Osteomyelitis Of Bone Research Articles

An Actinomyces Long-Bone Osteomyelitis Case Report and Review

Abstract Historically, anaerobic bacteria as monomicrobial pathogens or components of polymicrobial infections have been found to play a minor role in osteomyelitis. Various Actinomyces species reside as constituents of the normal human microbial flora found in the oropharynx and in the most people may also be present as commensal microorganisms in the gastrointestinal, genitourinary, and, to a lesser degree, the upper respiratory tracts. Bone infections due to Actinomyces species are relatively uncommon and usually associated with concomitant cervicofacial disease. To date, only a sparse amount of cases of long bone osteomyelitis due to Actinomyces bacteria have been published in the medical literature. We report a case of monomicrobial subacute late-onset tibia bone osteomyelitis involving Actinomyces presenting 10 years after an open reduction and internal fixation surgical procedure performed to stabilize a traumatic fracture and review actinomycotic osteomyelitis including the rare association of Actinomyces odontolyticus with long bone infections.

Risk of infection in postmenopausal women with rheumatoid arthritis and osteoporosis taking denosumab and bDMARDS.

Background: There is no clear consensus regarding the potential of denosumab for increasing the risk of infection in patients who concurrently receive biologic disease-modifying anti-rheumatic drugs (bDMARDs). In this study, we compared the rate of infection in postmenopausal women with rheumatoid arthritis who received concurrent bDMARDs and denosumab with those who received bDMARDs alone. Methods: In a case-control study, postmenopausal patients with a confirmed diagnosis of rheumatoid arthritis who received concurrent bDMARDs and denosumab for at least one year were identified and included as the case group (n=40). A total of 44 age-matched postmenopausal rheumatoid arthritis women who received bDMARDs alone were included as the control group of the study. Using a chi-squared test, the incidence of bacterial or viral infections was extracted from the patients’ profiles and compared between the two study groups. Statistical analyses were performed by SPSS for Windows, version 16 (Chicago, Illinois, USA). A p-value of fewer than 0.05 was regarded as significant. Results: The clinical and demographic characteristics of the patients of the two study groups were not significantly different. In total, four infections were recorded in the present series, two infections in each group. Accordingly, the rate of infection was 4.5% in the bDMARDs alone group and 5% in bDMARDs + denosumab group. This difference was not statistically significant (p=0.655, 95% CI: 0.121-6.742). Three out of four infections were herpes zoster infection. The other one was osteomyelitis of the first metatarsal bone, which occurred in the bDMARDs+denosumab group. None of the infections needed a hospitalization of IV antibiotics. Conclusion: The risk of infection is comparable between postmenopausal osteoporotic women with rheumatoid arthritis who receive bDMARDS alone and those who receive bDMARDS in combination with denosumab.

Masquelet technique for management of posttraumatic bone defect in a patient of chronic osteomyelitis of long bone

<p class="abstract">Masquelet technique, which is the use of a temporary cement spacer followed by staged bone grafting, is a treatment strategy for reconstruction of large, infected, bone defects. This paper describes a patient treated with this technique to successfully manage postinfective or posttraumatic osseous long bone defect. Sequestrectomy was done and the injured limb was stabilized and aligned with application of external fixator at the time of initial antibiotic cement spacer placement. After 6 weeks of proper antibiotic coverage, all antibiotics were stopped for next 2 weeks. Clinical evaluation and investigations were done to rule out any residual infection. Osseous consolidation was successfully achieved with staged bone grafting and internal stabilization of long bone defect.</p>

Bisphosphonates for delivering drugs to bone.

Advances in the design of potential bone-selective drugs for the treatment of various bone-related diseases are creating exciting new directions for multiple unmet medical needs. For bone-related cancers, off-target/non-bone toxicities with current drugs represent a significant barrier to the quality of life of affected patients. For bone infections and osteomyelitis, bacterial biofilms on infected bones limit the efficacy of antibiotics because it is hard to access the bacteria with current approaches. Promising new experimental approaches to therapy, based on bone-targeting of drugs, have been used in animal models of these conditions and demonstrate improved efficacy and safety. The success of these drug-design strategies bodes well for the development of therapies with improved efficacy for the treatment of diseases affecting the skeleton. LINKED ARTICLES: This article is part of a themed issue on The molecular pharmacology of bone and cancer-related bone diseases. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v178.9/issuetoc.

