Search

Objectives: This study aims to investigate the reliability of the Lichtman classification among residents, orthopedic surgeons, and hand surgeons. Materials and methods: This study was carried out with 30 male observers (mean age 37.8 years; range, 26 to 62 years) who agreed to participate in the study. All observers were orthopedic surgeons. The observers were separated into three groups that consist of 10 residents, 10 orthopedic surgeons, and 10 hand surgeons. The anteroposterior and lateral wrist radiographs of 20 patients (12 males. 8 females; mean age 49 years; range, 38 to 74 years) diagnosed as Kienbock's disease were sent to observers via e-mail as a survey. All 40 radiographs were asked to be kept classified. Results: The classification of Kienbock's disease was analyzed by 30 observers on 40 digital radiographs. The overall agreement with the Lichtman classification was fair within all of the observers (kappa=0.203). When groups were evaluated within themselves, the agreement level was found poor in group 1 (kappa=0.162) and fair in group 2 (kappa=0.210) and group 3 (kappa=0.252). Conclusion: A useful classification system in orthopedics and traumatology should classify the type of musculoskeletal disorder reliably, facilitate communication in clinical practice, guide preoperative planning, and enable comparison of results between studies. The Lichtman classification alone is insufficient and should be supported by other imaging and measurement techniques. C1 [Aydemir, Ahmet Nadir; Yucens, Mehmet; Demirkan, Ahmet Fahir] Pamukkale Univ, Dept Orthoped & Traumatol, Fac Med, TR-20070 Denizli, Turkey. [Cansu, Cengiz Eren] Marmara Univ, Dept Orthoped & Traumatol, Fac Med, Istanbul, Turkey.

Summary This study estimated the incidence of osteonecrosis in a Swedish, nationwide cohort of older adults. Osteonecrosis was approximately 10 times more common than in previous studies. The strongest risk factors were dialysis, hip fracture, osteomyelitis, and organ transplantation, but only hip fractures could have contributed substantially to the disease burden. Introduction The aim of this study was to estimate the incidence of osteonecrosis in a Swedish, nationwide cohort of older adults and in a large number of risk groups in that cohort. Methods In this retrospective cohort study, we included everyone who was aged 50 years or older and who was living in Sweden on 31 December 2005. We used Swedish national databases to collect data about prescription medication use, diagnosed medical conditions, and performed medical and surgical procedures. The study outcome was diagnosis of primary or secondary osteonecrosis at any skeletal site. The strength of risk factors was assessed using age- and sex-standardized incidence ratios (SIRs). Results The study cohort comprised 3,338,463 adults. The 10-year risk of osteonecrosis was 0.4% (n = 13,425), and the incidence rate was 4.7 cases/10000 person-years (95% confidence interval [CI], 4.6 to 4.7 cases). The strongest risk factors for osteonecrosis were hip fracture (SIR, 7.98; 95% CI, 7.69–8.27), solid organ transplantation (SIR, 7.14; 95% CI, 5.59–8.99), dialysis (SIR, 6.65; 95% CI, 5.62–7.81), and osteomyelitis (SIR, 6.43; 95% CI, 5.70–7.23). A history of hip fracture was present in 21.7% of cases of osteonecrosis, but osteomyelitis, dialysis, and solid organ transplantation were present in only 0.5 to 2% of cases. Conclusions Osteonecrosis was approximately 10 times more common than a small number of previous population-based studies have suggested. The strongest risk factors for osteonecrosis were dialysis, hip fracture, osteomyelitis, and solid organ transplantation, but only hip fractures could have contributed substantially to the disease burden. Electronic supplementary material The online version of this article (10.1007/s00198-018-04826-2) contains supplementary material, which is available to authorized users.

Objectives: This study aims to clinically evaluate the efficacy of pedicle bone flap treatment in stage II Kienböck's disease. Patients and methods: This retrospective study included 10 patients (8 males, 2 females; mean age 33.3 years; range, 23 to 46 years) treated with pedicle bone flap between January 2012 and June 2016. In all patients, a fourth extensor compartment artery (ECA) pedicle bone flap from the dorsal surface of the radius was prepared and placed through a window opened on the lunate bone. Clinical results of the patients were evaluated according to the Mayo wrist score. Results: All patients could return to their daily activities after surgery. No superficial or deep infection developed requiring debridement or antibiotic use other than prophylaxis. None of the patients required reoperation due to complications or the progression of the disease. The mean Mayo wrist score was measured as 81 (good). Conclusion: In this study, results of the fourth ECA pedicle bone flap application were found to be effective in the treatment of avascular necrosis of the lunate bone. Further comparative and long-term follow-up studies are required including large and homogeneous patient groups. © 2019 Turkish Joint Diseases Foundation.

