Idiopathic Osteosclerosis and Condensing Osteitis in a Sample of the Lebanese Population: A Digital Panoramic Based Study.

Background: Idiopathic osteosclerosis (IO) is an area of enlarged bone production in the jaw that usually appears radiopaque and round, elliptical, or irregular in shape. Condensing osteitis (CO) is a focalized osseous reaction leading to periapical sclerotic bone growth. Objective: The aim of this study was to investigate the prevalence, localization, shape, and dental relationship of IO and CO in a group of Lebanese patients and to correlate these findings to age and gender. Methods: 520 digital panoramic radiographs of patients (215 men and 305 women) ranging in age from 18 to 77 (mean age 40.89 years) who visited the Faculty of Dental Medicine, Lebanese University, for dental treatment were included in this study and assessed for IO and CO. The prevalence of the two lesions according to gender and age, as well as their localization, and dental relationship, were recorded and saved in an Excel sheet. Results: Among the 520 radiographs, 47 (9%) showed IO, and 30 (5.8%) showed CO. Both lesions are more frequent among females in their third decade and are essentially found in the mandible, mainly in relation to the root apices. Conclusion: Within the limits of this study, we concluded that in our sample of the Lebanese population, the prevalence of IO and CO is low and supports the theory that IO can be defined as developmental variations of normal bony architecture unrelated to a local stimulant, and CO could be considered reactive bone formations related to pulpitis, deep restoration, or caries.

Incidence of calcaneal apophysitis (Sever's disease) and return-to-play in adolescent athletes of a German youth soccer academy: a retrospective study of 10 years.

BACKGROUND: Calcaneal apophysitis, or Sever's disease, is the most common cause of heel pain in childhood and adolescence. It is regarded as an overuse syndrome. Studies on the incidence of calcaneal apophysitis in young athletes and their associated return-to-play time are lacking in the current literature. The aim of our current study was to identify the incidence of calcaneal apophysitis in professional youth soccer, the associated time to return-to-play, predisposing factors and their impact on time to return-to-play. METHODS: Retrospective evaluation of injury data gathered from a German youth soccer academy in the years 2009-2018. In total, 4326 injury cases in 612 players were included in the study. The diagnosis and the follow-up visits were carried out in a weekly consultation hour at the youth academy. RESULTS: During the observation period of 10 years, 22 cases of calcaneal apophysitis were detected. The incidence of calcaneal apophysitis per 100 athletes per year was found to be 0.36. The mean age of the affected athletes at the time of diagnosis was 11.8 ± 2.1 years (MW ± SD). The complaints were unilateral in 20 and bilateral in two cases. Three of the 22 detected cases of calcaneal apophysitis (13.6%) were recurrent injuries. The mean time to return-to-play of the affected athletes was 60.7 ± 64.9 days (MW ± SD). Athletes with recurrent complaints showed longer recovery time and time to return-to-play when compared to players with primary diagnosed disease. Our results could show that neither age nor body mass index at the time of diagnosis had an impact on time to return-to-play. CONCLUSIONS: This is the first study investigating the incidence of calcaneal apophysitis and the associated time to return-to-play in youth elite soccer. Calcaneal apophysitis results in substantial time loss for the athletes. Further prospective clinical studies are required to fully understand the etiology and risk factors for calcaneal apophysitis and therefore develop preventive strategies.

Osteitis condensans ilii: prevalence and characteristics of a neglected mimic of sacroiliitis.

