Avascular Necrosis Of Bone Research Articles

Individual endoprosthetics of the talus bones of both feet: a case study

Relevance. Avascular necrosis of the talus bone occurs mainly among the working-age population. In the case of bilateral localization of the pathological process, the choice of tactics for the treatment of patients is an urgent and debatable issue today. Purpose of the study. To describe the surgical technology and short-term results of surgical treatment of a patient with avascular necrosis of both feet using the method of individual endoprosthetics with ceramic implants. Description of the case. A 32-year-old patient complained of pain in both ankle joints. Testing on scales before treatment: VAS - 9 points. AOFAS AH - 25 points, FFI - 139 points. A diagnosis: Avascular necrosis of the talus bones of both feet. Bilateral crusarthrosis g. 3. Based on computed tomography, modeling of individual endoprostheses of the talus bones of both feet was performed. At an interval of 4 months, surgical interventions were performed: individual endoprosthetics of the talus, plastic surgery of the lateral ligament complex according to Broström-Gould on the right foot, and individual endoprosthetics of the talus on the left foot. At a follow-up examination after 12 months after surgery on the right foot and 8 months after surgery on the left foot, the patient walks with full support on both lower limbs. Testing on scales: VAS -1 p., AOFAS AH - 82 p., FFI - 28 p.. On control radiographs, the axial relationships in the ankle joints are correct, the joint space is uniform, and no bone destruction is detected. Conclusion. Analysis of short-term results of surgical treatment showed that individual endoprosthetics of the talus for this pathology is a promising direction that allows preserving the function of the ankle joints and the weight-bearing ability of the lower extremities. The results of dynamic pedobarography allow us to conclude that the biomechanics of the step have significantly improved.

Three-Dimensional Planning for Vascularized Bone Grafts: Implementation and Surgical Application for Complex Bone Reconstruction in the Hand and Forearm.

Background/Objectives: Vascularized bone grafts have been successfully established for complex bone defects. The integration of three-dimensional (3D) simulation and printing technology may aid in more precise surgical planning and intraoperative bone shaping. The purpose of the present study was to describe the implementation and surgical application of this innovative technology for bone reconstruction. Methods: This prospective pilot study was conducted between June 2019 and June 2024. For this evaluation, patients who received vascularized bone reconstruction assisted with 3D technology were included. For reconstruction, the free medial femoral condyle (MFC) flap was used as the vascularized bone graft. Patient-specific 3D-printed templates, based on individual 3D simulations according to defect characteristics, were used for surgical planning, including flap elevation, shaping and inset. Results: A total of six patients (five male) with an average age of 39 years (range 19-62 years) and a mean follow-up time of 15 months (range 5-24 months) were analysed. The indications were as follows: avascular necrosis of the carpal bones, a metacarpal defect after tumor resection and pseudoarthrosis after a fractured ulna. Three patients received an osteochondral and three patients received a cortico-cancellous MFC flap. Conclusions: Our evaluation of clinical application revealed enhanced preoperative planning as well as intraoperative performance. Although the implementation for this technology is challenging, the new insights gained in planning and surgical guidance have led us to incorporate this technology into our standard routine.

Application of Mirror Image 3D-Printing Technology Bone Cement in Treatment of Stage IIIb Necrosis of the Lunate Bone.

At present, conventional operations are weak for pain relief and restoring the carpal joint function in the treatment of avascular necrosis of the lunate bone. Mirror image 3-dimensional (3D)-printing technology has rarely been reported for the treatment of lunate bone necrosis, The use of mirror 3D-printed lunar bone replacement and bone cement technology in the treatment of stage IIIb lunar bone necrosis has been rarely reported in previous literature. Personalized customized 3D-printed prostheses have become an effective solution for solving many complex cases, and the flexible application of bone cement technology can also achieve satisfactory clinical results. The authors report 3 patients who underwent mirror printing of lunar bone prostheses based on healthy side lunar bone computed tomography data, 3D printing of lunar bone prostheses replacement through small incisions, and intraoperative selection of alternative bone cement technology based on actual conditions. Mirror image 3D printing relieved the pain and resulted in satisfactory functional recovery for stage IIIb lunate bone necrosis.