Osteonecrosis (ON) is a clinical entity characterized by a pattern of cell death and complex process of bone resorption and formation. Studies related to ON have largely focused on certain anatomical sites; however, the evidence on vertebral body ON (VBON) is largely inconsistent and fragmented. The aim of this study was to clarify the pathophysiology, risk factors, imaging findings, and available treatment modalities for VBON. A systematic review of the relevant articles published in English was performed using PubMed, Embase, Medline, Google Scholar, Cochrane Central Register of Controlled Trials (CENTRAL), and CINAHL databases. A total of 81 articles were included in this study. Three main topics about VBON were identified: (1) pathophysiology and risk factors, (2) diagnosis, and (3) treatment. Forty-five studies were based on the pathophysiology, 52 on diagnosis, and 38 on the treatment options for VBON. The literature on VBON was limited and mainly focused on post-traumatic cases with a considerable overlap with nonunion and pseudoarthrosis.

El esqueleto humano es un conjunto organizado de piezas óseas que conforman y proporcionan soporte estructural al cuerpo. Diferentes funciones han sido descritas: soporte dinámico y mecánico, protección y mantenimiento de la homeostasis mineral. Para esto, el hueso debe mantener su metabolismo activo y ser capaz de adaptar su estructura a estímulos mecánicos reparando los daños estructurales a través del proceso de remodelación durante toda la vida. La osteoporosis, enfermedad de Paget, cáncer/infecciones en el hueso, van a alterar la fisiología del tejido dando lugar a la pérdida de su integridad. Los bifosfonatos (BFs) son agentes farmacológicos diseñados para el tratamiento de estas enfermedades, su principal mecanismo de acción es la inhibición de la resorción osteoclástica del hueso. La osteonecrosis de los maxilares (ONM) relacionada con la medicación consiste en la destrucción progresiva del tejido óseo, siendo uno de los efectos adversos de este tipo de tratamiento. Por esta razón, el objetivo de este artículo fue hacer una revisión acerca de los principales aspectos farmacológicos y clínicos de la ONM relacionada con los bifosfonatos en odontología. El diagnóstico clínico y el tratamiento adecuado son fundamentales para reducir el riesgo de osteonecrosis en pacientes bajo terapia antiresortiva o antes de iniciar su administración. Por esta razón, la prevención es aún más importante. The human skeleton is an organized set of bony pieces that make up and provide the structural support of the body. Different functions have been described: dynamic and mechanical support, protection and maintenance of mineral homeostasis. For this, the bone must maintain its active metabolism and be able to adapt its structure to mechanical stimuli repairing the structural damages through the process of remodeling throughout the life. Osteoporosis, Paget‘s disease, cancer and bone infections, will alter the physiology of the tissue resulting in the loss of its integrity. Bisphosphonates (BFs) are pharmacological agents designed for the treatment of these diseases, their main mechanism of action is the inhibition of bone osteoclastic resorption. Medication related osteonecrosis of the jaw (ONJ) consists of the progressive destruction of the bone tissue, being one of the adverse effects of this type of treatment. For this reason, the objective of this article was to make a review about the main pharmacological and clinical aspects of ONJs related to bisphosphonates in dentistry. Clinical diagnosis and appropriate treatment are essential to reduce the risk of osteonecrosis in patients undergoing antiresorptive therapy or before starting administration. For this reason, prevention is even more important.

OBJECTIVES: The purpose of this study was to evaluate the temperature change during low-speed drilling using infrared thermography. MATERIAL AND METHODS: Pig ribs were used to provide cortical bone of a similar quality to human mandible. Heat production by three implant drill systems (two conventional drilling systems and one low-speed drilling system) was evaluated by measuring the bone temperature using infrared thermography. Each system had two different bur sizes. The drill systems used were twist drill (2.0 mm/2.5 mm), which establishes the direction of the implant, and finally a 3.0 mm-pilot drill. Thermal images were recorded using the IRI1001 system (Infrared Integrated Systems Ltd.). Baseline temperature was 31±1ºC. Measurements were repeated 10 times, and a static load of 10 kg was applied while drilling. Data were analyzed using descriptive statistics. Statistical analysis was conducted with two-way ANOVA. RESULTS AND CONCLUSIONS: Mean values (n=10 drill sequences) for maximum recorded temperature (Max TºC), change in temperature (ΔTºC) from baseline were as follows. The changes in temperature (ΔTºC) were 1.57ºC and 2.46ºC for the lowest and the highest values, respectively. Drilling at 50 rpm without irrigation did not produce overheating. There was no significant difference in heat production between the 3 implant drill systems (p>0.05). No implant drill system produced heat exceeding 47ºC, which is the critical temperature for bone necrosis during low-speed drilling. Low-speed drilling without irrigation could be used during implant site preparation.