A retrospective cone beam computed tomography analysis of cemento-osseous dysplasia

Background/purposeRadiological examination is indispensable in the diagnosis and follow-up of cemento-osseous dysplasia (COD). The aim of this retrospective study was to describe a series of COD cases, identify the frequencies of COD subtypes, and investigate the demographic and radiological characteristics in relation to subtypes. Materials and methodsCone beam computed tomography (CBCT) images/reports of patients with a diagnosis of COD were included in the study. The data collected included information on the age, sex, subtype of COD, location of COD, and region involved. Information regarding the internal density, effects on surrounding structures, and presence of concomitant lesions was also collected. The data obtained were evaluated statistically. ResultsThe study group included CBCT images of 142 patients (130 females (91.5%) and 12 males (8.5%)) with a mean age of 46.97 ± 10.57 years. The mandible was involved in almost all cases (99.3%). The most common subtype was florid COD (51.4%) and lesions with hyperdense internal density (81.7%) were more commonly observed. Cortical thinning (78.2%) was a prominent feature. The frequency of root resorption in periapical COD cases (57.1%) was observed to be significantly higher (p < 0.05). All hypercementosis cases were associated with florid subtype (p < 0.05). In a minority of cases (6.3%), the lesions were associated with bone cysts and osteomyelitis. ConclusionCBCT images clearly demonstrated the effect of COD lesions on surrounding structures. CBCT is an appropriate imaging modality for the diagnosis and follow-up of COD which is the most common fibro-osseous lesion in clinical practice.

What's Your Diagnosis? Symptoms: Ear Pain and Chronic Ear Drainage

What's Your Diagnosis? Symptoms: Ear Pain and Chronic Ear Drainage

Implant-associated osteomyelitis: Development, characterisation, and application of a porcine model.

Implant-associated osteomyelitis: Development, characterisation, and application of a porcine model.

Limb salvage following snakebite using acute limb shortening and secondary lengthening

A case of 16-year-old boy from the remote tribal population of Uttarakhand is described, who sustained a viper snakebite. The patient after various interventions and referrals developed locoregional and systemic complications. He not only had an open tibiofibular fracture but a large bimalleolar defect over his lower limb. The wound infection with underlying osteomyelitis progressed to septic shock and failure of the conventional cross-leg flap. Computed tomography scan of the limb revealed a single patent vessel, eliminating the option of microvascular flap. Limb amputation was considered for source control; however, in an attempt to salvage the limb, the novel approach of acute limb shortening with secondary limb lengthening was performed with parental consent, an approach not previously reported in the management of snakebite injuries. Adequate infection control was achieved following removal of the osteomyelitic bone, and the defect was covered with overlapping tissue from the docked limb and a cross-thigh flap. Secondary lengthening was performed after 3 months, and following extensive surgical and rehabilitative interventions, the boy's limb was salvaged and he retains a near-normal gait. This case report entails a detailed account of how mutilating a snakebite injury could be and how unconventional techniques like acute limb shortening with secondary lengthening can be used in such injuries.

MRI Manifestations and Diagnostic Value of Chronic Osteomyelitis.

If chronic osteomyelitis is not treated promptly and thoroughly, the wound will not heal for a long time, and the affected limb will be dysfunctional or disabled. In severe cases, it may even require amputation. In this article, a total of 50 patients with chronic osteomyelitis who meet the inclusion criteria were selected from January 2019 to March 2020 and were divided into two groups based on patient compliance, namely, a treatment group and a control group. The results of this group of studies showed that osteomyelitis is mostly manifested as limited diffusion, showing high signal on DWI, and ADC value is significantly higher than that of normal bone area. The normal bone area did not show obvious focal abnormal signals on the conventional MRI image. The ADC value of the measured patient's osteomyelitis area was compared with the ADC value of the normal bone area. The ADC value was significantly higher than that of the normal bone area, and the difference was statistically significant. Studies have shown that membrane induction technology is superior to the bone handling group in terms of limb function scores and results satisfaction in the treatment of chronic osteomyelitis bone defects. Membrane induction technology has a low complication rate, a small number of X-ray examinations, a short healing time, and a high functional score. However, bone handling technology has a long treatment process, long fixation time and healing time, nail channel infection, joint stiffness, nerve damage, and many other complications.

