Introduction: Specialized studies say that tears Achilles tendon injury is one of the pathologies with the highest incidence in the spectrum of orthopedic pathologies nature.This particular is interest to motor age groups, with or without specific physical training and activity ranging from sedentary to intense physical activity.The management of therapy is the paramount importance, as the decision between surgical and conservative treatment and often is not easy in practice.Case presentation: A 14-year-old female patient was presented to the ER (emergency room) for pain in the left Achilles tendon, which is associated with functional impotence with plantar flexion.The patient was carefully examined and investigated, and the surgery was decided to restore functional integrity. Conclusion:Although, the Achilles tendon (the tendon of the sural triceps muscle), is one of the strongest tendons, with an average length between 9-11 centimeters, having the largest diameter in the human body, can suffer a rupture at an early age.The particularity of this case consists in solving the rupture of the Achilles tendon by suturing with allograft taken from the tendon of the plantar muscle.The patient's evolution was satisfactory with the resumption of the functionality of the left lower limb..
Background: Among arthritis patients, cardiovascular morbidity is increased, and sex disparities exist in cardiovascular diseases and arthritis. Thus, the hypothesis that the association between cardiovascular diseases and arthritis might vary according to sex seems plausible. Aim: To examine the relationship of arthritis with the most frequently diagnosed cardiovascular diseases, and to check if sex modifies this association. Methods: We analyzed data from a large representative sample of the U.S. population: The National Health and Nutrition Examination Survey (NHANES) 2005- 2006. Our cross-sectional analyses included 3621 participants aged between 20 and 69 years old. Self-reported diagnoses of arthritis (main independent variable) and cardiovascular diseases (dependent variable) were measured during face-to-face interviews, and different covariates were identified as potential confounders for the association examined. Analyses were stratified by sex. Results: In multivariate analyses, a significant positive association was found between arthritis and cardiovascular diseases (OR: 2.01; 95% CI: 1.38-2.94; p value=0.0003), but there was no effect modification by sex (men: OR: 1.95; 95% CI: 1.32-2.87 / women: OR: 2.38; 95% CI: 0.96-5.86) (p=0,729). Conclusions: In this large cross-sectional study, we observed a statistically significant association between self-reported diagnoses of arthritis and cardiovascular diseases in a cohort of non-institutionalized U.S. adults. The association persisted after adjustment for several confounders but was not modified by sex.
Several orthopedic injuries caused by marine creatures envenomation have been reported in recent years all around the world, occurring mainly during water sports practice. We reported a case of an Italian tourist who developed an acute forefoot infection by Staphylococcus lugdunensis following a penetrating wound at the plantar region of the fourth toe, caused by a Stonefish, during a session of snorkeling in Indonesia. Diagnosis by microbiological methods, soft tissue and bone biopsy, surgical debridement and administration of antimicrobials led to a successful treatment of this potentially severe infection in this case. From this experience, we suggest to consider this bacterium in the differential diagnosis of bone infection following stonefish envenomation in tropical areas.
Objective:The purpose of this study is to determine the time between the onset of rheumatoid arthritis (RA) symptoms and the introduction of methotrexate, as well as the associated factors. Methods:A multicenter cross-sectional study that included data from the Moroccan register of biologic patients with rheumatoid arthritis.Sociodemographic, economic patient data and disease data were collected.A logistic regression was performed to determine the factors that are associated with the change in the delay between the onset of symptoms and the initiation of cDMARD.Results: A total of 225 RA patients were included.The mean age was 51 ± 11 years, with a female predominance of 88% (n=197).The diagnosis lag time was 12 months (12-48).Seventy-three percent of the cases were housewives.Seventy-nine percent of patients received Methotrexate as the first CDMARDS.Salazopyrine was the second prescribed CDMARDS with 7%.Hydroxychloroquine was the third prescribed cDMARDs which 2.2%.The median lag time from symptoms onset to initiation of Methotrexate was 24 months (0.16-71).The factors, associated with the change in the delay between the onset of symptoms and the introduction of methotrexate in univariate analysis, were delay in diagnosis and corticosteroids Taking (p<0.05),only the delay of diagnosis in multivariate analysis persists p=0.0001. Conclusions:Our study suggests that there is a significant delay between diagnosis and the introduction of methotrexate as a first line cDMARDs.In multivariate analysis only the time to diagnosis was associated with the time to start methotrexate.