OBJECTIVES: Osteitis condensans ilii (OCI) is a benign condition characterised by triangular sclerosis of the iliac bone which may mimic radiographic sacroiliitis. Prevalence is estimated between 0.9 and 2.5%, with female predominance, but the most recent article reporting original epidemiological data in the general population was published in 1971. The aim of our study is to contribute updated figures about prevalence of OCI in Italy. METHOD: A retrospective review of pelvic radiographs was conducted. Consecutive patients visiting the emergency department of our Institution between 1st January and 31st December 2020 were enrolled. Individuals with a past diagnosis of axial spondyloarthritis were excluded. Presence of OCI was evaluated by two musculoskeletal radiologists. Clinical and radiologic features such as osteoarthritis and insertional enthesopathy were also assessed. RESULTS: We included 1047 individuals (61% female) with a median age of 74 years. OCI was present in 10 cases, accounting for a prevalence in the general population of 1.0% (95% CI 0.5-1.7). All patients with OCI were women and, in the female sample, prevalence was 1.6% (95% CI 0.7-2.8). Clinical characteristics and associated radiographic features were not different between patients with OCI and women without OCI. CONCLUSIONS: The prevalence of OCI observed in our study is consistent with previous literature, and we confirm that it is more frequently retrieved in women. Longitudinal research is warranted to elucidate the evolution, while knowledge about the disorder is needed to raise the awareness of rheumatologists and radiologists and to properly identify and report the condition. Key Points • OCI may mimic sacroiliitis and is a major differential diagnosis of radiographic axial spondyloarthritis. • Prevalence of OCI in our sample is 1.0%, in line with previous literature. • OCI predominantly affects women, and our study suggests that the disorder can be incidentally identified even after childbearing age. • Increased awareness of the characteristics of OCI can facilitate identification and reporting of the disorder.

Clinical characteristics and treatment status of pustulotic arthro-osteitis: A single-center study involving 51 cases.

Pustulotic arthro-osteitis (PAO) is a major complication of palmoplantar pustulosis (PPP). In orthopedic surgery outpatient clinics, PPP patients with osteoarticular symptoms are seen frequently, but PAO's clinical features remain not well known. To determine Japanese patients' clinical features and treatment status with PAO, we conducted a single-center retrospective epidemiologic survey. Clinical features, including gender, age, smoking habit, the onset pattern, interval between skin manifestation and osteoarticular symptoms, and the incidence of sternoclavicular joint lesions, axial and peripheral joint lesions, were examined. The association between physical status and image findings by X-ray, computed tomography, bone scintigraphy with Technetium99 , or magnetic resonance imaging was evaluated. The distribution pattern of peripheral joint lesions and the treatment status were evaluated. We identified 51 patients, 10 men and 41 women, with PAO. The average age was 48 years and 59% were smokers. The frequency of onset patterns was skin-leading type (63%), simultaneous onset (18%), and osteoarticular leading type (16%). The average interval between skin involvement and osteoarticular involvement in skin-leading type was significantly longer than that in osteoarticular leading type (7.1 years vs. 2.0 years). A sternoclavicular joint (SCJ) lesion was detected in 65% cases, and the physical findings of SCJ were significantly related to the image findings. Axial and peripheral joint lesions were detected in the same ratio (23 cases, 45%). In the peripheral joints, the finger joint was the most common (26%), followed by the shoulder joint (21%). Patients were treated with nonsteroidal anti-inflammatory drugs (76%), followed by conventional synthetic disease-modifying antirheumatic drugs (DMARDs) (29%) and biological DMARDs (9.8%). Tonsillectomy was performed in 11 cases. In conclusion, PAO more frequently involves SCJ in middle-aged women who smoke. Given that osteoarticular leading type was detected in 16% cases, seronegative oligoarthritis patients should be monitored for PPP, leading to a diagnosis of PAO.

Radiographic evaluation of reactive osteitis in traumatic injury of sacroiliac joints.

