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Emergency Radiology Apr 2024Emphysematous osteomyelitis (EO) is an uncommon fatal condition with high morbidity and mortality. Simultaneous involvement of the axial and appendicular skeleton with... (Review)
Review
Emphysematous osteomyelitis (EO) is an uncommon fatal condition with high morbidity and mortality. Simultaneous involvement of the axial and appendicular skeleton with multifocal disease is even rarer, with only a few cases being reported in the literature. We present a case of multifocal emphysematous osteomyelitis in a 56-year-old woman with concurrent emphysematous pyelonephritis complicated by psoas and epidural abscesses. The causative organism in our patient was Escherichia coli. Emergency radiologists should be aware of this condition and differentiate it from other benign entities that can present with intraosseous gas. Prompt diagnosis is important given the high morbidity and mortality with this condition. This case report emphasizes the specific pattern of intraosseous gas seen with EO, which can help diagnose EO with confidence.
Topics: Female; Humans; Middle Aged; Pyelonephritis; Emphysema; Tomography, X-Ray Computed; Osteomyelitis
PubMed: 38267799
DOI: 10.1007/s10140-024-02203-7 -
Osteoporosis International : a Journal... May 2024We ascertained the fracture risk factors stratified by vertebral and non-vertebral sites in rheumatoid arthritis (RA) females. Bone/muscle features, but not disease...
Damaged bone microarchitecture by Trabecular Bone Score (TBS) and low appendicular muscle mass: main risk factors for vertebral and non-vertebral fractures in women with long-standing rheumatoid arthritis.
UNLABELLED
We ascertained the fracture risk factors stratified by vertebral and non-vertebral sites in rheumatoid arthritis (RA) females. Bone/muscle features, but not disease activity, were the main markers for fractures in this long-standing RA population: low trabecular bone score (TBS) for vertebral fracture and decreased appendicular muscle mass for non-vertebral fracture.
PURPOSE
To assess risk factors for fractures, including clinical, laboratory and dual energy X-ray absorptiometry (DXA) parameters (bone mass, trabecular bone score-TBS, muscle mass) in women with established rheumatoid arthritis (RA).
METHODS
Three hundred females with RA (ACR, 2010) were studied. Clinical data were obtained by questionnaire and disease activity by composite indices (DAS28, CDAI, SDAI), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Bone mineral density (BMD), TBS, body composition and Vertebral Fracture Assessment (VFA) were performed by DXA. Logistic regression models were constructed to identify factors independently associated with vertebral (VF) and non-vertebral fractures (NVF), separately.
RESULTS
Through rigorous eligibility criteria, a total of 265 women were yielded for final data analysis (median age, 55 [22-86] years; mean disease duration, 16.2 years). Prevalence of VF and NVF were 30.6% and 17.4%, respectively. In multivariate analyzes, TBS (OR = 1.6, 95%CI = 1.09-2.36, p = 0.017), CRP (OR = 1.54, 95%CI = 1.15-2.08, p = 0.004), and parathormone (OR = 1.24, 95%CI = 1.05-1.45, p = 0.009) were risk factors for VF, whereas low appendicular muscle mass (OR = 2.71; 95%CI = 1.01-7,28; p = 0.048), body mass index (BMI) (OR = 0.90, 95%CI = 0.82-0.99; p = 0.025), ESR (OR = 1.18, 95%CI = 1.01-1,38, p = 0,038) and hip BMD (OR = 1.82, 95%CI = 1.10-3.03, p = 0.02) were associated with NVF.
CONCLUSION
In women with long-term RA, markers of fractures differed between distinct skeletal sites (vertebral and non-vertebral). The magnitude of association of bone/muscle parameters with fracture (TBS for VF and appendicular muscle mass for NVF) was greater than that of the association between RA activity and fracture. TBS seems to have greater discriminative power than BMD to identify subjects with VF in long-standing RA.
Topics: Humans; Female; Middle Aged; Spinal Fractures; Cancellous Bone; Lumbar Vertebrae; Bone Density; Absorptiometry, Photon; Risk Factors; Arthritis, Rheumatoid; Osteoporotic Fractures
PubMed: 38267666
DOI: 10.1007/s00198-024-07026-3 -
Biology Letters Jan 2024The diversity of vertebrate skeletons is often attributed to adaptations to distinct ecological factors such as diet, locomotion, and sensory environment. Although the...