Neurofibromatosis (NF1) is an autosomal-dominant genetic disorder with an incidence of 1:2600-3000.Tumor induced osteomalacia (TIO) is a metabolic disorder characterized by hypophosphatemia and inappropriately low serum levels of 1,25-OH D2.Symptoms are usually vague including chronic muscle and bone pain, weakness, and fatigue.Patients remain undiagnosed for years, often thought to have fibromyalgia.Pathogenesis of TIO involves tumor expression of Fibroblast growth factor 23 (FGF-23) causing phosphaturia.The metabolic abnormalities may be partially or completely corrected with phosphate supplementation and calcitriol.Definitive treatment requires excision of the tumoral lesions.We report case of a 32-year-old female presenting with widespread body pain and fatigue in a wheelchair bound state.Investigations showed Very low serum phosphorus, elevated FGF 23 levels and high urinary phosphorus loss, establishing the diagnosis of TIO.Phosphorus levels along with Vit D3 and calcium should be investigated in all cases of 'nonspecific' body pains.
Background: Major procedures in spine are accompanied by elevated intraoperative blood loss which often results in the need of blood transfusions.A prolonged hospital stays as well as at the intensive care unit are cost-sensible factors. Purpose:The aim of this study was to determine a possible correlation between the intraoperative blood loss and the duration of the intensive care unit treatment, and the overall hospital stay. Patients and Methods:This study presents a retrospective analysis of 253 patients treated in our spine surgical ward in 2018.To analyse a possible correlation the tests of Pearson's, Spearman rho's and Kendall-Tau-b's were used. Results:The intraoperative blood loss showed a significant correlation towards the duration on the intensive care unit (ICU) in both Spearman's rho and Kendall Tau-b's.Analysis of the correlation between intraoperative blood loss and overall length of hospital stay using Pearson's showed a direct correlation with a correlation coefficient of 0.155. Conclusions:This study shows a correlation between intraoperative blood loss both with the duration of intensive care unit treatment and the overall hospital stay which illustrates the financial impact of elevated intraoperative blood loss.
Although the real incidence of metallosis is unknown, metallosis is described as a rare diagnosis and it seems to be more frequent in hip than in knee arthroplasty with a 5% estimated incidence in the hip prosthetic replacements. Introduction:Metallosis is a condition that occurs when there is a high level of toxic metals in the blood.This occurs when metal particles detach from the implant and are released into the bloodstream or nearby tissues.The symptoms of metallosis are made from a mixture of several metals that includes chromium, cobalt, nickel, titanium and molybdenum.When friction occurs between the metal components, they discharge microscopic particles into the blood and surrounding tissues. Case presentation:The 46-year-old patient who developed postoperatively a metallosis following a total hip prosthesis.Total hip arthroplasty was performed for secondary hip osteoarthritis due to a congenital hip dysplasia of the patient. Conclusion:Metallosis develops as these metal ions accumulate in the bone, muscles, and other tissues around the implant, and this can lead to bone death or surrounding tissues.The particularity of this case is the fact that the trophic disorders caused by metallosis did not affect the prosthesis itself, but they affected the surrounding tissues.As a result of the disorders produced, external suppuration appeared, and the surgery was needed again.A correct and careful debridement can bring us a favorable result with the remission of local and systemic phenomena without the need to remove and change the implant.
The traumatic phenomena in the lower extremities can lead to the amputations in more than 20% of the patients, especially when it is associated with the significant soft tissue loss or the severe wound contamination the blast events will require the amputation in 93% of cases. Case presentation:We present the case of a female patient, 8 -year and 7-month-old who was brought by the rescue crew members to the emergency room of the Children's Clinical Hospital "Sf.Ioan", Galati, on 12.12.2020.The patient arrived at the emergency care center as a victim of a road accident, as a passenger.Intraoperatively (12.12.2020 -13H.45): a complete section of the popliteal vascular-nerve bundle is revealed, which is why it is decided to amputate the lower limb segment from the proximal 1/3 of the calf.The fixation of the supracondylar fracture focus was performed with the 3 pins, achieving the bone stabilization. Conclusion:The particularity of this case consists of the difficulty to explain to a child that an adult's carelessness changed the course of her life and of the difficulty to support her morally to accept this situation.
