scholarly journals Aseptic (avascular) bone necrosis in the foot and ankle

2020 ◽  
Vol 5 (10) ◽  
pp. 684-690
Author(s):  
Xavier Martin Oliva ◽  
Antonio Viladot Voegeli
Keyword(s):  
Metatarsophalangeal Joint ◽  
Growth Period ◽  
Common Denominator ◽  
Loose Bodies ◽  
Disease Treatment ◽  
Aseptic Necrosis ◽  
Bone Necrosis ◽  
Tarsal Bones ◽  
Advanced Stages ◽  
Talar Fractures

Aseptic necrosis may be defined as a group of diseases that have bone necrosis as a common denominator. They usually appear in the epiphyses and in the carpal and tarsal bones. They generally appear during a growth period and principally at those skeletal points subjected to particular stress. In Müller–Weiss disease in the advanced stages, talonavicular-cuneiform arthrodesis, with or without back foot correction, is the best surgical option. In Freiberg–Kohler disease, treatment can be conservative and we can maintain the head of the metatarsal by performing a joint debridement of the metatarsophalangeal joint with removal of loose bodies. The lateral upper and lower faces of the distal extremity of the metatarsal are resected, preserving the joint cartilage that in its centre portion is always healthy. The osteophyte border that may be present in the phalanx is resected. Most frequently, avascular necrosis (AVN) of the talus is a sequel to talar fractures, with the possibility that the AVN increases with the severity of the trauma and the damage associated with the already precarious blood supply of the talus. The surgical treatment used for sesamoid AVN is partial excision of the affected bone. Cite this article: EFORT Open Rev 2020;5:684-690. DOI: 10.1302/2058-5241.5.200007

scholarly journals Two types of bone necrosis in the Middle Triassic Pistosaurus longaevus bones: the results of integrated studies

2017 ◽  
Vol 4 (7) ◽  
pp. 170204 ◽  
Author(s):  
Dawid Surmik ◽  
Bruce M. Rothschild ◽  
Mateusz Dulski ◽  
Katarzyna Janiszewska
Keyword(s):  
Avascular Necrosis ◽  
Marine Mammals ◽  
Middle Triassic ◽  
Articular Surface ◽  
Mineralogical Composition ◽  
Aseptic Necrosis ◽  
Bone Necrosis ◽  
Vertebral Centra ◽  
Aquatic Vertebrates ◽  
Pathological Modification

Avascular necrosis, diagnosed on the basis of either a specific pathological modification of the articular surfaces of bone or its radiologic appearance in vertebral centra, has been recognized in many Mesozoic marine reptiles as well as in present-day marine mammals. Its presence in the zoological and paleontologic record is usually associated with decompression syndrome, a disease that affects secondarily aquatic vertebrates that could dive. Bone necrosis can also be caused by infectious processes, but it differs in appearance from decompression syndrome-associated aseptic necrosis. Herein, we report evidence of septic necrosis in the proximal articular surface of the femur of a marine reptile, Pistosaurus longaevus , from the Middle Triassic of Poland and Germany. This is the oldest recognition of septic necrosis associated with septic arthritis in the fossil record so far, and the mineralogical composition of pathologically altered bone is described herein in detail. The occurrence of septic necrosis is contrasted with decompression syndrome-associated avascular necrosis, also described in Pistosaurus longaevus bone from Middle Triassic of Germany.

Bone Necrosis and Urinary Hydroxyproline Excretion in Rabbits

1977 ◽  
Vol 52 (5) ◽  
pp. 523-526 ◽  
Author(s):  
C. R. Weatherley ◽  
G. Dale ◽  
J. McGurk ◽  
D. N. Walder
Keyword(s):  
Deep Sea ◽  
Experimental Production ◽  
Urinary Hydroxyproline ◽  
Aseptic Necrosis ◽  
Bone Necrosis ◽  
Histological Evidence ◽  
Chronic Complication ◽  
Before And After ◽  
Hydroxyproline Excretion ◽  
Early Indication

1. Aseptic necrosis of bone is a serious chronic complication of deep-sea diving and compressed-air work. 2. The changes to the bone which occur in this condition take time to develop to the stage where they cause the radiographic signs of bone necrosis, and consequently there is a delay of some months between the causal incident and the first diagnosis by radiography. 3. As a possible method for the earlier detection of bone necrosis the 24 h urinary excretion of hydroxyproline was measured over a period before and after experimental production of bone necrosis in rabbits by the intra-arterial injection of glass microspheres. 4. Total hydroxyproline excretion rose significantly within a few days of the injection in those rabbits in which there was later shown to be histological evidence of bone necrosis. This rise occurred long before there was any radiographic change. 5. It is suggested that measurement of urinary hydroxyproline might be used to give an early indication of bone necrosis in man.