The diversity of vertebrate skeletons is often attributed to adaptations to distinct ecological factors such as diet, locomotion, and sensory environment. Although the adaptive evolution of skull, appendicular skeleton, and vertebral column is well studied in vertebrates, comprehensive investigations of all skeletal components simultaneously are rarely performed. Consequently, we know little of how modes of evolution differ among skeletal components. Here, we tested if ecological and phylogenetic effects led to distinct modes of evolution among the cranial, appendicular and vertebral regions in extant carnivoran skeletons. Using multivariate evolutionary models, we found mosaic evolution in which only the mandible, hindlimb and posterior (i.e. last thoracic and lumbar) vertebrae showed evidence of adaptation towards ecological regimes whereas the remaining skeletal components reflect clade-specific evolutionary shifts. We hypothesize that the decoupled evolution of individual skeletal components may have led to the origination of distinct adaptive zones and morphologies among extant carnivoran families that reflect phylogenetic hierarchies. Overall, our work highlights the importance of examining multiple skeletal components simultaneously in ecomorphological analyses. Ongoing work integrating the fossil and palaeoenvironmental record will further clarify deep-time drivers that govern the carnivoran diversity we see today and reveal the complexity of evolutionary processes in multicomponent systems.
Topics: Humans; Animals; Phylogeny; Skull; Mandible; Head; Fossils
PubMed: 38263882
DOI: 10.1098/rsbl.2023.0526 -
Endocrine Apr 2024Osteoporosis is a systemic skeletal disease with increasing bone fragility and prone to fracture. Osteocalcin (OC), as the most abundant non collagen in bone matrix, has...
BACKGROUND
Osteoporosis is a systemic skeletal disease with increasing bone fragility and prone to fracture. Osteocalcin (OC), as the most abundant non collagen in bone matrix, has been extensively used in clinic as a biochemical marker of osteogenesis. Two forms of OC were stated on circulation, including carboxylated osteocalcin (cOC) and undercarboxylated osteocalcin (ucOC). OC was not only involved in bone mineralization, but also in the regulation of muscle function.
OBJECTIVE
This study explored the relationship between serum OC, cOC, ucOC levels and bone mineral density (BMD), bone microarchitecture, muscle mass and physical activity in Chinese postmenopausal women.
METHOD
216 community-dwelling postmenopausal women were randomized enrolled. All subjects completed biochemical measurements, including serum β-isomer of C-terminal telopeptides of type I collagen (β-CTX), N-terminal propeptide of type 1 procollagen (P1NP), alkaline phosphatase (ALP), OC, cOC and ucOC. They completed X-ray absorptiometry (DXA) scan to measure BMD, appendicular lean mass (ALM) and trabecular bone score (TBS). They completed high resolution peripheral quantitative CT (HR-pQCT) to assess peripheral bone microarchitectures.
RESULTS
Serum OC, cOC and ucOC were elevated in osteoporosis postmenopausal women. In bone geometry, serum ucOC was positively related with total bone area (Tt.Ar) and trabecular area(Tb.Ar). In bone volumetric density, serum OC and ucOC were negatively associated with total volume bone mineral density (Tt.vBMD) and trabecular volume bone mineral density (Tb.vBMD). In bone microarchitecture, serum OC and ucOC were negatively correlative with Tb.N and Tb.BV/TV, and were positively correlated with Tb.Sp. Serum OC and ucOC were positively associated with Tb.1/N.SD. Serum OC was negatively related with Tb.Th. Serum ucOC was positively associated with ALM. The high level of serum OC was the risk factor of osteoporosis. ALM was the protective factor for osteoporosis.
CONCLUSION
All forms of serum OC were negatively associated with BMD. Serum OC and ucOC mainly influenced microstructure of trabecular bone in peripheral skeletons. Serum ucOC participated in modulating both bone microstructure and muscle mass.
Topics: Female; Humans; Beijing; Bone Density; Muscles; Osteocalcin; Osteoporosis; Osteoporosis, Postmenopausal; Postmenopause
PubMed: 38206435
DOI: 10.1007/s12020-023-03668-1 -
Injury Nov 2023Isolated fractures of the iliac wing are a rare injury, usually occurring in high-energy trauma, and are associated with other non-musculoskeletal and soft tissue...
INTRODUCTION
Isolated fractures of the iliac wing are a rare injury, usually occurring in high-energy trauma, and are associated with other non-musculoskeletal and soft tissue injuries that could compromise the patient's life. Surgical indications are unclear, and there is limited information on the most frequent fracture patterns.
