Chronic Osteitis Research Articles

Prevalence of Infective Endocarditis among Patients with Staphylococcus aureus Bacteraemia and Bone and Joint Infections.

We aimed to evaluate the occurrence of infective endocarditis (IE) among patients with bone and joint infections (BJIs) and Staphylococcus aureus bacteraemia. This observational study was conducted at Lausanne University Hospital, Switzerland, from 2014 to 2023, and included episodes involving BJI, S. aureus bacteraemia, and cardiac imaging studies. The endocarditis team defined IE. Among the 384 included episodes, 289 (75%) involved native BJI (NBJI; 118 septic arthritis, 105 acute vertebral or non-vertebral osteomyelitis, 101 chronic osteitis), and 112 (29%) involved orthopedic implant-associated infection (OIAI; 78 prosthetic joint infection and 35 osteosynthesis/spondylodesis infection). Fifty-one episodes involved two or more types of BJI, with 17 episodes exhibiting both NBJI and OIAI. IE was diagnosed in 102 (27%) episodes. IE prevalence was 31% among patients with NBJI and 13% among patients with OIAI (p < 0.001). The study revealed a high prevalence of IE among S. aureus bacteraemic patients with NBJI, with notably lower prevalence among those with OIAI.

The Use of Autologous Tibia Strut Grafts to Enhance Bone Healing of an Infected Long-Bone Nonunion

We treated five patients with an infected non-union of the femur and tibia with autologous tibia strut grafts. All patients had bone defects ranging from three to nine centimeters. Three patients suffered for more than seven years from chronic osteitis. Our objective was to describe this grafting technique and its results. We focused on healing time, postoperative complications and functional recovery. We retrospectively studied five patients with an infected non-union of the lower limb who had undergone previous surgeries to overcome the bone healing problem. In this group of patients, we had four femur non-union and one tibia non-union. All of them had a previous infection episode, in which medical and surgical therapy was needed. Of the participants, three were men, and two were females with a mean age of 43.3 years (28-55).

Transverse distraction osteogenesis : New chances for limb salvage?

Distraction osteogenesis (DO) is atechnique that can be successfully used to treat leg length discrepancies and to reconstruct long defects of bone. By gradual distraction of the bone fragments by approximately 1 mm per day, hypervascularization and an increased bone healing potential (growth stimulus) occur. So far, DO has almost exclusively been used longitudinally to generate new biologically active bone. Chronic wounds, ulcers and osteitis, especially in the region of the foot, are always achallenge for the treating surgeon, since treatment is tedious, the outcome uncertain and associated with possible loss of the extremity. Transverse distraction osteogenesis (tDO) now uses the growth stimulus of the DO translationally to treat distally located, chronic wounds and thus leads to accelerated wound healing. At the end of the 5‑week treatment, the transversely distracted fragment, located far proximal to the chronic wound, is back in its original location. The biological stimulus has along-lasting effect, longer than the tDO itself. Further investigations into the mechanisms of action and treatment outcomes of tDO are required. If the previous results are confirmed, tDO may become agame changer and enable the limb salvage for alarge proportion of findings that previously required amputation.

English

Involvement of the submandibular gland in actinomycotic osteomyelitis in the absence of sinus is rare. Cervicofacial form is characterized by contiguous spread, suppurative osteomyelitic &amp; granulomatous inflammation of the mandible and formation of multiple abscesses and hallmark discharging sinuses draining serosanguinous fluid containing sulphur granules. As the imaging finding of this entity is rarely described, in this case report, a rare case of mandibular actinomycotic osteomyelitis, with a submandibular swelling, but without draining sinus is reported. The imaging findings of cone beam computed tomography (CBCT) &amp; ultrasonography (US) of the case are discussed with a review. In subacute stage, mandibular actinomycosis may show no hallmark sinuses. Sclerotic margins around the lesion may be found on radiograph. Imaging is useful in ruling out clinical diagnostic challenge when it includes involvement of mandible &amp; submandibular region. Cervicofacial actinomycosis commonly occurs as perimandibular infection, rarely as osteomyelitis of the mandible.1 It may present as two distinct morphological patterns; first, "lumpy jaw," and second, simulating an acute pyogenic infection affecting the submandibular area, discharging sinus being a hallmark finding.1 Other variant reported include chronic osteitis, osteolytic lesion, hard nodule on the tongue, lockjaw, periapical, or paradental abscess. Diagnosis of cases presenting in multiple areas in the absence of multiple discharging sinuses is a challenge.2 Usefulness the imaging findings are rarely enumerated. This report is of a twin presentation of a non - sinus forming actinomycotic mandibular osteomyelitis and a submandibular swelling, along with a review of various diagnostic imaging features.

