Intraosseous Bone Research Articles

Morphological characteristics of femoral neck fractures in young and middle-aged population: a retrospective descriptive study

BackgroundA understanding of morphological characteristics are important to femoral neck fractures (FNFs) resulting in high rates of complications in the young and middle-aged adults and the detailed data is lack in the literature. We aimed to report on the detailed morphological characteristics and the relationship between them in young and middle-aged adults with femoral neck fractures (FNFs).MethodsThe postoperative CT images of one hundred and fifty-two adults with FNFs were retrospectively reviewed. After image standardization, morphological characteristics including fracture orientation, cortex comminution, and intraosseous bone defects were measured and analyzed. Additionally, the distribution and correlation of these morphological features were analyzed using Pauwels classification, the right angle of the neck axis (VNA) classification, and the anteromedial oblique angle (AMA).ResultsPauwels III fractures accounted for approximately half (55.2%) of the FNFs analyzed. Pauwels II and III could be detected in all four VNA types, and the distribution of the Pauwels types in VNA classification showed significant differences (χ2 = 106.363, p < 0.001). The VNA (9.0° ± 12.1) showed positive correlation with the neck-shaft angle (139.5° ± 6.3) and modified Pauwels angle (49.8° ± 10.6) (r = 0.441, r = 0.855, all p < 0.001). Cortical comminutions were commonly observed in the posterior (86.7%) and the inferior (80.7%). AMAs within the cases without posterior and inferior cortex comminutions were significantly larger than those with comminution (t = 2.594, 2.1196; p = 0.01, 0.036), but no difference could be detected after the AMA being divided into three groups (< 85°, 85°-95°, > 95°). The MPA, VNA and AMA of the group with an intraosseous defect were significantly different compared with those without (t = 2.847, 2.314, 2.268; p = 0.005, 0.022,0.025). The incidence of intraosseous defects within the groups with coronal and axial cortex comminutions were significantly higher than those within the groups without comminutions (χ2 = 34.87, 25.303; p < 0.001).ConclusionsThe present study highlights the morphological diversity and complexity within FNFs in young and middle-aged adults, which allows for more accurate simulation of FNF patterns in the future biomechanical studies.

MRI-detected intraosseous bone marrow edema recedes after effective therapy of periodontitis

ObjectivesT2 STIR MRI sequences can detect preclinical changes associated with periodontal inflammation, i.e. intraosseous edema in the tooth-supporting bone. In this study, we assessed whether MRI can be used for monitoring periodontal disease.Material and methodsIn a prospective cohort study, we examined 35 patients with periodontitis between 10/2018 and 04/2019 by using 3D isotropic T2-weighted short tau inversion recovery (STIR) and Fast Field Echo T1-weighted Black bone sequences. All patients received standardized clinical exams before and three months after non-surgical periodontal therapy. Bone marrow edema extent was quantified in the STIR sequence at 922 sites before and after treatment. Results were compared with standard clinical findings. Non-parametric statistical analysis was performed.ResultsNon-surgical periodontal treatment caused significant improvement in mean probing depth (p < 0.001) and frequency of bleeding on probing (p < 0.001). The mean depth of osseous edema per site was reduced from a median [IQR] of 2 [1, 3] mm at baseline to 1 [0, 3] mm, (p < 0.001). Periodontal treatment reduced the frequency of sites with edema from 35 to 24% (p < 0.01).ConclusionThe decrease of periodontal bone marrow edema, as observed with T2 STIR MR imaging, is indicative of successful periodontal healing.Clinical relevance statementT2 STIR hyperintense bone marrow edema in the periodontal bone decreases after treatment and can therefore be used to evaluate treatment success. Furthermore, MRI reveals new options to depict hidden aspects of periodontitis.Key Points• T2 STIR hyperintense periodontal intraosseous edema was prospectively investigated in 35 patients with periodontitis before and after treatment and compared to clinical outcomes.• The frequency of affected sites was reduced from 35 to 24% (p < 0.001), and mean edema depth was reduced from a median [IQR] of 2 [1, 3] mm at baseline to 1 [0, 3] mm 3 months after treatment. (p < 0.001).• T2 STIR sequences can be used to monitor the posttreatment course of periodontitis.

