Osseous Reaction Research Articles

Idiopathic Osteosclerosis and Condensing Osteitis in a Sample of the Lebanese Population: A Digital Panoramic Based Study.

Idiopathic osteosclerosis (IO) is an area of enlarged bone production in the jaw that usually appears radiopaque and round, elliptical, or irregular in shape. Condensing osteitis (CO) is a focalized osseous reaction leading to periapical sclerotic bone growth. The aim of this study was to investigate the prevalence, localization, shape, and dental relationship of IO and CO in a group of Lebanese patients and to correlate these findings to age and gender. 520 digital panoramic radiographs of patients (215 men and 305 women) ranging in age from 18 to 77 (mean age 40.89 years) who visited the Faculty of Dental Medicine, Lebanese University, for dental treatment were included in this study and assessed for IO and CO. The prevalence of the two lesions according to gender and age, as well as their localization, and dental relationship, were recorded and saved in an Excel sheet. Among the 520 radiographs, 47 (9%) showed IO, and 30 (5.8%) showed CO. Both lesions are more frequent among females in their third decade and are essentially found in the mandible, mainly in relation to the root apices. Within the limits of this study, we concluded that in our sample of the Lebanese population, the prevalence of IO and CO is low and supports the theory that IO can be defined as developmental variations of normal bony architecture unrelated to a local stimulant, and CO could be considered reactive bone formations related to pulpitis, deep restoration, or caries.

Treating of the Articular Cartilage in Rabbits Using Different Doses of Platelet-Rich Plasma

The current study was designed to evaluate the effects of autologous platelets rich plasma (PRP) on the articular cartilage repair. The present study was conducted on twenty-four adult male rabbits. Surgically (24) animals have received the same defect (5mm in diameter) which is made on the lateral condyle of the distal end of the femoral bone. The animals were divided randomly into three equal groups. Group (I) remain without treatment as a positive control group, group (II) which treated with a single dose of prepared PRP injected into the intraarticular space immediately after the creation of the of defect, group (III) treated with two doses of PRP (the first dose administered immediately after the surgery and second dose after (15) days of the first dose. Results were evaluated through the Biochemical analysis of the alkaline phosphatase (ALP) and Ca2+ at 15, 30, and 60 days after treatment. The biochemical findings of the current study showed that the total ALP was not significantly differed in animals of a group (II, III), whereas animals of a group (I) showed an elevation of ALP in the last period which indicates the osseous reaction especially in late stages of cartilage repair; however, the other two groups (II, III) didn’t show a great change in ALP levels in all periods of blood sample collection. The Ca+ levels also showed no significant differences among groups, only in the last period in the control positive group, so we concluded that the increase in ALP, and Ca+ levels in control group is an evidence of continues inflammatory process, and increase ability of ossification of the new tissue formed in the site of the lesion.

Relationship Between Age at Initial Shoulder Instability and Overall Outcomes After Arthroscopic Bankart Repair: Mean 6-Year Follow-up.

Background:Age at surgery plays a crucial role in the frequency of recurrent shoulder instability. However, there are few studies that evaluate the relationship between age at initial shoulder instability and overall outcomes after stabilization surgery.Purpose:To compare clinical outcomes and structural changes after arthroscopic Bankart repair in patients who experienced initial shoulder instability during adolescence versus those with later onset instability.Study Design:Cohort study; Level of evidence, 3.Methods:This study included patients who underwent arthroscopic Bankart repair at a single institution between 2007 and 2017. Comparisons were made between patients who experienced initial shoulder instability during adolescence (age 13-19 years; group A) and those with later onset instability (age 20-35 years; group B). Clinical outcomes (recurrence rate, postoperative pain, functional scores, active range of motion, and return to sports) and structural changes demonstrated by magnetic resonance imaging (MRI) were evaluated at minimum 2-year follow-up. In addition, functional outcomes within each group were compared between the patients with and without postoperative recurrence.Results:A total of 58 patients were included (24 patients in group A and 34 patients in group B). The mean follow-up was 72.1 months. Group A demonstrated a significantly higher recurrence rate than group B (41.7% vs 11.8%, respectively; P = .009; risk ratio, 5.36 [95% CI, 1.43-20.09]) as well as significantly lower Rowe (76.9 ± 20.1 vs 88.7 ± 13.2, respectively; P = .01) and Constant-Murley scores (92.2 ± 7.6 vs 96.3 ± 4.2, respectively; P = .01). Postoperative MRI revealed no significant structural differences between the groups regarding the glenoid labrum, glenohumeral cartilage, or osseous reaction around the implanted anchors. In group A, patients with recurrence had less satisfaction regarding postoperative sports level than those without recurrence, whereas in group B, patients with recurrence had more postoperative pain and functional impairment compared with those without recurrence.Conclusion:Initial shoulder instability during adolescence was associated with a higher recurrence rate and lower functional scores after arthroscopic Bankart repair compared with later onset instability, although no significant structural differences were found between the groups on MRI at a mean 6-year follow-up.