Clinical and radiological studies were performed on 25 hips of 25 patients with rapidly destructive coxopathy within 3 years after the onset. The mean age at the time of onset was 68.3 years. Two patients were males, and the other 23 were females ; many patients were aged females. The mean Japanese Orthopaedic Association hip score for pain was 13/40 while that for the range of motion (flexion) was 9.4/12. Inspite of marked pain, the motion range was relatively good. The mean disease duration was 10.3 months in the group showing an increased blood sedimentation rate and 20.8 months in the group with a normal sedimentation rate, being shorter in the former showing positive inflammatory reactios. Hypertension was observed in 44%. Radiographic examination showed osteoporosis in all patients. According to Singh's classification, the disease duration was shorter in patients with advanced osteoporosis. The Center-Edge angle and Acetabular-Head Index as the acetabular covering rate were below the mean value in 65%, showing slight dysplasia of hip joint. Histopathological examination revealed exposure of eburnated bone on the surface of the capital lesion in many patients, but only slight proliferative changes. In the synovial membrane, villous hyperplasia and cell proliferation were observed in the surface layer in most of patients. Free fragments of the cartilage and bone were phagositized with nonspecific inflammatory findings in the deep layer.

This study investigated pain experience following dental implant placement in relation to insertion torque using questionnaires. A total 80 implants were placed in 20 patients. Each patient received 4 implants at different times. One implant was inserted and, then, after 40 days was placed the second implant, after 80 days was placed the third implant and after 120 days was placed the fourth implant. At each time the peri-implant bone levels were evaluated on intraoral radiographs taken with the paralleling technique. The implants were placed with a dynamometric key at 35N, 50N, 65N, 85N. Patients were asked to evaluate their pain experience during surgery, 24 hours after surgery, and at 2 days, 4 days, 1, 2, and 4 weeks after surgery on special pain assessment forms. A separate form was used for each time point. Pain was assessed using a descriptive numerical rating scale of 0 to 10, with 0 indicative of no pain and 10 representing the worst pain imaginable. Patients were instructed that a score of 1 to 3 was indicative of mild pain, 4 to 6 was indicative of moderate pain, and 7 to 10 was indicative of severe pain. A significant correlation pain scores and insertion torque was found between group III and group IV vs group II and group I during surgery, at 24 hours, 2 days, 4 days, 1 week, 2 weeks p⩽0.05. No statistical difference was found between group I vs. group II during surgery, at 24 hours, 2 days, 4 days, 1 week, 2 weeks p⩾0.05. In conclusion, elevated insertion torque values produces pain and resoption of the crestal bone around the implants.

Nowadays three quarters of adolescents with cancer are cured but half of them experience a late toxic effect of antineoplastic therapy that interferes with their physical and psychosocial health. This review recapitulates late effects associated with radiation therapy, chemotherapy and surgery, reviews risk factors and prognosis and suggests follow-up and management strategies, excluding fertility issues. Adolescents with cancer should be the focus of active clinical research for the optimisation of antineoplastic treatment as well as for breakthroughs in the follow-up, prevention and management of toxic effects. © 2007 Elsevier Ltd. All rights reserved. 33 7 656 663