Radiological evaluation of postoperative osteomyelitis in long bones: Which is the best tool?

Currently, definitive diagnosis of osteomyelitis involves a combination of clinical signs, symptoms, laboratory tests, imaging modalities and cultures from blood, joint or body fluid. Imaging plays a critical role in the osteomyelitis diagnosis. Each of these tests incurs an additional cost to the patient or healthcare system and their use varies according to the preference of the healthcare professional and the healthcare setup. Imaging plays a critical role in the diagnosis and management of postoperative long bone osteomyelitis, with the aim of reducing long-term complications such as non-union, amputation and pathological fractures. In this review, we discuss the key findings on different radiological modalities and correlate them with disease pathophysiology. Currently, magnetic resonance imaging is the best available imaging modality due to its sensitivity in detecting early signs of long bone osteomyelitis and high soft tissue resolution. Other modalities such as radio-nuclear medicine, computed tomography and ultrasound have been proved to be useful in different clinical scenarios as described in this narrative review.

Mechanisms of Antibiotic Failure During Staphylococcus aureus Osteomyelitis.

Staphylococcus aureus is a highly successful Gram-positive pathogen capable of causing both superficial and invasive, life-threatening diseases. Of the invasive disease manifestations, osteomyelitis or infection of bone, is one of the most prevalent, with S. aureus serving as the most common etiologic agent. Treatment of osteomyelitis is arduous, and is made more difficult by the widespread emergence of antimicrobial resistant strains, the capacity of staphylococci to exhibit tolerance to antibiotics despite originating from a genetically susceptible background, and the significant bone remodeling and destruction that accompanies infection. As a result, there is a need for a better understanding of the factors that lead to antibiotic failure in invasive staphylococcal infections such as osteomyelitis. In this review article, we discuss the different non-resistance mechanisms of antibiotic failure in S. aureus. We focus on how bacterial niche and destructive tissue remodeling impact antibiotic efficacy, the significance of biofilm formation in promoting antibiotic tolerance and persister cell formation, metabolically quiescent small colony variants (SCVs), and potential antibiotic-protected reservoirs within the substructure of bone.

Invasive diagnostic and therapeutic measures are unnecessary in patients with symptomatic van Neck–Odelberg disease (ischiopubic synchondrosis): a retrospective single-center study of 21 patients with median follow-up of 5 years

Background and purpose — Van Neck–Odelberg disease (VND) is a self-limiting skeletal phenomenon characterized by a symptomatic or asymptomatic uni- or bilateral overgrowth of the pre-pubescent ischiopubic synchondrosis. It is frequently misinterpreted as a neoplastic, traumatic, or infectious process, often resulting in excessive diagnostic and therapeutic measures. This study assessed the demographic, clinical, and radiographic features of the condition and analyzed diagnostic and therapeutic pathways in a large single-center cohort. Patients and methods — We retrospectively analyzed 21 consecutive patients (13 male) with a median age of 10 years (IQR 8–13) and a median follow-up of 5 years (IQR 42–94 months), who were diagnosed at our department between 1995 and 2019. Results — VND was unilateral in 17 cases and bilateral in 4 cases. Initial referral diagnoses included suspected primary bone tumor (n = 9), fracture (n = 3), osteomyelitis (n = 2), and metastasis (n = 1). The referral diagnosis was more likely to be VND in asymptomatic than symptomatic patients (4/6 vs. 2/15). More MRI scans were performed in unilateral than bilateral VND (median 2 vs. 0). All 15 symptomatic patients underwent nonoperative treatment and reported a resolution of symptoms and return to physical activity after a median time of 5 months (IQR 0–6). Interpretation — By understanding the physiological course of VND during skeletal maturation, unnecessary diagnostic and therapeutic measures can be avoided and uncertainty and anxiety amongst affected patients, their families, and treating physicians can be minimized.

