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The Journal of the American Academy of... Mar 2021Talar osteonecrosis results from trauma to the fragile blood supply to the talus. Many etiologies exist that can cause talar osteonecrosis, with the most common being...
Talar osteonecrosis results from trauma to the fragile blood supply to the talus. Many etiologies exist that can cause talar osteonecrosis, with the most common being talar neck fractures. Patients with talar osteonecrosis frequently present with progressive ankle pain and limited range of motion. Treatment strategy depends primarily on the stage of disease. Conservative care in the form of medications and bracing treatment can be beneficial for patients with low functional status and early disease stages. Surgical options also exist for early disease without talar collapse that can potentially preserve the tibiotalar joint. Once talar collapse develops, surgical treatment is move invasive and typically involves an arthrodesis or talus arthroplasty. Although some treatment guidelines exist based on the disease stage, talar osteonecrosis is a complex problem, and treatment strategy should always be determined on a case-by-case basis carefully examining all clinical aspects.
Topics: Arthrodesis; Arthroplasty; Fractures, Bone; Humans; Osteonecrosis; Talus
PubMed: 33315647
DOI: 10.5435/JAAOS-D-20-00418 -
Wiener Medizinische Wochenschrift (1946) Dec 2010Gaucher disease (GD), the most prevalent lysosomal storage disorder, affects multiple organ systems. Patients with non-neuronopathic (type 1) GD, the most common form of... (Review)
Review
Gaucher disease (GD), the most prevalent lysosomal storage disorder, affects multiple organ systems. Patients with non-neuronopathic (type 1) GD, the most common form of GD, present with hepatomegaly, splenomegaly, anemia, bleeding tendencies, thrombocytopenia, skeletal pathologies, growth retardation, and, in severe cases, pulmonary disease. The bone manifestations include bone infarcts, avascular bone necrosis, lytic lesions, osteosclerosis, fractures due to osteopenia or osteoporosis, and rarely acute osteomyelitis. Bone pain of varying intensity, fractures, and progressive joint collapses may cause impaired mobility and performances status, and increased morbidity. Enzyme replacement therapy and substrate reduction therapy have demonstrated to have beneficial effects on bone pain, bone crises, and the extent of osteoporosis. This review article gives an overview of the clinical appearance of bone pathology in GD, the possible pathophysiological mechanisms, diagnostic approaches, and the therapeutic effects of enzyme replacement therapy, substrate reduction therapy, and bone specific therapies as evaluated in current literature.
Topics: Biopsy; Bone Density Conservation Agents; Bone Diseases; Bone and Bones; Combined Modality Therapy; Cytokines; Diagnosis, Differential; Diphosphonates; Enzyme Replacement Therapy; Gaucher Disease; Humans; Magnetic Resonance Imaging; Mobility Limitation; Osteomyelitis; Osteonecrosis; Osteoporosis; Quality of Life; Spinal Diseases; Spine
PubMed: 21221913
DOI: 10.1007/s10354-010-0841-y -
Acta Morphologica Academiae Scientiarum... 1981The post-traumatic and vascular necrosis of broken bones were studied in rabbits. AFter experimental traumatization and vascular lesion a similar type of necrosis was...
The post-traumatic and vascular necrosis of broken bones were studied in rabbits. AFter experimental traumatization and vascular lesion a similar type of necrosis was encountered. There were, however, differences in the distribution of the necrotic areas and in the position of the fracture-line. In the case of post-traumatic necrosis the fracture line was situated at the border of the intact and the necrosed tissue, whereas in vascular necrosis of secondarily broken bones it was found in the necrobiotic area. Surveying morphometrically the distribution of necrotic areas it was observed that in traumatic necrosis large fields occur on either side of the fracture-line which retained in 95% the nuclear staining of their osteocytes while in vascular necrosis such areas were not seen. On this basis traumatic and vascular necrosis can be differentiated provided the sample is taken from the surroundings of the fracture-line.
