Synergistic treatment of infected burn wound utilizing maggot debridement and acellular fish skin grafting - a case report.

Here we report about a patient with a full thickness burn injury of the left lower extremity with approximately 8% of total body surface area affected. Initial therapy consisted of necrosectomy and wound coverage with split thickness graft. The patient developed a wound infection with Pseudomonas aeruginosa, resulting in the failure of the skin graft to achieve complete healing. The case was further complicated by the patient's concurrent presentation of anemia, characterized by a hematocrit level of 19.8% on 11th day after admission. Additionally, the patient refused acceptance of any blood transfusion, adding a significant layer of complexity to the management strategy. In summary, the patient's critical state required an immediate intervention. Due to the contraindication for a further surgical debridement and autograft, we changed the treatment strategy to a conservative approach. First, the wound was debrided employing maggot therapy 17 days after admission. Subsequently, free soft tissue coverage was accomplished using decellularized fish skin dressings on 45th day. This approach yielded satisfactory wound closure. Following an approximately two-month hospitalization period (52nd day after admission), the patient was discharged with a stable wound condition, nearing complete healing.

Life-Threatening Bleeding Following a Stable Fracture of the Superior Pubic Ramus: A Case Report.

Corona mortis, an anatomical variant documented in the literature, presents a noteworthy concern due to its proximity to the superior pubic ramus. Consequently, it remains susceptible to injury, even in stable, benign fractures of the pelvis, typically addressed through conservative management. Stable pelvic fractures are infrequently associated with complications; therefore, diligent monitoring is often overlooked in clinical practice. However, it becomes crucial, particularly in the elderly population given their suboptimal hemostatic capabilities. The standard approach for managing bleeding associated with pelvic fractures involves superselective embolization, a minimally invasive procedure with favorable outcomes. We present a case involving a 61-year-old female who experienced a stable pelvic fracture following low-energy trauma. Despite the ostensibly benign nature of the fracture, the patient exhibited hemodynamic instability attributable to bleeding from the corona mortis, necessitating embolization. The pelvic fracture itself was managed conservatively, leading to the patient's subsequent discharge in a stable condition. Therefore, we advocate for a comprehensive physical examination, serial hemoglobin monitoring, and additional imaging modalities based on the patient's clinical condition.

Feasibility of implementing a remote system for lymphoedema conservative therapy: a case study.

BACKGROUND: Poor access to lymphoedema specialists and communication between them and patients prevents appropriate lymphoedema management. Therefore, development and dissemination of remote systems is necessary to improve care in rural areas with limited medical personnel or access to medical coordination. AIMS: The authors evaluated the elements required for providing patient education on conservative therapy for lymphoedema, to determine the feasibility of remote management. METHODS: The study involved connecting a health professional in a local clinic (point A) treating a patient with lymphoedema, who was present alongside the clinician, with a specialist certified lymphoedema therapist (CLT) located remotely in a university (point B). FINDINGS: The CLT was able to greet, interview and provide guidance to the patient on conservative therapy. Direct contact with the patient was not possible, which limited visualisation, palpation, leg circumference measurement, and lymphatic drainage management. CONCLUSION: The findings suggest that remote a lymphoedema management approach involving conservative therapy benefits both patients and health professionals, particularly in rural regions. Future studies are needed to confirm the effectiveness of this approach to confirm adequate treatment.

Withholding or withdrawing life support in nephrology: a perspective in the French-speaking background / Adaptation raisonnée des thérapeutiques (ART en néphrologie) - Guide pratique LAT-MRC1.

Chronic kidney disease (CKD) characterized by long duration, simplicity at beginning versus complexity at advanced stages. Hemodialysis and peritoneal dialysis are renal replacement therapy allowing life extension, but comorbidities and frailty could be burdensome over time. The academic society, Société Francophone de Néphrologie, Dialyse, Transplantation (SFNDT), publishes clinical practice guidelines to optimize CKD treatment in this context, to support shared decision-making in the appropriate initiation of and withdrawal from dialysis, and to supervise end-of-life cares in the French-speaking countries.