Technology for Repairing Osteomyelitic Bone Defects Using Autologous Mesenchymal Stromal Cells on a Collagen Matrix in Experiment.

The aim of the study was to develop a technology for repairing an osteomyelitic bone defect using autologous adipose tissue mesenchymal stromal cells (MSCs) bound to a collagen matrix and to test the efficacy of this technique.Materials and Methods.The study was carried out with 17 rabbits. A bone defect was created using a milling cutter applied to the proximal third of the leg. The wound (8.0×4.0 mm and a depth of 4.0 mm) involved the periosteum, cortical layer, and cancellous substance. Staphylococcus aureus strain was used as an infectious agent.After the development of chronic osteomyelitis, the animals underwent osteonecrectomy. In the study group, autologous MSCs in Collatamp EG collagen carrier were placed into the bone defect. MSCs were obtained from adipose tissue and cultured in the matrix for 5 days. In control, the defect was filled with the collagen matrix without cells.Results.On day 14 upon the initiation of chronic osteomyelitis, bacteriological examination of the discharge from the fistula showed the presence of mixed bacterial flora (Staphylococcus aureus and Escherichia coli) in all operated animals. Results of X-ray, laboratory, and histological tests confirmed the formation of a focus of chronic osteomyelitis.Two months after the treatment (collagen with or without MSCs) began, all animals of the study group showed mature bone tissue regenerated in the affected zone. In the control group, proliferation of osteoblasts on the surface of the bone trabeculae was also observed; however, mature osteoid tissue was more often detected in the study group (35.0 vs 20.0% in control). In the study group (MSCs + collagen matrix), there was a decrease in bone marrow fibrosis (50.0 vs 100.0% in control) and cartilage formation (30.0 and 66.7%, respectively). After full treatment, newly formed bone trabeculae were detected more often (100.0 vs 60.0% in control); they were more mature and filled the defect area more efficiently.Conclusion.Our results indicate that the use of a collagen matrix with autologous MSCs is a promising plastic material for repairing osteomyelitic defects following necrectomy.The MSCs were able to increase the density of the filling material in the bone cavity, significantly accelerate the formation of bone beams around the matrix, and increase the tissue volume around the implant. The presence of MSCs significantly decreased the interference of a connective tissue component with osteogenesis and chondrogenesis.

Fluorescent tetracycline bone labeling as an intraoperative tool to debride necrotic bone during septic hip revision: a preliminary case series.

A plausible cause of persistent infection after septic hip revision may be the presence of nonviable osteomyelitic bone. Since surgical excision of these necrotic fragments is often challenging, the use of fluorescent tetracycline bone labeling (FTBL) as an intraoperative tool may pose an additional assessment aid to provide a visual index of surgical debridement. Methods: We present a single-center study performed in a university hospital from January 2018 to June 2020, in which all consecutive cases of chronic hip periprosthetic joint infection (PJI) undergoing revision using FTBL were retrospectively reviewed. In all cases, the patient was under treatment with tetracyclines at the moment of the revision surgery. During the surgery, all bone failing to fluoresce was considered nonviable and thus removed and sent for both culture and histology. Results: We include three cases in which the FTBL technique was used. In all cases, the histopathological examinations of the nonfluorescent removed bone were consistent with chronic osteomyelitis. Conclusion: The intraoperative use of FTBL successfully aided the surgeon to detect the presence of nonviable bone in all the presented cases of chronic prosthetic hip infection.

From a plant secretion to the promising bone grafts: Cryogels of silicon-integrated quince seed mucilage by microwave-assisted sol–gel reaction