Ex vivo study of detergent-assisted intraosseous bone wash treatment of osteonecrosis.

Avascular necrosis (AVN) involves ischemic cell death of the bone. AVN leaves an abundance of necrotic lipids and debris in the bone marrow, which instigates inflammatory bone repair. Consequently, the necrotic bone microenvironment stimulates excessive bone resorption, leading to joint deformities and osteoarthritis. Here, we performed a detergent-assisted bone wash using poloxamer 407 (P407) to clean the necrotic bone environment by removing lipids and necrotic debris. The new concept was tested using an established ex vivo AVN model of porcine cadaver humeral heads. The P407 wash was performed using P407 solution and followed with saline via two intraosseous needles. Visual inspection and image analyses of average pixel light intensity showed that the P407 wash produced a better-cleaned bone than the saline wash. Analyses of the collected bone wash solution showed a two-fold increase in triglycerides (101 vs. 53 mmol/head, p = 0.006) and a 10-fold increase in the dry weight of the removed debris (1.34 vs. 0.13 g/head, p = 0.02) with the P407 wash compared to saline. The histological evaluation showed significantly decreased Oil-Red-O (fats) staining in the P407-washed bone compared with the saline-washed bone. The in vitro assays of Alizarin red and qPCR showed the P407 wash neither altered the osteogenic behaviors of porcine bone marrow-derived mesenchymal cells (pBMMCs) nor raised inflammatory responses of porcine bone marrow-derived macrophages (pBMMs). In conclusion, detergent-assisted bone wash using P407 produced a better removal of nonsoluble debris from the bone marrow space than the saline wash without causing changes to osteogenesis or inflammatory reactions.

Validation of a 3-Dimensional-Printed Infant Tibia for Intraosseous Needle Insertion Training.

Current bone models used for pediatric intraosseous (IO) placement training are expensive or lack anatomic and/or functional fidelity. This technical report describes the development and validation of a 3-dimensional printed (3DP) tibia from a pediatric lower extremity computed tomography scan for IO procedural training. Multiple 3DP tibia models were printed using a dual-extrusion fused-filament fabrication printer. Models underwent iterative optimization until 2 final models, one of polypropylene (3DP clear) and the other of polylactic acid/polypropylene (3DP white), were selected. Using an exploratory sequential mixed-methods design, a novel IO bone model assessment tool was generated. Physicians then used the assessment tool to evaluate and compare common IO bone models to the novel 3DP models during IO needle insertion. Thirty physicians evaluated the provided pediatric IO bone models. Compared with a chicken bone as a reference, the 3DP white bone had statistically significantly higher mean scores of anatomy, heft, sense of being anchored in the bone, quality of bone resistance, and "give" when interfaced with an IO needle. Twenty-two of the 30 participants ranked the 3DP white bone as either 1st or 2nd in terms of ranked preference of pediatric IO bone model. A 3DP white bone costs $1.10 to make. The 3DP IO tibia models created from real-life computed tomography images have high degrees of anatomic and functional realism. These IO training models are easily replicable, highly appraised, and can be printed at a fraction of the cost of commercially available plastic models.

Is lower extremity vein pathology a risk factor for the development of osteoarthritis of the knee joint?

