1/236. Assessment of bone viability by scintiscanning in frostbite injuries.Radionuclide bone imaging with a radiotechnetium-labeled phosphate (99mTc-methylene diphosphonate) has been employed to study the extremities injured by frostbite. The degree of accretion of the radiopharmaceutical in bone is dependent on the integrity of the vascular supply. This property has been used successfully to distinguish viable and nonviable bone.- - - - - - - - - - ranking = 1keywords = bone (Clic here for more details about this article) |
2/236. Does avascular necrosis cause collapse of the dome of the talus in severe haemophilia?Arthropathy of the ankle joint is commonly observed in people with severe haemophilia. A review of the radiological appearance of ankle arthropathy provides evidence that the changes in the talar bone of the ankle joint are probably due to avascular necrosis. This may arise due to impairment to the arterial supply, as it enters the talar neck, secondary to the increased pressure at the time of haemarthroses.- - - - - - - - - - ranking = 0.14285714285714keywords = bone (Clic here for more details about this article) |
3/236. Heat-induced segmental necrosis after reaming of one humeral and two tibial fractures with a narrow medullary canal.In three cases referred to our clinic (a simple fracture of the humeral shaft, a simple, closed fracture, and a wedge fracture of the mid-third of the tibia), bone necrosis had resulted from excessive heat produced by reaming extremely narrow medullary cavities (5-5.5 mm diameter) with the 9 mm front-cutting reamer as part of a reamed nailing procedure. In any one case, different degrees of damage can occur from the metaphysis to the diaphysis. Based on the clinical course and the histological evaluation, we postulate that heat-induced damage can be divided into four degrees of severity (0-3): Grade 0: no damage; no devascularization, no heat-induced damage. Grade 1: The heat damaged zone is cut away during subsequent reaming, the only damage is devascularization. Grade 2: The damaged zones are not eliminated by subsequent reaming. The bone is devascularized and heat damaged. Grade 3: The entire cross section of the bone including the periosteum is devitalized by exposure to excessive heat. Depending on the severity of additional damage to the soft tissues, grave consequences are to be expected and further operations are unavoidable. The effects of heat-induced damage are particularly critical in the presence of infection (cases 2 and 3). The fundamental aspects and the extent of heat necrosis will be discussed. After discussion with the AO Technical Commission on the cause of heat-induced necrosis, we would recommend the following preventive measures: 1. preoperative measurement of the smallest diameter of the medullary cavity in two planes. 2. reaming with the standard instrumentation (9 mm) only if the medullary cavity has a diameter of at least 8 mm at its narrowest point. 3. Extremely narrow cavities should first be reamed manually or an alternative to nailing should be sought. 4. It is strongly recommended that only sharp reamers be used in such cases and blunt or damaged reamers replaced.- - - - - - - - - - ranking = 0.42857142857143keywords = bone (Clic here for more details about this article) |
4/236. A novel surgical procedure for osteonecrosis of the humeral head: reposition of the joint surface and bone engraftment.A novel surgical procedure was performed on a 33-year-old woman with idiopathic osteonecrosis of the head of the left humerus. The operation involved repositioning of the joint cartilage and bone engraftment through her humeral head from under the greater tuberosity with shoulder arthroscopy. The patient wore an abduction brace for 8 weeks after the operation to hold the joint surface in its new position. This surgical procedure resulted in considerable improvement of the functional status of the shoulder by relieving pain and increasing range-of-motion. A preoperative radiograph showed stage IV osteonecrosis of the humeral head. However, at follow-up, repositioning of the joint surface and improvement of the necrotic bone were observed by radiography and magnetic resonance imaging.- - - - - - - - - - ranking = 0.85714285714286keywords = bone (Clic here for more details about this article) |
5/236. pathology findings with acrylic implants.We report the pathological findings in cases of acrylic implants obtained by direct intratumoral injection of polymethyl-methacrylate (PMMA) and N-butyl-cyano-acrylate (NBCA). Direct intratumoral injection of acrylic implants was performed for a variety of primary and secondary bone lesions. These types of treatments have been used at our institution in the last 4 years for 40 vertebroplasty (PMMA) procedures and for nine bone lesions of other locations (PMMA, NBCA). Postmortem histology became available for 1 case of PMMA and for 5 cases with NBCA intratumoral acrylic implants. The pathological findings associated with PMMA and NBCA were evaluated and compared. PMMA exhibited a macroscopic and microscopic rim of tumor necrosis, 6 months after implantation. NBCA exhibited compressive effects on the nearby tumor tissue, however, without signs of significant necrosis outside the acrylic tumor cast. Tumor captured inside the acrylic cast showed extensive to near complete necrosis. Acrylic implants may lead to necrosis when injected directly in tumors. The necrotizing effect may extend beyond the limits of an implant in the case of PMMA. Such an extended effect of PMMA, when compared with NBCA, may be due to the variable toxicity of acrylic implants, including the different degrees of the exothermic reaction during polymerization.- - - - - - - - - - ranking = 0.28571428571429keywords = bone (Clic here for more details about this article) |
