Sequestrum Formation Research Articles

A diagnostic model for differentiating tuberculous spondylodiscitis from pyogenic spondylodiscitis based on pathogen-confirmed patients.

This study aimed to distinguish tuberculous spondylodiscitis (TS) from pyogenic spondylodiscitis (PS) based on laboratory, magnetic resonance imaging (MRI) and computed tomography (CT) findings. Further, a novel diagnostic model for differential diagnosis was developed. We obtained MRI, CT and laboratory data from TS and PS patients. Predictive models were built using binary logistic regression analysis. The receiver operating characteristic curve was analyzed. Both internal and external validation was performed. A total of 81 patients with PS (n = 46) or TS (n = 35) were enrolled. All patients had etiological evidence from the focal lesion. Disc signal or height preservation, skip lesion or multi segment (involved segments ≥ 3) involvement, paravertebral calcification, massive sequestra formation, subligamentous bone destruction, bone erosion with osteosclerotic margin, higher White Blood Cell Count (WBC) and positive result of tuberculosis infection T cell spot test (T-SPOT.TB) were more prevalent in the TS group. A diagnostic model was developed and included four predictors: WBC<7.265 * (10^9/L), skip lesion or involved segments ≥ 3, massive sequestra formation and subligamentous bone destruction. The model showed good sensitivity, specificity, and total accuracy (91.4%, 95.7%, and 93.8%, respectively); the area under the receiver operating characteristic curve (AUC) was 0.981, similar to the results of internal validation using bootstrap resampling (1000 replicates) and external validation set, indicating good clinical predictive ability. This study develop a good diagnostic model based on both CT and MRI, as well as laboratory findings, which may help clinicians distinguish between TS and PS.

Impact of COVID-19 Disease on the Development of Osteomyelitis of Jaws: A Systematic Review.

Background/Objectives: Osteomyelitis is characterized by an inflammatory process affecting both bone and bone marrow, leading to cell death and the formation of bone sequestrum. Recent literature from the past five years has documented instances of osteomyelitis following infections of SARS-CoV-2. This systematic review explores the link between osteomyelitis of the jaw (OMJ) and COVID-19 infections. Methods: This review adhered to the PRISMA guidelines, systematically analyzing literature from 2020 to 2024 sourced from databases including Medline, Embase, Scopus, and Web of Science. PROSPERO ID: CRD42024526257. Results: The review selected 42 articles, detailing 201 cases of osteomyelitis of the jaw related to COVID-19 (COMJ). The demographic breakdown included 195 male (74.4%) and 67 female patients (25.6%), with a median age of 52.7 years, ranging from 24 to 71 years. A significant portion of COMJ patients (41.5%) were hospitalized due to COVID-19, and 58.5% received corticosteroid therapy. Diabetes mellitus was a common comorbidity among COMJ patients (65.1%). Most cases involved maxilla (182 cases; 90.5%), with nearly half showing sinus involvement (49.4%). The mandible was affected in 19 cases (9.5%). Mucormycosis and aspergillosis emerged as the predominant fungal infections, identified in 103 (51.2%) and 50 (24.9%) cases, respectively. Conclusions: Individuals with pre-existing health conditions such as diabetes mellitus who have been treated for COVID-19 are at an increased risk of developing OMJ, particularly maxillary fungal osteomyelitis. COMJ poses a significant diagnostic and therapeutic challenge for dental and maxillofacial professionals, who are often the first to encounter these cases.

The Use of the Taylor Spatial Frame in Treating Tibial Osteomyelitis Following Traumatic Tibial Fracture.