The aim of the workwas to assess the relationship between venous insufficiency and osteoarthritis of the knee joint.Materials and Methods. The study included 214 knee joints from April 2018 to March 2021 in 107 subjects (19 men, 88 women), mean age of patients was 54.6 ± 8.6 years (range, 40 to 73 years). The study group included 61 patients diagnosed with knee osteoarthritis; the control group included 46 healthy volunteers without knee joint disease complaints. Demographic and clinical characteristics of all study participants were taken into account. The venous system of the lower extremities was assessed by ultrasound Doppler imaging. The results were assessed by standard radiography based on the Kellgren-Lawrence classification and ultrasonography. Pain severity was assessed using the Likert scale, and functioning was assessed by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).Results. Venous insufficiency was detected in 40.9% of patients in the group of patients with knee osteoarthritis and in 15.2% of the control group (p=0.007). There was no statistically significant difference in cartilage thickness and Kellgren-Lawrence classification for the presence of venous insufficiency (p&gt;0.05). However, the percentage of radiological medial tibial sclerosis was higher in patients with venous insufficiency in the osteoarthritis group (60%, p&gt;0.05). Overall WOMAC scores were similar in both groups, whereas WOMAC pain scale scores were higher in patients with deep venous insufficiency (p&gt;0.05).Discussion. Previously, researchers have found that patients with knee OA develop symptoms of chronic VH more frequently than their healthy peers, that VH and OA share common risk factors, and that the risk of these diseases increases with age. Our results showed no difference in the incidence of VN between groups after correction depending on age. Our results are consistent with the literature in that deep venous system lesions increase the risk of intraosseous hypertension to a greater extent than superficial venous system lesions.Conclusion. The evidence of increased radiological medial tibial sclerosis and higher WOMAC pain scale scores in patients with venous lesions in osteoarthritis create the hypothesis that venous pathology may affect the intraosseous bone microenvironment, leading to pain and early subchondral bone lesions, which manifest as subchondral sclerosis.

Evaluation of the Efficacy of Mineralized Dentin Graft in the Treatment of Intraosseous Defects: An Experimental In Vivo Study.

Background and Objectives: Dentin grafts have osteoinductive and osteoconductive properties and are considered as an alternative to autogenous graft. This study evaluates the efficacy of autogenous mineralized dentin graft (AMDG) alone or with xenograft and compares it with those of various graft materials used in the treatment of intraosseous bone defects. Materials and Methods: The third incisor teeth of six sheep (2–3 years old) were extracted and AMDG was obtained. Six defects were prepared on each tibia of these six sheep: empty defect (group E); autogenous graft (group A), dentin graft (group D), xenograft (group X), autogenous + xenograft (group A + X) and dentin + xenograft (group D + X). Three sheep in each group were sacrificed in the post-operative 3rd and 6th week and the histologic analyses were performed. Results: The D and D + X groups showed histological features similar to the other groups in the 3rd and 6th weeks. No statistically significant difference was found regarding the rates of new bone formation between the D and D + X groups (p = 1.0) and the other groups at both time intervals (p > 0.05). Conclusions: Similar results observed in this study between groups A, D, X, A + X and D + X demonstrate that AMDG can be successfully used in the treatment of intraosseous bone defects. Further experimental and clinical studies are needed to be able to evaluate the effectiveness of dentin grafts in different types of indications.

The Treatment of Bone Marrow Lesions Associated with Advanced Knee Osteoarthritis: Comparing Intraosseous and Intraarticular Injections with Bone Marrow Concentrate and Platelet Products

Bone marrow lesions are a radiographic indication of bony pathology closely associated with advanced osteoarthritis of the adjacent joint. Injection of autologous orthobiologic products, including bone marrow concentrate and platelet-rich plasma, have demonstrated safety and efficacy in treating both advanced osteoarthritis (via intraarticular injection) and associated bone marrow lesions (via intraosseous injection). The relative efficacy of intraarticular versus intraosseous injection of orthobiologics has not been evaluated at the present time. The objective was to evaluate differences in orthobiologic bone marrow lesions treatment, either as a collateral result of intraarticular injection with bone marrow concentrate and platelet products alone, or intraosseous plus intraarticular injection as measured by patient reported outcomes. This study employed a prospective case-matched cohort design. This study took place at a single outpatient interventional orthopedic pain clinic. Using data from a prospective orthobiologic treatment registry of knee patients, a population of knee osteoarthritis with bone marrow lesions patients who had undergone only intraarticular knee injections of bone marrow concentrate and platelets (for symptomatic advanced osteoarthritis) were age, gender, and disease severity case-matched to a series of advanced osteoarthritis and bone marrow lesions patients who underwent intraosseous plus intraarticular injections. Self-reported patient outcomes for Numeric Pain Scale, International Knee Documentation Committee, lower extremity functional scale, and a modified single assessment numeric evaluation were compared between the 2 treatment groups. Eighty patients were included, 40 in each group. Although pain and functional outcome scores were significantly improved in both treatment groups, there was no statistically significant differences in patient reported outcomes based on the type of treatment. There are several limitations to this study, including multiple providers performing the injections, varying onset of symptoms to treatment, and additional injections after their initial treatment, that were not controlled. In addition, increasing the sample size may be beneficial as well, particularly with the large bone marrow lesions group, which did suggest possible improvement with intraosseous plus intraarticular over the intraarticular, although was not statistically significant in our sample. Limited data availability for this cohort as well as some missing data are other limitations to consider. Treating knee bone marrow lesions with intraosseous bone marrow concentrate and platelet products did not affect patient reported outcomes.

