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Surgical management of the diabetic foot:The current evidence

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World Journal of Orthopedics 2024年第5期15卷 404-417页

作者： Richard Henry Randall Roberts Gareth Rhys Davies-Jones James Brock Vaishnav Satheesh Greg AJ Robertson Department of Trauma and Orthopaedics Wrexham Maelor HospitalWrexham LL137TDUnited Kingdom Department of Trauma and Orthopaedics The Robert Jones and Agnes Hunt Orthopaedic HospitalOswestry SY107AGUnited Kingdom

The prevalence of diabetes mellitus and its associated complications,particularly diabetic foot pathologies,poses significant healthcare challenges and economic burdens globally.This review synthesises current evidence on the surgical management of the diabetic foot,focusing on the interplay between neuropathy,ischemia,and infection that commonly culminates in ulcers,infections,and,in severe cases,amputations.The escalating incidence of diabetes mellitus underscores the urgency for effective management strategies,as diabetic foot complications are a leading cause of hospital admissions among diabetic patients,significantly impacting morbidity and mortality rates.This review explores the pathophysiological mechanisms underlying diabetic foot complications and further examines diabetic foot ulcers,infections,and skeletal pathologies such as Charcot arthropathy,emphasising the critical role of early diagnosis,comprehensive management strategies,and interdisciplinary care in mitigating adverse outcomes.In addressing surgical interventions,this review evaluates conservative surgeries,amputations,and reconstructive procedures,highlighting the importance of tailored approaches based on individual patient profiles and the specific characteristics of foot pathologies.The integration of advanced diagnostic tools,novel surgical techniques,and postoperative care,including offloading and infection control,are discussed in the context of optimising healing and preserving limb function.

关键词： Diabetes Diabetic foot Charcot osteomyelitis Amputation Diabetic foot attack Conservative surgery

Biological analysis of an innovative biodegradable antibiotic eluting bioactive glass/gypsum composite bone cement for treating experimental chronic MRSA osteomyelitis

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Journal of Pharmaceutical Analysis 2022年第1期12卷 164-177页

作者： Surajit Mistry Subhasish Burman Subhasis Roy Nilendu Jyoti Maitra Rajiv Roy Abhijit Chanda Department of Periodontics Burdwan Dental College&HospitalBurdwan713101India Department of Oral&Maxillofacial Surgery Burdwan Dental College&HospitalBurdwan713101India Department of Veterinary Clinical Complex(Surgery&Radiology) West Bengal University of Animal&Fishery SciencesKolkata700037India Directorate of Research Extension&Farms West Bengal University of Animal&Fishery SciencesKolkata700037India Department of Orthopaedics Calcutta National Medical College&HospitalKolkata700014India School of Bio-Science&Engineering Jadavpur UniversityKolkata734432India

A multi-barrier antibiotics loaded biodegradable composite bone cement for resolving chronic osteomyelitis has been studied to understand the physico-mechanical properties,drug loading/eluting efficiency,and different merits and demerits prior to clinical application.After successful induction of bone infection in 28 rabbits using methicillin-resistant Staphylococcus aureus(MRSA)strains,calcium sulfate/bioactive glass based composite cement was implanted in 12 defects to assess its performance over parenteral therapy with microscopic and radiological examination for 90 days.The composite cement revealed acceptable physico-mechanical properties and controlled drug elution kinetics.Furthermore,the antibiotics concentrations in bone up to 42 days were sufficient to kill MRSA without eliciting adverse drug reactions.The striking feature of platelets aggregation by composite cement could assist bone healing.The controlled degradation with simultaneous entrapment of composite cement within the osteoid tissues and complete repair of infected cortical defects(holes)in rabbit tibia at 6 weeks indicated the excellent anti-infective and osteoconductive properties of composite cement.Thus,the animal study demonstrated the superiority of composite over injectable antibiotic therapy based on infection resolution and bone regeneration.We thereby conclude that the composite cement can be effectively applied in the treatment of resistant cases of chronic osteomyelitis.