Tibial osteomyelitis can follow open fractures with bacteria colonising the wound and persisting through biofilm and sequestrum formation. The treatment is complex, requiring eradication through debridement before limb reconstruction, for which the Taylor spatial frame (TSF) is one option. This study evaluates patient outcomes after reconstruction and identifies factors associated with post-operative complications. Fifty-one cases of tibial osteomyelitis were treated by the Ilizarov technique from 2015 to 2021 at a major trauma centre. Bacterial samples and treatment factors were assessed. Patient outcomes were complication rates and time to bony union. Complications were expressed as odds-ratios (OR) with 95% confidence intervals. Linear regression was used to assess factors associated with time to union. The mean follow-up was 24.1 months with the mean time to radiological union being 11 months. Post-operative complications were noted in 76.5% of patients with pin-site infections most common (52.9%), followed by fracture malunion (29.4%). Smoking was associated with increased fracture malunion (OR = 4.148, 95% confidence Interval [1.13-15.18], p = 0.031). The time to union was positively associated with complications, age and time to full weight-bearing (FWB). All other measured factors were found not significant. Tibial osteomyelitis is treated reliably by debridement and reconstruction using the Ilizarov technique using a TSF application. The most common complication was pin-site infection. Optimising patients through cessation of smoking and encouraging post-operative weight-bearing can reduce the complication rate and improve time to union. The Ilizarov technique using a TSF can treat significant deformities that result from the management of tibial osteomyelitis. Geetala R, Zhang J, Maghsoudi D, et al. The Use of the Taylor Spatial Frame in Treating Tibial Osteomyelitis Following Traumatic Tibial Fracture. Strategies Trauma Limb Reconstr 2024;19(1):32-35.

Prevalence of radiographic findings in chronic osteomyelitis

BackgroundSimple radiography in conjunction with pertinent medical history and a comprehensive physical examination is typically adequate for diagnosing chronic osteomyelitis (CO). However, radiographic manifestations of CO lack specificity; therefore, the concordance among specialists in this regard has not been systematically assessed. This study aimed to compare and evaluate the proficiency of orthopedic surgeons and radiologists in identifying radiographic indicators present in simple radiographs for diagnosing CO.MethodsThis cross-sectional study was a correlational investigation utilizing plain radiographs obtained from a cohort of 60 patients diagnosed with CO. Comprehensive assessments of the demographic and clinical characteristics, comorbidities, and microbiological parameters were conducted. Additional variables included the anatomical location of the CO, existence of fistulas, disease duration, and presence of pseudoarthrosis. This study meticulously documented the presence or absence of six specific findings: bone destruction, which incorporates erosion and radiolucencies around implants; bone sclerosis; cortical thinning concomitant with erosion; cortical thickening; sequestrum formation; and soft-tissue swelling.ResultsMost patients were men (75%), with a mean age of 45.1 years. Hematogenous etiology of CO represented 23%. Bone sclerosis (71.3%) and cortical thickening (67.7%) were the most common radiographic findings, followed by soft-tissue swelling (51.3%), sequestration (47.3%), bone destruction (33.3%), and cortical erosion (30.3%). The mean agreement was 74.2%, showing a marked disagreement rate of 25.8% among all radiographic findings. The presence or absence of soft tissue edema, a prominent radiographic finding that was more important than the other findings, showed the greatest disagreement.ConclusionsRadiographic findings in CO were universally observed in all patients, demonstrating a high degree of concordance among specialists, with the exception of soft tissue swelling.

Subchondral bone sequestrum formation in the proximal intra-articular and osteochondral region of the third metatarsal bone of an Appaloosa mare treated for septic arthritis

Abstract OBJECTIVE To raise awareness of the potential for intra-articular subchondral bone sequestrum formation secondary to a traumatic or septic process to enable more rapid identification of this uncommon but possible outcome in future cases. ANIMAL A client-owned 12-year-old Appaloosa mare. CLINICAL PRESENTATION, PROGRESSION, AND PROCEDURES The mare had a wound to the lateral aspect of the fourth metatarsal bone (MT4) that communicated with the distal tarsal joints. Radiographs revealed a displaced, comminuted fracture of MT4. TREATMENT AND OUTCOME The horse underwent aggressive debridement of the wound and MT4 as well as, on 2 occasions, needle joint lavage. Systemic, regional, and IA antibiotic therapy was also performed together with a bone graft from the tuber coxae. The horse’s comfort improved, and the wound appeared to be healing. Five weeks following discharge, the horse re-presented with a non–weight-bearing lameness and radiographs revealed marked osteomyelitis of the tarsometatarsal and distal intertarsal joints. Postmortem examination of the limb identified a sequestrum within the proximal articular surface of the third metatarsal bone. CLINICAL RELEVANCE The present report highlights the importance of arthroscopic lavage to visualize the cartilage surface and the benefits of advanced imaging to detect associated changes within the bone earlier than conventional radiographs. To our knowledge, no reports exist of intra-articular subchondral bone sequestra in the tarsometatarsal joint in horses.

Three-dimensional clinical assessment for MRONJ risk in oncologic patients following tooth extractions.