scholarly journals Surgical management of a severe congenital deformity of the hind limb in a Shetland pony foal – a case report

2021 ◽  
Vol 90 (4) ◽  
pp. 391-397
Author(s):  
Cristian Crecan ◽  
Iancu Morar ◽  
Mirela Rus ◽  
Cosmin Pestean
Keyword(s):  
Case Report ◽  
Surgical Management ◽  
Hind Limb ◽  
Metatarsophalangeal Joint ◽  
Extensor Tendon ◽  
Congenital Deformity ◽  
Metatarsal Osteotomy ◽  
Medial Side ◽  
Tarsal Bones ◽  
The Right

This case report describes the surgical management of a severe congenital deformity in a Shetland pony. A two-week-old foal was presented with the right hind limb showing a 90-degree torsion of the tarsal region towards the medial side and the metatarsophalangeal joint forced in a 90-degree extension behind the right tarsus. As assessed through radiography, the tibial malleoli and the trochlea of the talus were poorly developed, the flexor tendons inserted topographically correctly on the phalanges but due to articular torsion, the tenaculum of long and lateral digital extensor tendons were projected laterally and the common digital extensor tendon on the medioplantar aspect. At the age of one month, a corrective ostectomy of the tibial malleoli, trochlear ridge, and talus was performed to reposition the adjacent bones. The tarsal bones were repositioned through an arthrotomy and subsequently the tarsal region fused by means of two cortex screws inserted in a lag fashion. Complete correction of the torsion was achieved through metatarsal osteotomy. A 20-hole 3.5-mm reconstruction plate was used for stabilization of the tibia and metatarsus, resulting in a pantarsal arthrodesis. Partial tibia shortening was performed to improve angulation of the tarsal region. At nine months after surgery, the pony was keeping the right limb hoof sole on the ground.

scholarly journals Treatment of isolated talonavicular coalition: Case report and literature review

2018 ◽  
Vol 46 (12) ◽  
pp. 5322-5330
Author(s):  
Xiaojun Duan ◽  
Liu Yang
Keyword(s):  
Growth Period ◽  
Nonoperative Treatment ◽  
Ankle Arthritis ◽  
Ankle Pain ◽  
Tarsal Coalition ◽  
Talocalcaneal Coalition ◽  
First Case ◽  
Tarsal Bones ◽  
Late Growth

Tarsal coalition refers to an abnormal fibrous, cartilaginous, or bony connection that develops between two or more tarsal bones. Talocalcaneal coalition and calcaneonavicular coalition account for more than 90% of all cases of tarsal coalition. Coalition exists early at birth, but bony connection usually develops during the patient’s late growth period. Isolated cases of talonavicular coalition have rarely been reported. We herein report a case involving an 11-year-old patient with an isolated talonavicular coalition from a soft tissue to bony connection who was treated with arthroscopy for ankle arthritis. To our knowledge, this is the first case in which the whole formation of the talonavicular coalition was observed with a series of radiographic and magnetic resonance imaging examinations. The pain caused by the talonavicular coalition was managed by nonoperative treatment, while the ankle pain caused by the arthritis was relieved after ankle arthroscopy. At 6 years postoperatively, the patient remained pain-free while walking for 30 minutes and was satisfied with the operative outcome. Continuous follow-up confirmed that after the formation of talonavicular coalition, the coalition can continue to progress, forming bony talocalcaneal coalition and calcaneocuboid coalition.

scholarly journals What Kind of Procedure Should be Indicated for the Comminuted Talar Fracture as Initial Treatment?

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Ryuhei Katsui ◽  
Yoshinori Takakura ◽  
Norihiro Samoto ◽  
Akira Taniguchi ◽  
Yasuhito Tanaka
Keyword(s):  
Initial Treatment ◽  
Open Fracture ◽  
Weight Bearing ◽  
Plaster Cast ◽  
Medial Malleolus ◽  
Cast Immobilization ◽  
Aseptic Necrosis ◽  
Bony Destruction ◽  
Custom Made ◽  
Talar Fractures

