Osteomyelitis In Presence Research Articles

Characterization of an Acute Rodent Osteomyelitis Infectious Model Using a Tibial Intramedullary Implant Inoculation.

Chronic osteomyelitis in presence of orthopedic implants is a condition observed in the field of biomaterials as it impairs early bone-implant contact, fixation and integration. In this study, a surgical intramedullary tibial insertion was performed using a titanium wire previously inoculated with Staphylococcus aureus in order to develop an osteomyelitis model in a clinically relevant long bone and in absence of any prophylactic treatment. As such, twenty-two male Sprague-Dawley rats received a sterile or inoculated intramedullary biomaterial with either 2 × 106 or 1 × 107 S. aureus colony forming units. Bacterial burden, inflammation, morphological changes, as well as newly formed bone tissues were evaluated for histopathology following a period of either eight or fifteen days of implantation. The implant inoculated in presence of the highest bacterial load was effective to produce significant periprosthetic infection observations in addition to hard and soft tissue inflammation consistent with the development of osteomyelitis. In contrast, neither the sterile nor the low-dose implant inoculation showed inflammation and clinical infection signs, but rather produced an expected bone remodeling and appropriate healing associated with biomaterial implantation. Complete health assessment is presented with histopathological periprosthetic results.

Role of 99mTc MDP bone and 67Gallium imaging in evaluation of diabetic osteopathy

Background and objectives Osteomyelitis (OM), Foot Ulcers (FU) and neuropathic arthropathies, i.e. Charcot's Foot (CF) are complications of Diabetes Mellitus (DM) which can coexist. This retrospective study was undertaken to highlight the sensitivity of bone scan in diagnosing OM, to study patterns of 99mTc Methylene DiPhosphonate (MDP) bone and 67Gallium (Gallium citrate) uptake, their sensitivity in Charcot's detection and whether Gallium can be a useful cost effective adjunct imaging in evaluation of diabetic osteopathy. Methods 86 diabetic patients (M:F = 50:36) in age range 46–75 years (mean 52 ± 6 years) with clinical suspicion of OM/CF with normal X-rays were analyzed. All patients underwent 99mTc MDP three phase bone scan. A combined 67Ga scans were performed in 14 patients. OM positive patients further had bone curettage and bacteriological culture. Results Of 86 patients, bone scan wise, 34 had OM and 31 had positive bacteriological cultures. 15 patients showed no OM or CF. In remaining 37 patients, 16 (Group: A) had OM in metatarsal bones/phalanges apart from hot spots in other tarsal bones, with no clinical evidence of foot ulcers suggesting coexisting unsuspected CF. 21 patients (Group: B) showed tracer uptake only in tarsal bones with no coexisting foot ulcers (“CF Group”). 67Ga imaging was performed in 14 patients (6 from Group: A and 8 from Group: B) showing variable uptake patterns. In Group: A all six patients showed moderate congruent 67Ga and MDP uptake in sites of OM and three of them showed congruent but less 67Ga uptake in tarsals. In Group: B, three showed moderate 67Ga uptake congruent to MDP uptake in tarsals and five patients there is nil to mild uptake. Conclusion Our study shows three-phase bone scan has 100% sensitivity and 91.2% specificity for detecting diabetic Osteomyelitis in presence of normal X-rays. Bone scan is a simple and useful screening modality to detect OM and unsuspected cases of Charcot's foot in diabetics. Navicular and cuneiform bones are earliest to be involved in Charcot's foot. 67Gallium imaging has little incremental value in evaluation of diabetic osteopathy.