Large Drill Holes Are Still Present in the Long Term After Arthroscopic Bankart Repair With Absorbable Tacks: An 18-Year Randomized Prospective Study

Background: Studies have demonstrated the development of an osseous reaction at the drill sites of anchors after arthroscopic shoulder surgery. Purpose: To investigate the drill-hole size at 18 years after arthroscopic Bankart repair using either fast polygluconate acid (PGA) or slow polylevolactic acid (PLLA) absorbable tacks and to compare the functional outcomes and development of osteoarthritis. Study design: Randomized controlled trial; Level of evidence, 2. Methods: 40 patients with unidirectional anterior shoulder instability, treated with arthroscopic Bankart repair, were randomized into the PGA group (n = 20) or the PLLA group (n = 20). Plain radiographs of both shoulders, as well as computed tomography (CT) images of the operated shoulder, were used to evaluate the drill-hole size, volume, and degenerative changes. Functional outcomes were assessed by use of the Rowe score, Constant score, and Western Ontario Shoulder Instability (WOSI) index. Results: Of the 40 patients, 32 patients returned for the follow-up (15 PGA and 17 PLLA). No significant differences were found in the population characteristics between the study groups. The mean follow-up time was 18 years for both groups. No significant differences were seen in range of motion, strength in abduction, or Constant, Rowe, and WOSI scores between the groups. Recurrence rate was 33% in the PGA group and 6% in the PLLA group during the follow-up period (P = .07). The drill-hole appearance on plain radiographs (invisible/hardly visible/visible/cystic) was 11/2/2/0 and 6/5/5/1 for the PGA and PLLA groups, respectively (P = .036). The mean ± SD drill-hole volume as estimated on CT images was 89 ± 94 and 184 ± 158 mm3 in the PGA and PLLA groups, respectively (P = .051). Degenerative changes (normal/minor/moderate/severe) on plain radiographs were 7/4/4/0 and 3/8/5/1 for the PGA and PLLA groups, respectively (P = .21), and on CT images were 5/7/3/0 and 2/6/6/3 for the PGA and PLLA groups, respectively (P = .030). Conclusion: This long-term follow-up study demonstrated that the PLLA group had significantly more visible drill holes than the PGA group on plain radiographs. However, this difference was not evident on CT imaging, with both groups having several visible cystic drill holes and a substantial drill-hole volume defect. No significant differences were found between the study groups in terms of clinical outcomes.

Postoperative bone marrow edema lasts no more than 6 months after uncomplicated arthroscopic double-row rotator cuff repair with PEEK anchors.

To assess the natural evolution of the osseous reaction following arthroscopic double-row rotator cuff repair with PEEK anchors and to analyze its correlation with clinical shoulder function. Between 2015 and 2017, 159 patients received arthroscopic double-row rotator cuff repair with PEEK anchors and underwent serial clinical and radiological follow-up (3, 6, 12, and 24months). Radiological results were analyzed by tendon integrity, bone marrow edema, and peri-implant osteolysis. Clinical shoulder function was evaluated with the Constant score. One-hundred and seventeen patients were enrolled; among them, 63% demonstrated bone marrow edema around the anchors on postoperative 3-month MRI. The edema area percentage was 41% ± 7%. At 6months, edema was only seen in 12% of cases, with an area percentage of 18% ± 5%. At 12 and 24months, edema was rarely present. Fluid signals around the anchor were observed in 17.6%, 42.7%, 33.3%, and 21.0% of patients at 3, 6, 12, and 24months, respectively; the tunnel widening values were 1.1 ± 0.4mm, 1.8 ± 0.5mm, 2.3 ± 0.6mm, and 2.2 ± 0.7mm at each follow-up, respectively. The sign of osteolysis was significantly more obvious around the lateral anchor than around the medial anchor. The presence of an osseous reaction was not correlated with worse clinical outcome. Osseous reactions following arthroscopic rotator cuff repair are common and significant even with PEEK anchors. Bone marrow edema does not last more than 6months in patients without complications. Peri-implant osteolysis is more evident around the lateral anchor than around the medial anchor and improves gradually over time. The sign of osteolysis is not correlated with clinical shoulder function. Based on these findings, surgeons should be cautious about bone marrow edema lasting more than 6months following arthroscopic rotator cuff repair. Level IV.