La maladie rénale chronique (MRC) se caractérise par sa durée ­ 10 à 20 ans, parfois plus ­, sa simplicité aux stades initiaux, puis sa complexité aux stades avancés. Hémodialyse (HD) et dialyse péritonéale (DP) sont des traitements de suppléance d'une fonction vitale qui peuvent être réalisés pendant de nombreuses années. Les personnes dialysées vieillissent avec ce traitement et acquièrent avec l'âge des comorbidités parfois sévères et chroniques. Dans certains cas, l'état clinique est tellement altéré que le démarrage de la dialyse ou sa poursuite peuvent être discutés. Parfois, la dialyse peut même être considérée comme de l'obstination déraisonnable. Or, son interruption a pour conséquence la mort dans un délai fluctuant avec des symptômes très variés, dépendants de la diurèse résiduelle, des comorbidités, de l'état nutritionnel, etc. Le temps long qui caractérise la prise en charge de la MRC, et particulièrement la dialyse, doit permettre un cheminement et le recul nécessaires vers une adaptation raisonnée des thérapeutiques (ART en néphrologie), qui est l'objet de ce guide. Celui-ci comporte des situations cliniques qui servent de repères aux soignants dans leur pratique, des encadrés qui soulignent les principaux messages et préconisations, ainsi qu'un volet « Francophonie ¼ qui élargit la réflexion aux pays francophones où la législation de la fin de vie peut différer de celle de la France.

RADIOGRAPHIC EVALUATION OF CONSERVATIVE TREATMENT OF DISTAL RADIUS FRACTURES.

Objective: This article aims to evaluate the evolution of radio-graphic parameters (radial tilt, volar tilt, and radial height) of distal radius fractures in patients indicated for conservative treatment at three different times: date of diagnosis, first outpatient visit within 2 weeks after closed reduction, and last outpatient visit. Methods: We included 84 patients seen at the emergency department of Hospital Municipal Odilon Behrens, with a diagnosis of distal radius fracture and an indication for conservative treatment. We considered only those patients who had serial radiographs taken at least three different times (n=69) in this analysis. Results: There was an improvement in radiographic parameters of volar tilt after closed reduction and immobilization, which was maintained until the last outpatient visit. Radial inclination and radial height showed increased values from the first to the second radiographic evaluation and both values had regression when comparing the second to the third (last) evaluation. Conclusion: Universal classification stable fractures tend to evolve well with conservative therapy. Level of Evidence II; Development of Diagnostic Criteria in Consecutive Patients (with Gold Standard of Reference Applied).

Objetivo: O objetivo deste artigo foi avaliar a evolução dos parâmetros radiográficos (inclinação radial, inclinação volar e altura radial) das fraturas da extremidade distal do rádio em pacientes com indicação de tratamento conservador em três momentos diferentes: data do diagnóstico, primeira consulta ambulatorial dentro de. semanas após a redução fechada e última consulta ambulatorial. Métodos: Incluímos 84 pacientes atendidos no departamento de emergência do Hospital Municipal Odilon Behrens, com diagnóstico de fratura distal do rádio e indicação de. conservador. Consideramos nesta análise apenas os pacientes que tiveram radiografias seriadas realizadas pelo menos três vezes diferentes (n=69). Resultados: Houve uma melhora nos parâmetros radiográficos da inclinação volar após a redução fechada e a imobilização, que foi mantida até a última consulta ambulatorial. A inclinação radial e a altura radial apresentaram valores aumentados da primeira para a segunda avaliação radiográfica e ambos os valores tiveram regressão quando comparados da segunda para a terceira (última) avaliação. Conclusão: As fraturas estáveis de classificação universal tendem a evoluir bem com a terapia conservadora. Nível de Evidência II; Desenvolvimento de critérios diagnósticos em pacientes consecutivos (com aplicação de referência padrão ouro).

Conservative treatment of sexual dysfunction among men undergoing prostate cancer treatment: a systematic review.