Talar head replacement for treatment of Müller – Weiss syndrome: three clinical cases

Introduction Müller – Weiss syndrome is a rare condition that is characterized by avascular necrosis of the navicular bone leading to severe foot deformity, pain disturbing activities of daily living. There is no generally accepted treatment for avascular necrosis of the scaphoid, and the available treatments have disadvantages, which necessitates the need for new options.The objective was to present short-term results of three patients with osteonecrosis of the scaphoid and local necrosis of the talar head treated with ceramic talar head prosthesis, plastic surgery, metal osteosynthesis of the scaphoid and related surgical techniques.Material and methods Three patients diagnosed with Müller – Weiss syndrome were treated with ceramic talar head replacement, autologous bone grafting and metal osteosynthesis of the scaphoid bone with accompanying surgical techniques. Severity of pain and the condition of patients were assessed with the VAS and AOFAS AH scores.Results Short-term results showed consolidation at the site of metal osteosynthesis in all patients with no signs of instability of the talus hemiprosthesis. VAS and AOFAS AH scores indicated decrease in the pain and improved condition of the patients.Discussion Hemiarthroplasty of the talar head combined with plastic surgery and restoration of a congruent joint surface of the scaphoid, and associated surgical techniques may become an effective alternative to existing treatments for patients with Müller – Weiss syndrome, with further study.Conclusion The short-term findings showed that hemiarthroplasty was practical for restoration of the talonavicular mobility maintaining stable fixation of the talus.

Medial Femoral Condyle Free Flap: A Systematic Review and Proportional Meta-analysis of Applications and Surgical Outcomes

Background: Recalcitrant bone nonunion and osseous defect treatment is challenging and often requires vascularized bone transfer. The medial femoral condyle flap has become an increasingly popular option for reconstruction. The study aims at reviewing its different applications and synthesizing its surgical outcomes. Method: A systematic review including all studies assessing surgical outcomes of free medial femoral condyle flap for bone reconstruction in adults was conducted on January 31, 2023. Flap failure and postoperative complications were synthesized with a proportional meta-analysis. Results: Forty articles describing bony reconstruction in the head and neck, upper limb, and lower limb areas were selected. Indications ranged from bony nonunion and bone defects to avascular bone necrosis. Multiple flaps were raised as either pure periosteal, cortico-periosteal, cortico-cancellous-periosteal, or cortico-chondro-periosteal. A minority of composite flaps were reported. Overall failure rate was 1% [95% confidence interval (CI), 0.00–0.08] in head & neck applications, 4% in the lower limb (95% CI, 0.00–0.16), 2% in the upper limb (95% CI, 0.00–0.06), and 1% in articles analyzing various locations simultaneously (95% CI, 0.00–0.04). Overall donor site complication rate was 4% (95% CI, 0.01–0.06). Major reported complications were: femoral fractures (n = 3), superficial femoral artery injury (n = 1), medial collateral ligament injury (n = 1), and septic shock due to pace-maker colonization (n = 1). Conclusion: The medial femoral condyle flap is a versatile option for bone reconstruction with high success rates and low donor site morbidity.

Reduced Corticosteroid Exposure Is Safe and Does Not Reduce Disease Control among Hodgkin Lymphoma Patients Treated with Escalated BEACOPP (eBEACOPP).