Minimally invasive treatment of tibial plateau depression fractures using balloon tibioplasty: Clinical outcome and absorption of bioabsorbable calcium phosphate cement.

The exact reconstruction of the tibial plateau and articular surface is the main operative aim in the treatment of tibial plateau depression fractures. For selected cases, a novel technique with the use of balloon tibioplasty in combination of bioabsorbable calcium phosphate cement is available. In this study, the first objective was to answer the question whether the clinical outcome parameters after balloon tibioplasty are comparable to open reduction procedures described in the literature. Secondly, we asked whether the cement absorption is safe in relation to adverse effects like osteolysis and measured the absorption ability during the bone conversion process in the proximal tibia bone. Eight patients (mean age 54 years; 4 males and 4 females) received the abovementioned surgical procedure. Mean follow-up period was 27 months. This study evaluated clinical outcome and radiological measured cement absorption within the postoperative course. Cement absorption was measured on X-rays and calculated based on the greatest extend on anterior-posterior and lateral view radiographs just after the operation on the latest available follow-up. WOMAC score showed a mean of 93. Radiologic absorption was 1/5 at a mean of 18 months. No osteolysis reaction was seen surrounding the cement. This far, promising clinical and radiological results have been shown with WOMAC scores comparable to the results of noninjured knees. The indication for this relatively new technique is restricted to isolated depression fractures. It is a useful tool to facilitate the reduction of select depressed tibial fractures. The radiologic absorption effect seems to be quite fast in bone remodeling and safe without any osteolysis or osseous reaction.

Condensing osteitis in the diagnosis consultation at Egas Moniz University Clinic

Introduction: Condensing Osteitis or Focal Sclerosing Osteomyelitis Condensing is characterized by the formation of periapical sclerotic bone; it consists on a focalized osseous reaction leading to bone growth resulting from inflammatory stimuli or local low intensity trauma [1–3]. Although described as a result of periapical of pulp inflammation and /or infection [3], it’s also observable in vital teeth as a consequence of occlusal trauma [1,2,4] and, thus, aetiologically not associated with pulp aggression, which may lead to misdiagnosis [5]. Clinically, in most cases, there is absent or mild pain, no lymphadenopathy and no cortical expansion [6]. Radiologically, these radiopaque lesions are associated with previously restored teeth or teeth undergoing trauma [1], mostly in the molar region of the mandible [1,7,8]. Condensing Osteitis is less frequent in the maxilla probably due to lower cortical thickness and abundant irrigation [6]. Its radiological appearance remains even with exodontia of the involved tooth [1]. The objective of this study was to statistically analyze condensing osteitis lesions detected in ortopanthomographies in the diagnosis consultation of the I.U.E.M. university clinic. Materials and methods: Observational study. The defined study group included patients who attended the diagnosis consultation at Egas Moniz University Clinic. 1947 patients were randomly selected. Frequency tables were determined according to the following criteria: sex, age, location, presence or absence of paresthesia. Non vital teeth and edentulous spaces were excluded. Statistical results were rounded to the centesimals. This paper has been conducted in an ethical and responsible manner, and is in full compliance with all relevant codes of experimentation and legislation. Results: 62 cases were observed (3,2%). More frequent in female patients (53,22%). No maxillary lesions (0%) were observed in the sample group (100% mandible lesions). Mandibular molars (53,23%) and premolars (43,54%) were the most frequently affected teeth, more specifically tooth 46 (20,97%), tooth 45 (19,35%) and tooth 36 (16,13%). 2 canines (3,23%) were observed to be associated with condensing osteitis. Lower right mandibular teeth were observed to have a higher incidence of condensing osteitis cases (54,84%), when compared to lower left mandibular teeth (45,16%). No cases of paresthesia were observed. Mean age was found to be 39,1 years old. Discussion and conclusions: Condensing osteitis was observed only in a small minority of the selected study universe and, thus, it can be considered as statistically infrequent. Mandible molar teeth were most frequently affected, which is in accordance to the referenced bibliography. Statistically, only slight differences were observed when considering the gender factor and thus these lesions are expected to occur in both male and female patiens. Aetiological treatment of pulp inflammation or occlusal trauma is recommended. In other cases, biopsy should be considered and differential diagnosis should include cement-osseous dysplasia, osteoma, cementoblastoma, osteoblastoma, hipercementosis [1]. Although statistically infrequent, Condensing Osteitis must be considered clinically relevant, not only regarding its differential diagnosis, but also because bone biopsies present the clinical implications of being invasive procedures, which can lead to vertical and horizontal bone loss, thus requiring immediate or further surgical procedures for local regeneration and rehabilitation. Furthermore, in the premolar and molar regions of the mandible, the risk of nerve lesion must be considered when performing a bone biopsy.

