Bone Swelling Research Articles

Carpometacarpal Joint Fracture Dislocation of Second to Fifth Finger

BackgroundCarpometacarpal joint fracture dislocation of the second to fifth finger is a rare hand injury associated with high energy trauma. Due to severe swelling and overlapping of bones on the radiograph of wrist-hand, dislocations are missed. We reported a series of six patients with rare carpometacarpal joint fracture dislocation treated with open reduction.MethodsWe retrospectively studied six cases of carpometacarpal joint fracture dislocation. All patients were treated with open reduction and internal fixation with Kirschner wire. Functional assessment was done with Quick Disabilities of the Arm, Shoulder and Hand score (Quick DASH score) at regular intervals.ResultsAverage Quick DASH score was improved from 75.76 to 1.9 from 6 weeks to 18 months of duration. Of the six patients, three patients had a Quick DASH score of 0 at the end of 18 months.ConclusionsCareful hand examination and radiographic assessment is necessary to avoid missed diagnosis of carpometacarpal joint fracture dislocation. Early open reduction and internal fixation lead to excellent recovery of hand function.

Alkaline phosphatase activity-guided isolation of active compounds and new dammarane-type triterpenes from Cissus quadrangularis hexane extract

Ethnopharmacological relevanceThe stem of Cissus quadrangularis L. (CQ) is used in traditional medicine to treat bone fractures and swelling. Anti-osteoporotic activity of CQ hexane extract has been reported, but the active compounds in this extract remain unknown. Thus, we aimed to identify the active compounds in CQ hexane extract using bioassay-guided isolation. Materials and methodsThe CQ hexane extract was fractionated sequentially with benzene, dichloromethane, ethyl acetate, and methanol. The examination of CQ extract and its fractions was guided by bioassays for alkaline phosphatase (ALP) activity during the differentiation of MC3T3-E1 osteoblastic cells. The cells were treated with or without the CQ extract and its fractions for a period of time, and then the stimulatory effect of the alkaline phosphatase enzyme, a bone differentiation marker, was investigated. The compounds obtained were structurally elucidated using spectroscopic techniques and re-evaluated for activity during bone differentiation. ResultsA total of 29 compounds were isolated, viz., triterpenes, fatty acid methyl esters, glycerolipids, steroids, phytols, and cerebrosides. Four new dammarane-type triterpenes were isolated for the first time from nature, and this report is the first to identify this group of compounds from the Vitaceae family. Seven compounds, viz., glycerolipids and squalene, stimulated ALP activity at a dose of 10μg/mL. Moreover, the synergistic effect of these compounds on bone formation was demonstrated. ConclusionThis report describes, for the first time, the isolation of active compounds from CQ hexane extract; these active compounds will be useful for the quality control of extracts from this plant used to treat osteoporosis.

Gradual adaptation of bone structure to aquatic lifestyle in extinct sloths from Peru

Non-pathological densification (osteosclerosis) and swelling (pachyostosis) of bones are the main modifications affecting the skeleton of land vertebrates (tetrapods) that returned to water. However, a precise temporal calibration of the acquisition of such adaptations is still wanting. Here, we assess the timing of such acquisition using the aquatic sloth Thalassocnus, from the Neogene of the Pisco Formation, Peru. This genus is represented by five species occurring in successive vertebrate-bearing horizons of distinct ages. It yields the most detailed data about the gradual acquisition of aquatic adaptations among tetrapods, in displaying increasing osteosclerosis and pachyostosis through time. Such modifications, reflecting a shift in the habitat from terrestrial to aquatic, occurred over a short geological time span (ca 4 Myr). Otherwise, the bones of terrestrial pilosans (sloths and anteaters) are much more compact than the mean mammalian condition, which suggests that the osteosclerosis of Thalassocnus may represent an exaptation.