METHODS
A descriptive multicenter case series study of isolated fractures of the iliac wing treated surgically in three referral trauma hospitals in Latin America. The different fracture patterns are described, the "iliac ring" concept is proposed, and a classification is made.
RESULTS
Twenty-eight patients were included; 24 were male, the median age was 31 years RIQ (24-46), the most frequent trauma mechanism was a traffic accident, and in 14 patients, the ISS >16. The most frequent associated injury was to the appendicular skeleton at another level in 13 patients. In the new classification, according to the number of fragments, 11 patients were classified as type A (1 fragment), ten patients as type B (two fragments), and seven patients as type C (three or more fragments). The most compromised anatomical area was the crest and anterosuperior iliac spines in 26 patients, followed by the fossa and anteroinferior iliac spine in 17 and 8 patients, respectively.
DISCUSSION
The patterns of isolated fractures of the iliac wing allow the identification of three types of fractures. Identifying these patterns can help the surgeon decide to perform surgery in these scenarios and choose the fixation technique according to the number and location of the fragments.
Topics: Humans; Male; Adult; Female; Fractures, Bone; Ilium; Spinal Fractures; Joint Dislocations; Neck Injuries; Pelvic Bones; Fracture Fixation, Internal
PubMed: 38143137
DOI: 10.1016/j.injury.2023.110837 -
Journal of Anatomy May 2024The anatomy of the archosaurian pelvis and hindlimb has adopted a diversity of successful configurations allowing a wide range of postures during the evolution of the...
The anatomy of the archosaurian pelvis and hindlimb has adopted a diversity of successful configurations allowing a wide range of postures during the evolution of the group (e.g., erect, sprawling). For this reason, thorough studies of the structure and function of the pelvic and hindlimb musculature of crocodylians are required and provide the possibility to expand their implications for the evolution of archosaurian locomotion, as well as to identify potential new characters based on muscles and their bony correlates. In this study, we give a detailed description of the pelvic and hindlimb musculature of the South American alligator Caiman yacare, providing comprehensive novel information regarding lower limb and autopodial muscles. Particularly for the pedal muscles, we propose a new classification for the dorsal and ventral muscles of the autopodium based on the organisation of these muscles in successive layers. We have studied the myology in a global background in which we have compared the Caiman yacare musculature with other crocodylians. In this sense, differences in the arrangement of m. flexor tibialis internus 1, m. flexor tibialis externus, m. iliofibularis, mm. puboischiofemorales internii 1 and 2, between Ca. yacare and other crocodylians were found. We also discuss the muscle attachments that have different bony correlates among the crocodylian species and their morphological variation. Most of the correlates did not exhibit great variation among the species compared. The majority of the recognised correlates were identified in the pelvic girdle; additionally, some bony correlates associated with the pedal muscles are highlighted here for the first time. This research provides a wide framework for future studies on comparative anatomy and functional morphology, which could contribute to improving the character definition used in phylogenetic analyses and to understand the patterns of musculoskeletal hindlimb evolution.
Topics: Animals; Alligators and Crocodiles; Phylogeny; Muscle, Skeletal; Lower Extremity; Hindlimb; Pelvis
PubMed: 38104997
DOI: 10.1111/joa.13995 -
Pediatric Radiology Jan 2024Research into artificial intelligence (AI)-based fracture detection in children is scarce and has disregarded the detection of indirect fracture signs and dislocations.
BACKGROUND
Research into artificial intelligence (AI)-based fracture detection in children is scarce and has disregarded the detection of indirect fracture signs and dislocations.
OBJECTIVE
To assess the diagnostic accuracy of an existing AI-tool for the detection of fractures, indirect fracture signs, and dislocations.
MATERIALS AND METHODS
An AI software, BoneView (Gleamer, Paris, France), was assessed for diagnostic accuracy of fracture detection using paediatric radiology consensus diagnoses as reference. Radiographs from a single emergency department were enrolled retrospectively going back from December 2021, limited to 1,000 radiographs per body part. Enrolment criteria were as follows: suspected fractures of the forearm, lower leg, or elbow; age 0-18 years; and radiographs in at least two projections.