An unusual bone reaction to a retained organic foreign body in the hand

Penetrating wounds of the hand with an embedded foreign body are common in active children and manual workers. Organic material, particularly thorns, can cause an inflammatory tissue reaction, ranging from a localized foreign body granuloma to a severe soft tissue and osseous reaction. We report the case of a 57-year-old man presented to our emergency department with a painful swelling of his fourth right finger. He had fallen into bushes 4 month prior to his presentation. Plain radiographs showed a solid periosteal new-bone formation along the second phalanx, interrupted by a rounded well-limited radiolucent area at the mid-phalangeal level that we described like a “crab claw periosteal reaction”. The osteoblastic reaction to an organic foreign body is very rare, we report an exceptional case of an unusual osteoblastic reaction to a retained organic foreign body in the hand that has been to our knowledge only once reported in the literature.

Surgical site infection after occlusion of the internal carotid artery with a thrombectomy catheter: Five cases

SummaryAlthough rare, guttural pouch mycosis is a potentially life‐threatening disease in the horse. The disease is most commonly treated surgically. One surgical option is occlusion of the internal carotid artery with a combination of ligation and use of a balloon tipped venous thrombectomy catheter. Complications of such treatment are rarely reported. This case series of five individuals describes the appearance, diagnosis and management of medium (>2 weeks) and long‐term (>10 years) complications (including abscess formation, draining sinuses and wound dehiscence) of internal carotid artery occlusion with a venous thrombectomy catheter and management of these surgical site infections. The clinical presentations included swelling and/or discharging tracts in the parotid region. In one horse, an osseous reaction of the basisphenoid bone and penetration of the contralateral guttural pouch by the implant were identified by computed tomography. In all five horses, the surgical site infections were successfully resolved following removal of the venous thrombectomy catheter.

Primary Prosthetic Replacement of the Distal Radioulnar Joint (DRUJ) in Rheumatoid Arthritis Using the First Choice Hemi-DRUJ Resurfacing Implant

Objective/Hypothesis: In rheumatoid arthritis, resection of the ulnar head has been the gold standard for pain and dysfunction in the distal radioulnar joint (DRUJ). The ulnar head is today, however, considered to be essential for the wrist function and alternatives are being investigated. We present a 5-year clinical and radiological follow-up of a primary hemi-DRUJ resurfacing implant. Materials and Methods: Between November 2006 and October 2010, 12 female rheumatoid arthritis patients, mean age 59 years (range, 39-72 years), were operated with an uncemented metal hemiprosthesis (First Choice, Ascension Orthopedics, Texas, USA). Ten patients had a concomitant partial or total wrist fusion. A follow-up protocol was designed before study start, and clinical and radiographic data were recorded prospectively at 1, 2, and 5 years. Results: One patient was revised after 2 years due to a suspected low-grade infection, and 1 patient was reoperated due to reduced forearm rotation. All patients were subjectively and objectively stable at the 5-year follow-up. Pronation/supination remained unchanged from preoperatively to final follow-up, whereas grip strength and subjective outcome (DASH, VAS pain) improved. Radiographically, a remodeling of the sigmoid notch was seen in half of the patients with a minor radial shift of the prosthesis into the radius in some patients. With the remodeling, a gradual increase of the contact area between the prosthetic head and the sigmoid notch was seen over time with 79% of bony contact after 1 year and 90% after 5 years. Bone resorption around the collar of the prosthesis was noted in all but one patient. In 3 of 11 patients, the resorption was within 2 to 4 mm from the collar and in 3 of 11 patients between 4 and 7 mm. Only one patient showed a major resorption of 20 mm, and this was seen already at 2 years. This patient was the only one showing a subsidence of more than 2 mm. No radiolucent zone greater than 1 mm around the ulnar stem was observed. In 1 patient a thin zone, indicative of a loosening membrane was noted after 1 year, but no deterioration was seen over time. This patient scored VAS 0 both at rest and during activity and a DASH score of 3. Conclusions: The preliminary results of the prosthesis in rheumatoid patients are encouraging, and the patients report minimal discomfort, an acceptable range of forearm rotation, and a well-functioning stable wrist. The concept of using a hemiprosthesis thus seems to be appropriate also for the rheumatoid DRUJ, at least as seen in this medium-term study. The important finding that no major DRUJ instability was encountered is promising, and in the short/medium perspective, it is possible to achieve dynamic and static stability with a reasonable range of motion (ROM) and minimal discomfort without competent primary stabilizers. Longer follow-ups are of course necessary, especially evaluating the osseous reaction of the nonsubstituted subchondral bone on the radial side, as well as the long-term stability of the joint.