Introduction Primitive bone tumours of the pelvis represent a considerable challenge for carcinologic surgeons. Resections made in the acetabular zone could disrupt the continuity of the pelvic ring. The morbidity that comes after such a procedure requires a reconstruction surgery in order to improve the functional outcome. In this aim, multiple techniques have been reported. Case report We report the case of a 23-year-old male with no medical history diagnosed with a right pelvic bone osteosarcoma located in Enneking zones I and II. He first underwent neoadjuvant chemotherapy followed by a large resection of the whole bone. A reconstruction was then made using a vascularized fibular autologous graft and stabilized by a long customized lombo-femoral plate. Recovery of walking was possible using crutches. No recurrence was note at one year follow-up. Conclusion Malignant primitive tumours of the pelvis threaten the vital and functional prognoses of patients. It is now possible to perform conservative resections in more than 80% of case without compromising the survival of patients or their functional outcome.
Purpose: Aneurysmal bone cysts are benign and expansile osteolytic lesions that can occur in any location in the spine. This report describes clinical characteristics and treatment results of 9 young patients with aneurysmal bone cyst of the spine. Methods: Between 1997 and 2015, 9 young patients with aneurysmal bone cyst of the spine were surgically treated in our department. The clinical records, radiographs, and operative reports were analysed. Results: This study included 9 paediatric cases (6 girls, 3 boys) managed for aneurysmal bone cyst. The mean age was 11 years. Posterior spinal elements were affected in all cases. The lesion affected the cervical spine (1 case), thoracic spine (3 cases), and lumbar region (5 cases). The radiological aspect was typical in all cases. MRI imaging was very suggestive of the diagnosis showing specific features of the lesion. It was described as an expansil lytic process arising from vertebral posterior elements. All patients underwent a surgical removal of the tumor following a surgical biopsy. A segmental instrumented fusion in order to establish a proper spinal stability was made in 5 cases. Histological report confirmed the diagnosis of aneurysmal cyst in all patients. The mean follow-up was 7, 7 years. The follow-up course was uneventful. Conclusion: The presented study demonstrates that lesional resection and structural spinal integrity made by local spinal fusion allow good outcomes with a low rate of complications and low recurrence.
Involvement of the sacrum is extremely rare, and it has also been reported that the diagnosis of osteoid osteoma in the sacrum can be delayed compared to other skeletal locations. We report the case of a six-year-old girl student who complained of chronic back pain for several months and with some relief with non-steroid anti-inflammatory drugs (NSAID). Further investigations, which included bone and CT scan, revealed the presence of an osteoid osteoma at the second sacral vertebra (S2 vertebra). The patient made an excellent recovery after surgical excision.