INTRODUCTION: One of the changes caused by pelvic cancers is the decrease in patients' sexual function, which influences their quality of life (QoL) during and after treatment. Sexual dysfunction (SD) is associated with severe ejaculatory dysfunction, sexual dissatisfaction, reduced libido and sexual desire, decreased intensity of orgasm, difficulty in erection, and lower sexual frequency. OBJECTIVES: This systematic review investigated the effectiveness of conservative treatments (nonsurgical and nonpharmacologic) for SD in males with pelvic cancer. METHODS: Systematic searches were performed in the Cochrane Library, PubMed, CINAHL, PEDro, Embase, and VHL databases in September 2023 by using MeSH terms related to population, study design, intervention, and outcome. RESULTS: Only prostate cancer studies were included due to a lack of studies in other treatments. Studies used pelvic floor muscle training (8 studies); biofeedback (1 study); a penile vibrator (1 study); electrostimulation (2 studies); shock wave therapy (2 studies); aerobic, resistance, and flexibility exercises (2 studies); and a vacuum erection device (1 study). All articles assessed sexual function and reported improvements in the intervention group, including 5 with no differences between the groups. Articles involving shock wave therapy described improvements in SD but were not clinically relevant. Studies evaluating QoL reported benefits in the experimental groups. Adverse effects of a vacuum erection device and penile vibrator were reported. CONCLUSION: Conservative treatments are more effective than others in treating SD in men with prostate cancer. Further studies are needed to assess the unwanted effects of these treatments. In this study, we found evidence that this type of therapy improves sexual function and QoL in this population.

Chemical neurolysis for the conservative treatment of hip fractures.

Aim: Hip fracture management is challenging when surgical risks outweigh benefits. Inadequate analgesia from conservative treatments prompted new procedures targeting hip capsule denervation. This study evaluates the efficacy and safety of single injection chemical hip neurolysis in the pericapsular nerve group plane. Materials & methods: In eligible patients, an ultrasound-guided diagnostic block was performed using 5 ml of 2% lidocaine in the pericapsular nerve group plane. If positive, 6 ml of 99.9% alcohol was administered. Results: From May 2022 to May 2023, five patients underwent hip neurolysis. None reported pain at day 5 or during follow-up. There were no adverse effects. Conclusion: Chemical neurolysis seems to provide effective and safe conservative treatment for hip fractures, offering reliable analgesia for nonsurgical candidates.

Managing hip fractures is difficult, especially when surgery is too risky. Traditional pain relief methods often do not work well enough, so doctors are exploring new ways to reduce pain by targeting the nerves around the hip.In this study, we looked at a new technique called chemical neurolysis to see if it can safely and effectively relieve pain for people with hip fractures who can not have surgery.For this procedure, doctors first used a special technique to find the right spot near the hip using ultrasound. Then, they injected a small amount of a numbing medicine called lidocaine to see if it helped with the pain. If it did, they followed up by injecting alcohol to block the pain nerves more permanently.Between May 2022 and May 2023, five patients received this treatment. All of them reported no pain 5 days after the procedure and there were no negative side effects. We continued to check on them regularly to monitor their progress.In conclusion, chemical neurolysis appears to be a safe and effective way to manage hip fracture pain for patients who cannot undergo surgery, providing reliable pain relief without major risks.

Prediction and Mechanisms of Spontaneous Resorption in Lumbar Disc Herniation: Narrative Review.

The major symptoms of lumbar disc herniation (LDH) are low back pain, radiative lower extremity pain, and lower limb movement disorder. Patients with LDH suffer from great distress in their daily life accompanied by severe economic hardship and difficulty in self-care, with an increasing tendency in the aging population. PubMed and the Cochrane Central Register of Controlled Trials were searched for relevant studies of spontaneous resorption or regression in LDH after conservative treatment and for other potential studies, which included those from inception to June 30, 2023. The objective of this narrative review is to summarize previous literatures about spontaneous resorption in LDH and to discuss the mechanisms and influencing factors in order to assess the probability of spontaneous resorption by conservative treatment. Spontaneous resorption without surgical treatment is influenced by the types and sizes of the LDH, inflammatory responses, and therapeutic factors. If the lumbar disc herniated tissue comprises a higher percentage of cartilage or modic changes have been shown on magnetic resonance imaging (MRI), resorption in LDH is prevented. The bull's eye sign on enhanced MRI, which is a ring enhancement around a protruding disc, is a vital indicator for easy reabsorption. In addition, the type of extrusion and sequestration in LDH could forecast the higher feasibility of natural reabsorption. Moreover, the higher the proportion of protrusion on the intervertebral disc tissue within the spinal canal, the greater the likelihood of reabsorption. Therefore, which illustrates the feasibility of conservative treatments for LDH. Nonsurgical management of LDH with clinical symptoms is recommended by the authors.

