogs

    International Nuclear Information System (INIS)

    The efficacy of clindamycin in the treatment of experimentally induced, posttraumatic Staphylococcus aureus osteomyelitis was studied in dogs. At the end of the experiment, bacteria could not be isolated from bone marrow of 15 of 16 (93.7%) dogs treated with clindamycin, whereas bacteria could not be isolated from similar specimens obtained from 6 of 13 (46.1%) untreated dogs. None of the 16 dogs treated with clindamycin had histopathologic evidence of osteomyelitis at the end of the experiment. Five of the 13 untreated control dogs had histopathologic evidence of osteomyelitis. The recovery rate was 31% in untreated dogs, whereas 94% of dogs treated with clindamycin recovered from osteomyelitis. Clindamycin, 11 mg/kg of body weight, given orally, q 12 h, for 28 days, was efficacious in the treatment of experimentally induced, posttraumatic S aureus osteomyelitis in dogs

  4. Gingival pustules and sterile diffuse sclerosing osteomyelitis as a feature of synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome.

    Science.gov (United States)

    Chou, Annie; Schulman, Joshua M; Gross, Andrew J; Jordan, Richard C; Ramos, Daniel M

    2016-05-01

    Synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome represents the rare co-occurrence of sterile inflammatory osteoarticular disease in association with a variety of cutaneous manifestations. Oral involvement is uncommon. The etiology of SAPHO is complex and is likely the combined result of infectious, genetic, and immunologic factors. Due to diverse clinical presentations, SAPHO is difficult to diagnose. Here, we describe the case of a 74-year-old man, who had a history of SAPHO syndrome and presented with gingival pustules and sterile diffuse sclerosing osteomyelitis of the mandible. This is the first case report describing neutrophilic mucositis as a feature of SAPHO. PMID:26619759

  5. Surgical Treatment of Calcaneal Spur. Tratamiento quirúrgico del espolón calcáneo.

    Directory of Open Access Journals (Sweden)

    Juan Carlos Cabrera Suárez

    2007-02-01

    Full Text Available

    Background: Pain in the plantar region of the heel is technically known as talalgia, and it is a very frequent complaint in the orthopaedic service in Guyana. Due to its frequent mortality, the current investigation was carried out. Objectives: To characterize the application of the surgical treatment to a group of patients in Guyana. Method: 70 patients surgically treated were studied presenting rebel talalgia with no responses to the conservative treatment. Age, sex, race, educational level, antibiotic prophylaxis, final outcomes, and patient's satisfaction with the treatment were the set of variables selected. Results: High morbidity of the heel pain syndrome was evidenced in this studied. The most frequent cause was the calcaneal spur. There is predominance in female Indian race. The high influenced of the socio-cultural factor in the genesis of this disease is proved as well as the impossibility of carrying out the conservative treatment due to high cost of medications. Conclusions: The efficacy achieved with combined treatment technique allowed the results obtained. All this contributed to achieve high satisfaction levels.

    Fundamento: El dolor en la región plantar del talón, conocido técnicamente como talalgia, es motivo frecuente de consulta en el servicio de ortopedia de la República de Guyana. Objetivo: Caracterizar la aplicación del tratamiento quirúrgico a un grupo de pacientes de la República Cooperativa de Guyana, con diagnóstico de espolón calcáneo. Método: Se realizó un estudio descriptivo longitudinal de 70 pacientes tratados quirúrgicamente, por presentar talalgia rebelde al tratamiento conservador; las variables analizadas fueron: edad, sexo, raza, nivel cultural, profilaxis antibiótica y satisfacción con el resultado del tratamiento. Resultados: Se

  6. Tuberculous osteomyelitis/arthritis of the first costoclavicular joint and sternum

    Institute of Scientific and Technical Information of China (English)

    Prasan; Patel; Robin; R; Gray

    2014-01-01

    A young Somali immigrant presents with a two-year history of a large, firm, painful right anterolateral chest wall sternal mass. The patient denied any history of trauma or infection at the site and did not have a fever, erythematous lesion at the site, clubbing, or lymphadenopathy. A lateral chest radiograph demonstrated a low density mass isolated to the subcutaneous soft tissue overlying the sternum, ribs and clavicle. Computed tomography(CT) with contrast demonstrated a cystic lesion in the right anterolateral chest wall deep to the pectoralis muscle. Enhanced CT of the chest demonstrated sclerosis and destruction of the rib and costochondral joint and manubrio-sternal joint narrowing. Ultrasound-guided biopsy and aspiration returned 500 cc of purulent, cloudy yellow, foul-smelling fluid. Acidfact bacilli stain and the nucleic acid amplification test identified and confirmed Mycobacterium tuberculosis. A diagnosis of tuberculous osteomyelitis/septic arthritis was made and antibiotic coverage for tuberculosis was initiated.

  7. Sternal Osteomyelitis and Abscess Caused by Elbowing during a Basketball Game

    Directory of Open Access Journals (Sweden)

    Hideo Ichimura

    2012-01-01

    Full Text Available A 15-year-old boy was referred to our hospital for further investigation and treatment of sternal osteomyelitis due to blunt chest trauma, more specifically elbowing during a basketball game 19 days earlier. On an initial presentation, his chest was markedly swollen and chest computed tomography demonstrated a sternal fracture and massive fluid collection in the chest wall. Since his general condition remained fairly good, we initially selected minimal drainage concomitant with antibiotics; if it was unsuccessful, we planned to switch to a more radical debridement procedure. The patient recovered without further invasive intervention and was discharged on postoperative day 26. There is no sign of recurrence six months after operation. This case report indicates that minimal drainage would be a good option for treatment in a phased strategy.