Osseoconductivity of a Specific Streptavidin–Biotin–Fibronectin Surface Coating of Biotinylated Titanium Implants – A Rabbit Animal Study

Biofunctionalized implant surfaces may accelerate bony integration and increase long-term stability. The aim of the study was to evaluate the osseous reaction toward biomimetic titanium implants surfaces coated with quasicovalent immobilized fibronectin in an in vivo animal model. A total of 84 implants (uncoated [control 1, n = 36], streptavidin-biotin coated [test 1, n = 24], streptavidin-biotin-fibronectin coated [test 2, n = 24]) were inserted 1 mm supracortically in the proximal tibia of 12 rabbits. The samples were examined after 3 and 6 weeks. Total bone-implant contact (tBIC; %), bone-implant contact in the cortical (cBIC; %) and in the spongious bone (sBIC; %) as well as the percentage of linear bone fill (PLF; %) were evaluated. After 3 weeks, streptavidin-biotin-fibronectin implants had a significant higher sBIC (p = .043) and PLF (p = .007) compared with the uncoated samples. After 6 weeks, this difference was significant for tBIC (p = .016) and cBIC (p < .001). Additionally, uncoated screws showed a significant higher sBIC when compared with the fibronectin coating (p < .001). Streptavidin-biotin-coated implants showed less bone growth at both time points of all examined parameters when compared with their counterparts (all p < .001). Quasicovalent immobilization of biotinylated fibronectin with the streptavidin-biotin-fibronectin system on smooth surface titanium shows a beneficial faster osseous healing in vivo. Besides, an antifouling effect of the streptavidin-biotin coating was proven.

Radiological Characterisation of Ossified Ungular Cartilages of the Foot

AimsOssified ungular cartilages may be associated with foot pain. There are no detailed descriptions of their radiological appearance. Dorsopalmar images are considered best for evaluation of ossification; the usefulness of oblique images has not been assessed. The aims were to describe the radiological appearance of ossified cartilages and to determine the usefulness of oblique images.MethodsRadiographs of all feet (n = 169, 2005–2012) with ≥ Grade 2 ossification (Dyson et al. ) of one/both ungular cartilages were assessed subjectively using a purpose‐designed grading system, after a repeatability study in which 10 sets of radiographs were examined 10 times. Detection of abnormalities was compared among conventional and oblique images.ResultsRadiological abnormalities including focal/diffuse increase in trabecular bone opacity, loss of trabecular architecture, and loss of definition between the trabecular bone and the cortices were more frequent in lateral cartilages (72, 59 and 60, respectively) than medial (41, 36 and 33, respectively). Cartilage shape varied in dorsopalmar images, being straight (270), curving axially (19) or abaxially (10). There was modelling of the cortices in 52 lateral (33 mild, 19 moderate) and 23 medial (17 mild, 6 moderate) cartilages. There were separate centres of ossification (SCsO) in 30 lateral and 14 medial cartilages. Fractures were present in 18 medial and 13 lateral cartilages, 20 at the base. Accurately distinguishing between fractures and osseous reaction around junctions between ossification centres was impossible in 8 cartilages. In total SCsO or fractures were seen in 59 dorsopalmar and 81 oblique images. Fracture sites and junctions between ossification centres were consistently best seen in oblique images. Palmar curvature of the cartilages could only be accurately detected in oblique images and was present in 31 cartilages.Conclusions and practical significanceLateral cartilages had a greater variation in radiological appearance than medial cartilages. Oblique images can provide information not available from other images.Ethical animal researchNot required by this Congress: retrospective analysis of archived radiographs. Sources of funding: None. Competing interests: None.