Purpose: Osteoporosis is a widespread disease in aging Western societies, and powerful diagnostic and therapeutic tools have been developed in the past decade. However, in clinical practice we notice that a fair number of at-risk patients remain undiagnosed and/or untreated, with potentially avoidable individual suffering and high costs for society. Since diagnosis can be delayed by lack of both physician and patient awareness, we evaluated the level of knowledge about osteoporosis among older patients with orthopaedic disorders. Methods: A semi-structured questionnaire was handed out, over a period of one month, to outpatients ≥ 50 years old seen at a local Swiss cantonal hospital. Patients where asked about osteoporosis, perceptions of own disability, and diagnostic tests. Descriptive statistics were used to report the data. Results: Of the 197 patients included in the study, the majority had heard about osteoporosis, but only 20% could reasonably describe the disease. Regarding diagnosis, 44% of the women and 5% of the men claimed they had done a bone density scan, even though only 30% of the women and 3% of the men appeared to have had one. Osteoporosis was diagnosed in 47% of the patients evaluated. Vitamin D levels were measured in only 22% of the patients, a total of 30% reported loss of height, and 22% reported frequent falls. Conclusion: Despite ours being a society with readily available medical information, awareness of osteoporosis in our region was low. Whether this is a local phenomenon will need to be confirmed in a nationwide study. *Correspondence to: Tim Christopher Krappel, School of Management, Economics, Law, Social Sciences and International Affairs, University of St. Gallen, Bachtrasse 110, CH 3900 Brig, Switzerland, E-mail: krappeltim@gmail.com
1Rocky Vista University College of Osteopathic Medicine, USA 2Department of Physiology and Developmental Biology, Brigham Young University, USA 3Yale School of Medicine, USA 4Pacific Northwest University of Health Sciences, College of Osteopathic Medicine 5Division of Integrative Anatomy, Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, USA 6Department of Statistics, Utah Valley University, USA 7Department of Neurobiology and Anatomy, University of Utah Medical School, USA 8Department of Anatomy and Neurobiology, Boston University School of Medicine, USA
Background: The scientific literature shows an association between inflammatory arthritis and cardiovascular diseases (CVD) with inflammation being a shared characteristic between the two types of diseases. Among patients with arthritis, it is possible that the protective factors against inflammation, such as vitamin D, are also protective factors against the development of CVD. This effect may be different according to sex.Objective: To evaluate the impact of serum vitamin D concentration on the association between arthritis and CVD separately among men and women (effect modification of vitamin D and sex).Methods: Data came from a large representative sample of the US population: the National Health and Nutrition Examination Survey (NHANES) 2005-2006, which included 3406 adults aged between 20 and 69 years. Measurements of arthritis (primary independent variable) and CVD (dependent variable) were taken during face-to-face interviews, while the measurement of serum vitamin D was carried out on blood samples. Multivariate logistic regression analyses were performed in which the combined modifying effect of vitamin D (<20 ng/ml/> 20 ng/ml) and sex was tested, and adjusted for several potentially confounding variables.Results: Arthritis was statistically associated with CVD in both men and women, with <20 ng/ml or >20 ng/ml serum vitamin D. In men, the adjusted ratio of the odds ratios (ROR) comparing the association at <20 ng/ml vitamin D concentration to the association at >20 ng/ml concentration was 0.8 (95% CI 0.5 to 1.5); in women, the adjusted ROR was 0.7 (95% CI 0.3 to 1.5). Conclusions: In this large cross-sectional study, arthritis and CVD were statistically associated, but this association was not modified by sex nor vitamin D concentrations. Vitamin D supplementation is not recommended as part of the management of patients of both sexes suffering from inflammatory arthritis to prevent CVD.
Background: Cushing's disease is an endocrine disorder and may be associated with non-traumatic osteonecrosis of the hip. We report the case of avascular necrosis of the femoral heads (AVNFH) as the presenting manifestation of Cushing's disease. Case presentation: A 29-year-old male patient was referred to our department because of non-traumatic bilateral hip pain evolving for two years. The pain was associated with lameness when walking. He noticed a drop in libido since one year with erectile dysfunction. Physical examination revealed facio-truncal obesity, abdominal violaceous striae, dorsal hyper-kyphosis, a pain and limitation of internal rotation of the left hip with a Lequesne index of 16. The standard radiography showed a loss of sphericity of the left femoral head with an aspect of eggshell. The MRI confirmed the diagnosis of a bilateral AVNFH. The baseline cortisol level was 287 ng/ml. AVNFH as the presenting manifestation of Cushing's disease was suspected and confirmed by a pituitary MRI which revealed a pituitary adenoma. A discharge of the hips was indicated. The patient underwent surgical resection of the adenoma and was referred to the endocrinology department. The histopathological examination confirmed the diagnosis of pituitary adenoma (corticotrope adenoma). The patient has also received an intravenous perfusion of 5 mg of Zoledronic acid. The follow up was marked by the regression of the symptoms of Cushing's disease and the hip pain. Conclusion: AVNFH as the presenting manifestation of Cushing's disease is rarely described. Hence, it’s needed to exclude endogenous hypercorticism in any patient with idiopathic osteonecrosis.