Background and Objectives: eBEACOPP is the most effective chemotherapy regimen for younger patients with early unfavorable (EU) and advanced-stage (AS) Hodgkin lymphoma (HL), albeit with significant toxicities. The 14-day/cycle prednisone course contributes to side effects, including osteoarticular events like avascular bone necrosis (AVN). Our center has been using eBEACOPP since 2009 for AS and 2014 for EU patients. In 2016, we reduced prednisone treatment to 7-10 days to lessen AVN risk. We analyzed the effects of this approach. Materials and Methods: We retrospectively collected data on patients who received at least two cycles of eBEACOPP for first-line HL treatment. Results: A total of 162 patients (33 EU, 129 AS) were included. Their median age was 31 (range 19-59 years), and 88 were males. A total of 94 patients received full corticosteroid courses, and 68 received reduced corticosteroid courses. The overall response rate (ORR) was 98%. Different corticosteroid dosings had no significant effect on ORR, febrile neutropenia episodes, or hospital admissions. After a median follow-up (mFU) of 58 months, the 5yPFS for the entire cohort was 98% vs. 95% for the standard course vs. the short corticosteroids course, respectively (p = 0.37), while the 5yOS was 98% vs. 99% for the standard course vs. short corticosteroids course, respectively (p = 0.87). In AS patients intended to be treated with six eBEACOPP cycles, 5yPFS and 5yOS were 100% vs. 97% and 100% vs. 99% for standard vs. short corticosteroid courses, respectively (p = 0.56 and p = 0.17). In EU patients, 5yPFS was 97% (standard) vs. 95% (short) (p = 0.98) and 5yOS 100% vs. 93.3% (p = 0.87). Osteoarticular events were numerically lower in patients receiving the shorter prednisone course, both in the whole cohort and in the subgroup of patients treated with six cycles of eBEACOPP, but this difference failed to reach statistical significance. Conclusions: eBEACOPP provides excellent and durable first-line disease control. Shortening the corticosteroid course does not compromise efficacy, potentially reducing toxicity. However, longer follow-ups and larger studies are needed for confirmation.

A Comprehensive Review of COVID-19-Infection- and Steroid-Treatment-Associated Bone Avascular Necrosis: A Multi-Study Analysis

Background: The COVID-19 pandemic has presented numerous challenges to the global healthcare system and emerging evidence suggests a potential link between COVID-19 treatment, specifically steroid therapy, and the development of avascular necrosis (AVN) of the hip. This review aims to provide a comprehensive overview of recent studies and case reports investigating the relationship between COVID-19, corticosteroid therapy, and the development of AVN. Understanding the nuances of AVN in the context of COVID-19 is crucial for healthcare professionals to navigate treatment decisions and mitigate potential complications. Materials and Methods: The Preferred Reporting Items for Systematic Reviews and a Meta-Analysis (PRISMA) were used in the systematic review until 1 September 2023. The full texts of the remaining twenty-three (n = 23) articles were independently reviewed by the authors of this review. Conclusions: The association between steroid therapy for COVID-19 and the development of hip AVN is a noteworthy concern even though no relationship is evident between the duration of treatment, cumulative dosage of medication, maximum daily dosage received, and presence of AVN. Further research with larger cohorts and long-term follow up is needed to better understand the causative relationship and optimal management strategies for hip AVN in the context of COVID-19 and steroid therapy.

Avascular Bone Necrosis in Pediatric Patients with Sickle Cell Disease in Basrah, Iraq

BACKGROUND: Avascular necrosis (AVN) is regarded as a manifestation of severe sickle cell disease (SCD), with the femoral head being the most affected. OBJECTIVES: The main objectives of this study were to look for the frequency of AVN in pediatric patients with SCD, evaluate the clinical pattern and severity of AVN, and study the possible risk factors associated with AVN. MATERIALS AND METHODS: A cross-sectional study has been conducted on SCD patients, aged 6–18 years, who visited the Basrah Center for Hereditary Blood Diseases from the first of February 2021 to August 2021. Patients were screened for AVN by hip plain radiography and magnetic resonance imaging. The modified Ficat-Arlet staging system was used to classify different stages of AVN. RESULTS: The total number of screened patients was 291; 193 (66.3%) had sickle cell anemia, 71 (24.4%) with S/β0 thalassemia, 21 (7.2%) with S/β+ thalassemia, and 6 (2.1%) had S/D disease. Fifty-eight (19.9%) patients were found to have different stages of AVN; 7 (12.1%) were asymptomatic and 51 (87.9%) were symptomatic. The logistic regression analysis has revealed that frequent vaso-occlusive crises requiring hospitalization (B = 1.576, P = 0.003), acute splenic sequestration crises (B = 1.256, P = 0.003), homozygous sickle hemoglobin genotype (B = −0.208, P = 0.001), and low reticulocyte count (B = 1.452, P = 0.027) are significant variables associated with AVN. CONCLUSION: AVN was reported in a significant percentage of pediatric patients with SCD and was associated with selected indicators of disease severity. Further studies that evaluate the natural history, progress of AVN, and variations in selected variables over time like reticulocytes and the co-inheritance of α-thalassemia are important.