  8. Medidas do tendão do calcâneo no primeiro ano de vida Measurements of the calcaneal tendon in the first year of life

    Directory of Open Access Journals (Sweden)

    Ricardo Flávio de Araújo Bezerra

    2009-06-01

    Full Text Available OBJETIVO: Determinar as espessuras e larguras dos tendões do calcâneo (tendão de Aquiles em crianças eutróficas de ambos os gêneros, aos 2, 6, 9 e 12 meses de idade. MATERIAIS E MÉTODOS: Fizeram parte deste estudo prospectivo e descritivo 38 meninos e 31 meninas. As medidas dos tendões foram obtidas por meio de ultrassonografia, utilizando transdutor linear de 14 MHz, na altura do maléolo medial. RESULTADOS: Verificou-se que as espessuras dos tendões nos meninos foram de 2,4 mm, 2,3 mm, 2,4 mm e 2,4 mm, aos 2, 6, 9 e 12 meses, respectivamente. As larguras do tendão do calcâneo foram de 6,0 mm, 6,4 mm, 6,7 mm e 7,1 mm, respectivamente. Nas meninas, as espessuras obtidas aos 2, 6 e 9 meses foram de 2,4 mm, e aos 12 meses encontrou-se o valor de 2,5 mm. As quatro medidas da largura foram de 5,7 mm, 6,2 mm, 6,5 mm e 6,5 mm, respectivamente. CONCLUSÃO: Não houve diferença na espessura do tendão do calcâneo ao longo do primeiro ano de vida para ambos os gêneros, entretanto, houve diferença nas medidas da largura.OBJECTIVE: To determine the thickness and width of the calcaneal tendon (Achilles tendon in both male and female, eutrophic children at 2, 6, 9 and 12 months of age. MATERIALS AND METHODS: The present prospective and descriptive study included 38 boys and 31 girls. Measurements of the tendons were performed by means of ultrasonography, with a linear, 14-MHz probe, at the level of the medial malleolus. RESULTS: Tendon thicknesses observed in the boys were 2.4 mm, 2.3 mm, 2.4 mm, and 2.4 mm, respectively at 2, 6, 9 and 12 months. Widths were, respectively, 6.0 mm, 6.4 mm, 6.7 mm and 7.1 mm. In the girls, the tendon thicknesses observed at 2, 6 and 9 months were 2.4 mm, and 2.5 mm at 12 months. Widths were, respectively, 5.7 mm, 6.2 mm, 6.5 mm and 6.5 mm. CONCLUSION: No difference was observed in the calcaneal tendon thickness between boys and girls along the first year of their lives; however, width measurements demonstrated

  9. Imaging findings of synovitis-acne-pustulosis-hyperostosis-osteomyelitis syndrome

    International Nuclear Information System (INIS)

    Objective: To explore the imaging characteristics of SAPHO syndrome in 11 cases. Methods: Clinical features and imaging findings from 11 patients (6 male, 5 female, 28 to 68 years old) with SAPHO syndrome were analyzed retrospectively Including DR in 9 cases, CT in 10 cases, MRI and radioisotope scanning in 3 cases. Results: Multi-bones of anterior chest wall disorders were shown in 9 cases on DR images including superior sternum, anterior first rib and clavicle hyperostosis. Bony fusion and bony bridge were also seen in these cases. Hyperostosis osteosclerosis, bone destruction and bony fusion of sternoclavicular articulation and first rib were shown on CT images in 9 cases. Osteosclerosis of the joint between manubrium and midsternum was seen in 1 case on CT image. The sign of flying sea gull was seen in 2 cases on axial anterior chest wall CT images. The disorders of anterior chest wall were bilateral in 8 cases and unilateral in 2 cases. Sacroiliitis and osteomyelitis of ilium were found accompanied in 1 case. Osteomyelitis of thoracic vertebrae were found in 2 cases, while sclerosing osteitis of lumbar vertebrae and osteoarthritis of bilateral hands were observed respectively in 1 case. The thicken soft tissue surround clavicle head, thoracic vertebra disease with long T1, jumbly T2 and high fat suppression signal, long T1 and short T2 signal under sacroiliac joint were shown on MRI. Radioisotope scanning displayed higher radioactive uptake of radionuclides, with T shape in sternoclavicular area in 3 cases. Conclusions: Multi-bones of anterior chest wall involvement was the common imaging characteristics in 11 patients. Sacroiliitis, osteomyelitis of' vertebrae and ilium, sclerosing osteitis, ostearthritis of hand could be seen in some cases. (authors)

  10. Synovitis, Acne, Pustulosis, Hyperostosis and Osteitis (SAPHO) and chronic recurrent multifocal osteomyelitis (CRMO): Role of imaging in diagnosis

    International Nuclear Information System (INIS)

    There is a spectrum of musculoskeletal disorders which can be associated with dermatologic findings, the fundamental component of which is a nonbacterial osteitis. CRMO (Chronic recurrent multifocal osteomyelitis) and SAPHO syndrome (Synovitis, Acne, Pustulosis, Hyperostosis and Osteitis) describe paediatric and adult conditions, respectively, of inflammatory osteitis that can be associated with palmoplantar pustulosis and acne. Imaging findings are similar and a key component to the diagnosis in both conditions. This report describes two patients with strikingly similar radiologic presentations of clavicular osteitis in whom the diagnosis was made predominantly on the basis of imaging findings. The typical imaging features and radiographic hallmarks of both conditions will also be discussed.