Arthroscopic double-row repair of the rotator cuff: a comparison of bio-absorbable and non-resorbable anchors regarding osseous reaction

The aim of this study was to analyse the osseous reaction after arthroscopic double-row rotator cuff repair using bio-absorbable poly-L-lactic acid (PLLA) and non-absorbable polyetheretherketone (PEEK) suture anchors. Focus of interest was the appearance of peri-implant fluid and anchor tunnel widening. Thirty-six patients were evaluated at final follow-up (16 PLLA and 20 PEEK). Clinical results were acquired by use of the subjective shoulder value, the Constant score and the Western Ontario Rotator Cuff Index. Radiological results were analysed by supraspinatus tendon integrity, footprint coverage, muscular atrophy and fatty infiltration. Furthermore, anchor tunnel expansion was measured, anchor structure and peri-implant fluids graduated. At 28.4 ± 8.9-month follow-up, clinical outcome was similar (n.s.). MRI investigation revealed osseous reaction in both groups; tunnel widening was 0.9 ± 0.7 mm in PLLA and 0.8 ± 0.6 mm in PEEK anchors (n.s.). Peri-implant fluid was pronounced in PLLA anchors (p < 0.05). Tunnel widening was significantly higher in lateral anchors irrespectively of the material used. Tendon integrity, muscular atrophy, fatty infiltration and footprint coverage were not significantly different (n.s.). Both materials lead to osseous reaction in this study, whereas consequences of pronounced fluid in PLLA patients remain unclear. Pronounced tunnel widening in lateral anchors leads to the assumption that other causes such as mechanical stress potentially have to be considered when analysing osseous reaction. III.

Anatomical and Biomechanical Aspects of the Horse Spine: The Interpretation of Vertebral Fusion in a Medieval Horse from Wroclaw (Poland)

ABSTRACTThe investigation were carried out on the medieval horses thoracic and lumbar spine excavated between 2009‐2011 by the Institute of Archaeology, University of Wroclaw at New Market Square in Wroclaw (Wratislavia, Breslau), capital city of the Polish province of Lower Silesia. The pathological changes, like: ankylosis of the zygapophyses, fusion of the vertebral bodies and arches and the interspinal space calcification were observed. The X‐ray examination was done. During medieval artefact interpretation the biomechanical aspect of horse's locomotor system was taken into consideration. The archaeozoological material was compared with modern horse's spine (with similar pathological changes and known history of disease). The analysis proved, that the observed osseous reaction was a result of the long‐lasting inflammation. Such a disease appearance accompanies chronic inflammatory state of errector muscles of the spine. It is typical for those horses utilised for the saddle. Copyright © 2012 John Wiley &amp; Sons, Ltd.