Differential diagnosis of aseptic (avascular) necrosis and stress fracture of the sesamoid bone (review)

Objective. To clarify the features of differential diagnostics of aseptic (avascular) necrosis and stress fracture of the sesamoid bone. Material and methods. Using as key-words «sesamoid bone», «avascular necrosis», «clinical stage» and «treatment» the search of publications in PubMed, Scopus, and MedLine databases was conducted, in which the features of differential diagnostics of aseptic necrosis and stress fracture of sesamoid bone were summarized and analyzed. Results. Slight sclerosis enhancement detected on computed tomography confirms the presence of osteonecrosis of the sesamoid bone, whereas an irregularly shaped fragment with poorly corticated edges on the radiograph indicates a fracture. When radiologic and clinical findings are equivocal, CT and MRI can help identify true fractures by detecting oblique irregular surfaces of fragments. In osteonecrosis, MRI may show changes in the form of bone marrow edema localized to the sesamoid joints. Conclusions. In the article, based on the analysis of literature sources, the features of sesamoid bone anatomy were clarified and generalized, as well as their blood supply was described and the features of differential diagnostics of aseptic necrosis and stress fracture of the sesamoid bone in various localizations were considered. Radiologic stu-dies, including radiography, CT, and MRI, provide useful information about the presence and pathology involving these bones and should be used in conjunction with clinical findings to guide patient management

Effectiveness analysis of percutaneous parallel screw fixation via posterolateral "safe zone" for Hawkins type Ⅰ- Ⅲ talar neck fractures

To explore the effectiveness of the percutaneous parallel screw fixation via the posterolateral "safe zone" for Hawkins type Ⅰ-Ⅲ talar neck fractures. A retrospective analysis was conducted on the clinical data from 35 patients who met the selection criteria of talar neck fractures between January 2019 and June 2021. According to the surgical method, they were divided into a study group (14 cases, using percutaneous posterolateral "safe zone" parallel screw fixation) and a control group (21 cases, using traditional open reduction and anterior cross screw internal fixation). There was no significant difference in gender, age, affected side, Hawkins classification, and time from injury to operation between the two groups ( P>0.05). The operation time, bone healing time, complications, and Hawkins sign were recorded, and the improvement of pain and ankle-foot function were evaluated by visual analogue scale (VAS) score and American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score at last follow-up. The overall quality of life was assessed by the short form of 12-item health survey (SF-12), which was divided into physical and psychological scores; and the satisfaction of patients was evaluated by the 5-point Likert scale. The operation time in the study group was significantly shorter than that in the control group ( P<0.05). All patients werefollowed up 13-35 months, with an average of 20.6 months; there was no significant difference in the follow-up time between the two groups ( P>0.05). The time of bone healing in the study group was shorter than that in the control group, and the positive rate of Hawkins sign (83.33%) was higher than that in the control group (33.33%), and the differences were significant ( P<0.05). In the control group, there were 2 cases of incision delayed healing, 7 cases of avascular necrosis of bone, 3 cases of joint degeneration, 1 case of bone nonunion, and 3 cases of internal fixation irritation; while in the study group, there were only 2 cases of joint degeneration, and there was a significant difference in the incidence of complications between the two groups ( P<0.05). At last follow-up, there was no significant difference in VAS score between the two groups ( P>0.05), but the SF-12 physical and psychological scores, AOFAS ankle and hindfoot scores, and patients' satisfaction in the study group were significantly better than those in the control group ( P<0.05). The treatment of Hawkins type Ⅰ-Ⅲ talar neck fractures with percutaneous parallel screw fixation via the posterolateral "safe zone" can achieve better effectiveness than traditional open surgery, with the advantages of less trauma, fewer complications, faster recovery, and higher patient satisfaction.