  11. Surgical treatment of displaced intraarticular calcaneal fractures in children%应用跗骨窦有限切口克氏针内固定加植骨治疗儿童跟骨关节内骨折

    Institute of Scientific and Technical Information of China (English)

    李凡; 勘武生; 刘郁东; 徐剑; 李明静

    2015-01-01

    Objective To retrospectively evaluate the surgical outcomes of displaced intraarticular calcaneal fractures in children after open reduction,internal fixation with Kirschner wire and bone grafting via limited tarsal sinus incision.Methods The clinical data of 26 boys (77 sides) with displaced intraarticular calcaneal fractures from June 2010 to February 2014 were collected for respective analyses.Limited open reduction,internal fixation and bone grafting via limited tarsal sinus incision with k-wire were performed.Their average age was 9.6 (2-15) years.Preoperative radiographs and computed tomographic scans were used to classify the fractures.According to the Sanders classification,there were 6 feet of type Ⅱ (4 type Ⅱa,2 type Ⅱb),14 feet of type Ⅲ (6 type Ⅲab,5 type Ⅲac & 3 type Ⅲbc) and 7 feet of type Ⅳ.The functional outcomes were assessed by the modified American Orthopedic Foot & Ankle Society (AOFAS) ankle and hindfoot score.Results The mean follow-up period was 21 (8-30) months.All fractures healed clinically after 4 weeks postoperation.In patients with type Ⅱ fractures,B hler angle was restored from 16.8 ± 12.9 to 36.8 ±7.5 (P<0.05)and Gissane angle from 104.8°± 12.8° to 124.3°± 9.6°(P<0.05); In type Ⅲ fractures,B? hler angle improved from 15.4°± 14.1° to 34.4°± 9.1°(P<0.000 1) and Gissane angle from 100.6° ± 10.1° to 119.8° ± 11.7°(P<0.05) ; In type Ⅳ fractures,B? hler angle was restored from 8.6° ± 10.5° to 34.7° ± 5.3°(P<0.05) and Gissane angle from 105.4° ± 4.0° to 121.4° ± 8.9°(P<0.05).The mean modified AOFAS scores were 65.2 ± 2.5,67.0 ± 1.6 and 65.0 ± 2.8 in patients with type Ⅱ,type Ⅲ and type Ⅳ respectively.The differences of AOFAS scores were not statistically significant among three groups (P<0.05).Pin hole infection occurred in one foot.There was on onset of wound infection,tissue necrosis,osteomyelitis or traumatic arthritis.Conclusions Limited open reduction

  12. Diagnostic flowcharts in osteomyelitis, spondylodiscitis and prosthetic joint infection

    International Nuclear Information System (INIS)

    Infections of the bone, spine and prosthetic joints are serious and complex conditions to diagnose and to treat. Structured diagnostic workup may very well improve the accuracy and speed of diagnosis, thereby improving the outcome since treatment may very well be more successful and less harmful if timely management is started. Literature shows no uniform advise on diagnosis. The EANM organized a consensus meeting with representatives from the involved disciplines in order to develop common flowcharts for the diagnosis of osteomyelitis, spondylodiscitis and prosthetic joint infections. In this report the proceedings of this consensus meeting, including the proposed flowcharts for diagnosis, are published.

  13. Rare site for tubercular osteomyelitis with HIV infection

    Directory of Open Access Journals (Sweden)

    Vijay Bohra

    2012-01-01

    Full Text Available Tuberculosis of the scapula is a rare clinical entity. Few cases have been reported in the literature so far. We report a case of tuberculosis of the scapula in a HIV positive patient, which was managed successfully with antitubercular drugs. This case illustrates the difficulties in diagnosing tubercular osteomyelitis of the scapula as it has an insidious onset, paucity of constitutional symptoms and frequent absence of associated pulmonary involvement. Pitfall in diagnosis is the delay in considering the diagnosis of bony tuberculosis, especially in patients who have normal chest radiographs.

  14. Assessment of the bone quality of black male athletes using calcaneal ultrasound: a cross-sectional study

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    Sendeht Ayuba J

    2008-05-01

    Full Text Available Abstract Background Lifestyle, genetics and environmental factors are established determinants of bone density. We aimed to describe the bone characteristics of competitive top-ranked Nigerian male athletes using calcaneal ultrasound and to assess whether intensive training promotes higher bone density in an environment with reportedly low calcium intake; to compare the bone characteristics of footballers with runners and other sportsmen; and to assess the correlation of stiffness index (SI with activity level, since energy expenditure correlates with length of training and by extension, magnitude of skeletal loading. Methods We recruited 102 male athletes: these included football (n = 68, running (n = 15, handball (n = 7, taekwando (n = 6, cycling (n = 2, judo (1, badminton (1 and high jump (1. Anthropometric data were first recorded on a structured form and energy expenditure was indirectly estimated with a validated questionnaire. Bone density was assessed using the Lunar Achilles+ calcaneal ultrasonometer. Results The mean age of athletes was 25 ± 6 years. The means of BMI and energy expenditure were 21.9 ± 2.0 kg/m2 and 35.0 ± 13.7 kcal/kg/day, respectively. Footballers were younger (p Conclusion Repetitive skeletal loading at the heel has the potential to improve bone density in black male athletes. The magnitude of increase may be higher in medium impact sports such as soccer and running compared with low or non-impact sports such as judo or taekwando, and is independent of age and BMI. However, future longitudinal data will be required to support our observations.

  15. Hyperthermal effect of laser osteoperforation in a treatment of experimental acute purulent osteomyelitis

    Science.gov (United States)

    Privalov, Valeriy A.; Svetlakov, Andrey L.; Kuchakovsky, O. S.; Lappa, Alexander V.; Kazakov, Alexey A.; Kozel, A. I.