Gout is frequently associated with nephrolithiasis. Uric acid nephrolithiasis in gout correlates with the degree of hyperuricemia and hyperuricosuria. A decrease in serum and tissue uric acid burden may result in improvement in uric acid nephrolithiasis in patients with gout. We present a case of severe chronic tophaceous gout with recurrent uric acid nephrolithiasis who had a remarkable improvement in his gout, as well as the resolution of uric acid renal calculi after treatment with pegloticase. Pegloticase has been approved for the treatment of chronic gout refractory to conventional therapy, however, its effects on uric acid nephrolithiasis have not been evaluated. Our case is first such reported case, and further studies evaluating the efficacy of pegloticase in improving uric acid calculi are needed to confirm our findings.
Spinal tuberculosis is a common extrapulmonary tuberculosis, causing abscess formation or bone destruction. With a climbing multidrug resistance of Mycobacterium tuberculosis, it remains highly prevalent. As spinal cord compression causes high disability rate, surgical intervention is a much-needed option. However, an optional surgical approach is still highly desirable. We have reported a one-stage surgical protocol for twenty-six cases with thoracic and lumbar tuberculosis. Eight of them had thoracic tuberculosis and eighteen were thoracolumbar tuberculosis. In addition to antituberculosis therapy, we approached with posterior pedicle screws for internal fixation, interlaminar bone graft and anterior debridement combined with autogenous bone grafting. After a longitudinal follow-up as long as 36 months, symptoms of lumbago and back pain were relieved with functional nerve recovery. This study is an update for the patients with thoracolumbar tuberculosis who were not well treated with non-operative treatment, optimal clinical outcome can be achieved by following a one-stage operation protocol. *Correspondence to: Kunzheng Wang, Department of Medicine, Joint center, Xi‘an Jiaotong University, Xi‘an, Shaanxi 710061, E-Mail:wangkz088@yeah.net Bo Wang, Department of Spine Section, University of Chinese Academy of Sciences Shenzhen Hospital, Shenzhen 518003, Guangdong, China, E-mail: bo_wang-sz@outlook.com, same7213@163.com
Vitamin D fulfills various functions in bone and mineral metabolism through its action on three main organs: the intestine, kidney, and bones. Calcitriol [1,25-(OH) 2 -D 3 ] is the metabolically active form of vitamin D and has a high affinity for its receptor (VDR), which is expressed in most cell types. This union allows it to perform its functions at the skeletal and extra-skeletal level. Prolonged deficiency of this vitamin is mainly associated with alterations in bone mineralization and a decrease in bone mineral density leading to the subsequent development of osteomalacia and osteoporosis. This article will review the metabolism of vitamin D, its actions at the musculoskeletal level and the consequences of the deficiency, as well as the necessary guidelines to establish the diagnosis and adequate treatment of supplementation.
The term "neglected clubfoot" encompasses several clinical pictures from inveterate clubfoot to relapsed clubfoot or to resistant clubfoot.Treatment with external fixators is a valid option in several case series.In our retrospective study, we wanted to analyze the results obtained in correcting the relapsed /inveterate clubfoot by using external fixators.In our Unit 101 patients underwent surgical procedures for congenital clubfoot correction from September 2006 to August 2019.A total of 8 patients (6 male and 2 female) were enrolled in the present study; in two cases the deformity was bilateral so that the total number of feet considered is 10.The age range of the patients considered at the first treatment of the clubfoot with external fixator ranges from 5 to 10 years with an average age of 7.3 years.The follow-up range is from 13 years to 4 months with an average follow-up of 6.5 years.Of the 10 feet treated with external fixator, 9 were subjected to correction using the Ilizarov apparatus (Ilizarov, TrueLok Orthofix, RRS Dial Medicali) and 1 through Taylor Spatial Frame (TSF Smith & Nephew).In evaluating the results of our study, we considered primary and secondary parameters.The primary outcome was therefore good for 7 feet (70%), discrete for 1 foot and poor in the 2 feet.There is a statistically evidence of all the subdomains of the 2 questionnaires administered (AOFAS and FFI) which demonstrate a clinal and mechanical improvement after treatment.No major complications were recorded among the patients.The principle of distraction-osteogenesis is a useful option and should be considered as a rescue solution in complex deformities.Its execution by surgeons with considerable experience is crucial.The new hexapod fixators simplify the correction process but remain useful tools in expert hands.