The prevalence of athletic pubalgia imaging findings on MRI in patients with femoroacetabular impingement.

To determine the prevalence of athletic pubalgia imaging findings on MRI in patients with femoroacetabular impingement and assess for correlative risk factors. A retrospective search identified 156 hips with femoroacetabular impingement and a control group of 113 without femoroacetabular impingement that had an MRI performed between January 1, 2015, and January 1, 2018. Two fellowship-trained musculoskeletal radiologists reviewed studies for the presence of acute osteitis pubis, chronic osteitis pubis, adductor tendinosis, and tendon tear; rectus abdominis tendinosis and tendon tear; and aponeurotic plate tear. Findings were correlated with various clinical and imaging risk factors. Univariate and multivariate statistical analyses were performed. Imaging findings of adductor tendinosis (p = 0.02) and chronic osteitis pubis (p = 0.01) were more prevalent in FAI patients than controls. Univariate analyses in FAI patients showed that an alpha angle ≥ 60° had a higher prevalence of aponeurotic plate tears (p = 0.02) and adductor tendinosis (p = 0.049). Multivariate analyses showed that an alpha angle ≥ 60° had a higher prevalence of chronic osteitis pubis (OR = 2.27, p = 0.031), sports participation had a higher prevalence of adductor tendon tears (OR = 4.69, p = 0.013) and chronic osteitis pubis (OR = 2.61, p = 0.0058), and males had a higher prevalence of acute osteitis pubis (OR = 5.17, p= 0.032). Sports participation, alpha angle ≥ 60°, and male sex predict a higher prevalence of athletic pubalgia imaging findings in patients with femoroacetabular impingement.

Facial Nerve Paralysis in a 54-Year-Old Woman with Exacerbated Chronic Suppurative Otitis Media and Chronic Mastoiditis: A Case Report

We present the case of a 54-year old woman diagnosed with chronic suppurative otitis media, who was admitted to the ENT Department with four-week-old, sudden-onset, left-sided facial nerve paralysis, and ipsilateral otalgia and hemicrania. Physical examination revealed positive signs of acute postaural inflammation. The patient’s facial nerve paralysis was scored as VI, according to the House-Brackmann scale. A cranio-facial computer tomography examination revealed mastoid cavity opacification, mucosal hypertrophy, and signs of chronic osteitis, with minimal mucous accumulation. The patient underwent a radical modified mastoidectomy with type-I tympanoplasty to verify the presence of a cholesteatoma, and to remove the offending lesions. Post-operatively, patient evolution was favorable, and prognosis remained encouraging. The patient’s evolution will be followed by check-ups every three months to assess progress and benefits of the treatment.

Efficacy of dextrose prolotherapy in elite professional male soccer players with chronic osteitis pubis

Efficacy of dextrose prolotherapy in elite professional male soccer players with chronic osteitis pubis

Frontal sinus ablation (Riedel-Mosher’s procedure): indications and role in the endonasal endoscopic era.

The aim of this article is to describe the Riedel-Mosher’s surgical technique and identify its current role in the endoscopic endonasal era based on the experience of a tertiary care medical centre. It also provides a brief excursus on materials available for frontal reconstruction. A retrospective review of patients submitted to Riedel-Mosher’s procedure from 2005 to 2018 at a single tertiary care centre was carried out. Details of the surgical technique along with data on frontal reconstruction timing and materials used were collected. A total of 21 patients (16 males and 5 females) underwent the Riedel-Mosher’s procedure. The age of the patients ranged from 15 to 84 years. The underlying pathology was represented mainly by chronic osteitis of the frontal bone (17 cases), followed by benign tumours (3 cases) and malignancy (1 case). Perioperative complications occurred in 3 patients. Cranioplasty was carried out only on 16 cases and delayed by an average time of 10 months. Materials for reconstruction included titanium, ceramic, plastic and free flap . Nowadays, Riedel-Mosher’s procedure is still indicated in selected cases of benign and malignant pathologies of the frontal sinus and/or frontal bone. Surgical expertise is key to approach the frontal sinus safely. Its reconstruction requires proper planning and a wide variety of materials to perform it is now available.