6/236. Pedicle bone grafting versus transtrochanteric rotational osteotomy for idiopathic osteonecrosis of the femoral head--four patients with both procedures.The clinical and radiographic results of vascularized pedicle iliac bone grafting (PBG) and Sugioka's transtrochanteric anterior rotational osteotomy of the femoral head (ARO) for idiopathic osteonecrosis of the femoral head were compared. Four male patients with bilateral osteonecrosis of the femoral head were treated with PBG in the first hip and with ARO in the second. All patients had stage 2 or 3 involvement according to Ficat's classification. Average age at the time of PBG and ARO was 42 and 43 years, respectively. Average follow-up of PBG and ARO was 7.5 and 5.7 years. At final follow-up, the average Harris hip scores of PBG and ARO were 73 and 85, respectively. Collapse was observed in 3 PBG hips and in 1 ARO hip. Three patients were more satisfied with the ARO procedure than with the PBG treatment, and one patient was undecided. ARO was considered better surgical treatment than PBG from both a clinical and radiological perspective.- - - - - - - - - - ranking = 0.71428571428571keywords = bone (Clic here for more details about this article) |
7/236. Maxillofacial osteonecrosis in a patient with multiple "idiopathic" facial pains.Previous investigations have identified focal areas of alveolar bone tenderness, increased mucosal temperature, abnormal anesthetic response, radiographic abnormality, increased radioisotope uptake on bone scans, and abnormal marrow within the quadrant of pain in patients with chronic, idiopathic facial pain. The present case reports a 53-year-old man with multiple debilitating, "idiopathic" chronic facial pains, including trigeminal neuralgia and atypical facial neuralgia. At necropsy he was found to have numerous separate and distinct areas of ischemic osteonecrosis on the side affected by the pains, one immediately beneath the major trigger point for the lancinating pain of the trigeminal neuralgia. This disease, called NICO (neuralgia-inducing cavitational osteonecrosis) when the jaws are involved, is a variation of the osteonecrosis that occurs in other bones, especially the femur. The underlying problem is vascular insufficiency, with intramedullary hypertension and multiple intraosseous infarctions occurring over time. The present case report illustrates the extreme difficulties involved in the diagnosis and treatment of this disease.- - - - - - - - - - ranking = 0.42857142857143keywords = bone (Clic here for more details about this article) |
8/236. Three cases of osteonecrosis of the lunate bone of the wrist in scleroderma.This report describes three cases of osteonecrosis of the lunate bone of the wrist in patients with systemic sclerosis presenting with wrist pain. All three patients had limited skin scleroderma but severe Raynaud's phenomenon. Two patients never received corticosteroids and one patient received only low doses for a brief period. None of the patients had other definable risk factors for osteonecrosis. Two patients underwent vascular bone grafting with improvement in symptoms. osteonecrosis may represent an under-recognized cause of wrist pain in scleroderma patients.- - - - - - - - - - ranking = 0.85714285714286keywords = bone (Clic here for more details about this article) |
9/236. Subchondral insufficiency fracture of the femoral head and medial femoral condyle.This case report documents the clinical, radiographic, and histologic findings in a 69-year-old obese man, who had subchondral insufficiency fracture both in the femoral head and medial femoral condyle. On plain radiographs, both lesions underwent subchondral collapse. Magnetic resonance images of the left hip showed a bone marrow edema pattern with associated low-intensity band on T1-weighted images, which was convex to the articular surface. The histopathologic findings in the hip and knee were characterized by the presence of a subchondral fracture with associated callus and granulation tissue along both sides of a fracture line. There was no evidence of antecedent osteonecrosis. To our knowledge, this is the first case report to describe the multiple occurrence of collapsed subchondral insufficiency fracture.- - - - - - - - - - ranking = 0.14285714285714keywords = bone (Clic here for more details about this article) |
10/236. Aseptic bone necrosis in Japanese divers.Medical examination was performed on the divers in Ohura for 7 years from 1969 to 1972. Aseptic bone necrosis was found in 268 of 450 divers (59.5%). men with over 5 years of experience in diving were highly affected (more than 54.4%). These bone lesions were found most frequently in the proximal end of the femur and the humerus. There was a significantly higher incidence of bone lesions in the men who dived over 30 meters. In the group of men with one or more bone lesions, 73.1% were known to have been treated for bends. The bone, once exposed to a certain compression of air, would have a tendency to develop bone lesions even after cessation of diving. Type A2 (linear opacity) led to the structural failure of the joint surface of the femur and the humerus. Histopathological study was carried out on the sections of bone obtained from three autopsy cases and four operated cases. Formation of air bubbles in the bone marrow cavity seemed to be the most important as the cause for the occurrence of aseptic bone necrosis, and local circulatory disturbance might be the most responsible for the progression of the bone lesion.- - - - - - - - - - ranking = 2keywords = bone (Clic here for more details about this article) |
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