To identify clinical and local radiographic predictors for medication-related osteonecrosis of the jaws (MRONJ) by the assessment of pre-operative CBCT images of oncologic patients treated with anti-resorptive drugs (ARDs) undergoing tooth extractions. This retrospective, longitudinal, case-control study included clinical and imaging data of 97 patients, divided into study and control group. Patients in the study group (n = 47; 87 tooth extractions) had received at least one dose of ARD, undergone tooth extraction(s), and had a pre-operative CBCT. An age-, gender-, and tooth extraction-matched control group (n = 50; 106 tooth extractions) was selected. Three calibrated, blinded, and independent examiners evaluated each tooth extraction site. Statistical analysis used χ2/Fisher's exact/Mann-Whitney U test to contrast control and study group, ARD type used, and sites with or without MRONJ development. p-value ≤ 0.05 was considered significant. From the study group, 15 patients (32%) and 33 sites (38%) developed MRONJ after tooth extraction. When controls were compared to study sites, the latter showed significantly more thickening of the lamina dura, widened periodontal ligament space, osteosclerosis, osteolysis, and sequestrum formation. In the study group, MRONJ risk significantly increased in patients who had multiple tooth extractions, were smokers, and had shorter drug holidays. Periosteal reaction and sequestrum formation may indicate latent MRONJ lesions. Additionally, patients given bisphosphonates showed considerably more osteosclerosis than those given denosumab. Periosteal reaction and sequestrum formation are suspected to be pre-clinical MRONJ lesions. Furthermore, ARD induced bony changes and radiographic variations between ARD types were seen.

How does the clinical and tomographic appearance of MRONJ influences its treatment prognosis?

To identify clinical and tomographic prognostic factors for conservative and surgical treatment of medication-related osteonecrosis of the jaws (MRONJ). A retrospective search identified patients treated with antiresorptive drugs (ARDs), diagnosed with Stage 1, 2 or 3 MRONJ, and having CBCT scans previous to conservative or surgical treatment. Following data collection, imaging assessment of the following parameters on each MRONJ site was performed: involvement of teeth and/or implants, presence of osteosclerosis, osteolysis, sequestrum formation, periosteal reaction, and pathological fractures. For statistical analysis, patients and lesions were divided into conservative and surgical treatment. Comparisons were made between successful and unsuccessful outcomes. Significance was set at p ≤ 0.05. 115 ARD-treated patients who developed 143 osteonecrosis lesions were selected. 40 patients and 58 lesions received conservative treatment, of which 14 patients (35%) and 25 lesions (43%) healed. Additionally, 75 patients and 85 lesions underwent surgery, with 48 patients (64%) and 55 lesions (65%) that healed. Clinical and tomographic risk factors for conservative treatment were MRONJ staging, tooth involvement, extensive osteosclerosis, and deep sequestrum formation (p < 0.05). Complementarily, poor prognostic indicators for surgical therapy were a short bisphosphonate (BP) holiday, MRONJ staging, absence of sequestrum formation, and presence of periosteal reaction (p < 0.05). Lesions at Stage 3 MRONJ, with tooth involvement, or sequestrum formation showed poor outcomes when conservative treatment is chosen. Alternatively, surgical treatment is most effective when BPs are discontinued, in Stage 1 lesions, in the presence of sequestrum formation, and absence of periosteal reaction.

Extensive Sequestration Chronic Maxillary Osteomyelitis in an Uncontrolled Diabetic Patient: Comprehensive Case Management of a Rare Entity.

The hallmark of osteomyelitis was progressive bone destruction and sequestrum formation. In the underlying disease, like diabetes mellitus, osteomyelitis becomes severe and exacerbates the condition. It was essential for the oral and maxillofacial surgeon to comprehend its complex medical and surgical management to achieve complete disease eradication. The aim of this article was to report a rare case and comprehensive management of extensive sequestrating maxillary osteomyelitis with uncontrolled diabetes mellitus patients. A 58-year-old male patient with pain and swelling accompanied by discharge of pus in the sinistra maxilla region. The systemic disease was identified as uncontrolled diabetes mellitus, and had a history of unhealing wounds 1 year ago after upper left molar extraction. Computed tomography scan result showed extensive sequester formation and bony destruction in the right extending to the left maxilla. Microbial culture results were Klebsiella pneumoniae and Morganella morganii. Subsequently, extensive sequestrectomy and multiple extractions of the involved jaw and teeth were performed after diabetes mellitus was regulated. A suspension suture against oral and nasal mucosa was performed to avoid dead space formation. Comprehensive perioperative management in maxillary osteomyelitis in uncontrolled diabetes mellitus includes sequestrectomy, definitive antibiotic therapy based on culture results, and diabetes regulation to improve the successful management of this case.