Category: Trauma Introduction/Purpose: Open reduction is most difficult to perform in comminuted talar fractures, because it necessitates osteotomy of the lateral or medial malleolus. Furthermore, the incidence of aseptic talar necrosis after a comminuted fracture is extremely high. Fifty-seven tali in 55 patients with aseptic necrosis of the talus underwent replacement with an artificial ceramic whole talus from 2005 to 2015, and we obtained excellent and good results. Based on the results, we performed replacement with an artificial ceramic talus, as the initial treatment, for 6 patients with comminuted talar fractures with bony destruction or defects. Methods: From 2009 to 2016, six feet in 6 patients with comminuted talar fractures were replaced with ceramic whole-talus prostheses as the initial treatment. Of them, 5 were male and one was female, with a mean age of 40.3 years (range, 19–59 years). The causes of the fractures were fall from a high place in 2 patients and traffic accident in 4. The ceramic prosthesis was made based on the computed tomographic scan of the normal opposite talus. The production of the custom-made prosthesis required a period of 5 weeks. In 3 patients, the capacity of the original talus was acquired by external fixation before replacement. Plaster cast immobilization was retained for 2 weeks each of non-weight bearing and weight-bearing. Preoperative and postoperative assessments were performed in accordance with the American Orthopaedic Foot and Ankle Society ankle/hindfoot score system. Results: Follow-up was conducted for 12 to 84 months (mean, 53.8 months). The postoperative AOFAS score was 68-100 (mean, 81.8). The result of the replacement with ceramic whole-talus prosthesis was excellent in 4, good in one, and fair in one. Three patients had resumed participation in sports activities (golf, aerobics, and jogging). However, 2 patients with open fracture and bony defects had limitation of the range of motion of the ankle. The patient with a fair result is still undergoing therapy for femoral and tibial fractures. Conclusion: A ceramic whole-talus prosthesis was used to replace 6 comminuted talar fractures as the initial treatment. The results using these prostheses were excellent, and good except one patient with open fracture and bony defects. Replacement with a ceramic whole-talus prosthesis should be indicated for comminuted fractures with bony destruction or defects.

scholarly journals Spirocercosis in Dogs in Israel

2019 ◽  
Vol 63 (2) ◽  
pp. 8-14
Author(s):  
N. Geva ◽  
G. Štrkolcová
Keyword(s):  
Intermediate Host ◽  
Clinical Signs ◽  
Preventative Treatment ◽  
Disease Treatment ◽  
Spirocerca Lupi ◽  
Infective Larvae ◽  
Negative Results ◽  
Faecal Samples ◽  
Advanced Stages ◽  
Paratenic Hosts

Abstract Spirocerca lupi is a nematode causing spirocercosis disease that affects mostly carnivores and especially canidae. The life cycle of S. lupi includes a coprophagous beetle as an obligatory intermediate host and a variety of facultative paratenic hosts. In Israel, spirocercosis is considered to be a serious condition with a variety of clinical signs comprising a great risk to canine populations. The diagnosis at an early infective stage is unreliable and the vast majority of infected dogs are diagnosed only when the disease has advanced. In advanced stages of the disease, treatment is difficult and there is a high risk for complications. A study was carried out to compare the prevalence of S. lupi in the central region of Israel with a previous investigation and by that consequently try to estimate the efficacy of preventative treatment used nowadays in Israel. The study was done by the use of two different methods: looking for the infective larvae (L3) in the main intermediate host in Israel, Ontophagus sellatus, and searching for the eggs of S. lupi by performing flotation methods on faecal samples. Beetles and faecal samples were collected from four different locations in the winter and summer of 2017, 2018, and 2019. According to the literature review and collection of data from case studies, the prevalence of spirocercosis is increasing in Israel, despite the negative results from the dissections of beetles and faecal samples.

scholarly journals Predictive Value of Magnetic Resonance Imaging in Avascular Necrosis following Talar Fractures

2000 ◽  
Vol 8 (1) ◽  
pp. 73-78 ◽  
Author(s):  
Toshikazu Kubo ◽  
Keishi Kamata ◽  
Masahiko Noguchi ◽  
Shigehiro Inoue ◽  
Motoyuki Horii ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Type Ii ◽  
Resonance Imaging ◽  
Mr Images ◽  
Bone Necrosis ◽  
Post Operative Period ◽  
Bone Changes ◽  
Talar Fractures ◽  
Magnetic Resonance Imaging Mri

Ischemic bone necrosis following talar fractures is a problematic complication and its early diagnosis is important. Patients with Hawkins Type II and III talar fractures received internal fixation using titanium alloy screws, and chronological bone changes were observed with Magnetic Resonance Imaging (MRI). With the Type II patient, Hawkins' sign was radiographically confirmed 2 months after the surgery. Furthermore, there were no changes of MR images for 2 years and a good clinical outcome was obtained. However, in the Type III patient, Hawkins' sign was negative and MRI revealed a low signal-intensity band on the talus 2 months after the surgery and then necrosis was radiographically confirmed; pain appeared 10 months later. These 2 cases suggest that MRI is a useful means for detecting bone necrosis with talar fractures in the early post-operative period.