OBJECTIVES: After traumatic Sacroiliac (SI) joint injury, follow up radiographic imaging can demonstrate subchondral bone resorption resembling inflammatory sacroiliitis. No studies have described the incidence of marginal SI post-traumatic osteitis, the probable temporal relationship to the initial traumatic injury, or the possible effect of unilateral hardware fixation on the contralateral SI joint. METHODS: A Level 1 trauma center imaging database was queried to identify patients with pelvic bony trauma between 2005 and 2017 with CT baseline preserved SI cortication and unilateral/bilateral traumatic SI diastasis. Serial radiographs were retrospectively evaluated by 2 musculoskeletal-trained radiologists at initial, 6 weeks, 3 months and 6 months following trauma, with documentation of diastasis, subchondral resorption, and operative fixation. RESULTS: 206 SI joints in 106 total patients met inclusion criteria. There was a statistically significant association between injury and presence of resorption at 6 weeks post-trauma for the right SI joint only. There was no other statistically significant relationship between injury and presence of resorption at any other post-trauma evaluation. There was no statistical relationship between resorption and surgical fixation. There was a statistically significant increased incidence of resorption in the post-traumatic population when compared to an atraumatic population undergoing CT pelvis study for non-SI related indications as well as compared to the incidence of inflammatory sacroiliitis in a general population. CONCLUSIONS: This study confirms an incidence of sub-acute subchondral bone resorption following traumatic joint injury above that expected for a general, non-traumatic population. Accurate interpretation of this traumatic finding minimizes inappropriate consultation and intervention for inflammatory sacroiliitis.

[Osteoarticular infections in patients with sickle cell disease in Lubumbashi: epidemiological study focusing on etiology and management]. / Les infections ostéo-articulaires chez les drépanocytaires à Lubumbashi: étude épidémiologique, étiologie et prise en charge.

INTRODUCTION: infections are the leading cause of morbidity and mortality in patients with sickle cell disease, especially before age 5 years. The purpose of this study was to highlight the epidemiological features, etiologies and management of osteoarticular infections in patients with sickle cell disease in Lubumbashi. METHODS: we conducted a descriptive, cross-sectional and retrospective study at the Research Center for Sickle Cell Disease in Lubumbashi (RCSCDL) over a three-year period from June 2014 to June 2017. It included all patients with sickle cell disease on follow up at the RCSCDL who developed osteoarticular infection. Data were obtained from a survey form. Parameters were patient's age, age at first visit, sex, reason for consultation, history, physical signs, diagnosis, paraclinical assessment and treatment. RESULTS: we identified 35 cases of osteoarticular infections out of a total of 380 cases of sickle-cell disease, reflecting a rate of 9.2%. The most affected age group was people under 5 years of age (37.1%); the average age was 10.9±9.5 years ranging from 8 months and 37 years. There was a slight female predominance (51.4% of cases; sex ratio 1.06 in favor of women). Most patients with osteoarticular infection had a history of transfusion (16.6%) and splenectomy (8.6%). The most common reason for consulting was limb pain (84%); 20 patients (57.1%) had bulbar conjunctival icterus and 26 (74.3%) were pale. Clinical examination showed limb swelling and wound in 27 patients (77.1%) and 19 patients (54.3%), respectively. Clinical palpation of the splenomegaly was performed in 6 patients (17.1%). Three types of osteoarticular infections were detected. They were dominated by osteomyelitis (24 cases; 68.57%) followed by osteitis (7 cases; 20%) and suppurative arthritis (4 cases; 11.43%). Out of 24 cases of osteomyelitis, 18 were acute (75%) and 6 were chronic (25%), of which 4 had a hyperostosing behaviour and 2 a fistulising behaviour. Tibia was the most affected bone (18 cases), X-ray mainly showed osteolysis (27 cases; 77.1%) and then periosteolysis (15 cases; 42.9%). Homozygous sickle cell disease was found in 88.6% of cases. Hemoculture was performed in 17 out the 35 patients and salmonella was isolated in 15 out of 17 cultures (88.23%). Pyoculture was performed in 10 patients; it isolated other germs. Assessment of inflammation was performed in 21 patients: 15 had hyperleukocytosis, 13 pathological white blood cell formula , all had increased sedimentation rate (greater than 20mm in the 1st hour). With respect to immunization schedule, 62.86% of patients received EPI vaccines while patients with sickle cell disease who needed specific vaccine had an adherence rate of 17.14%. With respect to therapy, all of our patients received medical treatment; 6 patients underwent sequestrectomy (17.14%) while the majority of patients (25 cases) underwent orthopedic treatment. Conclusion: bone infection in patients with sickle cell disease is a worryng issue in our poor environment where there isn't a specific vaccine for patients with sickle cell disease.