Skin infection and progressive paraparesis

A 35-year-old female agricultural worker presented with a 4 month history of productive cough, fever, and left subcostal pain, followed by progressive paraparesis and urinary incontinence. 10 years previously, she had been treated for a skin infection on her back at another centre for 3 years, without further follow-up. Examination showed more than one irregular scars, hyperpigmented papules, and few skin sinuses with scanty purulent discharge, without erythema, on the middle and left side of the upper back. The patient was afebrile and did not have palpable cervical or supraclavicular lymphadenopathy. We heard no rales, rhonchi, or substantial wheezing. The patient had fl accid paraplegia with complete sensory loss at T4 level and urinary sphincter incontinence. Laboratory tests showed a leucocyte count of 9·1 cells per μL, a normal liver enzyme profi le, a C-reactive protein concentration of 59·1 mg/dL (normal range 0–0·5 mg/dL), and no evidence of venereal disease or HIV. Protein concentration in her cerebrospinal fl uid was 800 mg/dL, glucose was 32 mg/dL, and no cells were present. Cerebrospinal fl uid stains, bacterial culture, and PCR for Mycobacterium tuberculosis were negative. Chest radiography showed a paravertebral mass with a fragmentary pattern of osseous patchy destruction and periosteal reaction (fi gure, A). Spiral CT showed a left paravertebral extensive osteolytic lesion involving vertebral bodies and costovertebral unions (fi gure, B). T2-weighted MRI (fi gure, C–E) showed widespread hyperintense lesions that infi ltrated vertebral bodies without involvement of intersomatic spaces (arrow), pleural thickening, and lung consolidation of the left lower lobe (asterisks). Gram stain and modifi ed acid-fast stain (Kinyoun) of sinus discharge showed variably Gram-positive and faintly acid-fast positive, slender, non-branching fi lamentous bacilli, consistent with a diagnosis of Nocardia sp. Intravenous amikacin, co-trimoxazole, and an orthopaedic corset were indicated. Surgery for debridement was off ered, but the patient did not choose to have the procedure. The patient attended our neurological care centre 2 months after discharge and showed a discrete amelioration of neurological symptoms, but did not return for further follow-up. Initially, diff erential diagnosis included extramedullary neoplasms and granulomatous infections (aspergillosis, histoplasmosis, tuberculosis, chromomycosis, blastomycosis, coccidiodomycosis, botryomycosis, sporotrichosis, frambesia, and syphilis). Gadolinium MRI is especially useful because it could help the practitioner to diff erentiate between vertebral intraosseous abscesses, meningeal involvement, subligamentous spread, and paraspinal abscess.

Osseous reaction to implantation of two endodontic cements: Mineral trioxide aggregate (MTA) and calcium enriched mixture (CEM)

Aim: The aim of the present in vivo study was to determine bone tissue reaction to calcium enriched mixture (CEM) and mineral trioxide aggregate (MTA) using a rat femur model. Study Design: Sixty-three rats were selected and randomly divided into three groups of 21 each [experimental groups (n=15), control (n=6)]. Implantation cavities were prepared in each femoral bone and randomly filled with the biomaterials only in the experimental groups. The animals in three groups were sacrificed 1, 4, and 8 weeks postoperatively. Histologic evaluations comprising inflammation severity and new bone formation were blindly made on H&E-stained decalcified 6-µm sections. Results: At 1, 4, and 8 weeks after implantation number of inflammatory cells had decreased in the CEM, MTA and control groups, respectively, with no statistically significant differences. Conversely, new bone formation had increased in all the experimental and control groups, without statistically significant differences. Conclusion: The results suggest that biocompatibility of MTA, as gold standard, and CEM cement as a new endodontic biomaterial are comparable Key words:Endodontics, MTA,CEM, osseous reaction.

MRI graduation of osseous reaction and drill hole consolidation after arthroscopic Bankart repair with PLLA anchors and the clinical relevance

Conventionally, radiography studies revealed prolonged glenoidal drill hole visibilities with an unclear influence to the clinical outcome after arthroscopic Bankart repair using Poly-Laevo-Lactic-Acid (PLLA) anchors. The primary aim of the present study was the separated assessment of drill hole consolidation (DHC) and the concomitant osseous reaction (OR) of the glenoidal bio-degradation process in new specific magnetic resonance grading systems. In accordance with the specific DHC and the OR graduation, the clinical relevance was the secondary focus. Twenty-eight patients with arthroscopic Bankart repair using knotless PLLA anchors were prospectively followed and analyzed using a clinical scoring system (3, 6, 15 and 32months). The T2-weighted OR and T1-weighted DHC were assessed using specific magnetic resonance imaging grading protocols (15 and 32months). Longitudinal assessments revealed successive clinical status improvements over time (32months: Rowe 95.7±3.8; Walch-Duplay 93.8±6.6; Constant 93.9±4.5; ASES 93.8±6.9; DASH 28.6±7.2; NAS(pain) 1.1±1.3; NAS(function) 1.3±1.4). The initial OR level regressed over the 15-32month period while the DHC showed significant drill hole reductions (P<0.05). The inferior glenoid revealed a significantly increased bio-degradation capacity (P<0.05) with drill hole enlargements in 14.3%. Neither the OR nor the drill hole enlargements influenced the clinical status. In no case were clinical or radiologic signs for a foreign body reaction. Knotless bio-anchors provide secure glenoidal fixation for Bankart repair without any specific clinical or MR evidence of an inflammatory response. The clinical status remained unaffected by the bio-degradation process. IV.

