BONY SEQUESTRUM IN CHRONIC OSTEOMYELITIS: CHARACTERISTIC ON 18F-FDG-PET-CT IMAGES
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Aim The localization of sequestrum in chronic osteomyelitis (COM) is crucial in preoperative planning. The identification of sequestrum on plain X-ray could be difficult. CT and MRI were reported to show the sequestrum. We aimed to analyze the sequestrum characteristics on 18F-FDG-PET-CT images. Methods A prospective study included all patients diagnosed with long-bone chronic osteomyelitis. All patients had preoperative 18F-FDG-PET-CT. Images were analyzed using RadiAnt DICOM Viewer. Axial cuts were used to measure the Standard Uptake Ratio (SUV)max in the Region of Interest (ROI) in the sequestrum, the surrounding area, and the normal bone in the same cut. Surgical debridement was done as standard; samples were taken for microbiology and histopathology, and the intraoperative finding was documented. Results Nineteen patients (17 males/2 females) were operated on in one center between October/2021 and Jan/2023 at a mean age of 32±18. There were 10 tibias, 7 femurs, one ulna, and one fibula. Ten had postoperative COM, six open fractures, and three hematogenous OM. They all showed sequestrum on PET-CT; the dead bone appeared void, surrounded by a halo of increased uptake. There was a trend of lower uptake in the sequestrum compared to the halo around. The mean SUVmax at the sequestrum was 4.18±3.16, compared to the surrounding halo, 7.08±5.81. The normal bone has a mean SUVmax of 1.61±1.42. Sequestrum was removed successfully in all cases. Conclusion 18F-FDG-PET-CT can precisely localize the sequestrum preoperatively, it has a lower uptake than tissues around it. This would facilitate planning and improve the quality of debridement.Keywords:
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Dr. Rothman of Haverhill, MA questioned the short duration of antimicrobial treatment and use of oral route for the patient with osteomyelitis presented by Bennett in PIR 1:153, November 1979. He noted that the traditional regimen for osteomyelitis calls for six weeks of intravenous antimicrobial therapy. Dr. Bennett quotes from Telzlaff et al (J Pediatr 92:485, 1978). In this report good results were found when antimicrobial regimens for patients with osteomyelitis and suppurative arthritis consisted of a brief initial period of parenteral therapy of only one to seven days followed by oral antimicrobial therapy begun when there was a definitive decrease in clinical signs of inflammation and continued for three weeks or longer. It is important to note that surgical drainage of pus was carried out, that antimicrobial blood levels were obtained after initiation of oral therapy to ensure adequate levels, that therapy was continued until all signs and symptoms had subsided, that there was no evidence of cortical destruction or sequestrum formation on roentgenogram, and the erythrocyte sedimentation rate was less than 20 mg/hr. When these conditions are met it is clear that oral therapy can be an adequate substitute for prolonged intravenous therapy for osteomyelitis in children.
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Objective To evaluate the clinical value of DR in the diagnosis of traumatic osteomyelitis though investi gating the DR imaging studies of traumatic osteomyelitis.Methods While 103 patients with clinical manifestations of the traumatic osteomyelitis patients were checked the DR,the results were analyzed.Results DR can accurately show the traumatic osteomyelitis,soft tissue swelling,cortical destruction,sequestrum,periosteal reaction,abscess.Conclusion DR is economical and effective of the imaging methods in diagnosis of traumatic osteomyelitis
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Introduction: The exact definition of osteomyelitis is inflammation of bone or bone marrow or both, but for all practical purposes this inflammation invariably is the result of infection. Various factors responsible for osteomyelitis include vascular insufficiency due to any cause, hematogenous spread of infection from a distant focus and surgery or trauma. Acute Osteomyelitis usually presents with fever, chills, pain or irritability. The classic signs of inflammation, including swelling, or redness and limited joint movement may also occur. Chronic osteomyelitis may present with bone destruction and sequestrum formation and is a difficult form of osteomyelitis to treat. Aims and Objectives: To study demographic details, organisms involved and outcome of treatment in patients with osteomyelitis. Materials and Methods: After obtaining approval from institutional ethical committee we conducted a prospective study of 60 patients diagnosed with either acute, subacute or chronic osteomyelitis on the basis of imaging and culture and sensitivity. Patients were included in this study on the basis of predefined inclusion criteria and were treated by antibiotics and when