    1999-01-01

    We suggest to use laser osteoperforation as a new approach to surgical treatment of acute haemotogenic osteomyelitis. In the present work this approach is studied in experiment on 30 rabbits with an emphasis on a role of hypertermia. The osteomyelitis was produced with the help of an original technique by percutaneous introduction of microorganisms `Staph. Aureus' in medullar channel. The animals were divided into 2 group, experimental (17 rabbits) and control (13). On the 7th day of the illness all animals were subjected to the osteoperforation, with Nd:YAG laser (1064 nm) in the first group and with mechanic drill in the second. During the laser osteoperforation the dynamic control of temperature was performed simultaneously in 5 - 7 points in medullar channel. The original measuring- computational system designed for temperature measurements in the presence of intense laser radiation was used. Significant increase of temperature in medulla was fixed near laser channels, in the range up to 2 mm. In the experimental group the perforation results rapid positive clinical changes and convalescence of all animals confirmed by clinical, roentgenological, and histological tests. In the control group there was no positive dynamics, there were intermuscular phlegmon and plo-inflammatory changes in medulla, sequestra were formed. The reason of such an advantage of laser perforation consists in new factors of action in addition to decompression of medullar channel (available in both methods). The laser produces hypertermia of the medulla which kills a significant part of microorganisms, and it creates intensive radiation field which, possible, stimulates reparative processes.

  16. Unilobed Rotational Flap for Plantar Hallux Interphalangeal Joint Ulceration Complicated by Osteomyelitis.

    Science.gov (United States)

    Boffeli, Troy J; Hyllengren, Shelby B

    2015-01-01

    Diabetes-related neuropathic ulcers located at the plantar aspect of the hallux interphalangeal joint are often chronic or recurrent and frequently become complicated by osteomyelitis. Once infected, treatment will typically involve hallux amputation. Although intended as a definitive procedure, amputation of the first toe is not desirable from a cosmetic or functional standpoint and often leads to transfer ulcers at adjacent locations of the foot. Reconstructive wound surgery, combined with limited bone resection, is possible if the infection is caught early before the local tissue and bone have become necrotic. In addition to neuropathy, biomechanical issues, including ankle equinus, hallux limitus, hallux extensus, and hallux valgus, predispose patients with diabetes mellitus to developing plantar hallux ulcers. We commonly employ a proximal based unilobed plantar rotational flap combined with hallux interphalangeal joint arthroplasty as an alternative to hallux amputation. We present a typical case with long-term follow-up to highlight our flap protocol, including patient selection criteria, flap design, surgical technique, bone resection and biopsy pearls, staging timeline, and a typical postoperative course. Periodic follow-up during the next 72 months for unrelated conditions allowed long-term monitoring with no recurrence of osteomyelitis or subsequent amputation. The foot remained ulcer free 6 years later. The benefits of this surgical approach include complete excision of the ulcer, adequate exposure for bone resection, early bone biopsy before the spread of infection or necrosis of local tissue, flap coverage with viable soft tissue, and partial offloading of mechanical pressure at the plantar interphalangeal joint. PMID:25681281

  17. Acute haematogenous community-acquired methicillin-resistant Staphylococcus aureus osteomyelitis in an adult: Case report and review of literature

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    Dhanoa Amreeta

    2012-10-01

    Full Text Available Abstract Background Methicillin-resistant Staphylococcus aureus (MRSA has of late emerged as a cause of community-acquired infections among immunocompetent adults without risk factors. Skin and soft tissue infections represent the majority of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA clinical presentations, whilst invasive and life-threatening illness like necrotizing pneumonia, necrotizing fasciitis, pyomyositis, osteomyelitis and sepsis syndrome are less common. Although more widely described in the pediatric age group, the occurrence of CA-MRSA osteomyelitis in adults is an uncommonly reported entity. Case presentation We describe an invasive CA-MRSA infection in a 28 year-old previously healthy male, manifesting with bacteraemia, osteomyelitis of femur, pyomyositis and septic arthritis of the knee. Initially a preliminary diagnosis of osteosarcoma was suggested by imaging studies and patient underwent a bone biopsy. MRSA was subsequently isolated from blood cultures taken on day of admission, bone, tissue and pus cultures. Incision and drainage of abscess was performed and patient was treated with vancomycin, with fusidic acid added later. It took 6 months for the inflammatory markers to normalize, warranting 6-months of anti-MRSA therapy. Patient was a fervent deer hunter and we speculate that he acquired this infection from extensive direct contact with deer. Molecular characterization of this isolate showed that it belonged to multilocus sequence type (MLST ST30 and exhibited the staphylococcal chromosome cassette mec (SCCmec type IV, staphylococcus protein A (spa type t019, accessory gene regulator (agr type III and dru type dt10m. This strain harbored Panton-Valentine leukocidin (pvl genes together with 3 other virulent genes; sei (enterotoxin, hlg (hemolysin and fnbA (fibronectin binding protein. Conclusion This case study alerts physicians that beyond the most commonly encountered skin and soft tissue

  18. Acute hematogenous osteomyelitis - exclusion by means of turbo-STIR sequence?

    International Nuclear Information System (INIS)

    The timely diagnosis and early initiation of antibiotic therapy determine the clinical course of an acute hematogenous osteomyelitis. Consequently, a fast and efficient MRI examination protocol is crucial. We retrospectively evaluated various MR sequences used in the examination of 8 children having osteomyelitis. The examinations were conducted using a 0.5 T MR machine. All patients had a high signal intensity of the lesion in the IR sequence with fat suppression (turbo-STIR). An acute osteomyelitis can be excluded in the absence of signal intensity increase in the turbo-STIR sequence without the necessity of having to perform additional sequences. (orig.)