The sixty-year story of Finnish Bacillus Calmette-Guérin (BCG) osteitis.

AIM: A review published in 2015 showed that 331 Bacillus Calmette-Guérin (BCG) osteitis cases were globally reported in 1976-2012. The 222 Finnish cases from 1960 to 1988 formed two-thirds of all cases. The present narrative review summarises epidemiological, clinical and immunological findings obtained from this Finnish cohort in relation to data from other countries. METHODS: Six reports including 93 BCG osteitis cases, which were not included in the 2015 review, were identified from PubMed. RESULTS: In all, 424 BCG osteitis cases have been published. Population-based data were available only from Finland and Taiwan. The BCG osteitis incidence in Finnish infants was 6.4/100 000/year in 1960-1988 compared to 3.4/100 000/year in Taiwanese infants in 1998-2012. The incidence in Finland increased to 36.9/100 000 in 1971-1977, and the vaccinations were temporarily discontinued. Over half of lesions were in lower limbs and nearly all were solitary in both cohorts. The outcomes after surgery and chemotherapy were good. Immunology of BCG osteitis was studied only in the Finnish cohort. There were deviations from population data in polymorphisms of genes regulating Toll-like receptors 1, 2 and 6, mannose-binding lectin and interleukin-17A. CONCLUSION: BCG osteitis after vaccination is rare. Preliminary findings in innate immunity raise a question of genetic background.

Characteristics of Japanese patients with pustulotic arthro-osteitis associated with palmoplantar pustulosis: a multicenter study.

BACKGROUND: Pustulotic arthro-osteitis (PAO) is a major comorbidity of palmoplantar pustulosis (PPP), which is frequently seen in Japanese patients. To determine the characteristics of Japanese patients with PAO, we conducted a multicenter, retrospective epidemiologic survey at four university hospitals. METHODS: Clinical features including age, gender, duration of disease, extrapalmoplantar lesion, smoking habit, focal infection, site of joint pain, bone scintigraphy with Technetium99 , and therapies were retrospectively evaluated. RESULTS: In total, 165 patients with PAO were identified among 576 patients with PPP (28.6%). The male to female ratio was 1 : 3.7, and the mean age was 50.2 years. The mean disease duration of PAO was 6.0 years. Smoking habit was observed in 104 patients. Focal infection was detected in 74 patients, who developed tonsillar infection (n = 41), sinusitis (8), odontogenic infection (40), and others (2). Fifteen patients had multifocal infection. Technetium bone scintigraphy was performed in 97 cases. Increased uptake was most frequently observed in the sternocostoclavicular regions, followed by wrist and ankle, sacroiliac joint, knee and elbow, finger and toe, lumbar spine, thoracic spine, scapula, and thigh. Patients were mainly treated with nonsteroidal anti-inflammatory drugs, methotrexate, cyclosporine, antibiotics, and biologics, as well as tonsillectomy and dental treatment. CONCLUSION: PAO frequently involves the anterior chest wall of middle-aged women with smoking habit and is closely associated with focal infection.

Complications associated with hexapod circular fixation for acute fractures of the tibia diaphysis: A retrospective descriptive study at a high volume trauma centre.

The use of hexapod circular external fixation in acute tibia fracture care is increasing as more general orthopaedic surgeons are gaining expertise with the use of this treatment modality. Limited data is currently available on the complications that may be encountered with this treatment strategy. AIM: To review the complications and outcomes of acute diaphyseal tibia fractures definitively treated with hexapod circular external fixation at a high volume orthopaedic trauma centre. METHODS: Retrospective review of clinical and radiological data of adult patients with acute diaphyseal tibia fractures treated with hexapod external fixation between 2012 and 2015 at a single centre. RESULTS: A total of 102 diaphyseal fractures were definitively treated with hexapod circular external fixation. Union was achieved in 101 cases with an average time to union of 25.6 weeks. Complications included pin site infection (56%); wound complications (19.67%); osteitis (11.76%); malunion (15.69%) and knee and ankle joint contractures (31.32%). CONCLUSION: Hexapod circular external fixation as definitive treatment of for diaphyseal tibia fractures demonstrates an excellent union rate with acceptable time to union. Complications rates are comparable to that of all fine wire circular fixators. Malalignment in is however a concern, considering that this device enables the surgeon to achieve accurate alignment through gradual deformity correction aided by computer software.