Factors determining the short-term clinical outcomes of conservative treatment in patients with supraspinatus tear.

INTRODUCTION: To identify factors influencing the better and worse changes in the Western Ontario Rotator Cuff Index of patients undergoing conservative treatment for supraspinatus tendon tear. METHODS: The study included 30 patients with supraspinatus tendon tear who underwent conservative treatment. The average duration of intervention was 35.4 days. The Western Ontario Rotator Cuff Index, shoulder range of motion, isometric muscle strength, supraspinatus tendon thickness, thickness of the supraspinatus, infraspinatus, and teres minor muscles, and acromiohumeral interval were assessed before and after the intervention. In the statistical analyses, change in the Western Ontario Rotator Cuff Index was the dependent variable, and the amount of change in each measurement variable before and after the intervention was the independent variable. RESULTS: The average Western Ontario Rotator Cuff Index improved from 1067 at pre-treatment to 997 at post-treatment, but without a significant difference (p = 0.29). A multiple regression analysis revealed that supraspinatus tendon thickness and muscle strength in shoulder external rotation at 90° scaption had a significant effect on the change in the Western Ontario Rotator Cuff Index (R2 = 0.44, p < 0.01). CONCLUSION: Supraspinatus tendon thickness and muscle strength in shoulder external rotation at 90° scaption were important factors for the Western Ontario Rotator Cuff Index score in the early stages of conservative treatment for patients with supraspinatus tendon tear.

Stumped by a Case of Appendicitis After Appendectomy.

Background: Stump appendicitis-a rare, delayed complication of appendectomy-is most commonly managed with surgical exploration and stump appendectomy. Conservative management in the pediatric population is poorly characterized in the literature. Case Report: We report a case of a 10-year-old male who was diagnosed with stump appendicitis and initially treated nonoperatively. He received intravenous antibiotics and supportive therapy while in the hospital, was discharged on a course of oral antibiotics, and remained asymptomatic for the following 9 weeks until he underwent an elective interval stump appendectomy. We also review the literature on this uncommon condition and treatment plan. Conclusion: Considering stump appendicitis in the differential of children with history of appendectomy is imperative. Nonoperative management of stump appendicitis may be successful and beneficial in select pediatric cases compared to the standard surgical management.

The efficacy of shoes modification and orthotics in hallux valgus deformity: a comprehensive review of literature.

Hallux valgus (HV) is a frequent forefoot deformity affecting about 23% of adults and 35.7% of people over 65. The exact etiology is not fully understood. The first ray plays a significant role in walking cause it bears the principal amount of weight and maintains the position of the medial arch. Several factors that deteriorate the integrality of the first ray, such as foot deformities, restrictive footwear, and pes planus, may be ascribed to the HV occurrence. Before any surgical correction, conservative treatment should always be initiated first. Currently, there is no consensus that conservative management by shoe modification and foot orthoses could correct the pathology or terminate the clinical worsening of the condition.From a careful analysis of the literature, proper footwear should be a shoe with an adequate length, wide toe box, cushioned sole, and a lowered heel to not increase the load on the metatarsal heads and cause pain. Personalized 3D printed customized toe spreaders may be applied in patients with HV, improving symptoms and bringing pain relief. Compensating the subtalar joint hyperpronation through foot orthoses plays a fundamental role in the HV development, preventing or at least controlling the condition's progress; this, along with weight reduction and regular physical activity.Data obtained suggest that dynamic foot orthoses prefer a biomechanical type with 3/4-length, which is less likely to negatively affect the dorsal or medial pressures, which instead were noted to increase with the sulcus- and full-length orthoses.Although some studies suggest that foot orthoses would favor the correction of HV deformity, results have been very variable and just in few studies appear to correct HV or reduce its progression, improving symptoms and bringing pain relief. In the case of HV surgical correction, orthoses seem to maintain the correct position acquired over time.