Design and fabrication of biologically active cryogels using novel biopolymer(s) are still of great importance at regenerating bone defects such as traumatic bone injuries, maxillofacial surgery, osteomyelitis, and osteoporosis. Nowadays, plant mucilage, an herbal biomaterial, has been drawn attention by scientists due to their marvelous potential to fabricate 3-dimensional (3D) physical constructs for the field of regenerative medicine. Herein, a 3D cryogel from silicon-integrated quince seed mucilage (QSM) is constructed using microwave-assisted sol-gel reaction, characterized in-depth by attenuated total reflectance Fourier transform-infrared spectroscopy (ATR-FTIR), solid-state silicon cross-polarization magic-angle nuclear magnetic resonance (29Si-CP-MAS NMR), X-ray diffraction (XRD), thermogravimetric analysis (TGA), differential scanning calorimeter (DSC), micro-mechanical testing, porosity, and swelling tests, contact angle measurements, Brunauer-Emmet-Teller and Barret-Joyner-Halenda (BET-BJH) analysis, enzymatic biodegradation test, and field emission-scanning electron microscopy-energy dispersive X-ray spectroscopy (FE-SEM-EDX) mapping. The osteobiologic capacity of the cryogels is determined using human adipose-derived mesenchymal stem cells (hAMSCs) under invitro conditions. Osteogenic differentiation of hAMSCs on both QSM and silica-modified QSM (Si-QSM) cryogels is analyzed by histochemistry, immunohistochemistry, and quantitative-real time (q-RT) PCR techniques. The results obtained from invitro experiments demonstrate that the upregulation of osteogenesis-related genes in Si-QSM cryogels presents a stronger and earlier development over QSM cryogels throughout the culture period, which in turn reveals the great potential of this novel Si-incorporated QSM cryogels for bone tissue engineering applications.

Vascularized bone grafts for post-traumatic defects in the upper extremity.

Vascularized bone grafts (VBGs) are widely employed to reconstruct upper extremity bone defects. Conventional bone grafting is generally used to treat defects smaller than 5–6 cm, when tissue vascularization is adequate and there is no infection risk. Vascularized fibular grafts (VFGs) are mainly used in the humerus, radius or ulna in cases of persistent non-union where traditional bone grafting has failed or for bone defects larger than 6 cm. Furthermore, VFGs are considered to be the standard treatment for large bone defects located in the radius, ulna and humerus and enable the reconstruction of soft-tissue loss, as VFGs can be harvested as osteocutaneous flaps. VBGs enable one-stage surgical reconstruction and are highly infection-resistant because of their autonomous vascularization. A vascularized medial femoral condyle (VFMC) free flap can be used to treat small defects and non-unions in the upper extremity. Relative contraindications to these procedures are diabetes, immunosuppression, chronic infections, alcohol, tobacco, drug abuse and obesity. The aim of our study was to illustrate the use of VFGs to treat large post-traumatic bone defects and osteomyelitis located in the upper extremity. Moreover, the use of VFMC autografts is presented.

Facile surface functional polyetheretherketone with antibacterial and immunoregulatory activities for enhanced regeneration toward bacterium-infected bone destruction

Existing biologically inert or unmodified implants to treat infectious bone defects or osteomyelitis still cannot effectively solve bacterial infection and osseointegration. In this work, a simple co-deposition strategy was developed to modify porous polyetheretherketone (PEEK) with improved antibacterial activity and controllable immunoregulatory ability. After PEEK was treated by H2SO4 to obtain porous PEEK (SPEEK), the self-polymerization of dopamine was operated on SPEEK in the solution of dopamine and gentamicin sulfate (GS) to prepare polydopamine (pDA) and GS layer-modified SPEEK (labeled as SPEEK–pDA–GS). The morphology, surface property, and molecular structure of SPEEK–pDA–GS were investigated. Besides the antibacterial property of SPEEK–pDA–GS ascribed to the successful immobilization of GS, SPEEK–pDA–GS exhibited promoted osseointegration through the results of mineralization, alkaline phosphatase (ALP) levels and osteogenic gene expression. Furthermore, the evaluation of the cell proliferation suggested that SPEEK–pDA–GS possessed the biocompatibility and the immunoregulatory ability that induced macrophages to anti-inflammatory M2 phenotype. Using rat as model, in vivo results containing X-ray, μ-CT, immunohistochemistry, and pathological analysis showed the excellent healing effect of SPEEK–pDA–GS on bone defect with infection with biological safety. This work illustrates a new insight into the simple and effective modification of PEEK and other implants with antibacterial, immunoregulatory, and osseointegration abilities for clinical requirement.