Association between cam-type femoroacetabular impingement and osteitis pubis in non-athletic population on magnetic resonance imaging.

BACKGROUND: Osteitis pubis (OP) is a common source of groin and extra-articular hip pain and is associated with intra-articular hip pathology. In this study, we aimed to determine the prevalence of osteitis pubis on magnetic resonance imaging (MRI) in non-athletic patients with cam-type femoroacetabular impingement (FAI). METHODS: This retrospective cross-sectional study included 178 subjects: 90 patients with cam-type FAI diagnosed by MRI and 88 subjects used as a control group. Additionally, their MRI data were analyzed for the characteristics of osteitis pubis, with severity graded from minimal to severe on a four-point scale. RESULTS: A total of 98 patients and 88 controls were studied. Seventy-two males (80%) and 18 females (20%) were the patient group, whereas 71 males (80.68%) and 17 females (19.32%) were the control group. The mean alpha angle of the patients with FAI was 65.8 ± 3.3° in the right side and 66.2 ± 3.2° in the left side, whereas in the control group, it was 47 ± 5.6° in the right side and 47.8 ± 5.2° in the left side. Alpha angle measurements were significantly higher in the patient group than the control group (p < 0.001). A statistically significant increase in the prevalence of osteitis pubis was found in patients with cam-type FAI (45.56%) compared to control subjects (5.68%) (p < 0.001). CONCLUSIONS: This study demonstrated that the frequency of osteitis pubis was increased in non-athletic patients with FAI syndrome. Further studies are required to determine whether these findings reflect the clinical symptoms in patients with hip pain.

Feasibility and reliability of the Spondyloarthritis Research Consortium of Canada sacroiliac joint inflammation score in children.

BACKGROUND: Published methods for quantification of magnetic resonance imaging (MRI) evidence of inflammation in the sacroiliac joint lack validation in pediatric populations. We evaluated the reliability and construct validity of the Spondyloarthritis Research Consortium of Canada (SPARCC) sacroiliac joint inflammation score (SIS) in children with suspected or confirmed juvenile spondyloarthritis (JSpA). METHODS: The SPARCC SIS measures the presence, depth, and intensity of bone marrow inflammation on MRI through the cartilaginous part of the joint. Six readers blinded to clinical details except age, participated in two reading exercises, each preceded by a calibration exercise. Inter-observer reliability was assessed using intraclass correlation coefficients (ICCs) and for pre-specified acceptable reliability the inraclass correlation coefficient (ICC) was > 0.8. RESULTS: The SPARCC SIS had face validity and was feasible to score in pediatric cases in both reading exercises. Cases were mostly male (64%) and the median age at the time of imaging was 14.9 years. After calibration, the median ICC across all readers for the SIS total score was 0.81 (IQR 0.71-0.89). SPARCC SIS had weak correlation with disease activity (DA) as measured by the JSpADA (r = - 0.12) but discriminated significantly between those with and without elevated C-reactive protein (p = 0.03). CONCLUSION: The SPARCC SIS was feasible to score and had acceptable reliability in children. The ICC improved with additional calibration and reading exercises, for both experienced and inexperienced readers.

From radiation osteitis to osteoradionecrosis: incidence and MR morphology of radiation-induced sacral pathologies following pelvic radiotherapy.