P08 Chronic non-infectiveo osteitis (CNO) presenting as a lytic skull lesion

P08 Chronic non-infectiveo osteitis (CNO) presenting as a lytic skull lesion

Chronic mandible inflammation as the first symptom of chronic recurrent multifocal osteomyelitis (CRMO) – a case report

Chronic recurrent multifocal osteitis (CRMO) is a rare disease of an unknown aetiology, occurring mainly in children aged 4-14 years. It is characterised by recurring episodes of osteitis, with no detectable cause, lasting from several months up to a few years. It usually affects the metaphysis of long bones. Primary lesions in the form of isolated focuses rarely occur in the mandible. The clinical symptoms of CRMO include ostealgia, soft tissue swelling (oedema), skin reddening, and mild fever. The diagnosis is difficult. It involves numerous laboratory and radiological investigations. In order to exclude infectious and neoplastic aetiology, it is advisable to perform a tissue biopsy. The disease is long-lasting with exacerbations and remissions. The prognosis is uncertain. Non-steroidal anti-inflammatory drugs and empirical antibiotic therapy are a recommended first-line therapy; if no improvement is observed, corticosteroids should be used. The analysed case concerns a 10-year-old boy with mandible inflammation as the first symptom of chronic recurrent multifocal osteitis (CRMO). Mandibular lesions may be the first symptom of chronic recurrent multifocal osteitis. The non-specific onset and variable clinical picture delay the diagnosis. Early diagnosis enables early treatment, which prevents complications.

Modern aspects of etiology, diagnostics and treatment of osteomyelitisS

There are 3-10 % cases of chronic osteomyelitis among abscessed surgical disorders. Osteomyelitis develops in 3-25 % of cases after open bone fractures and in 1-8 % of cases after closed fracture surgical treatment, along with this chronic osteomyelitis relapses happen in 20-35 % of cases, which, in turn, needs definitive treatment to the extent of abscission. Staphylococcus aureus dominates in cases of chronic osteitis. The role of proteuses, enterococcuses, bacteroids, peptococcuses and other microorganisms grows. Osteomyelitis is a type of purulent surgical infection in which a macroorganism interacts with a pathogenic microflora. The osteomyelitis clinic differs from the phase, form and pathogenetic process. There are primary and secondary (osteomyelitis, acute and chronic phase, toxic, septicopyemic and local forms. The methods of treatment of osteomyelitis are conservative and surgical, and also their combination.

VERIFICATION AND TREATMENT OF RESISTANT CHRONIC RHINOSINUSITIS WITH NASAL POLYPS AT MULTIMORBID CARDIOVASCULAR PATHOLOGY

Objective: Identify the diagnostic signs for chronic rhinosinusitis with nasal polyps (CRSwNP &amp; resistant forms) with multimorbid cardiovascular pathology (MCVP) (coronary artery disease (CAd), hypertension, metabolic syndrome (MS). Identify effectiveness of photodynamic therapy in CRSwNP treatment. Design and methods: The study included 75 patients (mean age 35,8±7,93, 39,2% - female,60,8% - male) with CRSwNP and MCVP divided into 3 groups by simple random sampling. Patients in group 1 (n = 27) received standard therapy CRSwNP, hypertension, CAd, NPMd, 8-weeks anti- bacterial and leukotriene receptor antagonists treatment. Surgical interventions history of the last 5 five years: from 1 to 2. Patients in group 2 (n = 28) received standard therapy CRSwNP, hypertension, CAd, NPMd, 8-weeks antibacterial and leukotriene receptor antagonists treatment. Surgical inter- ventions history of the last 5 five years: more than 3. Patients of group 3 (n = 20) received standard therapy CRSwNP, hypertension, CAd, NPMd, 8-weeks antibacterial treatment, 8-weeks leukotriene receptor antagonists treatment and sessions of photodynamic therapy of the paranasal sinuses. Surgical interventions history of the last 5 five years: more than 3. used in the study: complex psychological test methods, ENT and laboratory-instrumental evaluation of the cardiovascular system. Results: depres- sion was detected in 46,3%, 71,9%, 58,3% of patients, (first, second, third groups). Types «non-dipper» and «night-peaker» found in patients 2nd and 3rd groups- corresponds with (CRSwNP &amp; resistant forms). Bone transformation zone as a result of chronic inflammation within the ethmoidal labyrinth and maxillary sinuses identified in the second and third patients group (85% of cases). The use of pho- todynamic therapy in the resistant CRSwNP forms treatment improves the functional indicators of the nasal cavity and paranasal sinuses. Conclusions: Patients with CRSwNP have symptoms of depression and «non-dipper» and «night-peaker» patterns. All CRSwNP patients are defined trigger points with areas of chronic osteitis and odontogenic osteomyelitis. The use of photodynamic therapy for CRSwNP treatment, reduces the number of CRSwNP recurrence.