scholarly journals Aseptic necrosis of bone in ICR mice

1988 ◽  
Vol 22 (1) ◽  
pp. 51-53 ◽  
Author(s):  
K. Yamasaki ◽  
C. Itakura
Keyword(s):  
Articular Cartilage ◽  
Connective Tissue ◽  
Aseptic Necrosis ◽  
Histological Changes ◽  
Bone Necrosis ◽  
Degenerative Osteoarthritis ◽  
Focal Necrosis ◽  
Icr Mice ◽  
Massive Necrosis ◽  
Extensive Necrosis

Aseptic bone necrosis was observed in the tibia of 23 ICR mice. Histological changes were characterized by a loss of marrow tissue with proliferation of connective tissue and bone necrosis with empty osteocytic lacunae. Focal necrosis was confined beneath the articular cartilage. Extensive necrosis was present in half or all of the epiphysis. Massive necrosis was noted in the diaphysis of one animal. It was considered that focal necrosis might be related to degenerative osteoarthritis, and that extensive and massive necroses might have been caused by a disturbance of the blood supply.

Tarsal fractures: part 1

2020 ◽  
Vol 25 (1) ◽  
pp. 31-36 ◽  
Author(s):  
Karen Lisette Perry
Keyword(s):  
The Body ◽  
Anatomical Reconstruction ◽  
Articular Fractures ◽  
Appropriate Treatment ◽  
Fracture Management ◽  
Tarsal Bones ◽  
Talar Fractures ◽  
K Wires

While fractures of the tarsal bones may not be common in non-racing dog and cat populations, an awareness of these injuries and the gold-standard treatment thereof remains important. Failure to diagnose these fractures and pursue appropriate treatment can have devastating consequences for long-term limb use; racing dogs may fail to return to racing and potentially be condemned to euthanasia while non-racing dogs may go on to suffer debilitating osteoarthritis. For many tarsal fractures, surgical stabilisation is indicated and in order to plan this, an accurate diagnosis must be made. While various radiographic views may assist in achieving this diagnosis, computed tomography is more sensitive for detection and classification of tarsal fractures. Fractures of the talus are generally classified as articular fractures of the body or non-articular fractures of the head or neck. Treatment of talar fractures depends on the site of the fracture and degree of comminution, with intra-articular and certain extra-articular fractures necessitating anatomical reconstruction with a lag screw or multiple K-wires. The prognosis is variable depending on fracture type and accuracy of reduction, but following articular fracture management, most patients will suffer from clinically relevant osteoarthritis later in life.

Nonsurgical Therapies for Hepatocellular and Cholangiocellular Carcinoma

Swiss Surgery ◽  
1999 ◽  
Vol 5 (3) ◽  
pp. 116-121 ◽  
Author(s):  
Schmassmann
Keyword(s):  
Current Trend ◽  
Percutaneous Ethanol Injection ◽  
Cholangiocellular Carcinoma ◽  
Multidisciplinary Therapy ◽  
Term Survival ◽  
Ethanol Injection ◽  
First Choice ◽  
Tumor Stages ◽  
Choice Of Treatment ◽  
Advanced Stages

Surgical resection is the first choice of treatment for patients with hepatocellular (HCC) and cholangiocellular carcinomas. Prolongation of survival is, however, the only realistic goal for most patients, which can be often achieved by nonsurgical therapies. Inoperable patients with large or multiple HCCs are usually treated with transarterial chemoembolization (TACE) with lipiodol in combination with a chemotherapeutic drug and gelfoam. Three-year survival depends on the stage of the disease and is about 20%. Patients with earlier tumor stages (one or two tumor nodules less than 3cm in size) are suitable for treatment with percutaneous ethanol injection (PEI) alone or in combination with TACE. Several studies have shown that in these early stages, the 3-year survival rate is approximately 55%-70% in the actively treated patients which is significantly higher than in untreated patients. In advanced stages of the disease, TACE and PEI have no effect on survival and should not be performed. Some of these patients have been successfully treated with octreotide. Patients with inoperable cholangiocellular carcinoma are treated by endoscopic or percutaneous stent placement. If stenting does not achieve adequate biliary drainage, multidisciplinary therapy including internal / external radiotherapy or photodynamic therapy should be considered in patients with potential long-term survival. In conclusion, nonresectional therapies play an essential role in the therapy of inoperable hepato- and cholangiocellular carcinomas as they lead to satisfactory survival. Multidisciplinary therapy appears to be the current trend of management.

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