OBJECTIVE: To investigate the incidence rate, time-to-onset and recovery, MRI morphology and occurrence of insufficiency fractures in radiation-induced changes in the sacrum following pelvic radiotherapy. MATERIAL AND METHODS: 410 patients with pelvic malignancies treated with radiotherapy were reviewed. Follow-up was 1-124 months (mean 22 months). Serial MRI (average four studies/patient) were analysed using a new semi-quantitative score (Radiation-Induced Sacral Changes=RISC). A size category (I/II/III), a type category for MR signal morphologies (a/b/c) and sacral insufficiency fractures (+/-) were applied. RESULTS: Seventy-two patients (17.6 %) were found to have new pathological signal changes. Radiation osteitis was documented in 83.3 % (60/72, RISC stage a + b), and definite osteonecrosis (stage c) in 12 patients (16.7 %, 12/72). Thirty-one patients (43.1 %) had sacral insufficiency fractures. Initial bone marrow signal changes were found 1-35 months (median 4 months) after radiotherapy. The maximum manifestation of radiation-induced signal changes occurred after 1-35 months (mean 11 months). Fifty-six cases (77.8 %) showed a significant signal recovery within 16.5 months. CONCLUSION: Radiation-induced bone marrow changes appear with a high incidence at the sacrum with an early onset and frequent recovery. The majority presented a pattern of radiation osteitis, whereas osteoradionecrosis was proportionately rare. KEY POINTS: • Radiation-induced sacral bone marrow changes appear frequently (17.6 %) following pelvic radiotherapy. • Insufficiency fractures are common late effects (43 %). • Radiation osteitis develops early (4 mo), with recovery between 16.5 and 39.5 months. • Definite radiological osteoradionecrosis is proportionately rare (3 %). • A 3-stage classification system simplifies and standardizes the morphological disease staging.

Frontal sinus revision rate after nasal polyposis surgery including frontal recess clearance and middle turbinectomy: A long-term analysis.

OBJECTIVE: To determine the frontal sinus revision rate after nasal polyposis (NP) surgery including frontal recess clearance (FRC) and middle turbinectomy (MT), to search for predictive factors and to analyse surgical management. METHODS: Longitudinal analysis of 153 patients who consecutively underwent bilateral sphenoethmoidectomy with FRC and MT for NP with a minimum follow-up of 7 years. Decision of revision surgery was made in case of medically refractory chronic frontal sinusitis or frontal mucocele. Univariate and multivariate analysis incorporating clinical and radiological variables were performed. RESULTS: The frontal sinus revision rate was 6.5% (10/153). The mean time between the initial procedure and revision surgery was 3 years, 10 months. Osteitis around the frontal sinus outflow tract (FSOT) was associated with a higher risk of frontal sinus revision surgery (p=0.01). Asthma and aspirin intolerance did not increase the risk, as well as frontal sinus ostium diameter or residual frontoethmoid cells. Among revised patients, 60% required multiple procedures and 70% required frontal sinus ostium enlargement. CONCLUSIONS: Our long-term study reports that NP surgery including FRC and MT is associated with a low frontal sinus revision rate (6.5%). Patients developing osteitis around the FSOT have a higher risk of frontal sinus revision surgery. As mucosal damage can lead to osteitis, FSOT mucosa should be preserved during initial NP surgery. However, as multiple procedures are common among NP patients requiring frontal sinus revision, frontal sinus ostium enlargement should be considered during first revision in the hope of reducing the need of further revisions.

Bacteriological aspects of chronic osteoarticular infections in adults: the influence of the osteosynthesis material.