A new missense mutation in FGF23 gene in a male with hyperostosis–hyperphosphatemia syndrome (HHS)

Hyperostosis-hyperphosphataemia syndrome (HHS) is a rare autosomal recessive metabolic disorder, characterized by recurrent painful swelling of long bones, periosteal new bone formation and cortical hyperostosis or intramedullary sclerosis, hyperphosphatemia and low intact fibroblast growth factor 23 (FGF23) protein levels. It is caused by mutations in 2 genes, N-acetylgalactosaminyltransferase 3 (GalNAc-transferase; GALNT3) and FGF23. We have performed mutation analysis of the GALNT3 and FGF23 genes in a patient with HHS and detected a homozygous mutation in exon 3 of FGF23 gene (NM_020638.2: c.471C>A) which results in amino acid change from phenylalanine 157 to leucin (p.F157L) in receptor interaction site.

Differential X-Ray Diagnostics of Aneurysmal and Simple Bone Cyst

Background: Improving the differential diagnostics of aneurysmal bone cyst using X-ray studies Patients and Methods: There were 50 patients (28 men, 22 women) aged from 13 to 52 with cystic bone formations in the study group. Radiological diagnoses included 24 patients with aneurysmal bone cyst and 26 with simple bone cyst. X-ray evaluation of following characteristics was done: location, size , texture, contours, bone shape, periosteaum reaction, and the presence of pathological fractures. To verify the diagnosis, all the patients were conducted MRI of the affected bones in the T1, T2 , STIR conditions in axial, coronary, and sagittal planes. Specific indices were calculated for aneurysmal bone cyst such radiological signs as texture, localization of the tumor, and bone deformity Results: The effect of long bones in the group is 72.5% (including 28.6% of aneurysmal bone cysts, 81.4% of simple bone cyst), flat bones were affected in 27.5% of cases (including 78.5% of aneurysmal bone cysts, 21.5% of simple bone cysts). In 45.5% of the cases aneurysmal bone cyst was located in the metaphysis of long bones, 38.5% in the pineal gland, and17.5% in the shaft. Simple bone cysts in 31.5% of the cases were located in the metaphysis, 28.5% in the epiphysis and 17% in the diaphysis. There was no significant difference between X-rays and MRI data concerning localization of revealed structures. The average diameter of aneurysmal bone cysts was 7.8 cm, and that of simple bone cysts was 6.2 cm. A chamber structure was revealed at 38.2% of patients, including 21.5% of aneurismal bone cysts, and 78.5% of simple bone cysts. The multi-chamber structure was observed in 61.8% of patients (79.5% of them had aneurysmal bone cyst, and 20.5% had simple bone cyst). In 52.2% of patients (78.6% of them had aneurysmal bone cysts, 21.4% had simple bone cysts) the contents of cysts on MRI was heterogeneous due to the presence of blood. In all patients, the lumen of cysts on radiographs was defined as a homogeneous area of enlightenment. Pathological fracture was detected in 12.4% of patients with aneurysmal bone cyst, and 21.4% of patients with simple bone cyst. The presence of sclerotic loops was revealed in 62.6% of patients ( aneurysmal bone cyst, 18.5%; simple bone cyst, 81.5%). Swelling of bone was observed in 78.2% of patients, including aneurysmal bone cyst in 58.5% and simple bone cyst in 41.5% of cases. There was periosteal reaction in the form of linear periostitis in 24.5% of patients with aneurysmal bone cyst. No changes in the periosteum were found in the patients with simple bone cyst. The percentages pertaining to indicators of specific structure, localization of new formation, and changes in the shape of bones for aneurysmal bone cysts were 81.8%, 63.2%, and 42.4%, respectively. Conclusions: According to our data, the structure of formation is the most specific out of all radiographic evidences. MRI is superior to X-ray in evaluation of structure bone cyst formation. It most accurately indicates the nature of their contents. Results of X-ray method and MRI regarding identification of location, size and contour of bone cyst, bone deformation, periosteal reaction, and the presence of pathologic fracture did not show significant difference.