SURAL NEURO-CUTANEOUS FLAP IN THE MANAGEMENT OF FOOT AND ANKLE SOFT TISSUE DEFECTS IN A DIABETIC POPULATION.

Soft tissue defects in the foot and ankle region are challenging conditions particularly in diabetic patients. We evaluated the reliability of the sural flap in treating such defects among a diabetic population. This is a continuous retrospective series of 14 patients with type 2 diabetes treated with an ipsilateral sural flap for soft tissue defects around the rear foot (11 cases) and over the malleolar areas (3 cases). Three patients had an open tibia fracture (Gustillo IIIb), four had chronic osteitis and seven had a chronic heel ulcer. The mean follow-up at 28 months showed healing of the flap at a mean of 24 days, donor site healing in two weeks, one case of total flap necrosis, three cases of skin edge necrosis, two cases of temporary venous congestion and 10 cases of hypoesthesia of the lateral border of the foot. No infection or recurrence of infection was encountered. We found the sural flap useful, reproducible and reliable in treating soft tissue defects in diabetic patients with a low frequency of serious complications.

First isolation of Clostridium indolis in a patient with chronic osteitis: a case report and literature review of human infections related to Clostridium saccharolyticum group species

Clostridium indolis is an anaerobic spore-forming Gram-positive bacillus belonging to the Clostridium saccharolyticum group. Its clinical significance in human remains poorly known. We describe the first case of osteitis related to C. indolis, identified by MALDI-TOF mass spectrometry and provide a literature review of human infections related to C. saccharolyticum group species.

Chronic non-infectious osteitis: single centre case series

Background Chronic non-infectious osteitis (CNO), also known as Chronic Recurrent Multifocal Osteomyelitis, is a noninfectious inflammatory osteopathy predominantly affecting children and adolescents. Diagnosis is often difficult as initial symptoms and clinical course can vary widely. CNO can result in significant morbidity. Treatment regimes are varied but bisphosphonate therapy with pamidronate is proving effective at reducing pain and improving bone remodelling in some patients.