BACKGROUND: The aim of this study is to establish the bacterial epidemiology of chronic osteoarticular infections in adults, to study the susceptibility of the isolated strains to antibiotics and to demonstrate the influence of osteosynthesis material thereon. PATIENTS AND METHODS: This is a retrospective study of 78 months, from January 2006 to June 2012, providing bacteriological samples from patients with osteitis and osteoarthritis in the Mohammed V military teaching hospital of Rabat. Isolation and identification of bacteria were made by bacteriological classical techniques. The antimicrobial susceptibility testing of the isolates was performed by disk diffusion agar method, as recommended by the Committee of the susceptibility of the French Society for Microbiology (CA-SFM). RESULTS: We collected 234 cases, 53% (n = 124) of patients without osteosynthesis material (group A) and 47% (n = 110) patients with osteosynthesis material (group B).We isolated 371 bacteria which 51.49 (n = 191) in group A and 48.51% (n = 180) in group B. Gram-positive cocci were the most frequent (n = 234), followed by the Gram-negative bacilli (n = 114) and the Gram-positive bacilli (n = 19). Our study shows that the rate of resistance to antibiotics in strains obtained from patients with osteosynthesis material is higher compared to those obtained from patients without osteosynthesis material. CONCLUSIONS: Chronic OA infection in adults is difficult to diagnose and treat. Its good management must be multidisciplinary.

Prevalence of Periapical Rarefying Osteitis in Patients with Rheumatoid Arthritis.

INTRODUCTION: The effect of rheumatoid arthritis (RA) on the healing and pathophyisiology of apical periodontitis is unknown because there is no study in the literature evaluating the association of RA with the prevalence of periapical rarefying osteitis (PAR) and endodontic treatment. Therefore, the goal of this cross-sectional study was to evaluate the prevalence of PAR and root canal treatment in RA patients when compared with controlled individuals. METHODS: Full-mouth radiographs of 131 individuals with RA were examined and compared with 131 controls that were sex and age matched exactly with the diseased group. The total number of teeth, presence or absence of root canal filling, quality of root canal filling, quality of restoration, and periapical status were recorded. RESULTS: Overall, the prevalence of teeth with PAR was 4.0% in the diseased group and 3.5% in the control group (P > .05). The prevalence of root canal-treated teeth was 6.2% in the RA group and 5.6% in the control group (P > .05). Controls have significantly more teeth than those with RA (P = .027). CONCLUSIONS: The prevalence of PAR and endodontic treatment was not significantly different in individuals with RA compared with control patients.

Cranioplasty Infection and Resorption Are Associated with the Presence of a Ventriculoperitoneal Shunt: A Systematic Review and Meta-Analysis.

BACKGROUND: Following decompressive craniectomy, hydrocephalus is a common complication often necessitating placement of a ventriculoperitoneal shunt (VPS). Complications in the presence of a VPS have been reported, but a clear association has not been established. METHODS: PRISMA guidelines were used to perform a literature search using PubMed to identify articles that published the complication rates associated with staged or simultaneous cranioplasty and VPS placement. From these event rates, odds ratios (ORs) with 95% confidence intervals (CIs) of complications were calculated. Data were pooled using the Mantel-Haenszel method. The Oxford Center for Evidence-Based Medicine guidelines were used to assess the quality of individual articles and studies. The Newcastle-Ottawa Scale was used to assess the risk of bias in studies. RESULTS: Of the 30 papers reviewed for complications in the presence and absence of a VPS, 7 studies, with a total of 1635 patients, were eligible for meta-analysis. Overall rates of complications (n = 1635; OR, 9.75; 95% CI, 4.8-20.1), infection (OR, 4.9; 95% CI, 2.2-10.7), and bone resorption (OR, 10.6; 95% CI, 4.9-23.0) were increased when a VPS was placed at the time of cranioplasty. Simultaneous procedures were associated with increased complication rates (n = 283; OR, 4.3; 95% CI, 2.3-8.2) compared with staged procedures. CONCLUSIONS: Cranioplasty in the presence of a VPS is associated with a higher rate of overall complications, including infection and bone resorption. Performing cranioplasty and VPS placement in the same operation is associated with an increased rate of complications compared with staged procedures. Surgeons should consider staging these procedures when possible and counsel patients about these risks.

Bacterial Osteomyelitis or Nonbacterial Osteitis in Children: A Study Involving the German Surveillance Unit for Rare Diseases in Childhood.