  19. Leucocyte scintiscanning and skeleton scintiscanning in case of acute or chronic osteomyelitis

    International Nuclear Information System (INIS)

    The investigations were intended to show whether a combination of the two nuclear medicine techniques results in better diagnosis and follow-up of osteomyelitis. It was found that in case of acute osteomyelitis, the combination of leucocyte scintiscanning and skeleton scintiscanning provided highly sensitive and specific diagnostic data, allowing good distinction between osteomyelitis and the soft tissue effects. Leucocyte scintiscanning is a suitable tool for therapeutical follow-up examination, preferably to be made about four weeks after termination of therapy. (orig./MG)

  20. Diagnosis of osteomyelitis in children by combined blood pool and bone imaging

    International Nuclear Information System (INIS)

    Differentiation of osteomyelitis from cellulitis or septic arthritis can be difficult. The radiological examination often does not have the characteristic features. Seventy of 71 children with osteomyelitis had focal areas of increased radioactivity demonstrated by /sup 99m/Tc methylene diphosphonate bone scans at the site of the infection. The addition of blood pool images aids in the interpretation of the study as they permit evaluation of the effect of hyperemia. The 13 children with cellulitis had diffuse increase in radioactivity involving both the bones and soft tissues. Bone imaging as the initial screening procedure for osteomyelitis is recommended. (auth)

  1. The clinical significance of radionuclide bone and gallium scanning in osteomyelitis of the head and neck

    Energy Technology Data Exchange (ETDEWEB)

    Noyek, A.M.; Kirsh, J.C.; Greyson, N.D.; Wortzman, G.; Jazrawy, H.; Freeman, J.L.; Blair, R.L.; Chapnik, J.S.

    1984-05-01

    Osteomyelitis of the head and neck remains a difficult clinical problem both in diagnosis and treatment evaluation. The purpose of this manuscript is to review our clinical experience with 25 cases of osteomyelitis distributed evenly among the temporal bone and skull base, the paranasal sinuses, and the mandible. Radionuclide bone and gallium scan images accurately depicted the biologic activity of the disease process and permitted accurate treatment evaluation and patient monitoring. This work demonstrates the potentials and limitations of radionuclide imaging with bone and gallium scan agents and attempts to define a role for their contemporary use in the management of osteomyelitis of the head and neck.

  2. Osteomyelitis or Charcot neuro-osteoarthropathy? Differentiating these disorders in diabetic patients with a foot problem

    Directory of Open Access Journals (Sweden)

    Bulent M. Ertugrul

    2013-11-01

    Full Text Available Both osteomyelitis and Charcot neuro-osteoarthropathy (CN are potentially limb-threatening complications of diabetic neuropathy, but they require quite different treatments. Almost all bone infections in the diabetic foot originate from an infected foot ulcer while diabetic osteoarthropathy is a non-infectious process in which peripheral neuropathy plays the critical role. Differentiating between diabetic foot osteomyelitis and CN requires careful evaluation of the patient, including the medical history, physical examination, selected laboratory findings, and imaging studies. Based on available studies, we review the approaches to the diagnostic differentiation of osteomyelitis from CN of the foot in diabetic patients.

  3. Osteomyelitis or Charcot neuro-osteoarthropathy? Differentiating these disorders in diabetic patients with a foot problem.

    Science.gov (United States)

    Ertugrul, Bulent M; Lipsky, Benjamin A; Savk, Oner

    2013-01-01

    Both osteomyelitis and Charcot neuro-osteoarthropathy (CN) are potentially limb-threatening complications of diabetic neuropathy, but they require quite different treatments. Almost all bone infections in the diabetic foot originate from an infected foot ulcer while diabetic osteoarthropathy is a non-infectious process in which peripheral neuropathy plays the critical role. Differentiating between diabetic foot osteomyelitis and CN requires careful evaluation of the patient, including the medical history, physical examination, selected laboratory findings, and imaging studies. Based on available studies, we review the approaches to the diagnostic differentiation of osteomyelitis from CN of the foot in diabetic patients. PMID:24205433

  4. The clinical significance of radionuclide bone and gallium scanning in osteomyelitis of the head and neck

    International Nuclear Information System (INIS)

    Osteomyelitis of the head and neck remains a difficult clinical problem both in diagnosis and treatment evaluation. The purpose of this manuscript is to review our clinical experience with 25 cases of osteomyelitis distributed evenly among the temporal bone and skull base, the paranasal sinuses, and the mandible. Radionuclide bone and gallium scan images accurately depicted the biologic activity of the disease process and permitted accurate treatment evaluation and patient monitoring. This work demonstrates the potentials and limitations of radionuclide imaging with bone and gallium scan agents and attempts to define a role for their contemporary use in the management of osteomyelitis of the head and neck

  5. Mycotic osteomyelitis due to Scedosporium Apiospermum: MR imaging-pathologic correlation

    Energy Technology Data Exchange (ETDEWEB)

    Sydnor, Malcolm K.; Knight, Thomas E. [Department of Radiology, Medical College of Virginia Hospital, Virginia Commonwealth University, P. O. Box 980615, Richmond, 23298-0615, VA (United States); Kaushik, Shaifali [Department of Radiology, VA Medical Center, 100 Emancipation Drive, 23667, Hampton, VA (United States); Department of Radiology, Medical College of Virginia Hospital, Virginia Commonwealth University, P. O. Box 980615, Richmond, 23298-0615, VA (United States); Bridges, C.Lee [Department of Pathology, Medical College of Virginia Hospital, Virginia Commonwealth University, P.O. Box 980662, Richmond, 23298-0662, VA (United States); McCarty, John M. [Department of Internal Medicine, Medical College of Virginia Hospital, Virginia Commonwealth University, P.O. Box 980157, Richmond, 23298-0662, VA (United States)

    2003-11-01

    Mycotic osteomyelitis is rare and occurs in immunocompromised patients after inoculation of the pathogen at a penetrating trauma site. Mycotic osteomyelitis due to Scedosporium Apiospermum is extremely rare, with only 13 cases of septic arthritis reported previously. Ours is only the third case of S. apiospermum osteomyelitis in an immunocompromised patient and the only patient with a histopathologic diagnosis from an amputation specimen. Recognition of this pathogen may be delayed due to insidious onset and negative joint fluid cultures, often requiring synovial or bone biopsies to establish the diagnosis. Delay in appropriate treatment may result in disseminating infection or even death. (orig.)