Withholding or withdrawing life support in nephrology: a perspective in the French-speaking background / Adaptation raisonnée des thérapeutiques (ART en néphrologie) - Guide pratique LAT-MRC1.

Chronic kidney disease (CKD) characterized by long duration, simplicity at beginning versus complexity at advanced stages. Hemodialysis and peritoneal dialysis are renal replacement therapy allowing life extension, but comorbidities and frailty could be burdensome over time. The academic society, Société Francophone de Néphrologie, Dialyse, Transplantation (SFNDT), publishes clinical practice guidelines to optimize CKD treatment in this context, to support shared decision-making in the appropriate initiation of and withdrawal from dialysis, and to supervise end-of-life cares in the French-speaking countries.

La maladie rénale chronique (MRC) se caractérise par sa durée ­ 10 à 20 ans, parfois plus ­, sa simplicité aux stades initiaux, puis sa complexité aux stades avancés. Hémodialyse (HD) et dialyse péritonéale (DP) sont des traitements de suppléance d'une fonction vitale qui peuvent être réalisés pendant de nombreuses années. Les personnes dialysées vieillissent avec ce traitement et acquièrent avec l'âge des comorbidités parfois sévères et chroniques. Dans certains cas, l'état clinique est tellement altéré que le démarrage de la dialyse ou sa poursuite peuvent être discutés. Parfois, la dialyse peut même être considérée comme de l'obstination déraisonnable. Or, son interruption a pour conséquence la mort dans un délai fluctuant avec des symptômes très variés, dépendants de la diurèse résiduelle, des comorbidités, de l'état nutritionnel, etc. Le temps long qui caractérise la prise en charge de la MRC, et particulièrement la dialyse, doit permettre un cheminement et le recul nécessaires vers une adaptation raisonnée des thérapeutiques (ART en néphrologie), qui est l'objet de ce guide. Celui-ci comporte des situations cliniques qui servent de repères aux soignants dans leur pratique, des encadrés qui soulignent les principaux messages et préconisations, ainsi qu'un volet « Francophonie ¼ qui élargit la réflexion aux pays francophones où la législation de la fin de vie peut différer de celle de la France.

The treatment, outcomes and management of hand, wrist, finger, and thumb injuries in the professional/amateur contact sport athletes: A scoping review.

INTRODUCTION: Amateur and professional participation in sport and physical activity worldwide is increasing in popularity, which in turn is increasing the volume and types of injuries sustained by athletes. Ensuring these injuries are treated appropriately and efficiently is paramount for athletes' recovery and return to sport in a timely and safe manner. METHODS: A scoping review to map the evidence regarding the treatment, outcomes and management of hand, wrist, finger, and thumb injuries in the professional/amateur athlete from contact sports. A search of seven electronic databases; SPORTdiscus, CINAHL, Medline, Scopus, Web of Science, Embase and Cochrane Library and grey literature was conducted in January 2024. The reporting of the review is in line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews Checklist. Inductive content analysis was used to examine the data and the Critical Appraisal Skills Programme was used to appraise the quality of the included studies. RESULTS: Eight papers met the inclusion criteria and three themes emerged addressing the return to play/sport, surgical and conservative treatment and the most common/reoccurring injuries sustained from contact sports. CONCLUSION: Managing hand, wrist, finger, and thumb injuries in athletes requires a varied approach depending on the type of injury, treatment options, and external pressures. While conservative treatment is common and effective, surgical intervention may be necessary in certain cases to improve recovery and facilitate a faster return to sport. Preventive measures in high-risk sports settings could help reduce the incidence of these injuries.

The Role of Rehabilitation after Spinal Mesotherapy in a Three-Stage Treatment Concept.