The effectiveness of ultrasound examination to assess the healing process of bone lesions of the jaws: a systematic review.

To assess the potential of ultrasound examination (USE) as an adjunctive method to conventional radiology to evaluate the healing processes occurring after the treatment of bone lesions of the jaws. The research question was: what is the effectiveness of USE to evaluate the healing of intra-osseous bone lesions when compared to radiological or clinical examination? Six databases (PubMed, the Web of Science, Scopus, Embase, the Cochrane Library, and Best Evidence) were searched from their inception (PROSPERO CRD42019134482). A quality assessment was performed combining the Downs and Black tool and the Newcastle-Ottawa scale. The risk of bias was calculated using the Cochrane collaboration tool to assess the risk of bias. A total of 4404 records were screened, and 7 studies meeting the inclusion criteria were included in the systematic review. USE allowed to evaluate the healing of jaw bone lesions by assessing their reduction in size, the increase in echogenicity of the affected area, and the progressive decrease\disappearance of the vascular flow signal within the lesions. USE implemented with color power Doppler is an advanced imaging technique feasible to monitor the early and long-term response of the intra-osseous lesions of the jaws to both surgical and nonsurgical treatment. This systematic review brought evidence that USE can constitute a safe alternative imaging technique in the dental clinical practice for the management of central lesions of the maxillary bones.

Intra-Lesional Medicaments for the Management of Intra-Osseous Lesions of Maxilla and Mandible - Systematic Review.

Aims and Objectives:This study aimed to review the success or remission of intralesional medicaments in the management of intraosseous lesions in the oral cavity.Materials and Methods:A comprehensive search was performed in two databases (PubMed and Scopus). Research articles, case reports, case series, and clinical trials were included. Review articles, lesions not involving the bone, incomplete reporting, any other treatment other than intralesional medicaments to treat intraosseous bone lesions, publications without any treatment, and letter to editor were excluded. Data on remission (complete, partial, or no remission), details and regimen of the intervention, number of participants, and follow-up in months were recorded.Results:A total of 653 publications were available for title and abstract screening after the removal of duplicates. Seven articles were excluded, which were not in English. After title and abstract screening, a total of 88 publications were available for full-text screening. Fifty-five articles were included in qualitative synthesis. A total of 168 patients from 55 publications were evaluated. Minimum follow-up was 1 month and maximum was 264 months. More than two-third (n = 38) of the publications were case reports on single patient. More than two-third (n = 38) of the publications had complete remission.Conclusion:Intralesional medications have shown variable success rates. Extensive lesions may undergo intralesional medications followed by surgical management.

新規イメージング法による骨内血管網－骨基質異方性構造の相関解明

新規イメージング法による骨内血管網－骨基質異方性構造の相関解明

QUANTIFICATION OF INTRA OSSEOUS BONE DEFECTS BY CONVENTIONAL VERSUS 3DIMENSIONAL IMAGING TECHNIQUES - AN IN VIVO STUDY.

Background:- The aim of this prospective cross sectional study was to determine the accuracy of CBCT in quantifying intra-osseous periodontal bone defects. Methods:- 5 patients with intra-bony defects were selected and 10 defects were assessed. A total of 60 measurements were performed.Periapical radiographs and Cone beam CT scan images were obtained. Height and depth of each defects was measured using appropriate software. Direct measurements were done during surgical interventions using a periodontal probe and were considered the standard reference. Measurements made by all three modalities were compared to each other. Results:- Linear measurements for all defects revealed no statistical differences between CBCT and direct intra-surgical measurements with respect to the height as well as the depth of the defect. There was a significant difference when comparing peri-apical radiographs to the other two methods. IOPA measurements were only 74.3% accurate as compared to the standard intra-surgical whereas the CBCT measurements were 86.5%. Conclusion:- All three modalities proved to be useful for identifying interproximal periodontal defect but CBCT took the lead with better accuracy in reproducing the clinical measurement of intra-bony periodontal bone defects and better visualization of the extent of the defect.