Topics: Animals; Bone and Bones; Female; Fractures, Bone; Osteonecrosis; Rabbits; Vascular Diseases; Wound Healing; Wounds and Injuries
PubMed: 7304274
DOI: No ID Found -
International Orthopaedics 1993A corticocancellous core was removed from the lateral condyle of both femurs in 26 skeletally mature dogs. The cavity was treated with cryosurgery, phenol cautery or... (Comparative Study)
Comparative Study
A corticocancellous core was removed from the lateral condyle of both femurs in 26 skeletally mature dogs. The cavity was treated with cryosurgery, phenol cautery or packing with bone cement. The animals were killed after 1, 4, and 12 weeks in the phenol and cement groups, and also after 24 weeks in the cryosurgery group. The extent of the bone necrosis and healing was assessed in each group. After cryosurgery the extent of necrosis was profound in that the area of damage was 365% compared to the area of the cavity; the depth of necrosis extended between 2.5 and 14 mm, beyond the cavity wall. The effect of phenol was negligible in that only microscopic areas of superficial focal necrosis were found around the cavity wall. Bone cement produced an area of necrosis of 153% compared with the cavity, with a depth of between 1.3 and 2.8 mm. Regeneration in the region of necrosis after cryosurgery was only scanty by 4 weeks, but by 12 weeks considerable areas of regeneration were identified and complete healing was observed by 24 weeks. Regeneration of the necrotized bone produced by bone cement packing was rapid and similar to that of the control specimens. These findings suggest that cryosurgery could play a significant role as a surgical adjunct to curettage in locally aggressive benign bone tumours and in some malignancies. Phenol cautery is not regarded as an adequate treatment after curettage of bone tumours. Although the extent of necrosis was relatively small, packing with bone cement is thought to be a useful choice in benign cases.
Topics: Animals; Cautery; Cryosurgery; Dogs; Femur; Methylmethacrylates; Osteonecrosis; Phenols; Wound Healing
PubMed: 8340174
DOI: 10.1007/BF00186382 -
Otolaryngology--head and Neck Surgery :... Sep 2000The goal of this study was to analyze temporal bone necrosis and classify its diagnosis and treatment according to extent of necrosis and cause.
OBJECTIVE
The goal of this study was to analyze temporal bone necrosis and classify its diagnosis and treatment according to extent of necrosis and cause.
METHODS AND MATERIAL
Twenty-six cases of temporal bone necrosis were retrospectively reviewed between 1988 and 1997 at the University of British Columbia.
RESULTS
Patients were classified on the basis of disease extent restricted to the tympanic bone or extension beyond the tympanic bone, as well as on the basis of the cause of disease; treatment based on classification. Patients with localized disease of the tympanic bone had minimal symptoms. Those with radiation-induced localized necrosis were less likely to respond to conservative medical management. Patients with diffuse disease were more likely to require surgical intervention.
CONCLUSIONS
Temporal bone necrosis comprises a spectrum of disease from idiopathic tympanic bone necrosis, which rarely requires surgery, to the more severe forms of radiation-induced diffuse temporal bone necrosis that may cause life-threatening complications requiring surgical intervention.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Osteonecrosis; Temporal Bone; Tomography, X-Ray Computed
PubMed: 10964300
DOI: 10.1067/mhn.2000.107459 -
Oral Diseases Mar 2019Oral ulceration with bone sequestration (OUBS) describes a site-specific intraoral ulcer that covers exposed, non-vital bone in patients lacking any etiological factor... (Review)
Review
OBJECTIVE
Oral ulceration with bone sequestration (OUBS) describes a site-specific intraoral ulcer that covers exposed, non-vital bone in patients lacking any etiological factor known to induce osteonecrosis. We aimed to conduct a retrospective study of eight new cases of OUBS and review the literature.
SUBJECTS AND METHODS
This is a retrospective study of OUBS cases, diagnosed and managed during 2007-2017. Inclusion criteria were the presence of oral ulcer with exposed non-vital bone at sites of bone prominence and the absence of any factor known to cause osteonecrosis. The English literature was reviewed on original OUBS cases.
RESULTS
Eight patients (5 males and 3 females, aged 27-75 years) were diagnosed with OUBS during years 2007-2017. Four cases involved the mandibular mylohyoid ridge, one a mandibular anterior exostosis and three the maxillary buccal/palatal exostoses. Exposed bone was removed under local anesthesia, resulting in complete healing in all cases. The literature review yielded 32 OUBS cases in the mandible.