Sedentary lifestyles, work overload, and lack of regular physical activity are risk factors for spinal pain syndrome. In everyday medical practice, spinal pain syndrome of a muscular or myofascial, or non-neurogenic, nature is diagnosed. This problem affects a large group of patients and reaches about 70-80% of spinal pain cases. Usually, one of the primary treatments is with NSAIDs (Non-steroidal Anti-Inflammatory Drugs). In this case, one treatment method that is safe and has no side effects is spinal mesotherapy. This method consists of performing multi-point intradermal microinjections with the administration of drugs or medical devices. Based on a new perspective on the treatment of spinal pathology-the so-called three-stage treatment concept-it is necessary to deal with the risk factor(s) of spinal pain syndrome and reduce or at least modify them (stage I). This is followed by a broadly understood medical therapy, in this case spinal mesotherapy (stage II), which aims to relax tense tissues, improve mobility in the spine and thus reduce pain. As a result, conditions are created for the necessary process, which is rehabilitation in the broadest sense (stage III). Movement therapy, which is crucial in spinal pain syndrome, is performed with less pain, after obtaining better patient mobility. The purpose of this article is to evaluate the role of rehabilitation of patients after spinal mesotherapy in terms of the three-stage treatment concept for spinal pathology.

The Use of Physiotherapy in the Conservative Treatment of Cubital Tunnel Syndrome: A Critical Review of the Literature.

BACKGROUND: The lack of a clear answer regarding the efficacy of physiotherapy in the treatment of cubital tunnel syndrome (CuTS) has led to attempts to critically assess the scientific studies conducted to date. MATERIALS AND METHODS: Two databases (MEDLINE via PubMed and PEDro) and Google Scholar were used to search for papers. The inclusion criteria were randomized controlled trials, case series, and case reports that evaluate the effects of physiotherapy in the treatment of patients with CuTS. RESULTS: A total of 18 studies met the eligibility criteria, capturing a total of 425 participants. Seven papers were randomized controlled trials, three more described prospective studies without a control group, and eight papers contained case reports. An analysis of the literature evaluating the effectiveness of various forms of broadly defined physiotherapy indicates that their use can have a beneficial effect in reducing many subjective and objective symptoms and improving function. In the majority of papers included in this review, their authors indicated positive therapeutic effects. Only one randomized controlled trial reported no change following therapy. It can therefore be stated that the results of the research conducted so far are optimistic. However, only 7 of the 18 papers were randomized controlled trials, while 3 were prospective studies, and 8 papers were case studies, in which 23 people with CuTS were studied. CONCLUSIONS: The small number of randomized clinical trials and their considerable heterogeneity do not allow firm conclusions to be drawn about the effectiveness of physiotherapy in the conservative treatment of CuTS.

Case report: Spontaneous regression of extruded lumbar disc herniation with acupuncture therapy.

Most patients with lumbar disc herniation (LDH) derive benefit from conservative treatment, prompting growing global interest in non-surgical approaches. Despite being recognized as one of the effective conservative therapies, there is currently limited evidence to support the sole efficacy of acupuncture in treating patients with acute extruded LDH. Here we report the case of a 52-year-old male who presented with low back pain and persistent radiating lower limb pain and numbness. Physical examination and magnetic resonance imaging (MRI) revealed an extruded LDH at the L5/S1 level, compressing the nerve root and causing severe radiculopathy symptoms. After 23 days of continuous inpatient acupuncture treatment, followed by 5 intermittent outpatient acupuncture treatment over 2 months, patient's pain and numbness was significantly alleviated and a followed-up MRI showed a remarkable regression of the extruded disc fragment. In this case, acupuncture as a monotherapy is safe and effective, but more conclusive evidence is needed.

Management of deceased and living kidney donor with lithiasis: a multicenter retrospective study on behalf of the renal transplant group of the Spanish urological association.

BACKGROUND: To maximize the availability of suitable grafts and ensure effective management, several reports have demonstrated successful outcomes when using kidney grafts with urolithiasis. This multicenter study reports on the management and long-term outcomes of kidney transplantation using renal grafts with lithiasis. METHODS: Retrospective data from three Spanish hospitals were analyzed for kidney transplants involving grafts with nephrolithiasis performed between December 2009 and August 2023. The study included adult patients, excluding those with incomplete records. It evaluated stone characteristics, complications, and outcomes in recipients and in living kidney donors. RESULTS: Out of 38 analyzed kidney transplants, 57.9% were cadaveric and 42.1% were from living kidney donors. Most diagnoses were incidental during donor evaluation, with an average stone size of 7.06 mm. After follow-up (median 26 months), all recipients but one had functioning grafts, and there were no stone recurrences in both recipients and living kidney donors. Conservative management was adopted in 28 cases, while 10 cases required ex-vivo flexible ureterorenoscopy for stone removal. Following conservative management, 5 patients needed additional treatments for stone-related events. CONCLUSIONS: Kidneys with lithiasis can be considered for transplantation in selected cases, resulting in good functional outcomes with no stone recurrence in recipients or living donors.