Osteopenia and osteonecrosis (ON) cause important longterm morbidity in renal transplant (Tx) recipients with increasing incidences because of longer graft survival and related drug exposure. A 38-year-old woman who started on haemodialysis in November 2001 had a renal Tx from a live relative in March 2003 due to chronic pyelonephritis with vesicoureteral reflux related end-stage renal disease. She had persistent secondary amenorrhoea 2 months before dialysis treatment. Throughout this period she had calcitriol and phosphorus binders for controlling secondary hyperparathyroidism. Her pre-Tx serum parathyroid hormone (PTH) was 73.2 pg/ml and body mass index (BMI) was 18.4 kg/m2 . Post-Tx immunosuppressive treatment was prednisolone (500 mg initially, then 30 mg/day), tapered to 25 mg/day by postoperative day 14, mycophenolate mofetil (2 g/day), cyclosporin (CsA; 100 mg/d) and daclizumab (a dose of 1 mg/kg, totalling five dosages with 2-week intervals). After an uneventful 4 weeks she complained of severe leg pain and symptoms of muscle weakness in the previous 4 days. The dose of prednisolone was tapered to 15 mg/day, but pain developed in both shoulders. Diffuse ON was diagnosed by hip and shoulder magnetic resonance imagings (MRI). At the time of diagnosis the total cumulative doses of prednisolone and CsA were 1220 mg and 2925 mg in 4 weeks, respectively. Serum creatinine was 0.7 mg/dl, calcium 10.5 mg/dl, Alkaline phosphatase (ALP) 271 IU/l, PTH 84 pg/ml, calcitonin 27 pg/ml and calcitriol 22.9 ng/dl. Bone mineral densities (BMD) of the lumbar spine and the hip region by Dual x-ray absorptiomtery (DEXA) after post-Tx 8 weeks were evaluated as osteoporosis with T scores of 3.2 and 3.9, respectively. Oral calcium, calcitriol and alendronate were added to the treatment. Her complaints regressed within 10 days. The dose of prednisolone was tapered to 10 mg/day at month 4 and to 5 mg/day at month 10. One year later, hip and shoulder MRIs showed normal findings. The respective post-Tx T scores of the lumbar spine and the femoral neck improved from -2.8 and -3.5 in the first year to -2.4 and -2.2 in the second year. Her serum creatinine level was 0.8 mg/dl with no complaint.

In the case of fracture or crack of human bones, a surgery method gives the best healing results because a traumatologist drills the bone, sets the immobilization screws and plates and with that procedure achieves an optimal immobilisation. A problem occurs if during the bone drilling, the maximal temperature of the bone tissue around the hole increases above some critical limit. This may result in thermal necrosis, which means the irreversible death of the bone cells around the drilled hole and the consequence is that immobilisation screw joint comes loose over time. In order to find a solution to the problem of reducing maximal bone drilling temperature, this paper studies the problem and presents the results of measuring the maximal bone drilling temperature in a high-speed drilling process with a step drill and a classic surgical type of the drill.

PubMedID: 16260355 Donor site necrosis is a very rare complication of palatal rotational flaps. The aim of this case report is to present a 43-year-old female, Type I diabetic patient with a chronic oroantral fistula in the right second molar region. The patient had bony necrosis in the donor site following palatal rotational flap operation. The treatment approach and the alternative methods are discussed. © 2005 Elsevier Inc. All rights reserved.

In case of fracture or crack of human bones, the most important is to return the bone parts as precisely as possible into their previous positions. The operative or surgery method in that case is the best. During the surgery traumatologist drill the bone in order to set the immobilization screws and plates and the goal is to insure maximum avoidance of motion of the fracture bone parts i. e. to achieve optimal immobilisation. During bone drilling, the surrounding tissue is heated and if the maximal temperature of the bone tissue around the bore increases above some critical limit, this may result in thermal necrosis (death of the bond cells around the drilled bore). The consequence of thermal necrosis is that immobilisation screw joint loose over time. This paper presents the results of research realised in measuring the maximal bone drilling temperature depending on some technological parameters and type of the drill.

Surgery in case of bone fractures can be performed in two basic ways. The first method is conservative, without direct action on the bone, whereas the other, operative method is more advanced but requires direct contact with the bone. In the latter case, the traumatologist uses various tools and equipment in order to re-establish the primary physiological position of the fractured parts. One of the operative procedures includes also bone drilling in order to set the immobilization screws and plates. During bone drilling, the surrounding tissue is heated. If the amount of developed heat near the bore is high enough to increase the temperature of the bone tissue above the critical limit, this may result in thermal necrosis. The death of the cells due to the thermal necrosis around the drilled bore causes them to lose their adequate properties, and the screw joint gets loose over time. This work studies the influence of some of the technological parameters on the bone drilling temperature increase and recommends improvements in the selection of the technological parameters and geometry of the drill.

Corticosteroid - induced avascular necrosis of head of femur is reported in an elderly woman patient with pemphigus.