  6. [Contribution to the treatment of acute haematogenous anc chronic secondary osteomyelitis in children (author's transl)].

    Science.gov (United States)

    Pillich, J; Továrek, J; Fait, M

    1978-02-01

    The possibility of utilizing antistaphylococcal vaccine and local phage lysate for complex therapy of chronic and acute haematogenous osteomyelitis in children is demonstrated on three clinical cases. The study reassurmes good experience with this therapy in adult patients with chronic osteomyelitis. The results obtained so far in children suggest that the application of antistaphylococcal vaccine and of local phage lysate positively influences the course of the osteomyelitic disease and reduces the number of relpases. In order to specify and intensify the clinical effect of the above mentioned preparations, this method is being employed in other cases of chronic and acute haematogenous osteomyelitis. PMID:148797

  7. Osteomyelitis in lower limbs and pulmonary septic emboli - a case report and radiological diagnosis; Osteomielite em membros inferiores e embolia septica pulmonar na infancia - relato de um caso e diagnostico por imagem

    Energy Technology Data Exchange (ETDEWEB)

    Doria, Angela Schwarz [Hospital de Clinicas (HCFMUSP), Sao Paulo, SP (Brazil). Instituto de Crianca. Servico de Diagnostico por Imagem; Amaro Junior, Edson [Hospital de Clinicas (HCFMUSP), Sao Paulo, SP (Brazil). Inst. de Radiologia; Torre, Marcia Barbosa; Bogus, Luis Carlos Nogueira; Andrade, Marcio Ramalho; Barba, Mario Flores [Hospital de Clinicas (HCFMUSP), Sao Paulo, SP (Brazil). Instituto da Crianca. Servico de Radiologia; Scatigno Neto, Andre [Hospital de Clinicas (HCFMUSP), Sao Paulo, SP (Brazil). Faculdade de Medicina. Hospital das Clinicas

    1996-11-01

    The authors describe a case of osteomyelitis in the lower limbs with subsequent septic emboli pulmonary spread, as a complication of the prior clinical presentation. They discuss clinical and pathological aspects, as well as, the possibility of diagnosis utilizing plain radiography, computed tomography and scintigraphy. (author) 10 refs., 7 figs.

  8. Percutaneous reduction and fixation of an intra-articular calcaneal fracture using an inflatable bone tamp: description of a novel and safe technique

    Directory of Open Access Journals (Sweden)

    Mauffrey Cyril

    2012-03-01

    Full Text Available Abstract Calcaneal fractures are common injuries involving the hind foot and often a source of significant long-term morbidity. Treatment options have changed throughout the ages from periods of preferred nonoperative management to closed reduction with a mallet, and more recently, open reduction and anatomic internal fixation. The current treatment of choice; however, is often debated, as open management of these fractures carries many risks to include wound breakdown and infection. A less invasive form of surgical management through small incisions, while maintaining the ability to obtain joint congruency, anatomic alignment, and restore calcaneal height and width would be ideal. We propose a novel form of fracture reduction using an inflatable bone tamp and percutaneous fracture fixation. Preoperative planning and experienced fluoroscopy is crucial to successful management using this method. Although we achieved successful radiographic outcome in this case, long-term functional outcome of this technique are yet to be published.

  9. Acute hematogenous osteomyelitis in young children - clinical and radiological features

    International Nuclear Information System (INIS)

    Acute hematogenous osteomyelitis is a bacterial infectious disease which mainly affects the paediatrics age group. The incidence seems to decline through the last decade. The authors analyzed the clinical, bacteriological and radiological features of acute hematogenous osteomyelitis in 49 young children. Their age ranged from 12 days to 2.9 years (19 new-born and 30 babies). The most affected locus was the femur (46.9 %), followed by the humerus (40.9 %) and tibia (6.2 %). The adjacent joint was involved in 38.8 %. Up to the third day after onset of symptoms were admitted 32 children (65.3 %). A bacteriological diagnosis has been achieved in only 19 cases (38.8 %) which underwent different surgical procedures. Staphylococcus aureus (9 children; 64.3 %) was the most common causative microbe. Radiological characteristic showed mainly widening of joints, destruction of cartilage, bone destruction and osteoporosis. The median duration of antibiotic therapy was 31 days. Nine children underwent needle aspiration while another 10 required locus incision or open surgery with debridement or sequestrectomy. Definitive clinical restoration was observed in 42 cases (85.7%). (authors)

  10. Treatment of osteomyelitis with antibiotic-soaked porous glass ceramic.

    Science.gov (United States)

    Kawanabe, K; Okada, Y; Matsusue, Y; Iida, H; Nakamura, T

    1998-05-01

    We have developed a new drug delivery system using porous apatite-wollastonite glass ceramic (A-W GC) to treat osteomyelitis. A-W GC (porosity, 70% and 20% to 30%), or porous hydroxyapatite (HA) blocks (porosity 35% to 48%) used as controls, were soaked in mixtures of two antibiotics, isepamicin sulphate (ISP) and cefmetazole (CMZ) under high vacuum. We evaluated the release concentrations of the antibiotics from the blocks. The bactericidal concentration of ISP from A-W GC was maintained for more than 42 days, but that from HA decreased to below the detection limit after 28 days. The concentrations of CMZ from both materials were lower than those of ISP. An in vivo study using rabbit femora showed that an osseous concentration of ISP was maintained at eight weeks after implantation. Osteoconduction of the A-W GC block was good. Four patients with infected hip arthroplasties and one with osteomyelitis of the tibia have been treated with the new delivery system with excellent results. PMID:9619951

  11. Vertebral manifestation of chronic recurrent multifocal osteomyelitis (CRMO)

    International Nuclear Information System (INIS)