关键词： Antibiotics Biodegradable composite osteomyelitis MRSA strains Osteoconduction

Isolated cryptococcal osteomyelitis of the ulna in an immunocompetent patient:A case report

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World Journal of Clinical Cases 2022年第19期10卷 6617-6625页

作者： Jing-Long Ma Liang Liao Tao Wan Fu-Chun Yang Department of Orthopedic Trauma and Hand Surgery The First Affiliated Hospital of Guangxi Medical UniversityNanning 530021Guangxi ProvinceChina Guangxi Key Laboratory of Regenerative Medicine Department of OrthopedicsThe First Affiliated Hospital of Guangxi Medical UniversityNanning 530021Guangxi ProvinceChina

BACKGROUND Cryptococcal osteomyelitis is a bone infection caused by cryptococcus.As an opportunistic infection,bone cryptococcosis usually occurs in patients with immunodeficiency diseases or in those undergoing immunosuppressive therapy and often displays characteristics of disseminated disease.Isolated cryptococcal osteomyelitis is extremely unusual in immunocompetent person.The pathogenic fungus often invades vertebrae,femur,tibia,rib,clavicle,pelvis,and humerus,but the ulna is a rare target.CASE SUMMARY A 79-year-old woman complaining of chronic pain,skin ulceration and a sinus on her right forearm was admitted,and soon after was diagnosed with cryptococcal osteomyelitis in the right ulna.Unexpectedly,she was also found to have apparently normal immunity.After treatment with antifungal therapy combined with surgery debridement,the patient’s osteomyelitis healed with a satisfactory outcome.CONCLUSION Although rare,cryptococcal osteomyelitis should be considered in the differential diagnosis of osteolytic lesions even in immunocompetent patients,and good outcomes can be expected if early definitive diagnosis and etiological treatment are established.

关键词： Cryptococcus neoformans osteomyelitis Isolated lesions Ulna Immunocompetence Case report

Calcium pyrophosphate dihydrate crystals in a 9-year-old with osteomyelitis of the knee:A case report

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World Journal of Orthopedics 2022年第9期13卷 870-875页

作者： William Pavlis David S Constantinescu Rajan Murgai Spencer Barnhill Brian Black Department of Orthopaedics University of MiamiMiami33136United States

BACKGROUND Calcium pyrophosphate dihydrate deposition disease(CPPD),or pseudogout,is an inflammatory arthritis common among elderly patients,but rarely seen in patients under the age of 40.In the rare cases presented of young patients with CPPD,genetic predisposition or related metabolic conditions were almost always identified.CASE SUMMARY The authors report the case of a 9-year-old boy with no past medical history who presented with acute knee pain and swelling after a cat scratch injury 5 d prior.Synovial fluid analysis identified calcium pyrophosphate dihydrate crystals.Further MRI analysis identified osteomyelitis and a small soft tissue abscess.CONCLUSION This case presents the extremely rare diagnostic finding of calcium pyrophosphate dihydrate crystals in a previously healthy pediatric patient.The presence of osteomyelitis presents a unique insight into the pathogenesis of these crystals in pediatric patients.More research needs to be done on the role of CPPD in pediatric arthritis and joint infection.

关键词： Calcium pyrophosphate Pseudogout Pediatrics Crystals osteomyelitis Case report

Diagnosis and treatment of chronic osteomyelitis based on nanomaterials

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World Journal of Orthopedics 2023年第2期14卷 42-54页

作者： Ming Zeng Zheng Xu Zhen-Qi Song Jie-Xiao Li Zhong-Wen Tang Sheng Xiao Jie Wen Department of Pediatric Orthopedics Hunan Provincial People’s HospitalThe First Affiliated Hospital of Hunan Normal UniversityChangsha 410013Hunan ProvinceChina

Chronic osteomyelitis is a painful and serious disease caused by infected surgical prostheses or infected fractures.Traditional treatment includes surgical debridement followed by prolonged systemic antibiotics.However,excessive antibiotic use has been inducing rapid emergence of antibiotic-resistant bacteria worldwide.Additionally,it is difficult for antibiotics to penetrate internal sites of infection such as bone,thus limiting their efficacy.New approaches to treat chronic osteomyelitis remain a major challenge for orthopedic surgeons.Luckily,the development of nanotechnology has brought new antimicrobial options with high specificity to infection sites,offering a possible way to address these challenges.Substantial progress has been made in constructing antibacterial nanomaterials for treatment of chronic osteomyelitis.Here,we review some current strategies for treatment of chronic osteomyelitis and their underlying mechanisms.