Bone alterations are associated with ankle osteoarthritis joint pain.

The etiology of ankle osteoarthritis (OA) is largely unknown. We analyzed 24 ankle OA of 21 patients diagnosed by plain radiographs using magnetic resonance imaging (MRI). Ankle joint pain disappeared in 22 out of 24 joints by conservative treatment. MRI bone signal changes in and around the ankle joints were observed in 22 of 24 joints. Bone signal changes along the joint line were seen in 10 of 11 joints as a Kellgren-Lawrence (KL) grade of II to IV. Such signal changes were witnessed in only 4 of 13 joints with KL grade 0 or I. In the talocrural joint, bone alterations occurred in both tibia and talus bones through the joint line in cases of KL grade III or IV, while focal bone alterations were present in the talus only in KL grade I or II cases. Sixteen of 24 joints exhibited intraosseous bone signal changes, which tended to correspond to joint pain of any ankle OA stage. Our results suggest that bone alterations around the ankle joint might be one of the etiologies of OA and associated with ankle joint pain.

Methodological Consideration of Various Intraosseous and Heterotopic Bone Grafts Implantation in Animal Models

Bone fracture healing is a complex process including inflammation, repair and remodeling. Bone grafts or substitute are widely accepted to treat impaired healing. Newly developed bone substitutes must undergo in vitro and in vivo testing before clinical application. All kinds of intraosseous and heterotopic implant models in small and/ or large animals are used for different bone substitutes. Orthotopic implant at models is used for evaluation of graft materials. Based on the statistic of literatures, we find small animals should be used first before large animal as osseous defect models. Rabbit and rat are the commonly chosen animals, while femur and calvaria are the most implanted anatomic sites. Critical size defect models are useful as bone defect model, but vary considerably between animals. Typical heterotopic ossification after implantation of bone substitute is found almost in all species of animals. No bone formation is found after subcutaneous implantation of bone granule grafts in small animal, but in large animal. In contrast, bone block grafts show a distinguished result of bone formation in small animals as well as in large animals. This article reviews currently animal bone defect models and anatomic implant site for bone graft, gives a recommendation for the future research.

Biomechanical comparison of two techniques for arthroscopic suprapectoral biceps tenodesis: interference screw versus implant-free intraosseous tendon fixation

A novel arthroscopic technique allows for intraosseous tendon placement in biceps tenodesis using bone tunnels and suture while avoiding the expense of an implant. No biomechanical characterization exists for this construct. Tensile tests were used to compare a suture-only biceps tenodesis technique (arthroscopic biceps intraosseous tenodesis [ABIT]) with interference screws in 7 pairs of cadaveric shoulders. The ABIT used a modified finger-trap suture method to secure the tendon to itself through an intraosseous bone tunnel. Interference screw placement followed the manufacturer's protocol for implantation. An open technique was used to provide consistency during laboratory preparation. During cyclic loading, the screws were significantly stiffer (P = .040) but dissipated more energy (P = .002). During failure loading, suture-only specimens showed significantly greater failure loads (P < .001) and deformation (P = .046). The failure mechanism for the ABIT method was tendon elongation with progressive tensioning and slippage of the tendon through the suture mass. No complete tendon failure occurred for the ABIT. Gross tendon failure occurred in all interference screw tests at the bone-tendon-screw interface. No screw or suture failed in any biceps tendon test. The ABIT construct showed significantly higher failure loads and deformation compared with interference screws. The comparable stiffness after cycling of both constructs suggests that micromotion at the bone-tendon interface is similar, which-in addition to the intraosseous fixation-may be important in promoting healing. The ABIT construct was found to absorb and restore more energy (hysteresis), suggesting potential for greater tendon preservation, which may translate into improved construct longevity. The suture-only method can eliminate the expense of an implant.