necessary surgical intervention was done. In cases of skeletal tuberculosis appropriate antikochs treatment was given. Outcome of treatment was studied over a follow up period of 1 year. The data was tabulated and analyzed using SPSS 16.0 version software. Results: Out of 60 cases of either acute, subacute or chronic osteomyelitis there were 38 males (63.33%) and 22 females (36.66%) with a M:F ratio of 1:0.57. Most common age group affected was found to be between 51-60 (36.66%) years. Acute, subacute and chronic osteomyelitis was seen in 71.66%, 11.66% and 16.66% patients respectively. Most common bones involved were Tibia (20%) and Femur (18.33%) followed by iliac bones (15%) fibula (11.66%) and vertebrae (11.66%). In most of the cases (36/60) contagious spread or trauma was the mechanism of infection. Comorbidities like hypertension, diabetes, chemotherapeutic agents or steroid intake and immunosuppression was present in 32 (53.33%) patients. S. Aureus (25/60) followed by Pseudomonas (7/60) and enterococci (7/60) were commonly isolated organisms. Atypical mycobacterial infection was seen in 1 patient who was immunocompromised. 40 patients were completely cured while remaining 10 patients had some or the other problem associated with chronic osteomyelitis. Amputations was done in 4 cases and septic arthritis developed in other 2 cases. 4 patients died during study period due to causes unrelated to osteomyelitis. Conclusion: Diagnosis as well as management of osteomyelitis is a challenge for treating orthopaedician. Knowledge of predisposing factors, presenting complaints, possible complications and proper management is essential for successful management of acute as well as chronic osteomyelitis.
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Osteomyelitis can be classified, based on its origin, as hematogenous or posttraumatic. Posttraumatic osteomyelitis is more common in small animals and results from direct inoculation of infectious agents during trauma or surgery. Bone is naturally resistant to infection, and adjuvants play a crucial role in shifting surgical contamination toward bacterial proliferation (infection). Some of these factors are inherent to orthopedic procedures, such as the use of implants. The treatment of patients with osteomyelitis varies with the stage of the disease, the severity of signs, and the underlying cause. Systemic antibiotic therapy remains the mainstay in the treatment of osteomyelitis in small animals. Surgical stabilization of an infected site is indicated if instability is present at the fracture or osteotomy site. Strategies to stimulate bone healing in small animals include autogenous bone grafts, demineralized bone matrix, and osteo-conductive agents. Prevention of osteomyelitis starts with strict adherence to aseptic technique.
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Osteomyelitis is a limb-threatening complication of diabetic foot ulcers. Early identification of the disease is key to ensuring successful prognosis. In this study, we describe ultrasonographic features for the identification of osteomyelitis.Patients were screened through clinical, ultrasonographic and probe-to-bone tests.Ultrasonographic features in three patients that could be used to identify diabetic foot osteomyelitis included periosteal reaction, periosteal elevation, cortical erosions and presence of sequestrum, all of which were confirmed by a plain X-ray.An ultrasonographic examination could be used for the early detection of osteomyelitis, which could help clinicians devise prompt treatment strategies.
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Osteomyelitis is an infection-related inflammation of the bones and bone marrow. Generally in the legs, arms, spine. Foot and ankle osteomyelitis can be excruciatingly painful for patients and a difficult management challenge for orthopedic surgeons. Acute staphylococcal osteomyelitis had a 50% death rate in the pre-antibiotic era. Osteomyelitis of the foot and ankle can occur due to a variety of reasons, with diabetic foot infections being one of the most common. Osteomyelitis is a bone marrow inflammation which progression, involving the cortical plates and frequently periosteal tissues, along with the majority of cases occurring after bone trauma or surgery, or as a result of vascular insufficiency. Chronic nonbacterial osteomyelitis is an autoinflammatory disease that primarily affects children and adolescents and is characterized by recurrent or persistent osteitic foci. The symptom is bone pain, which may or may not be accompanied by soft tissue tenderness. Chronic osteomyelitis is related with avascular necrosis of bone along with the establishment or formation of sequestrum (dead bone), and surgical debridement, in addition to antibiotic therapy, is required for cure. Physiotherapy has effect in improving the quality of life of the patient with osteomyelitis.
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