Complex-Conservative Treatment of Sars-Cov-2 Associated Early-Stage Avascular Necrosis of The Femoral Head

Avascular necrosis of bones (osteonecrosis) has developed as a bad consequence of the COVID-19 (SARS-CoV-2) pandemic that has swept the world. In 5-58% of patients with the type of covid19 fertilizer, the bones were affected by avascular necrosis. In 39% of patients with SARS-CoV-2, avascular necrosis of the hip bone developed within a few months after atypical pneumonia. Avascular necrosis is a disease that often develops in people of working age (average age is 33-45 years) and leads to severe disability associated with the death of bone tissue in a particular area. Discussions about the pathogenesis of postcovid avascular necrosis, the possibility of its diagnosis and treatment in the early stages are subject to active discussion. Given that COVID-19 infection is common among young people and working-age people, early diagnosis and treatment of this form of osteonecrosis is of great social and economic importance

HLA-DR genotypes in patients with systemic lupus erythematosus in Taiwan.

Different human leukocyte antigen (HLA)-DR genotypes have been known to be associated with the risk of development of systemic lupus erythematosus (SLE) in different populations, although Lu et al. have reported previously that no correlation exists between the HLA-DR genotype and disease manifestation in SLE patients in Taiwan. We investigated the effects different HLA-DR genotypes had on SLE incidence in Taiwanese patients as to whether risk alleles were associated with different clinical manifestations, and the effects risk alleles had on the age of disease onset. Two hundred thirty-four SLE patients and 346 healthy controls were enrolled. HLA-DR genotyping was performed with the HLA FluoGene DRDQ kit for each subject. Chi-square tests and t tests were performed for statistical analysis. HLA-DR2 was significantly more frequently found in SLE patients than in controls (odds ratio [OR] = 2.05, 95% CI, 1.44-2.92, p < 0.001). Notably, HLA-DR6 appeared to trend toward negative correlation with SLE, whereas HLA-DR8 appeared to trend toward positive correlation. HLA-DR2 patients had an earlier onset of disease as well as a higher prevalence of oral ulcer, avascular necrosis of bone, and renal involvement (lupus nephritis). HLA-DR2 was associated with SLE susceptibility in this Taiwanese population as well as lower age of disease onset and more severe clinical manifestations.

Treatment of Kienbock’s Disease by an Experimental Conservative Approach: Case report

Kienböck’s disease is characterized by avascular necrosis of the lunate bone. There are four stages due to the severity of the disease. A 52-year-old woman was referred to the Tehran Healthcare Clinic to treat the stage II Kienböck’s disease according to the clinical finding and MRI report. Her main complaint was a painful feeling in the dorsal wrist, decreased range of motion of the wrist, and reduced grip strength for one year. The treatment was achieved after completion of our conservative course by special vibration therapy in less than two months. Even though the conservative approaches are generally not recommended in treatment of Kienböck’s disease and in many cases surgeon’s preference (radial shortening osteotomy for early disease and PRC in later stages), our theory is that the aggressive procedure should be the second choice of treatment, especially in the early stages (I and II).

Corticosteroid-Induced Avascular Bone Necrosis and Possible Association with Prior COVID-19 Infection

Corticosteroid is a frequent implicating factor for the development of avascular bone necrosis (AVN). The etiology of corticosteroid-induced AVN is not fully understood, but it includes fat hypertrophy, fat embolism, and intravascular coagulation that causes obstruction of blood supply to the bone. This association can be carried forward for COVID-19 as well since it is also a microvascular disease. Suffering from COVID-19 and prescription of glucocorticoids could both be responsible for AVN. Early recognition of this complication is essential as the prognosis is affected by the stage of the disease.