Endodontic treatment of a mandibular premolar abscess in a horse: A case study

SummaryA pulpar abscess of cheek tooth 307 (according to the Triadan numerical system) was diagnosed in a 7‐year‐old female Quarter Horse. History included a painful response to palpation in the mandibular region for approximately 4 weeks. Symptoms included swelling of the mandibular bone with subsequent fistulisation. A complete intraoral examination was performed and no lesions or abnormalities were found. Digital radiographs of the mandibular arcade demonstrated a periapical lesion of cheek tooth 307. Various therapeutic options were considered, including standing oral extraction, retrograde repulsion and endodontic therapy. Together with the client, a decision was made to perform endodontic therapy, with the double aim of preserving the tooth and maintaining normal molar occlusion. This was done under general anaesthesia without apicectomy, and using materials commonly used in the field of human endodontics. Following surgery, radiographs were taken and confirmed the complete sealing of the pulp canals. Recovery was uneventful and no post operative complications were observed. A complete intraoral follow‐up examination was performed one year after surgery, and revealed normal eruption and occlusion of the tooth involved. Radiographic examination confirmed the correct position and integrity of the sealant material, as well as normal perialveolar bone structure. This case report indicates that endodontic therapy, following the above protocol, involving pulpectomy and sealing of the pulp cavity, represents a valid alternative to the more commonly used technique of tooth extraction.

Profile of Secondary Bone Cancer in Lomé (Togo)

Objectives: To determine the epidemiological, clinical and paraclinical profile of bone metastases cancer. Patients and Methods: It was a retrospective study performed on a series of cases, admitted in Rheumatology department of the University Teaching Hospital of Lomé, Togo from October 1989 to December 2008. The diagnosis of bone metastasis was made because of the existence of inflammatory bone pain, or pathological fracture, or bone swelling and a bone condensing or mixed or osteolytic radiological image. The anatomopathological evidence was made after biopsy of the bone lesion or primary cancer. 2018 patients were hospitalized in rheumatology, and among them 77 had documented bone metastasis. Results: There were 53 men (68.8%) and 24 women (31.2%) with a sex ratio of 2.2. The mean age was 56.6 ± 12.6 years, ranging from 21 to 82 years. The primary cancer most frequently found was that of the prostate, representing 57.1% of bone metastasis and breast in 15.6%. The main manifestations of patients with bone metastases were inflammatory bone pain (76.6%) and alteration of general condition (75.3%). The spine was the main area of pain (64.9%). The metastasis was bone condensing in 48.1% of cases, osteolytic in 40.3% and mixed in 11.6%. The average survival was 22 months. Conclusion: The clinical and radiological presentation remains classic. Cancer of the prostate and breast are the main neoplasia responsible for bone metastasis in our series. The diagnosis of the primary tumor is often made at the stage of metastasis in black Africa.

A Case of Fibrous Dysplasia of the Mandible with Histopathological Evaluation after Long-term Observation

We report a case of fibrous dysplasia of the mandible with histopathological evaluation after long-term observation. A 2-year-old boy was referred to our clinic in 1988 because of a swelling of the left mandible. Radiographic examination revealed calcifying tissue-like radiopacities within a lesion. Histopathological examination showed fibrous tissue and woven bone. We diagnosed this case as fibrous dysplasia. We carried out curettage under general anesthesia. Six months after the operation, the patient had a bone swelling that grew rapidly in the same region. However, the bone swelling stopped growing after one year and we followed up the subsequent history until the end of the growth stage. After 16 years of surgical treatment, resection of the mandible inferior border was carried out for esthetic improvement of asymmetric mandible. Histopathological examination showed loose bone and fibrous tissue.

Efficacy of Platelet Rich Plasma in Third Molar Impaction Surgery, PRP in Third Molar Surgery

The use of autologous platelet concentrates mainly platelet rich plasma has been of relevance recently in the field of Oral and Maxillofacial surgery. These concentrates had the ability to improve the hard and soft tissue healing. This ability of the platelet concentrates had been studied in the healing after mandibular third molar impaction surgery. The various parameters like bone density, soft tissue healing, postoperative pain, swelling, and alveolar osteitis were taken into account. The patients were evaluated on 1 st , 2 nd , 7 th day, 1 st month, and 2 nd month postoperatively. The values for each parameter were found out and tabulated. Materials and Methods: Twelve patients, seven males and five females with bilaterally impacted mandibular third molars were included in the study. Autologous platelets were concentrated. This was applied on one of the sockets, which was randomly taken as the test side. The other socket was treated as the control. Results: Statistical analysis was done using Mann-Whitney U test for pain and soft tissue healing, which revealed the values for pain being statistically significant for the test side and no statistical difference was noted for soft tissue healing. Bone density and swelling were analyzed with t -test. Bone density values were statistically significant for the test side, while swelling did not show much statistical significance. None of the patients presented with alveolar osteitis in any side. Summary and Conclusion: Platelet rich plasma is a surgical additive that can be used to improve bone and soft tissue healing. It contains a wide array of growth factors that are responsible for their healing potential.