An Evaluation Surgical Treatment of Intraosseous Lipoma Our Cases

OBJECTIVE: In this study, we evaluated the retrospective analysis of 12 patients with the diagnosis of intraosseos lipoma, who were surgically treated between 2008-2013. METHODS: Seven of the patients were male and 5 were female. Four of the cysts were in tibia, 3 were in calcaneus, 2 in humerus, one in talus, one in distal femur and one in acetabulum. RESULTS: All the patients were treated with curretage and allogenic bone grafting. No intraoperative complications were recorded. The median visual analog score (VAS) was decreased from 4 to 1 at the postoperative 4th month and all the patients were pain free. The complete consolidation of the grafts radiologically was recorded in 4 (2-6) months. No pathological fractures or recurrences were encountered. CONCLUSION: Curretage and bone grafting is an actual teratment modality in the treatment of symptomatic intraosseous bone cysts.

Fibroblast Growth Factor‐2 Stimulates Periodontal Tissue Regeneration

Introduction: An ideal goal of periodontal therapy is to achieve the complete regeneration of periodontal tissue destroyed by the progression of periodontal diseases. The use of recombinant cytokines is one of the physiologically efficient procedures to stimulate periodontal tissue regeneration. Recently, the safety and efficacy of topical application of basic fibroblast growth factor (FGF‐2) to regenerate 2‐ or 3‐walled vertical bone defects was evaluated in Phase 2 multicenter clinical trials in Japan. The results revealed a significant difference in the percentage of increase in alveolar bone height at 36 weeks after administration between the placebo group and the 0.3% FGF‐2 group.Case Presentation: Two cases of intraosseous bone defects, which were treated with a topical application of FGF‐2, are presented. To our knowledge, this is the first case report of FGF‐2‐induced periodontal tissue regeneration. The flap operation was conducted in accordance with the modified Widman procedure, and recombinant human FGF‐2 with 3% hydroxypropylcellulose was used as a vehicle and topically applied to the vertical bone defects. A standardized dental radiograph revealed a considerable increase in radiopacity at the bone defects 36 weeks after administration; also, no serious adverse events attributable to the drug were identified in either case.Conclusion: These results strongly suggest that topical application of 0.3% FGF‐2 can be efficacious in an increase in the height of alveolar bone that has been destroyed by periodontitis.

Design of a multi-axis implantable MEMS sensor for intraosseous bone stress monitoring

The capability to assess the biomechanical properties of living bone is important for basic research as well as the clinical management of skeletal trauma and disease. Even though radiodensitometric imaging is commonly used to infer bone quality, bone strength does not necessarily correlate well with these non-invasive measurements. This paper reports on the design, fabrication and initial testing of an implantable ultra-miniature multi-axis sensor for directly measuring bone stresses at a micro-scale. The device, which is fabricated with CMOS-MEMS processes, is intended to be permanently implanted within open fractures, or embedded in bone grafts, or placed on implants at the interfaces between bone and prosthetics. The stress sensor comprises an array of piezoresistive pixels to detect a stress tensor at the interfacial area between the MEMS chip and bone, with a resolution to 100 Pa, in 1 s averaging. The sensor system design and manufacture is also compatible with the integration of wireless RF telemetry, for power and data retrieval, all within a 3 mm × 3 mm × 0.3 mm footprint. The piezoresistive elements are integrated within a textured surface to enhance sensor integration with bone. Finite element analysis led to a sensor design for normal and shear stress detection. A wired sensor was fabricated in the Jazz 0.35 µm BiCMOS process and then embedded in mock bone material to characterize its response to tensile and bending loads up to 250 kPa.