Computational modelling of hospital mattresses made from spacer fabrics

The appearance of pressure ulcers is a very common occurrence, especially for people with limited mobility who are obliged to spend a long time prone on a support surface. Pressure ulcers in severe cases can cause damage to underlying muscle and bone. Damage to deeper tissues, tendons and joints may also occur. Serious complications, such as infection of the bone (osteomyelitis) or blood (sepsis), can occur if pressure sores progress. While the main strategy for dealing with pressure ulcers is centred around the interaction of patient and care-giver (manually changing the position of the patient every two hours in order to relieve pressure on critical body areas, examination of patient for signs of pressure ulcer formation) there are auxiliary approaches, such as the choice of a pressure relieving support surface. Currently, a variety of support surfaces exists. The criteria of choice are dependent on factors such as the medical history of the patient and economic. The emergence of 3D spacer fabrics as textile materials with good compression behaviour makes them suitable candidates for the production of support surfaces that contribute to the prevention of pressure ulcers. In order to decide on their suitability, extended clinical trials involving actual patients must be performed. In the present paper, a computational methodology utilizing a tool, widely used in the area of engineering namely Finite Element (FE) Method, is proposed as a supporting tool for the preliminary evaluation of the suitability in terms of mechanical behaviour of certain 3D spacer fabrics, providing an insight of the deformation, stress and strain developed on the bodies (human body – mattress) as well as on their interface.

Surgical treatment of benign lesions and pathologic fractures of the proximal femur in children.

Benign lesions of the proximal femur region, such as simple bone cysts, aneurysmal bone cysts, and fibrous dysplasia, are common in children. Benign lesions may cause pathologic fractures, limb length inequities, and growth disturbances. Differential diagnoses, e.g., malignant bone tumors and osteomyelitis, are sometimes difficult to rule out. We aimed to evaluate outcomes in children with benign lesions of the proximal femur treated with curettage, bone grafting, and plate fixation. In this retrospective study, we included 30 children (median age 10.5years; range 1.1-17.8years) suffering from bone cysts and tumor-like lesions of the proximal femur region treated between 2002 and 2018. We analyzed plain X-ray images and CT scans in all children and obtained MRI scans in a selected group of children (63.3%). We examined histopathologic biopsy results for all bone lesions before initiating treatment. Surgical management comprised tumor curettage with adjuvant high-speed drilling and allogenic bone grafting supplemented by bone graft substitutes before plate fixation. Median follow-up interval was 87months (range 24-156months). We evaluated the healing of lesions according to Capanna's classification and rated functional outcomes according to Merle d'Aubigné and Postel score. Overall, 25 of 30 (83.3%) patients were admitted to hospital because of a pathologic fracture. We diagnosed simple bone cysts in 15 (50.0%) patients, aneurysmal bone cysts in 7 (23.5%) patients, and fibrous dysplasia in 8 (26.5%) patients. Bone consolidation was achieved in 22 of 30 (73.3%) patients after a mean of 5months (range 3-7months). The main complication was recurrence of the lesion in 4 of 30 (13.3%) patients. With respect to the Merle d'Aubigné and Postel scores, 17 of 30 (56.7%) patients obtained an excellent result (18 points), while 12 (40.0%) patients had a good result (15-17 points) and only 1 (3.3%) patient had a fair result (14 points). Surgical treatment of bone cysts and tumor-like lesions of the proximal femur by local resection or destruction of the lesion, followed by filling the defect with bone graft material and internal stabilization represents a safe and effective treatment option in children. Therapeutic, retrospective comparative study-Level III.

Klebsiella Distinctive Syndrome Presenting with Muscular Abscess and Osteomyelitis: Case Report

The present article describes a case of 46-year-old man who presented with progressive pain and swelling at the right lower back and buttock for three weeks. The investigation showed an abscess at the right lower back and buttock, osteomyelitis of the iliac bone, and a hepatic abscess. The causative pathogens were confirmed to be Klebsiella pneumoniae, both K1 and K2 serotype. This patient was treated with surgical management, percutaneous drainage, intravenous antibiotic, and control of his underlying disease risk factor, which was diabetic mellitus. Keywords: Klebsiella distinctive syndrome, Klebsiella liver abscess syndrome, Hypervirulent strain of Klebsiella pneumoniae, Klebsiella pneumoniae, Liver abscess