Collar Bone swellings--A Varied Presentation of Multiple Myeloma

Collar Bone swellings--A Varied Presentation of Multiple Myeloma

Escherichia coli and Enterococcus spp. isolation in maxillary osteomyelitis: a case report and literature review with special consideration of immunocompetent individuals

AbstractThe occurrence of maxillary osteomyelitis is rare in immunologically normal hosts. The nature of such infections is mainly polymicrobial, commonly attributable to micro‐organisms present in the oral cavity. A case of acute maxillary osteomyelitis with Escherichia coli and Enterococcus spp. infection is described in an otherwise healthy young female. Cases of maxillary osteomyelitis reported in immunocompetent individuals lacking any predisposing factors are also reviewed. The lesion presented as a painful bone swelling and incomplete wound healing after tooth extraction, showing radiolucency with irregular borders. The isolated microbial species were E. coli and Enterococcus spp. Contamination from an extra‐oral source through the wound may be implicated in the pathogenesis. A combination of surgical and antibiotic treatment proved to be successful. Nine maxillary osteomyelitis cases have been reported in the literature in immunocompetent individuals. Isolation of enteric bacteria was not described in any of those cases. Osteomyelitis should be included in the differential diagnosis of maxillary osteolytic lesions even in healthy individuals. The microbiological diagnosis is important for the antimicrobial intervention. This review shows that the main causative infectious agents in osteomyelitis remain unclear, as various bacteria have been reported to be involved.

Clinical applicability of magnetic resonance imaging in acute spinal cord trauma

To assess the clinical application of magnetic resonance imaging (MRI) in patients with acute spinal cord trauma (SCT) according to the type, extension, and severity of injury and the clinical-radiological correlation. Diagnostic imaging [computed tomography (CT) and MRI] tests of 98 patients with acute SCT were analyzed to assess their clinical diagnostic value. The following radiological findings of SCT were investigated: vertebral compression fractures, bursts and dislocations, posterior element fractures, C1 and C2 lesions, vertebral listhesis, bone swelling, spinal canal compression, disk herniation, extradural hematoma, spinal cord contusions, spinal cord swelling, and posterior ligamentous complex (PLC) injuries. The radiological findings were better visualized using MRI, except for the posterior elements (p = 0.001), which were better identified with CT. A total of 271 lesions were diagnosed as follows: 217 using MRI, 154 using CT, and 100 (36.9 %) using both MRI and CT. MRI detected 117 more lesions than CT. MRI was significantly superior to CT in the diagnosis of bone swelling, PLC injury, disk herniation, spinal canal compression, spinal cord contusion and swelling present in SCT. MRI detected a larger number of lesions than CT and is highly useful for the diagnosis of soft tissue and intrathecal injuries.

Dilemma in Differentiating between Acute Osteomyelitis and Bone Infarction in Children with Sickle Cell Disease: The Role of Ultrasound

BackgroundDistinguishing between acute presentations of osteomyelitis (OM) and vaso-occlusive crisis (VOC) bone infarction in children with sickle cell disease (SCD) remains challenging for clinicians, particularly in culture-negative cases. We examined the combined role of ultrasound scan (USS), C - reactive protein and White blood counts (WCC) in aiding early diagnosis in children with SCD presenting acutely with non-specific symptoms such as bone pain, fever or swelling which are common in acute osteomyelitis or VOC.MethodsWe reviewed the records of all children with SCD who were discharged from our department from October 2003 to December 2010 with a diagnosis of osteomyelitis based on clinical features and the results of radiological and laboratory investigations. A case control group with VOC who were investigated for OM were identified over the same period.ResultsIn the osteomyelitis group, USS finding of periosteal elevation and/or fluid collection was reported in 76% cases with the first scan (day 0–6). Overall 84% were diagnosed with USS (initial +repeat). 16% had negative USS. With VOC group, USS showed no evidence of fluid collection in 53/58 admissions (91%), none of the repeated USS showed any fluid collection. Mean C-reactive protein (CRP), and white cell count (WCC) were significantly higher in the OM.ConclusionThe use of Ultrasound in combination with CRP and WCC is a reliable, cost-effective diagnostic tool for differentiating osteomyelitis from VOC bone infarction in SCD. A repeat ultrasound and/or magnetic resonance imaging (MRI) scan may be is necessary to confirm the diagnosis.