Chronic Bi-Maxillary Osteomyelitis Caused by Actinomycetes in a Patient with Severe COVID-19

Osteomyelitis is defined as the inflammation of the either medullary, cortical, or cancellous bone, including nerves and blood vessels, causing necrosis and bone sequestrum formation; this condition has become a rare pathology, and odontogenic infections are considered the most frequent causal factor. This case shows a patient with bi-maxillary osteomyelitis caused by Actinomyces spp, which was worsened for severe COVID-19 infection. Patient was submitted at surgery as, amplified total bilateral maxillectomy through the surgical technique Weber-Fergusson, and prolonged use of combination of antibiotics, achieved a good recovery. Two years later follow-up, the patient no show imaging or clinical evidence of the infection of osteomyelitis. The present case shows an interesting relationship between a rare infection and its association with COVID-19.

Comparison of the effectiveness of 5-Fluorouracil and modified Carnoy's solution in reducing the recurrence of odontogenic keratocyst.

Odontogenic keratocysts (OKC) has a high potential for recurrence. Resection is currently the only fool-proof method to ensure that recurrence does not occur; however, it drastically affects the patient's function and aesthetics. Application of modified Carnoy's solution (MCS) as an adjunct to reduce the recurrence rate is currently in vogue. 5- Flurouracil (5-FU) is an anti-metabolite that has been used in the treatment of basal cell carcinoma and is relatively safer than MCS. The present study aims to compare the effectiveness of 5-UC and MCS in reducing the recurrence rate in OKC.. A total of 42 OKCs were enucleated followed by application of MCS (control group, n=21) or 5-FU dressing (study group, n=21) following enucleation. Pain, swelling, temporary and permanent paresthesia paresthesia, bone sequestrum formation, osteomyelitis and recurrence in both groups were evaluated at periodic intervals up to 12 months post-surgery. There was no significant difference in terms of pain, or swelling in both groups. Permanent paresthesia and recurrence rates were higher in patients treated with MC but the difference was not statistically significant. 5-FU is an easy-to-use, feasible, biocompatible and cost-effective alternative for MCS in the management of OKCs. Treatment with 5-FU, therefore, reduces the risk of recurrence and also the post-surgical morbidity associated with other treatment procedures.

Rubber Dam Clamp May Cause Cortical Necrosis: A Case Report

Tooth isolation methods used during endodontic procedures are necessary to create an aseptic field and protect the patient’s alimentary tract from irrigation and instrument insult. This case details changes that can occur in mandibular cortical bone architecture after the use of a stainless steel rubber dam clamp during an endodontic procedure. A 22-year-old, otherwise healthy woman underwent nonsurgical root canal therapy on tooth #31 (mandibular right second molar, symptomatic irreversible pulpitis and periapical periodontitis.) Cone-beam computed tomographic imaging obtained between treatments revealed irregular erosive and lytic changes of the crestal-lingual cortical bone, resulting in sequestrum formation with infection and exfoliation. Continued monitoring and 6-month post-treatment CBCT imaging revealed complete resolution without further intervention. When a stainless steel rubber dam clamp is placed onto gingiva overlying mandibular alveolar bone, bony changes can occur presenting with radiographic signs of cortical erosion and may result in necrosis of the cortical bone with sequestrum formation. Knowledge of this potential outcome improves our understanding of the normal course progression after dental procedures using a rubber dam clamp for tooth isolation.

Local radiographic risk factors for MRONJ in osteoporotic patients undergoing tooth extraction.

