Osteonecrosis of the humeral head in a human immunodeficiency virus-infected patient under tenofovir disoproxil fumarate–emtricitabine–lopinavir/ritonavir for 10 years: a case report

Background Human immunodeficiency virus-infected patients are 100 times more likely to develop aseptic osteonecrosis compared with the general population. While 90% of cases concern the femoral head, the involvement of humeral bone remains rare. Case presentation We report a case of aseptic osteonecrosis of the left humeral head complicating antiretroviral therapy in a female, 46-year-old, Bissau-Guinean human immunodeficiency virus-infected patient received in a context of progressive pain in the left shoulder followed by limitation of articular movements. Standard x-ray of the shoulder allowed us to make the diagnosis by showing a typical image of osteonecrosis. The treatment was medical combined with physiotherapy. Conclusions Aseptic osteonecrosis should be systematically looked for in human immunodeficiency virus patients on antiretroviral treatment. In addition to femoral head aseptic necrosis, the involvement of the humeral bone should also be considered.

Treatment of aseptic osteonecrosis of the talus. A draft of clinical guidelines

Clinical guidelines are an algorithm adapted for use in our country, based on the works systematized by the level of evidence, reflecting current approaches to the diagnosis and treatment of aseptic bone necrosis (osteonecrosis) of various localizations. Purpose of the study Creation of an algorithm for diagnosis and treatment of osteonecrosis based on the assessment of the evidence level of literature data. Material and methods The Guidelines are a systematized algorithm based on the level of evidence for the management of patients with osteonecrosis, reflecting current approaches to diagnosis, treatment and rehabilitation, which are based on literature data and the authors' own experience. Electronic databases of Medline, Embase, Web of Science, and Cochrane Library platforms were searched for related sources. Preference was given to the works with high levels of evidence. References to information sources are given in the order of their appearance in the text. The search depth was 50 years due to the availability of systematic literature reviews in the framework of previous international clinical guidelines. When specific medical procedures related to the diagnosis, conservative or surgical treatment of osteonecrosis were included in the clinical recommendations, their level of evidence was reliability, the appropriateness of their use, taking into account the unified scale for assessing the quality of evidence and the strength of the recommendations for application of medical technologies GRADE. Results The Guidelines reflect aspects of clinical, instrumental and laboratory examination of patients with osteonecrosis, treatment options depending on the location of the process and disease stage. Conclusion Clinical recommendations on the medical assistance to patients with aseptic osteonecrosis have been compiled according to the requirements imposed on clinical recommendations developed by medical professional non-profit institutions

Functional results after operative treatment of talus fractures

Fractures of the talus do not occur frequently, accounting for about 0.1% of all fractures. Failure to achieve anatomic reduction, exponentially increases the risk of postoperative aseptic osteonecrosis and posttraumatic osteoarthritis. The purpose of this study was to evaluate and compare the short-term and medium-term functional outcomes in patients who underwent open reduction and internal fixation of talus fractures. Materials and methods: At the University Clinic for Traumatology in the period between 2017 to 2020, 14 patients with talus fractures were surgically treated. The inclusion and exclusion factors were determined, all patients signed the consent and the study passed the ethics committee. Results: All patients underwent open reduction and internal fixation with screws or reconstructive plate. Follow-up was done on the 14th postoperative day, 1st month, 3rd month and 6th month. At the 6th month follow-up, the functional outcome was tested using the Kitaoka score unified by the American Orthopedic Foot and Ankle Society. This injury is too rare for conclusions to be brought out of and to be compared to larger studies. However, all major studies from reference trauma centers lead to the same conclusions, that the treatment of these fractures is complex Anatomical reduction is mandatory for a better outcome. Conclusion: A protocol for the treatment of posttraumatic osteoarthritis should be introduced, given the high rate of its occurrence despite the satisfactory surgical technique.

Mandible Aseptic Osteonecrosis Caused by admission of the Narcotic Substances Containing Aminophosphonic Impurities: Levelling with Trilon B

The aim of our study was to correct osteosclerotic changes (aseptic osteonecrotic lesion) of mandibular bones in laboratory white rats. Changes were caused by 1 and 3 monthly intragastric administration of amino phosphonic impurity. It was formed during artisanal manufacture of meta-amphetamine. A dose was 63 mg/kg 1 time per day, and followed by exposure to 5% water solution of Trilon B at a dose of 250 mg/kg. Mandible structure was researched by light microscopy. Three additional functional indices and elements of node-strut analysis were enrolled. Indices and their abbreviations were used in accordance to Committee on Histomorphometry Nomenclature (ASBMR). It was found that intragastric administration of Trilon B at a dose of 250 mg/kg after one-month- and three-month influence of amino phosphonic impurity (by-product of methamphetamine artisanal synthesis) at a dose of 63 mg/kg led to improvements of mandible bone remodeling. Also, enhancement of processes that removed osteosclerotic changes as well as an involution of myelofibrosis took place.