Aggressive osteoblastoma of ilium: Diagnosed on FNAC

Introduction: Aggressive osteoblastoma is a rare tumor which has a higher growth potential than conventional osteoblastomas and high risk of recurrence. Case Report: An aggressive osteoblastoma of ilium diagnosed on cytology which had three recurrences. Osteolytic lesion of hemate bone occurred in a 23­year­old patient. Tumor was excised and diagnosed as osteoblastoma on histopathology. First recurrence was managed with excision and implantation of rods, and bony chips from right iliac bone. Second recurrence was similarly managed by implantation of bony chips from the other iliac bone. Below elbow amputation was performed following third recurrence. After eleven months from the last surgery patient developed swelling of iliac bone and pulmonary metastasis. Conclustion: The case highlights the biological diversity of aggressive osteoblastoma and its potential for implantation at the site of surgery and distant metastasis. The case illustrates the difficulties which may be encountered in differentiating between benign and malignant form of osteoblastoma, and between aggressive osteoblastoma and osteosarcoma.

Osteosarcoma in Adult Patients Living with HIV/AIDS.

Background. HIV infection has reached epidemic proportions in South Africa, with an estimated prevalence of 21.5% in adults living in the province of KwaZulu-Natal. Several malignancies have been identified as part of the spectrum of immunosuppression-related manifestations of HIV infection. Very few reports, however, exist regarding the occurrence of non-AIDS-defining sarcomas in the extremities or limb girdles. Methods. A retrospective review was performed on all adult patients, between the ages of 30 and 60 years, with histologically confirmed osteosarcomas of the appendicular skeleton referred to a tertiary-level orthopaedic oncology unit. Results. Five out of the nine patients (62.5%) included in the study were found to be HIV positive. The average CD4 count of these patients was 278 (237–301) cells/mm3, indicating advanced immunological compromise. Three of the malignancies in HIV-positive patients occurred in preexisting benign or low-grade tumours. Conclusion. A heightened index of suspicion is required in HIV patients presenting with unexplained bone and joint pain or swelling. Judicious use of appropriate radiological investigation, including magnetic resonance imaging of suspicious lesions and timely referral to an appropriate specialized orthopaedic oncology unit, is recommended.

Novel, Biocompatible, and Disease Modifying VIP Nanomedicine for Rheumatoid Arthritis

Despite advances in rheumatoid arthritis (RA) treatment, efficacious and safe disease-modifying therapy still represents an unmet medical need. Here, we describe an innovative strategy to treat RA by targeting low doses of vasoactive intestinal peptide (VIP) self-associated with sterically stabilized micelles (SSMs). This spontaneous interaction of VIP with SSM protects the peptide from degradation or inactivation in biological fluids and prolongs circulation half-life. Treatment with targeted low doses of nanosized SSM-VIP but not free VIP in buffer significantly reduced the incidence and severity of arthritis in an experimental model, completely abrogating joint swelling and destruction of cartilage and bone. In addition, SSM associated VIP, unlike free VIP, had no side-effects on the systemic functions due to selective targeting to inflamed joints. Finally, low doses of VIP in SSM successfully downregulated both inflammatory and autoimmune components of RA. Collectively, our data clearly indicate that VIP-SSM should be developed to be used as a novel nanomedicine for the treatment of RA.