    Chronic recurrent multifocal osteomyelitis (CRMO) is a systemic osteo-articular disease that is characterized by a sterile, primarily chronic osteomyelitis with various distribution patterns of the individual lesions. In this article, we describe the 'axial type' with predominant involvement of the spine, which represents 13 of our 41 CMRO cases of different age groups. The important element of its diagnosis is the typical lympho-plasmacellular spondylitis that can be detected and staged by scintigraphy, MRI and conventional radiography. Potentially affected are all vertebrae from the mid-cervical spine to the sacrum. One or several segments can be involved, sometimes as transient inflammatory edema, sometimes as 'migratory spondylitis' or 'saltatory spondylitis', but also as chronic sclerosing type with early radiographically detectable manifestation. Vertebral deformity due to compression and total collapse (vertebra plana) are rare. A complicated course with patulous perivertebral edema can lead to concomitant symptomatic inflammatory changes in adjacent regions and organs. In the course of CRMO, spondylodiscitis only develops as secondary destruction following the spondylitis. This can help to differentiate spondyloarthropathies from CRMO that is initially detected as primary lesion in the spine. While CRMO generally has a good prognosis, its radiological differentiation from rheumatology conditions plays an important role. (orig.)

  12. Cefoperazone sodium impregnated polycaprolactone composite implant for osteomyelitis

    Directory of Open Access Journals (Sweden)

    Anand A

    2009-01-01

    Full Text Available The use of local antibiotics from a biodegradable implant for chronic osteomyelitis is an attractive alternative. The implant delivers high antibiotic concentration at tissue levels, obliterates dead space, aids bone repair and does not need to be removed. The purpose of this paper is to develop and evaluate a calcium sulphate and polycaprolactone based composite biodegradable implantable delivery system of cefoperazone sodium. Implants were prepared by modified fabrication technique to avoid solvent use. Interaction studies were carried out to check any incompatibility between ingredients. Prepared implants were evaluated for various in vitro parameters like dimensions, hardness, tensile strength, drug release profile and sterility. Morphological changes in pellet before and after drug release were evaluated by scanning electron microscopy. The pellet were also tested for microbiological efficacy and compared with plain drug solution in different concentrations. Developed pellets are regular in shape and size with good tensile strength. The release profile displayed drug levels above MIC continuously up to 2 months. Wide zone of inhibition by pellet against Staph. aureus as compared to drug solution proves its efficacy in treatment of osteomyelitis.

  13. Non-union of calcaneum – A rare complication of calcaneal fracture – A case report with brief review of literature

    OpenAIRE

    Kumar, Narinder

    2015-01-01

    Intra-articular fractures of calcaneum are known to be difficult to manage and lead to multiple complications including subtalar arthritis and malunion. However, non-union of calcaneum is rarely encountered. Only a total of six studies reporting on 12 patients could be found on reviewing the available literature (English language only). One such case of non-union of calcaneal fracture and its successful management is being reported in this case report. In addition, extremely limited literatur...

  14. Concomitant septic arthritis and osteomyelitis of the hip in young children; a new pathophysiological hypothesis suggested by MRI enhancement pattern

    International Nuclear Information System (INIS)

    In children, septic arthritis (SA) of the hip is either primary or concomitant with acute haematogenous osteomyelitis (AHO). However, seldom, patients with isolated SA at presentation, may later show osteomyelitis in the metaphysis. The aim of this study was to elaborate a physiopathological hypothesis based on the peculiar MRI findings to explain the onset of AHO after SA. Cases of acute infection of the hip admitted between January 2010 and December 2013 were retrospectively reviewed to assess radiographic and MRI features, as well as bacteriological findings. Only children with isolated SA were included in this study, whereas cases of concomitant SA and AHO at presentation were excluded. Ten patients met the inclusion criteria. Six (1–11 months) demonstrated, on the initial MRI, decreased perfusion on gadolinium enhanced fat-suppressed T1-weighted sequence of the femoral epiphysis and developed one month later metaphyseal AHO. Four (5–14 years) did not show decreased perfusion and did not develop AHO on follow-up. The type of germ involved influenced neither the type of enhancement pattern nor the outcome. Age under one year and decreased perfusion of the affected femoral epiphysis increases the risk of secondary AHO. Our study is the first report in human medicine supporting the physiopathological hypothesis described by Alderson et al. in an animal model: primary infection can originally affect the joint, then penetrate the epiphyseal cartilage, and finally spread into the metaphyseal region through transphyseal vessels present only in the first 12/18 months of life

  15. Discriminatory Performance of the Calcaneal Quantitative Ultrasound and Osteoporosis Self-Assessment Tool to Select Older Women for Dual-Energy X-ray Absorptiometry.

    Science.gov (United States)

    McLeod, Katherine M; Johnson, Shanthi; Rasali, Drona; Verma, Ashok

    2015-01-01

    The objective of this cross-sectional study was to evaluate the accuracy of the calcaneal quantitative ultrasound (QUS) and the Osteoporosis Self-Assessment Tool (OST) in identifying older women with osteoporosis as defined by dual-energy X-ray absorptiometry (DXA), and to establish optimal cutoffs to determine risk. We assessed bone mineral density of the femoral neck and lumbar spine using DXA and subsequent calcaneal QUS and OST measurements in 174 women aged 50-80 years. Pearson product correlation coefficients between QUS, OST, and DXA parameters were calculated. Receiver operating characteristic curves were constructed and areas under the curves (AUCs) and optimal thresholds for QUS and OST were defined based on sensitivity, specificity, and likelihood ratio analysis. The ability of calcaneal QUS to identify women with a T-score ≤-2.5 at the femoral neck (AUC = 0.892) consistently outperformed a T-score ≤-2.5 at the lumbar spine (AUC = 0.696) and OST at both the femoral neck and lumbar spine (AUC = 0.706-0.807). Stiffness index cutoff values that fall between 65 and 78 were found to warrant DXA screening, with a cutoff <65 indicating high likelihood of osteoporosis. Further prospective research is needed to examine the gender-related differences of QUS and OST diagnostic performance and their usefulness in clinical practice. PMID:25937306