C-Kit and Its Ligand Stem Cell Factor: Potential Contribution to Prostate Cancer Bone Metastasis

The tyrosine kinase receptor c-kit and its ligand stem cell factor (SCF) have not been explored in prostate cancer (PC) bone metastasis. Herein, we found that three human PC cell lines and bone marrow stromal cells express a membrane-bound SCF isoform and release a soluble SCF. Bone marrow stromal cells revealed strong expression of c-kit, whereas PC cells showed very low levels of the receptor or did not express it all. Using an experimental model of PC bone metastasis, we found that intraosseous bone tumors formed by otherwise c-kit–negative PC3 cells strongly expressed c-kit, as demonstrated using immunohistochemical and Western blot analyses. Subcuta-neous PC3 tumors were, however, c-kit–negative. Both bone and subcutaneous PC3 tumors were positive for SCF. Immunohistochemical analysis of human specimens revealed that the expression frequency of c-kit in epithelial cells was of 5% in benign prostatic hyperplasia, 14% in primary PC, and 40% in PC bone metastases, suggesting an overall trend of increased c-kit expression in clinical PC progression. Stem cell factor expression frequency was more than 80% in all the cases. Our data suggest that the bone microenvironment up-regulates c-kit expression on PC cells, favoring their intraosseous expansion.

The Use of a Powered Device for Intraosseous Drug and Fluid Administration in a National EMS: A 4-Year Experience

Provide evidence of success rate and limitations of the prehospital use of a powered device for intraosseous (IO) bone infusion, the bone injection gun (BIG) for critical patients in whom peripheral intravenous (IV) access cannot be readily obtained. This prospective study included all reports regarding the use of BIG in our national EMS during the study period. The BIG is a FDA and Israeli Health ministry approved device for IO cannulation. Starting April 2000, a new version was introduced to all ALS units. Simultaneously, our medical protocols were updated to include its use and mandatory reporting was initiated. Successful insertion was defined as "obtaining a good fluid flow through the needle without evidence of extravasation". This article presents an analysis of the data collected during this period. From May 2000 to June 2004, 189 patient encounters in which the BIG was employed met inclusion criteria and comprised the study group. Successful insertion on first attempt was achieved in 172 patients (91.0%). In two additional patients, a second attempt was successful. Forty-seven of the patients were below the age of 18 years (24.9%). One hundred ten patients (58.2%) were over 60 years of age. One hundred thirty-three were found without a palpable pulse (70.4%), and only 18 were found with a Glasgow coma scale of 9 or above. The cause was traumatic in 34 patients (18.0%). The BIG provides an effective alternative IV access for critical patients in whom a peripheral IV line cannot be readily obtained in the prehospital setting.

Magnetic Resonance Imaging Diagnosis and Computed Tomography-Guided Radiofrequency Ablation of Osteoid Osteoma

A 26-year-old male presented for magnetic resonance (MR) examination of the ankle for chronic ankle pain. MR images of the ankle revealed marked intraosseous bone marrow hyperintensity involving the talus on the fast inversion recovery sequence (Fig. 1). In addition, at the anteromedial margin of the posterior facet of the talus, a round, sclerotic lesion was present with an associated mild to moderate reactive synovitis in the subtalar joint (Fig. 1). Findings were consistent with an osteoid osteoma. Fig. 1 Selected magnetic resonance (MR) images of the hindfoot demonstrating the osteoid osteoma. Sagittal fast spin echo image (a) demonstrates the central nidus and peripheral rim of reactive sclerosis (arrow). Sagittal fast inversion recovery sequence (b ... Patient was referred for computed tomography (CT)-guided radiofrequency ablation of the lesion. Preprocedure CT images of the ankle again demonstrate the well-marginated sclerotic lesion in the posterior facet of the talus with a hypodense rim and centrally calcified nidus (Fig. 2). Fig. 2 Selected computerized tomography (CT) images of the hindfoot viewed with bone algorithm. Sagittal image (a), oblique coronal (b), and axial (c) images demonstrate the sclerotic central nidus of the osteoid osteoma (arrow) For the procedure, a radiofrequency probe was inserted into the lesion under CT guidance (Fig. 3). The probe was heated to 90°C for 6 min in the inferior and subsequently, the superior, portions of the lesion. The patient did well postprocedure. Fig. 3 Oblique coronal CT image taken during the radiofrequency ablation procedure with the patient in a lateral decubitus position, demonstrates the radiofrequency probe (arrow) centrally within the lesion