Profile of Secondary Bone Cancer in Brazzaville

Objectives: To report an epidemiology study and prognosis for metastatic bone tumor. Methodology: It was a descriptive, transversal study on records of patients hospitalized in Rheumatology and Oncology-Radiotherapy departments of the University Teaching Hospital of Brazzaville, Congo from 1 January 2005 to 31 July 2011 (7 years and 6 months). The diagnosis of bone metastasis was made because of the existence of bone pain, or pathological fracture, or bone swelling and a bone-condensing or mixed or osteolytic radiological image. The anatomo-pathological evidence was made after biopsy of the bone lesion or primary cancer. 3687 patients were hospitalized for active cancer, among them 81 had documented bone metastasis. Results: There were 60 men (74.1%) and 21 women (25.9%) with a sex ratio of 2.85. The average age was 53 years, ranging from 3 to 80 years. 75% of patients were more or equal to 50 years old at the discovery of the bone metastasis. Bone pain was the main mode of discovery (67.9% of cases). However, in 6.2% of cases, it was discovered incidentally. The metastasis was bone condensing in 50.7% of cases, osteolytic in 40.7% and mixed in 8.6%. They were unifocal in 25.9% and multifocal in 74.1% of cases. The Primary cancer most frequently found was that of the prostate in 55.6% of cases, breast in 20.7% and rhabdomyosarcoma in 4.9%. In 6.2% of cases, the primary site of cancer was unknown. The average survival was 25 months. Conclusion: The clinical and radiological presentation remains classic. Cancer of the prostate and breast are the main neoplasia responsible for bone metastasis in our series. The discovery of metastasis remains a major evolutionary step of cancer.

Rare presentation of giant cell tumor of bone in the lateral end of the clavicle

Patient: Male, 30Final Diagnosis: Giant cell bone tumorSymptoms: Bone swelling • painMedication: —Clinical Procedure: —Specialty: OncologyObjective:Unusual clinical courseBackground:Cooper first reported giant cell tumors (GCT) in the 18th century. The clavicle is a rare site for tumors. Metastatic tumors are more common than benign. This is the first case of GCT lateral end of clavicle to be reported in the literature.Case Reports:A 30-year-man was admitted with a 1-year history of progressively increasing swelling and pain over the left lateral end of the clavicle.The plain radiograph and PET scan revealed an expansile radiolucent lesion in the lateral end of the clavicle. Swelling was epiphsio-metaphyseal in location. It demonstrated geographical type of destruction with a narrow zone of transition. There was no periosteal reaction or soft-tissue component. The mitotic activity was found to be 0–1/10 HPF. Diagnosis was confirmed histopathologically. A wide excision of the mass, including 3 cm of healthy tissue of the clavicle, was performed.Conclusions:The presence of an expansile lytic lesion of the lateral end of the clavicle should be taken seriously and complete radiological and histopathological investigation should be done and giant cell tumor of the bone should be kept in mind despite its rarity.

Compound odontoma in deciduous dentition

Odontomas are benign tumors containing all the components of the odontogenic tissue. Disturbances in tooth eruption are one of the most common complications associated with odontomas. They are generally asymptomatic and are usually seen in second and third decades of life, rarely seen below 10 years of age. Herewith, we report an unusual occurrence of compound odontoma in a 4-year-old child visualized as a swelling of the cortical bone in the anterior maxilla.

Isolated tuberculosis of the wrist: A rare case of extrapulmonary tuberculosis

Introduction: Atypical infections with mycobacteria are unusual in the developed countries and tuberculous involvement of the wrist or carpal bones is a rare presentation. Case Report: This is a new rare case of tuberculosis of the wrist joint in a non-immunocompromised 24-year-old male without concomitant pulmonary tuberculosis. He then underwent two months course of intra-articular steroid injections and methotrexate therapy for a presumed diagnosis of inflammatory oligoarthritis of the wrist as radiographs were reported as normal. The diagnosis was initially obscured by lack of systemic symptoms and was established by direct visualization of acid-fast bacilli on joint fluid and biopsy of the abscess. Musculoskeletal involvement in tuberculosis may be easily missed because of its non-specific clinical signs. The disease may mimic inflammatory arthritis and high index of suspicion is required when dealing with long standing inflammatory swellings. Conclusion: Persistent swelling of bones or joints can be a presenting sign of tuberculosis. A normal chest radiograph or the absence of systemic symptoms does not exclude the possibility of bone tuberculosis. When confronted with unusual inflammatory findings, always send tissue for histology and alcohol and acid-fast bacilli (AAFB) culture.