A case of successful treatment of medication-related osteonecrosis of the jaw with conservative treatment for pathological mandibular fracture.

INTRODUCTION: Surgical therapy is effective for medication-related osteonecrosis of the jaw. However, appropriate conservative treatment options are still important for cases in which surgery is contraindicated. We report a case of medication-related osteonecrosis of the jaw successfully treated conservatively for a pathological mandibular fracture. PRESENTATION OF CASE: An 84-year-old female patient presented to our department with a chief complaint of inadequate healing of an extraction tooth socket. She had been taking minodronic acid hydrate for approximately five years for osteoporosis. The clinical examination revealed erythema, diffuse swelling of the left mandibular angle, erythema of the buccal gingiva adjacent to the left mandibular first molar, and fistula formation. Although surgery was recommended, the patient declined to proceed. Therefore, a conservative treatment was initiated. A pathological fracture of the inferior mandibular margin was observed one month after the initial visit. Mouth opening was restricted for six months using a bandage. Two months after the pathological fracture, the inferior margin of the fracture was aligned. Five months later, the inferior margin continued. One year later, the bony union of the fracture was observed. DISCUSSION: Conservative treatment and restricting mouth opening was effective in our case. Three years and seven months after the pathological fracture, no new sequestrum formation was observed, and the patient was doing well. CONCLUSION: Conservative treatment can be effective for medication-related osteonecrosis of the jaw with severe cases.

Predictors of early mortality following surgical or nonsurgical treatment of subaxial cervical spine fractures: a retrospective nationwide registry study.

BACKGROUND: Traumatic subaxial cervical spine fractures are a significant public health concern due to their association with spinal cord injuries (SCI). Despite being mostly caused by low-energy trauma, these fractures significantly contribute to morbidity and mortality. Currently, research regarding early mortality based on the choice of treatment following these fractures is limited. Identifying predictors of early mortality may aid in postoperative patient monitoring and improve outcomes. PURPOSE: This study aimed to identify predictors of 30-days, 90-days, and 1-year mortality in adults treated for subaxial fractures. STUDY DESIGN: A retrospective review of the nationwide Swedish Fracture Register (SFR). PATIENT SAMPLE: All adult patients in the SFR who underwent treatment for a subaxial cervical fracture (n = 1,963). OUTCOME MEASURES: Analyzed variables included age, sex, injury mechanism, neurological function, fracture characteristics, and treatment type. The primary endpoints were 30-days, 90-days, and 1-year mortality. METHODS: About 1,963 patients in the SFR, treated for subaxial cervical fractures between 2013 and 2021, were analyzed. Surgical procedures included anterior, posterior, or anteroposterior approaches. Nonsurgical treatment included collar treatment or medical examinations without intervention. Stepwise regression and Cox regression analysis were used to determine predictors. Model performance was tested using the area under the receiver operating characteristic curve (AUC). RESULTS: 620 patients underwent surgery and 1,343 received nonsurgical treatment. Surgical cases had primarily translation fractures, with 323 (52%) displaying no neurological deficits. Mortality rates at 30 days, 90 days, and 1 year were 22/620 (3.5%), 35/620 (5.6%), and 53/620 (8.5%), respectively. Age and SCI were predictors of mortality. Nonsurgically treated patients mostly had compression fracture, with 1,214 (90%) experiencing no neurological deficits. Mortality rates at 30 days, 90 days, and 1 year were 41/1,343 (3.1%), 71/1,343 (5.3%), and 118/1,343 (8.7%). Age, male sex, SCI and fractures occurring at the C3 or C6 levels were predictors of mortality. An intact neurological function was a positive predictor of survival among nonsurgically treated patients (AUC >0.78). CONCLUSIONS: Age and SCI emerged as significant predictors of early mortality in both surgically and nonsurgically treated patients. An intact neurological function served as a protective factor against early mortality in nonsurgically treated patients. Fractures at C3 or C6 vertebrae may impact mortality.