Short- and Medium-Term Results of Total Elbow Arthroplasty after Trauma

Treatment of distal humerus fractures by open reduction and internal fixation, especially in elderly patients, does not always result in satisfactory outcomes. Previous studies show good outcomes in total joint replacement of these fractures. The objective of this study is to present our experience with primary and secondary implantation of a semiconstrained elbow prosthesis after trauma. In two study centers, between 2003 and 2009, a total of 44 patients (34 women and 10 men) with an average age of 65 years were treated primarily (n = 19) or secondarily (n = 25) by semiconstrained total elbow replacement after distal humerus fractures. Primary treatment referred exclusively to 13C2 and 13C3 fractures according to the AO/ASIF-classification, except for two cases. Indications for secondary elbow arthroplasty were post-traumatic arthrosis (n = 10), non-union of the bone (n = 6), failed osteosynthesis (n = 5), post-traumatic chronic luxation (n = 2) and severe bony defect situation after chronic osteitis (n = 2). In two cases a prostheses exchange for a periprosthetic fracture after fall was performed. Clinical outcome was radiologically controlled and measured by the use of the Mayo Elbow Performance Score (MEPS) and DASH score after a mean follow-up of 38 (13 to 96) months. 33 Patients (75 %) had a follow-up examination clinically and radiologically. Mayo Elbow Performance Score was excellent or good in 27 (82 %) cases with a mean of 87 points (primary group 87 vs. secondary group 86). The average DASH score was 28 points (primary group 24 vs. secondary group 32). The flexion was on average 131° (110 to 145°), the extension deficit 30° (0 to 80°) to neutral position and the range of motion was 100° (40 to 145°) (primary group 102° vs. secondary group 97°). The mean operation time was 141 (100 to 250) minutes (primary group 138 vs. secondary group 144 min.). The length of stay in hospital was on average 15 days. Complications occurred due to ulnar paresthesia (n = 4), deep infection (n = 6), periprosthetic ulna fracture (n = 1), heterotopic ossifications requiring intervention (n = 1), elbow stiffness (n = 1), triceps insufficiency (n = 5) and triceps avulsion (n = 2). Primary elbow joint replacement seems to be a promising alternative for distal humerus fractures without a sufficient reconstruction opportunity, showing encouraging short- and medium-term results in the elderly. Secondary replacement can achieve satisfying results in failed osteosynthesis, non-union of the bone or post-traumatic arthrosis as well. The rate of complications and revisions is high.

COMPLEX TRAUMA OF THE LIMBS “LIMB AND LIFE THREATENING INJURIES”

Complex limb trauma are extremely severe and pose a threat both to the patient’s life, because of their systemic impact, as well as to the vitality of the traumatized limb, because of potentially severe septic complications. Post-traumatic (post fracture) osteitis is most often a consequence of an open fracture (always contaminated) or a closed operated fracture which was contaminated by pathogenic germs, the most common of which is Staphylococcus aureus (but Gram-negative bacteria, such as Klebsiella, Pseudomonas and Proteus are also worth mentioning). The consequence of an acute osteitis which was incompletely or inadequately treated is chronic osteitis, which requires long-term treatment, with inconsistent outcome results. To describe this topic, we present the case of a 15 year old pacient, which presents at the hospital as a surgical emergency, following a complex high energy trauma cause by a smash-up, whose survival and then healing, in spite of complete and correct approach, were extremely problematic/challenging, and called for a massive amount of human, financial and temporal resources.

Succesful treatment of diffuse sclerosing osteomyelitis of the mandible/mandibular chronic non-bacterial osteitis with intravenous pamidronate: resolution of pain and radiographic bone inflammation with improved cosmetic appearance - a case study

Diffuse sclerosing osteomyelitis of the manidble ( DSMO) is a form of chronic non-bacterial osteitis (CNO) and predominantly affects patients < 18 years. It can result in cosmetic disfigurement. No uniformly effective treatment exists. Intravenous pamidronate (IV-PAM) has been reported to be effective in multifocal CNO.

Mycétome actino-mycosique du pied, à propos d’un cas

Mycetoma is a chronic inflammatory cutaneous and subcutaneous pathology caused by either a fongic (eumycetoma) or bacterial (actinomycetoma) infection, which lead to a granulomatous tumefaction with multiple sinuses. When localized in the foot this infection is named "Madura foot". This infection is endemic to tropical and subtropical regions and rarely occurs in western countries. A historical case in Europe of a foot mycetoma evolving since 20 years without any treatment is presented. A histopathologic diagnosis of actinomycetoma has been done in 1987. The patient presented a severe Staphylococcus aureus chronic osteitis leading to a trans-tibial amputation. This case allows to present this infection which, even if rarely presented in France, can be meet especially among a migrant's population.

PReS-FINAL-2206: Clinical experiences in patients with chronic recurrent multifocal osteomyelitis (CRMO)

Chronic recurrent multifocal osteomyelitis (CRMO) is a form of chronic nonbacterial osteitis (CNO) characterized by one or more lytic bone lesions with no identifiable cause. (CRMO) is a rare (prevalence less than 1/1,000,000) auto-inflammatory disorder, characterized by relapsing and remitting episodes of pain related to the presence of foci of sterile bone inflammation.