Clinical and biological profile of Sickle Cell Anemia children in a rural area in Central Africa

ABSTRACTBackground:Sickle Cell Anemia (SCA) is the most common genetic disease worldwide caused by a single mutation in the gene HBB. The disease severity is very variable and depends on many factors. We evaluated the clinical and biological profile of sickle cell anemia children in rural Central Africa.Methods:This cross-sectional study was conducted in the Hôpital Saint Luc de Kisantu, located 120 km away from Kinshasa-DR Congo in an area of 35 km around Kisantu with a population of roughly 80 000 individuals. We included SCA patients aged 6 months to 18 years. We collected clinical and hematological data. The SCA scoring system proposed by Adegoke et al. in 2013 was applied to determine the disease severity. We searched for factors associated to the disease severity.Results:This study included 136 patients, 66 males and 70 females (sex-ratio M/F 0.94). The mean severity score was 8.21 ± 5.30 (ranges 0–23). Fifty-nine (43.4%) children had mild disease, 62 (45.6%) moderate and 15 (11%) severe disease. Girls had higher levels of HbF than boys (p = 0.003). An inverse correlation was observed between fetal hemoglobin and the disease severity (p = 0.005, r −0.239, IC95% −6.139; −1.469). Some factors such age influence the occurrence of certain chronic complications such as avascular bone necrosis.Conclusion:In conclusion, the disease severity of SCA depends on multiple factors. In this study, fetal hemoglobin was the main modulator of the disease severity. These data may also serve as a baseline to initiate HU treatment in this setting.

5606726 IMPACT OF ALLOGENEIC STEM CELL TRANSPLANTATION ON PHYSICAL, MENTAL, AND SOCIAL HEALTH OF ADULT SICKLE CELL DISEASE PATIENTS: A MIXED-METHODS STUDY

Background: Sickle cell disease (SCD) is characterized by chronic hemolytic anemia and recurrent painful vaso-occlusive crises, resulting in considerable physical and psychosocial disease burden and early mortality. In recent years, the application of allogeneic hematopoietic stem cell transplantation (HSCT) as a curative treatment for adult SCD patients has increased. As a result, a deeper understanding of the complex relationship between physical, mental, and social health before and after curation is needed. Aim: To explore the experiences and perspectives of adult SCD patients on the impact of HSCT on their physical, mental, and social health. Methods: A mixed methods study design, consisting of a semi-structured interview and completion of 9 Patient Reported Outcomes Measurement Information System (PROMIS®) item banks per participant was used. Adult SCD patients who underwent HSCT ≥ 1 year ago at the Amsterdam University Medical Center were eligible to take part in this study. Interviews were recorded, transcribed verbatim, and thematically analyzed using MAXQDA® software. Standardized T-scores of PROMIS® measures were evaluated and compared to reference scores of the Dutch general population. Results: Ten SCD patients with a median age of 29,5 years (range 19-49) were included in the study and interviewed between October 2021 and May 2022. Median time since HSCT was 2.7 years (range 1 - 3.5). All patients had successful engraftment. Relevant themes were (1) pain/living pain free, (2) physical wellbeing, (3) mental wellbeing, (4) perspective/outlook, (5) education and work, (6) family and friends and (7) activities and participation. Living pain free and the emergence of a future perspective were major improvements for most participants which resonated strongly in their daily lives. Nevertheless, emotional struggles with processing the impact of having had SCD on the one hand, while adjusting to the novel circumstances on the other hand, were common among participants. Before and after HSCT, participants experienced a lack of psychological help. Two patients with ongoing pain from avascular bone necrosis had mixed feelings about the success of the transplant. These two patients scored within the mild, moderate, or severe symptom category on ≥ 7 of 9 PROMIS® item banks. While mean PROMIS® T-scores of all participants fell within the reference values of the general population (Figure 1), a large variation between patients was observed which matched with our findings from the qualitative data. Conclusions: Adult SCD patients experience significant improvements in many aspects of their physical, mental, and social health after cure by HSCT. Yet, they are confronted with a new and often unfamiliar reality, which carries different challenges. Pain as a result of irreversible complications of SCD continues to have a negative impact on quality of life after HSCT. Clinicians should acknowledge these challenges and aim at creating realistic expectations in future transplant candidates. Moreover, patients expressed a need for tailored psychological care, which should be offered before and after HSCT.

The Utility of Tc-99m Hydroxydiphosphonate Single-Photon Emission Computed Tomography/Computed Tomography in Symptomatic Kohler's Disease.