To identify local radiographic risk factors for Medication-Related Osteonecrosis of the Jaws (MRONJ) in osteoporotic patients treated with antiresorptive drugs (ARD) and undergoing tooth extraction. Patients were included in this retrospective, longitudinal, case-control study, if having at least one administration of ARD, underwent tooth extraction(s), and had pre- and post-operative panoramic radiographs. Additionally, a matched control group was selected. Three calibrated, blinded, and independent observers assessed each tooth extraction site. Statistical analysis compared control against study group, and within the latter, sites MRONJ+ and MRONJ-. In total, 120 patients (99 females/21 males) with 354 tooth extractions were included, from which nine patients (7.5%) and eleven tooth extraction sites (3.1%) developed MRONJ. When comparing control with study group, the latter showed significantly more thickened lamina dura, persistence of the alveolar socket, heterogeneous bone patterns, and sequestrum formation. In the study group, MRONJ developed significantly more in males (19%, p= 0.049), smokers (25%, p= 0.008), in the mandible (82%, p= 0.027), when identifying a radiolucent or sclerotic trabecular pattern (p= 0.004) or when extracting teeth with furcation involvement (p< 0.001), root remnants (p= 0.017), or unrestored caries lesions (p= 0.005). Tooth extraction sites showing radiographic signs of chronic dental infection are prone to MRONJ.

Intrinsic antibacterial and osteoinductive sterosomes promote infected bone healing

Open fractures and internal fixation implants are often accompanied by bacterial infection, leading to osteomyelitis, characterized by intractable bone infection and sequestrum formation, and can result in lifelong disability or fatal sepsis. As common clinical treatment strategies, high-dose antibiotic application and autologous bone transplantation face the risk of recurrence and donor site injury. Herein, we designed and prepared a novel drug delivery system by rational selection of the antibacterial single-chain amphiphile (cetylpyridinium chloride, CPC) and osteoinductive sterol (20S-hydroxycholesterol, Oxy) to formulate CPC/Oxy sterosomes. We demonstrate their excellent biocompatibility and antibacterial ability through 2D and 3D settings in vitro. In addition, the osteogenic differentiation of bone marrow mesenchymal stem cells was investigated in cell monolayers and a hydrogel environment. Moreover, a rat infected critical-sized calvarial defect model was employed to illustrate the effects of antibacterial and osteogenic CPC/Oxy sterosomes in vivo. Our results showed that CPC/Oxy sterosomes not only exterminated bacterial infections, but also enhanced calvarial healing without additional antibiotics, bone formation promoters or exogenous cells. This research provides a promising and effective multifunctional sterosomal platform for the treatment of infected bone defects, with the potential to be combined with therapeutic genes, and small molecule drugs.

Functionalized DNA Nanomaterials Targeting Toll‐Like Receptor 4 Prevent Bisphosphonate‐Related Osteonecrosis of the Jaw via Regulating Mitochondrial Homeostasis in Macrophages

AbstractImbalance of macrophage polarization characterized by an increase in the percentage of pro‐inflammatory M1 macrophages and a decrease in anti‐inflammatory M2 macrophages is considered a critical pathogenic mechanism of bisphosphonate‐related osteonecrosis of the jaws (BRONJ). Because high levels of Toll‐like receptor 4 (TLR4) mediates mitochondrial dyshomeostasis in Zoledronic Acid (ZA)‐treated M1 macrophages, tetrahedral DNA nanomaterial (TDN)‐modified with TLR4‐siRNA on each vertex (TDN‐TLR4‐4siR) with excellent biocompatibility is synthesized. This novel TDN‐TLR4‐4siR nanomaterial reverses the polarization phenotype imbalance decreasing the percentage of M1 RAW264.7 macrophages. Mitochondrial dynamics analysis shows a shift from short rod‐like ultrastructure to elongated shapes with more mitochondrial network continuity in ZA‐primed M1 macrophages after treatment with TDN‐TLR4‐4siR, along with elevated expression of Mfn1 and Mfn2. TDN‐TLR4‐4siR further reduces intracellular ROS production and restored mitochondrial membrane potential. Furthermore, decreased sequestra formation and accelerated healing of the extraction wound are observed in the TDN‐TLR4‐4siR group, resulting in decreased incidence of rat BRONJ via reprogramming polarized macrophages. Consequently, this study establishes a novel strategy using TDN‐TLR4‐4siR nanomaterial to regulate mitochondrial homeostasis of polarized macrophages to prevent BRONJ.

