ABSTRACT
Aims: The standard of wide tumour-like resection for chronic osteomyelitis (COM) has been challenged recently by adequate debridement. This paper reviews the evolution of surgical debridement for long bone COM, and presents the outcome of adequate debridement in a tertiary bone infection unit. Methods: We analyzed the retrospective record review from 2014 to 2020 of patients with long bone COM. All were managed by multidisciplinary infection team (MDT) protocol. Adequate debridement was employed for all cases, and no case of wide resection was included. Results: A total of 53 patients (54 bones) with median age of 45.5 years (interquartile range 31 to 55) and mean follow-up of 29 months (12 to 59) were included. In all, ten bones were Cierny-Mader type I, 39 were type III, and five were type IV. All patients were treated with single-staged management, except for one (planned two-stage stabilization). Positive microbial cultures grew in 75%. Overall, 46 cases (85%) had resolution of COM after index procedure, and 49 (90.7%) had resolution on last follow-up. Four patients (7%) underwent second surgical procedure and six patients (11%) had complications. Conclusion: We challenge the need for wide tumour-like resection in all cases of COM. Through detailed preoperative evaluation and planning with MDT approach, adequate debridement and local delivery of high concentration of antibiotic appears to provide comparable outcomes versus radical debridement.
ABSTRACT
Purpose: Nonunion of fractures occurs in about 15% of all fractures causing repeated surgical interference and prolonged morbidity. We performed this systematic review to assess genes and polymorphisms influencing fractures' nonunion (FNU). Methods: We searched between 2000 and July 2022 in PubMed, EMBASE, the Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews, Genome Wide Association Studies (GWAS) Catalog, and the Science Citation Index, with the keywords nonunion of fractures, genetic influence, and GWAS. The exclusion criteria were review articles and correspondence. The data were retrieved to determine the number of studies, genes, and polymorphisms and the total number of subjects screened. Results: A total of 79 studies were reported on nonunion of fractures and genetic influence. After the inclusion and exclusion criteria, ten studies with 4402 patients' data were analyzed. Nine studies were case-controlled, and 1 GWAS. It was identified that patients with polymorphisms in the genes ANXA3, BMP2, CALY, CYR61, FGFR1, IL1ß, NOG, NOS2, PDGF gene, and TACR1 are prone to develop a nonunion of fractures. Conclusion: We believe that for patients who develop an early nonunion of fractures, a genetic study should be conducted for single nucleotide polymorphism (SNP) and genes so that alternative and more aggressive treatment can be performed to heal fractures without prolonged morbidity.
ABSTRACT
BACKGROUND AND OBJECTIVE: Recent studies have shown that vitamin D plays an important role in many disease processes. However, data is lacking which correlates the common symptoms attributed with vitamin D levels. This study was undertaken to find the correlation of symptoms and Vitamin D levels among ethnic Saudi Arabian population. METHODS: A structured questionnaire was made and translated in the Arabic language, which included, age, weight and height, ethnicity and marital status. Patients who were visiting orthopaedic clinics for the first time were included after a detailed history, which ruled out any associated metabolic conditions. Patient's biometric data and the answering of the questionnaire were conducted by one of the senior members of the research group. The symptoms which were included in the questionnaire were fatigue, muscle cramps, joint and back pain, blood sugar levels, recurrent infections, hair loss, mood swings, weight gain, irritable bowel, fractures and history of malignancy. All the scores were graded between 1 and 9 (mildest 1 and severe 9) and only for fracture and malignancy it was yes/no answer. A score of ≤4 was accepted as no impact of the vitamin D levels on symptoms and answer of ≥5 was accepted as impact on the symptoms. Residents whose mother tongue was Arabic conducted all interviews. Blood was collected for 25 OHD levels, calcium and parathyroid hormone levels. Deficiency of vitamin D was defined as ≤20 ng/ml, insufficiency 21-29 ng/ml and normal level ≥30 ng/ml. The data was entered in the data base and analyzed using SPSS Inc Version 20. RESULTS: Two hundred one patients completed the questionnaire but for final analysis the data of 187 was available for analysis as in 14 patients some of the data was missing. All were females and the average age was 55.9 ± 12.4 years, weight 78.9 ± 14.2 kg and height was 1.56 ± 7.01 m. The mean calcium level was 9.12 ± 0.33 mg/dl and, parathyroid hormone was 8.1 ± 6.06 pc/ml. The average 25 hydroxy vitamin D3 (25OHD) level was 21.8 ± 10.22 ng/ml. Forty-four (23.5%) of women had a normal vitamin D level, 51 (27.27%) had insufficiency and 92 (49.19%) had deficiency. Patients who complained of muscle cramps had 25OHD level of 18.86 ± 8.73 compared to patients who had no complains of cramps, 23.45 ± 9.2 ng/ml (p < 0.001) and symptom severity score (SSC) p value of p < 0.000. The results were similar for fatigue, Back pain, hair loss, mood swings and weight gain of P < 0.04, p < 0.07, p < 0.05, <0.03 and p < 0.09 for vitamin D levels and p < 0.001 for SSS. Forty-eight (25.6%) had a previous fracture in their history. CONCLUSIONS: This study shows that many symptoms, which have been attributed to low vitamin D levels, are not true. Muscle Cramps, fatigue, mood swings, hair loss, back pain and weight gains appears to be more common in patients with low 25OHD levels.