A Radiographic Assessment of Pediatric Fracture Healing and Time Since Injury*

Past studies and pediatric bone physiology indicate that younger individuals may heal at a faster rate. Additionally, in adults upper limb fractures heal faster than lower limb fractures; this trend is expected for pediatric fractures. This study aims to evaluate and compare rates of fracture repair in children based on age and skeletal element. Six stages are used to describe the bone repair process in 294 radiographs of tibial and radial fractures from 107 infants and young children. Healing rates are examined using ANOVA and Welch's t-test with a 95% confidence interval. Results indicate that younger individuals spend less time at stage 1, suggesting a delay in the start of healing. Furthermore, forearm fractures heal faster than leg fractures at stages 2 and 3, suggesting a role in the osseous reaction of bone healing. The healing schedule presented may allow the timing of injuries to be estimated from radiographs.

TU‐G‐211‐07: Combined NaF PET and FDG PET Based Assesment of Bone Metastasis Response after Chemotherapy Using Kinetic Analysis

Purpose: The differentiation between the residual tumor activity and the osseous reaction to the tumor is essential for therapy assessment of bone metastases. The 18‐F‐Sodium Fluoride (NaF) uptake reflects the osteoblastic process, while the FDG uptake reflects the tumor metabolism. The purpose of this study was to evaluate the assessment of treatment response with the kinetic analysis of concurrent NaF/FDG PET/CT images for specific clinical cases. Methods: Three prostate adenocarcinomas were treated with chemotherapy and imaged twice with NaF/FDG PET/CT: a baseline scan and a second scan after four weeks of chemotherapy. The NaF/FDG PET/CT imaging started with NaF injection, followed by 100 min dynamic PET imaging. Next, FDG was injected and followed by an additional 45 min of dynamic PET imaging. Macroparameters K_NaF and K_FDG (defined as K=K1×k3/(k2+k3)) were obtained by compartmental kinetic analysis. The accuracy of the kinetic parameter estimations was evaluated with simulations. Bone metastases were segmented (29 total). The ratio of mid‐therapy to pre‐therapy mean K_FDG and K_NaF parameters, which measured the response to therapy, was calculated for each metastasis. Results: The simulations revealed that the K_NaF and K_FDG estimations are highly correlated to the simulated value (r=0.9) while an estimated error is 50%. The K_FDG response and the K_NaF response are moderately correlated (r=0.7), but the mean K_FDG response over all the metastases is 0.7 while the mean K_NaF response is 0.9. The patterns in K_FDG and K_NaF parametric images are similar, but displaced and slightly distorted. Conclusions: Tumor metabolism and bone repair process can be imaged separately at the same time point using the presented imaging protocol, which was validated with simulations. The addition of FDG PET imaging to the osseous NaF PET imaging provides additional information to treatment response and has the potential to improve the assessment of bone metastasis in therapy.

MRI assessment of the structural labrum integrity after Bankart repair using knotless bio-anchors

Adequate labral restorations after Bankart repair have been demonstrated in cadaver models for knot-tying and knotless anchors and in vivo by magnetic resonance imaging for knot tying. The influence of glenoidal bio-degradation on clinical outcome, and conclusions regarding drill hole enlargement and foreign body reactions remain controversial. The labrum was analyzed in magnetic resonance images for 37 consecutive patients with Bankart repair using knotless PLLA anchors and for 31 volunteers as radiologic controls. The labrum was assessed regarding slope, height index (quotient between labral height to the glenoid height), and labrum morphology in axial and coronal T2 images. Glenoidal bio-degradation was graded in terms of the drill hole configuration in T1 images and the corresponding osseous reaction in T2 images. Constant-Murley, Walch-Duplay, and Rowe scoring were carried out preoperatively and at follow-up. At 15months after arthroscopy, the anterior slope (24.8°), height index (3.0), inferior slope (25.4°), and height index (2.5) were not significantly different from control values. Morphologic analysis revealed significant changes in the Bankart group (P<0.05) that were influenced by the number of preoperative dislocations. Bio-degradation proceeded slowly with no evidence of drill hole enlargement. Osseous reactions were significantly greater in inferior compared to superior implants. The clinical scores were excellent and were not influenced by bio-degradation. Knotless anchors facilitate labral restoration that is comparable to the knot-tying approach. Bio-degradation proceeds slowly without clinical or radiologic evidence of foreign body reactions. III.