A spatiotemporal drug release scaffold with antibiosis and bone regeneration for osteomyelitis

IntroductionScaffolds loaded with antibacterial agents and osteogenic drugs are considered essential tools for repairing bone defects caused by osteomyelitis. However, the simultaneous release of two drugs leads to premature osteogenesis and subsequent sequestrum formation in the pathological situation of unthorough antibiosis. ObjectivesIn this study, a spatiotemporal drug-release polydopamine-functionalized mesoporous silicon nanoparticle (MSN) core/shell drug delivery system loaded with antibacterial silver (Ag) nanoparticles and osteogenic dexamethasone (Dex) was constructed and introduced into a poly-l-lactic acid (PLLA) scaffold for osteomyelitis therapy. MethodsMSNs formed the inner core and were loaded with Dex through electrostatic adsorption (MSNs@Dex), and then polydopamine was used to seal the core through the self-assembly of dopamine as the outer shell (pMSNs@Dex). Ag nanoparticles were embedded in the polydopamine shell via an in situ growth technique. Finally, the Ag-pMSNs@Dex nanoparticles were introduced into PLLA scaffolds (Ag-pMSNs@Dex/PLLA) constructed by selective laser sintering (SLS). ResultsThe Ag-pMSNs@Dex/PLLA scaffold released Ag+ at the 12th hour, followed by the release of Dex starting on the fifth day. The experiments verified that the scaffold had excellent antibacterial performance against Escherichia coli and Staphylococcus aureus. Moreover, the scaffold significantly enhanced the osteogenic differentiation of mouse bone marrow mesenchymal stem cells. ConclusionThe findings suggested that this spatiotemporal drug release scaffold had promising potential for osteomyelitis therapy.

Implant Compression Necrosis: A Scrupulous Review

Currently when the implant is placed it deals with various mechanical stresses before it integrates with the bone. The stresses may cause micromovement that jeopardises the healing process in early stages. These stresses aggravate as the implant goes deeper into the bone and somewhat accounts for increased friction and torque. Excess torque at the insertion time may lead to bone compression which if crosses its physiologic limit may lead to a bloodless field i.e. ischemia following necrosis or sequestrum formation which in turn will cause implant failure. This is termed as compression necrosis. Too much torque levels may result in high levels of strain transmitted to adjacent bone. The crestal area around the implant is mainly comprised of cortical bone which has minimum blood supply and is exposed to extreme strain making it more vulnerable to bone necrosis and which is paramount to the failure of implant. An attempt has been made to review the physiologic effect of alveolar bone on compression necrosis the mechanism and histopathology behind compression necrosis factors leading to compression necrosis like excess torque strain macrogeometry of implants implant design and methods to avoid compression necrosis.

Unmasking the “Great Masquerader:” Tuberculosis of the Foot

Abstract Introduction: Osteoarticular tuberculosis (TB) accounts for only 1%–3% of extrapulmonary TB, of which ankle and foot involvement accounts for only 8%–10%. Foot and ankle TB has a varied clinical and radiological presentation and can mimic many conditions. The aim of this study is to throw light on the varied clinical and radiological presentations of this disease. Materials and Methods: We studied 20 patients with suspected osteoarticular TB of the ankle and foot region over 3 years. The patients were evaluated based on clinical presentation, radiology, magnetic resonance imaging (MRI) findings, molecular studies (cartridge-based nucleic acid amplification test [CBNAAT]), biopsy, microbiological staining and culture, erythrocyte sedimentation rate ESR, and C-reactive protein levels. The patients were categorized into subgroups in accordance with their findings. Results: All cases had some form of pain, swelling, tenderness, or inability to bear weight. Twenty-five percent presented with single or multiple draining sinuses at or around the ankle. On X-rays, 30% had unremarkable radiographs, and osteopenia/cavitation of one or more bones was found in 30% of cases. Sequestrum formation was seen in 20% of the cases. No advanced arthritis and collapse were noted. In MRI, all cases had marrow edema of one or more bones. Twenty percent had features of tenosynovitis. CBNAAT was done for all the patients of whom eight turned positive for the pathogen. Discussion: The classical features of skeletal TB may elusive in cases of TB of the foot and ankle. Plain radiographs may not be sensitive in detecting early cases. In MRI studies, the calcaneum and talus were mostly affected. This may indicate toward a hypothesis that the calcaneum/talus may be the primary source of origin in osteoarticular TB of the ankle and foot region. Biopsy remains the gold standard in diagnosing TB. All patients responded well to the medical management. We can conclude with surety that TB of the foot and ankle is primarily a medical condition if prompt and early diagnosis is made.