RESULTS
Lower leg radiographs showed 607 fractures. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were high (87.5%, 87.5%, 98.3%, 98.3%, respectively). Detection rate was low for toddler's fractures, trampoline fractures, and proximal tibial Salter-Harris-II fractures. Forearm radiographs showed 1,137 fractures. Sensitivity, specificity, PPV, and NPV were high (92.9%, 98.1%, 98.4%, 91.7%, respectively). Radial and ulnar bowing fractures were not reliably detected (one out of 11 radial bowing fractures and zero out of seven ulnar bowing fractures were correctly detected). Detection rate was low for styloid process avulsions, proximal radial buckle, and complete olecranon fractures. Elbow radiographs showed 517 fractures. Sensitivity and NPV were moderate (80.5%, 84.7%, respectively). Specificity and PPV were high (94.9%, 93.3%, respectively). For joint effusion, sensitivity, specificity, PPV, and NPV were moderate (85.1%, 85.7%, 89.5%, 80%, respectively). For elbow dislocations, sensitivity and PPV were low (65.8%, 50%, respectively). Specificity and NPV were high (97.7%, 98.8%, respectively).
CONCLUSIONS
The diagnostic performance of BoneView is promising for forearm and lower leg fractures. However, improvement is mandatory before clinicians can rely solely on AI-based paediatric fracture detection using this software.
Topics: Humans; Child; Infant, Newborn; Infant; Child, Preschool; Adolescent; Artificial Intelligence; Retrospective Studies; Radius Fractures; Ulna Fractures; Radiography; Joint Dislocations; Salter-Harris Fractures
PubMed: 38099929
DOI: 10.1007/s00247-023-05822-3 -
Journal of Endocrinological... Jun 2024To investigate the correlation between bone metabolism markers, bone mineral density (BMD), and sarcopenia.
OBJECTIVE
To investigate the correlation between bone metabolism markers, bone mineral density (BMD), and sarcopenia.
METHODS
A total of 331 consecutive patients aged ≥ 60 years who were hospitalized between November 2020 and December 2021 were enrolled. Participants were divided into sarcopenia and non-sarcopenia groups according to the Asian Working Group on Sarcopenia criteria (AWGS, 2019). The clinical data, bone metabolism markers (β-CTX, N-MID, and TP1NP), and BMD were compared between the two groups.
RESULTS
Age, β-CTX, and N-MID of the sarcopenia group were higher than those of the non-sarcopenia group (P < 0.05), but the BMD T values were lower than those of the non-sarcopenia group (P < 0.05). Binary logistic regression analysis showed that increased femoral neck BMD (FNBMD) was a protective factor for sarcopenia, while increased β-CTX was a risk factor. Pearson/Spearman correlation analysis showed that the diagnostic indices of sarcopenia were positively correlated with FNBMD and negatively correlated with β-CTX and N-MID. Multiple linear regression analysis revealed that BMI and FNBMD significantly positively affected muscle strength and appendicular skeletal muscle mass (ASM). The FNBMD significantly positively affected physical performance, while β-CTX significantly negatively affected muscle strength, ASM, and physical performance.
CONCLUSION
Increased FNBMD may be a protective factor against sarcopenia, and increased β-CTX may be a risk factor. The FNBMD significantly positively affected the diagnostic indices of sarcopenia, while β-CTX significantly negatively affected them. BMD and bone metabolism marker levels may be considered in early screening for sarcopenia.
Topics: Humans; Sarcopenia; Female; Male; Bone Density; Aged; Biomarkers; Middle Aged; Procollagen; Muscle, Skeletal; Peptide Fragments; Collagen Type I; Bone and Bones; Muscle Strength
PubMed: 38097848
DOI: 10.1007/s40618-023-02252-8 -
Qatar Medical Journal 2023infections of the appendicular skeleton are rare. A 72-year-old female presented with pain and deformity in her left lower limb and an inability to bear weight that had...
infections of the appendicular skeleton are rare. A 72-year-old female presented with pain and deformity in her left lower limb and an inability to bear weight that had persisted for the last six months. A femur biopsy confirmed the diagnosis of extensive osteomyelitis, and the patient was treated with amphotericin B and oral voriconazole. The patient died of COVID-19 after 2.5 months of treatment. A diagnosis of osteomyelitis may be delayed because of its varied clinical presentation. To the best of our knowledge, this is the first known case of de novo neglected and extensive (multisite, multibone) osteomyelitis in an immunocompetent patient. This case highlights the importance of awareness in patients and treating physicians of this rare infection and its early diagnosis to prevent extensive spread.
PubMed: 38089673
DOI: 10.5339/qmj.2023.25