BACKGROUND: Although bacterial osteomyelitis (BO) is a commonly recognized diagnosis in pediatrics, it is often difficult to distinguish from nonbacterial osteitis (NBO). The goal of our study was to distinguish between the 2 disease entities and better define NBO. METHODS: Using the German Surveillance Unit for Rare Diseases in Childhood (Erhebungseinheit für Seltene Paediatrische Erkrankungen in Deutschland), this prospective study during a 5-year period captured 657 patients at first diagnosis of either BO (n = 378) or NBO (n = 279) while analyzing epidemiologic, clinical and radiologic data. RESULTS: BO was reported in 1.2 per 100,000 children with a higher prevalence in younger male patients (58%), and NBO was reported in 0.45 per 100,000 children. BO patients tended to present with fevers (68%), elevated inflammation markers (82%) and local swelling (62%) but a shorter course of symptoms than NBO patients. NBO patients presented in good general health (86%) and were more likely to have multifocal lesions (66%). Staphylococcus aureus was the most prominent pathogen (83%), with only one methicillin-resistant S. aureus reported. Complications ranged from arthritis adjacent to the lesion to hyperostosis and vertebral fractures. CONCLUSIONS: BO and NBO can be distinguished based on symptoms, associated diseases and inflammation markers. NBO should always be considered in pediatric patients presenting with bone lesions and pain, especially in young female patients presenting with good general health, minimal inflammation markers and multifocal lesions in the vertebrae, clavicle and sternum.

Postoperative Neurosurgical Infection Rates After Shared-Resource Intraoperative Magnetic Resonance Imaging: A Single-Center Experience with 195 Cases.

OBJECTIVES: To determine the rate of surgical-site infections (SSI) in neurosurgical procedures involving a shared-resource intraoperative magnetic resonance imaging (ioMRI) scanner at a single institution derived from a prospective clinical quality management database. METHODS: All consecutive neurosurgical procedures that were performed with a high-field, 2-room ioMRI between April 2013 and June 2016 were included (N = 195; 109 craniotomies and 86 endoscopic transsphenoidal procedures). The incidence of SSIs within 3 months after surgery was assessed for both operative groups (craniotomies vs. transsphenoidal approach). RESULTS: Of the 109 craniotomies, 6 patients developed an SSI (5.5%, 95% confidence interval [CI] 1.2-9.8%), including 1 superficial SSI, 2 cases of bone flap osteitis, 1 intracranial abscess, and 2 cases of meningitis/ventriculitis. Wound revision surgery due to infection was necessary in 4 patients (4%). Of the 86 transsphenoidal skull base surgeries, 6 patients (7.0%, 95% CI 1.5-12.4%) developed an infection, including 2 non-central nervous system intranasal SSIs (3%) and 4 cases of meningitis (5%). Logistic regression analysis revealed that the likelihood of infection significantly decreased with the number of operations in the new operational setting (odds ratio 0.982, 95% CI 0.969-0.995, P = 0.008). CONCLUSIONS: The use of a shared-resource ioMRI in neurosurgery did not demonstrate increased rates of infection compared with the current available literature. The likelihood of infection decreased with the accumulating number of operations, underlining the importance of surgical staff training after the introduction of a shared-resource ioMRI.

[Surgery of sepsis in orthopedics and trauma - A highlight : Current survey by the section for bone and soft tissue infections of the German Society for Orthopedics and Trauma]. / Septische Chirurgie in OuU ­ ein Schlaglicht : Aktuelle Umfrage der DGOU-Sektion Knochen- und Weichteilinfektionen.

Surgery of sepsis in trauma surgery and orthopedics is attracting increasingly more attention due to the rising presence of multidrug-resistant pathogens and the increasing number of operative interventions. Despite extensive experience over decades neither the symptoms nor the treatment strategies have been evaluated and it has become obvious that a scientific investigation of this complex topic is necessary for optimization of patient care under economically sound conditions. The aim of this article is to give a snapshot from German healthcare institutions for trauma surgery and orthopedics to answer some questions on this topic from the section for bone and soft tissue infections (SeKuWi) of the German Society for Orthopedics and Trauma (DGOU) in cooperation with the German Society for Hospital Hygiene (DGKH).