  16. Usefulness of calcaneal quantitative ultrasound stiffness for the evaluation of bone health in HIV-1-infected subjects: comparison with dual X-ray absorptiometry

    Science.gov (United States)

    Fantauzzi, Alessandra; Floridia, Marco; Ceci, Fabrizio; Cacciatore, Francesco; Vullo, Vincenzo; Mezzaroma, Ivano

    2016-01-01

    Objectives With the development of effective treatments and the resulting increase in life expectancy, bone mineral density (BMD) alteration has emerged as an important comorbidity in human immunodeficiency virus type-1 (HIV-1)-infected individuals. The potential contributors to the pathogenesis of osteopenia/osteoporosis include a higher prevalence of risk factors, combined antiretroviral therapy (cART)-exposure, HIV-1 itself and chronic immune activation/inflammation. Dual-energy X-ray absorptiometry (DXA) is the “gold standard” technique for assessing bone status in HIV-1 population. Methods We conducted a cross-sectional study to investigate bone mineral status in a group of 158 HIV-1-infected subjects. The primary endpoint was the feasibility of calcaneal quantitative ultrasound (QUS) as a screening tool for BMD. All subjects were receiving stable cART and were virologically suppressed (HIV-RNA vitamin D levels ng/mL (P-values: 0.004, 0.016, and 0.015, respectively). Conclusion As an alternative and/or integrative examination to DXA, calcaneal QUS could be proposed as a useful screening in HIV-1-infected patients for assessing bone health impairment. In fact, the results obtained confirm that calcaneal QUS may be useful for monitoring bone status, being a noninvasive and inexpensive technique, especially in those subjects with the classical traditional risk factors for bone damage that were observed earlier in HIV-1 population. PMID:27330330

  17. Chronic osteomyelitis: bone and gallium scan patterns associated with active disease

    International Nuclear Information System (INIS)

    Bone and gallium scans are used to assess osteomyelitis patients with prior bone disease. To refine the criteria for interpreting these scans, the data from 136 consecutive patients with clinically suspected osteomyelitis were reviewed. Active osteomyelitis was diagnosed with surgery or biopsy and culture in 49 patients, excluded with the same criteria in 16, and excluded by clinical follow-up for at least 6 months in 71. Five different scintigraphic patterns were found. The true-positive and false-positive ratios, the likelihood ratios, and posterior probabilities for active osteomyelitis in each pattern were calculated. Only one pattern (gallium uptake exceeding bone-seeking radiopharmaceutical uptake) was indicative of active disease. Other patterns slightly raised or decreased the probability of disease. The extent of these changes varies directly with the prior probability of disease, determined from patient-specific factors (e.g., clinical data, laboratory data, findings on plain films) known best by the referring clinician

  18. Progress of imaging research on the early diagnosis of acute osteomyelitis

    International Nuclear Information System (INIS)

    The imaging diagnostic techniques include X-ray plain film, ultrasound, CT, MRI and radionuclide imaging. X-ray plain film is less sensitive to early acute osteomyelitis. Ultrasound can detect abscesses in the soft tissues and subperiosteal space earlier, but there are variations in image quality based on the different operators' levels of proficiency. High-resolution CT can find minimal lesions on bone, but it has a low sensitivity to predict acute osteomyelitis. MRI is superior to other imaging techniques at visualizing bone marrow lesions, but it is less sensitive in detecting sequestrum and calcification than CT. A variety of radionuclide imaging agents have been used in the early diagnosis of acute osteomyelitis in order to find a more sensitive and specific imaging technique. In this paper, different imaging diagnostic techniques of acute osteomyelitis are reviewed. (authors)

  19. Leukocyte scintigraphy with 111In in acute and chronic osteomyelitis of experimental animals

    International Nuclear Information System (INIS)

    Studies on 28 New Zealand white rabbits with experimentally induced osteomyelitis show that 111In-leukocyte scans turn negative when inflammation changes from the acute stage (histologically represented mainly by granulocytes and only small development of collageneous fibres) into the chronic stage (histologically showing marked lymphoplasmacytic infiltration and increased development of connective tissue). Falsely negative scans (i.e. cold lesions) are due to marked medullar necroses accompanied by diminished development of an abscess wall and reduced concentration of granulocytes within the necroses. Truly negative scans (i.e. cold lesions) are seen in chronic osteomyelitis with extended medullar fibrosis accompanied by reduced blood flow in comparison to the normal medullar bone of the contralateral side. The histological course of experimental osteomyelitis in rabbits is in some respect comparable with the stages of osteomyelitis in man and allows to predict the result of the leukocyte scan. (orig.)

  20. Combined bone marrow and gallium imaging. Differentiation of osteomyelitis and infarction in sickle hemoglobinopathy

    International Nuclear Information System (INIS)

    The clinical records and scintigrams of patients with sickle hemoglobinopathy who underwent combined Tc-99m bone marrow imaging and Ga-67 imaging to differentiate osteomyelitis from bony infarction were reviewed. Of 18 paired examinations in 15 patients, osteomyelitis was diagnosed correctly in six cases; in all six, gallium uptake at the symptomatic site was incongruently increased relative to the bone marrow activity. Of the 12 episodes of infarction, 11 showed congruent activity on both Tc-99m and Ga-67 images. The remaining study was interpreted incorrectly as osteomyelitis due to incongruent Tc-99m and Ga-67 uptake. The use of sequential Tc-99m bone marrow and Ga-67 imaging is an effective means of distinguishing osteomyelitis from bony infarction in patients with sickle hemoglobinopathy