CONCLUSION
Oral ulceration with bone sequestration is a distinct, probably under-reported rather than rare clinical entity that should be regarded the provisional diagnosis in case of an oral ulcer covering exposed, non-vital bone at sites of bone prominence in patients lacking any etiological factor known to induce osteonecrosis.
Topics: Adult; Aged; Female; Humans; Male; Mandibular Diseases; Maxillary Diseases; Middle Aged; Oral Ulcer; Osteonecrosis; Retrospective Studies
PubMed: 30383915
DOI: 10.1111/odi.13000 -
Journal of Oral and Maxillofacial... Mar 2004
Topics: Antineoplastic Agents; Diphosphonates; Humans; Jaw Diseases; Osteonecrosis
PubMed: 15015179
DOI: 10.1016/j.joms.2003.11.003 -
Dental Clinics of North America Jan 2016Osteonecrosis of the jaw is a major public health concern throughout the world. Use of radiotherapy for head and neck cancer and bone antiresorptives and antiangiogenic... (Review)
Review
Osteonecrosis of the jaw is a major public health concern throughout the world. Use of radiotherapy for head and neck cancer and bone antiresorptives and antiangiogenic agents have increased its incidence. Medication-related osteonecrosis of the jaw is more common relative to other types of osteonecrosis. Osteoradionecrosis occurs despite better treatment planning and shielding to minimize collateral damage to bone. Other related necrotic lesions are secondary to usage of recreational drugs and steroids. This article provides comprehensive information about these different types of bone necrosis; provides the readers with radiographic diagnostic criteria and updates on current theories on pathophysiology of osteonecrosis.
Topics: Bone Density Conservation Agents; Diphosphonates; Humans; Jaw; Jaw Diseases; Osteonecrosis; Osteoradionecrosis
PubMed: 26614957
DOI: 10.1016/j.cden.2015.08.009 -
The Netherlands Journal of Medicine Oct 1991The incidence of aseptic bone necrosis in 167 patients on glucocorticoid replacement therapy in our hospital was found to be 2.4% (4 patients). The diagnosis was made 16... (Review)
Review
The incidence of aseptic bone necrosis in 167 patients on glucocorticoid replacement therapy in our hospital was found to be 2.4% (4 patients). The diagnosis was made 16 months to five years after initiation of the therapy. A review of eight other cases reported in the literature is presented. The incidence of aseptic bone necrosis in patients on glucocorticoid replacement therapy seems much higher than might be expected. It is suggested that the dose of glucocorticoid substitution therapy be established individually at the lowest acceptable level.
Topics: Adult; Glucocorticoids; Humans; Male; Middle Aged; Osteonecrosis
PubMed: 1791877
DOI: No ID Found -
Orthopadie (Heidelberg, Germany) Oct 2022Humerus fractures play a major role in daily clinical routine, and subsequent osteonecrosis is common after osteosyntheses. (Review)
Review
BACKGROUND
Humerus fractures play a major role in daily clinical routine, and subsequent osteonecrosis is common after osteosyntheses.
OBJECTIVES
The current paper highlights the incidence and cause of osteonecrosis after proximal humerus fractures, with respect to presentation of anatomy and risk factors.
METHODS
Display of the literature and therapy options for humerus fracture and subsequent necrosis.
RESULTS
Humerus fractures are the seventh most frequent fractures in humans. The complication rate is 40%, and the described rate of necrosis is up to 34%. Accordingly, the surgical revision rate is at 19% according to recent literature.
CONCLUSION
The treatment of humerus head fracture must consider numerous variables. The individual type of fracture and the current individual situation of the patient must be included in the process of choosing the right treatment. Modern implants with screw locking features should be used, and for certain circumstances the direct implantation of a prosthesis should be considered. Thereby the expectations of the patient with respect to the postoperative activity level play a major role.
Topics: Bone Screws; Humans; Humeral Head; Necrosis; Osteonecrosis; Shoulder Fractures
PubMed: 36083347
DOI: 10.1007/s00132-022-04307-9