Farklı Piezocerrahi Aletlerinin Dokular Üzerine Olan Etkisinin Histopatolojik, Histokimyasal ve Histomorfometrik Olarak İncelenmesi: Deneysel Çalışma

Objective: Piezoelectric surgical instruments are widely used in medicine and dentistry. Devices with new features are produced day by day and offered to surgeons. The aim of this study is to evaluate the effects of new and old generation piezosurgery instruments and conventional rotary hand tools on bone after osteotomy histopathologically, histochemically and histomorphometrically. Material and Methods: In the parietal bones of 12 rabbits, bone defects with a diameter of 8 mm were created with two different piezosurgery tools and a conventional rotary tool. Animals were sacrificed on the 7th and 21st days and evaluated histopathologically, histochemically and histomorphometrically the amounts of new bone formation, sequestration, connective tissue, fibrin and cartilage and percentages of full-empty area in the total area. Results: In the histopathological examinations, the least sequestra formation was observed in the new generation piezosurgery group. In the histomorphometric analysis, it was determined that there was a statistically significant difference between the mean of new bone and total area measurements in all groups on the 7th day (p0.05). Conclusion: As a result of the histopathological evaluation, it was determined that filling (both bone and connective tissue) in the defect areas in the new generation piezosurgery group was higher in the short term follow up compared to other groups, but there was no significant difference between the groups in the midterm follow up.

Physiotherapy Rehabilitation in Idiopathic Chronic Osteomyelitis: A Case Report

Osteomyelitis is an infection-related inflammation of the bones and bone marrow. Generally in the legs, arms, spine. Foot and ankle osteomyelitis can be excruciatingly painful for patients and a difficult management challenge for orthopedic surgeons. Acute staphylococcal osteomyelitis had a 50% death rate in the pre-antibiotic era. Osteomyelitis of the foot and ankle can occur due to a variety of reasons, with diabetic foot infections being one of the most common. Osteomyelitis is a bone marrow inflammation which progression, involving the cortical plates and frequently periosteal tissues, along with the majority of cases occurring after bone trauma or surgery, or as a result of vascular insufficiency. Chronic nonbacterial osteomyelitis is an autoinflammatory disease that primarily affects children and adolescents and is characterized by recurrent or persistent osteitic foci. The symptom is bone pain, which may or may not be accompanied by soft tissue tenderness. Chronic osteomyelitis is related with avascular necrosis of bone along with the establishment or formation of sequestrum (dead bone), and surgical debridement, in addition to antibiotic therapy, is required for cure. Physiotherapy has effect in improving the quality of life of the patient with osteomyelitis.

An unusual case of bone regeneration of a necrotic mandible with pathologic fracture in an elderly hemodialysis patient with medication-related osteonecrosis of the jaw: a case report and review of the\xa0literature

BackgroundBisphosphonates are frequently used for osteoporosis. Medication-related osteonecrosis of the jaw, a complication of bone-modifying agents, including bisphosphonates or angiogenic inhibitors, can be challenging to treat in elderly patients with numerous preexisting conditions. Achieving good treatment outcomes is especially difficult in patients with pathological fractures accompanied with extraoral fistulae.Case presentationWe report an unusual case of prominent bone regeneration following palliative surgical treatment in a 72-year-old Japanese female patient undergoing hemodialysis. She previously had severe osteoporosis due to renal osteodystrophy and was receiving antiresorptive intravenous bisphosphonate. Computed tomography revealed a discontinuous left lower mandibular margin with a pathologic fracture and extensive, morphologically irregular sequestrum formation (80 × 35 × 20 mm). The patient was diagnosed with stage III medication-related osteonecrosis of the jaw and pathologic mandibular fracture. Immediately before the surgery, the anticoagulant used for dialysis was changed from heparin to nafamostat mesylate to reduce the risk of intraoperative bleeding. Sequestrectomy was performed under general anesthesia. Postoperative infection was not observed, the intraoral and submandibular fistula disappeared, and, surprisingly, prominent spontaneous bone regeneration was observed postoperatively at 6 months. Despite the severe systemic condition of the patient, the conservative surgical approach with sequestrectomy has yielded desirable results for more than 6 years since the surgery.ConclusionsThis rare report of spontaneous bone regeneration in a patient of advanced age and poor general condition is the oldest case of mandibular regeneration ever reported.