Kohler's disease (KD) is a rare disorder of the foot in children where there is avascular necrosis of the navicular bone (NB). It presents with pain and limping and is often misdiagnosed as an infection. However, by adding single-photon emission computed tomography-computed tomography (SPECT-CT) of the foot, the lesion is localized to the NB, leading to the diagnosis of KD. We report the case of a 6-year-old boy with limping and foot pain, who underwent a bone scan using Tc-99m hydroxydiphosphonate and SPECT-CT of the feet. SPECT-CT was necessary not only to localize the exact site of the pathology in an area with small bones but also to confidently reach the diagnosis of KD and proceed with the correct management plan.

The incidence, risk factors, and outcomes of symptomatic avascular necrosis of bone among Chinese pediatric patients with acute lymphoblastic leukemia

Avascular necrosis (AVN) of bone is a debilitating complication of pediatric patients with acute lymphoblastic leukemia (ALL). While it is extensively studied and reported in Western population, studies focused on Orientals are limited. This study aims to evaluate the incidence, risk factors, and clinical outcomes of AVN among Chinese children with ALL. This study is a retrospective, territory-wide population-based cohort study of pediatric patients with ALL enrolled on one of the three consecutive ALL study protocols (ALL-IC-BFM 2002, CCLG-ALL 2008, and CCCG-ALL 2015). A total of 24 out of 533 pediatric subjects with ALL (4.5%) had symptomatic AVN. Age was the single most important risk factor associated with the development of AVN. Only three patients were below age of 10 at the time of diagnosis of ALL. The incidences of AVN in patients aged above and below 10 years were 18.2% ± 3.6% and 0.8% ± 0.5%, respectively, and were significantly different (p < 0.005). Treatment protocol, immunophenotype, and gender were not predictive of AVN. Among the 24 patients, five required orthopedic interventions in view of progressive and severe disease. For subjects with hip joints involvement, follow-up assessments showed 12 of 22 hip joints had radiological progression over a median duration of 3.63 years. Seventeen of them did not have pain at the latest follow-up and among patients with pain (n=7), five did not experience any limitation on activities of daily living while two required use of walking aids or wheelchair. The incidence of symptomatic AVN in Chinese ALL patients was comparable to other studies in Western population. Adolescent age more than 10 years old was recognized to be the most important factor for development of AVN. Significant proportion of patients had radiological progression over time with a small percentage of subjects had daily activities affected.

Association Between Dental Infection and Increased Incidence of Complications in Sickle Cell Disease Children: A Cross-sectional Study in Jeddah City

Aim: Children with sickle cell disease (SCD) are prone to many complications. However, little is known about oral infectious. This study aimed to assess the oral health status of pediatric patients with SCD and explore the associations between oral health conditions and clinical complications of SCD. Materials and Methods: A cross-sectional study was conducted in children with SCD admitted to the pediatric wards of two government hospitals in Jeddah city. The children were examined for dental caries, gingival diseases, oral lesions, and dental infections. Oral findings were compared between children who were hospitalized for vaso-occlusive crisis (VOC) or had a history of VOC in the last 6 or 12 months and those who were admitted for other reasons such as blood transfusion or other complications or had no history of VOC in the last 6 or 12 months. Results: A total of 107 children with SCD were included, with a mean age of 9.82 ± 3.82 years, of which 51 (47.7%) were females. Of the total, 58 (54.2%) were admitted because of VOC. There was a significant relationship between VOC and dental attrition ( P = 0.038), osteomyelitis, and dental abscesses ( P = 0.004). A significant association was found between the presence of dental abscesses and a history of osteomyelitis or avascular necrosis of long bones in the previous 12 months ( P = 0.001 and P = 0.041, respectively). Conclusion: Dental abscesses and non-carious lesions are likely to be associated with VOC; however, further prospective cohort studies are warranted to confirm this association and establish a causal relationship.

Effect of Folic Acid on Avascular Bone Necrosis in mice Associated with Hypercholesterolemia

Effect of Folic Acid on Avascular Bone Necrosis in mice Associated with Hypercholesterolemia