关键词： osteomyelitis Nanomaterials Infectious disease Drug delivery

Subacute osteomyelitis due to Staphylococcus caprae in a teenager:A case report and review of the literature

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World Journal of Clinical Cases 2023年第20期11卷 4897-4902页

作者： Oscar Vazquez Giacomo De Marco Nathaly Gavira Celine Habre Marcia Bartucz Christina N Steiger Romain Dayer Dimitri Ceroni Paediatric Orthopaedics Unit Geneva Children’s HospitalGeneva University HospitalsGeneva 1211Switzerland Paediatric Radiology Unit Geneva Children’s HospitalGeneva University HospitalsGeneva 1211Switzerland

BACKGROUND Staphylococcus caprae(S.caprae)is a human commensal bacterium which can be detected in the nose,nails,and skin.It can be responsible for heterogeneous infections such as bacteremia,endocarditis,pneumonia,acute otitis externa,peritonitis,and urinary tract infections.Bone and joint infections due to S.caprae have also been reported,but most of them resulted from the infection of orthopedic devices,especially joint prostheses and internal osteosynthesis devices.Rare cases of primary osteoarticular infections caused by S.caprae have been described,including osteitis,arthritis,or spondylodiscitis.CASE SUMMARY We report an unusual case of subacute osteomyelitis in a toe phalanx caused by S.caprae in a 14.5-year-old girl.CONCLUSION Subacute S.caprae osteomyelitis is a little-known and probably underestimated community-acquired infectious disease.This microorganism’s pathogenicity should be seen as more than a classic nosocomial orthopedic device infection.

关键词： Subacute osteomyelitis Staphylococcus caprae Teenagers Case report

A rare post-coronavirus disease 2019 complication of maxillary mucormycotic osteomyelitis in a Southeast Asian patient

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Chinese Journal Of Plastic and Reconstructive Surgery 2022年第4期4卷 178-181页

作者： Bhoowit Lerttiendamrong Pavinee Annoppornchai Pemika Lerttiendamrong Pornthep Pungrasmi Division of Plastic and Reconstructive Surgery Department of SurgeryFaculty of MedicineChulalongkorn UniversityBangkok 10330Thailand Faculty of Dentistry Chulalongkorn UniversityBangkok 10330Thailand

Mucormycosis, a rapidly invasive form of fungal infection caused by Mucorales fungi, has high morbidity and mortality rates. Rhino-orbital-cerebral mucormycosis is the most common form of mucormycosis. With the coronavirus disease 2019(COVID-19) outbreak, a causal correlation between mucormycosis and COVID-19 has been suspected, contributing to the abrupt increase in opportunistic fungal infection cases. We present a case of a Southeast Asian woman in her 60s with complaints of pus discharge in the palatal region with maxillary teeth mobility for 3 months. Physical examination revealed multiple nonvital upper teeth with severe mobility. Incisional biopsy of the maxilla and multidetector computed tomography of the head and neck confirmed the diagnosis of osteomyelitis of the maxilla secondary to mucormycosis. Surgical treatment was performed, and amphotericin B and posaconazole were administered. No operative complications or further bone destruction were observed at 8 months postoperatively.

关键词： osteomyelitis Mucormycosis Coronavirus disease 2019 Plastic surgery

Septic Arthritis and Multifocal osteomyelitis Caused by Capnocytophaga Canimorsus: A Case Report

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Infectious Diseases & Immunity 2023年第3期3卷 136-139页

作者： Saul Levy-Blitchtein Paula Salmeron Dolores Rodriguez-Pardo Pablo Corona Carles Amat Mayli Lung-Suarez Microbiology Department Vall d'Hebron University HospitalBarcelonaSpain Department of Infectious Diseases Vall d'Hebron University HospitalBarcelonaSpain Orthopaedic Surgery Department Vall d'Hebron University HospitalBarcelonaSpain

Microbiological diagnosis of chronic osteoarticular infections remains a major challenge,particularly when the clinical presentation is atypical and the pathogen is uncommon.In this unique case,Capnocytophaga canimorsus,a microorganism belonging to the oral microbiota of some domestic animals,caused septic arthritis and multifocal osteomyelitis in the long bone of a 43-year-old immunocompetent man.The patient was treated with two-stage surgery and local and systemic antibiotic therapy,and had a successful recovery.C.canimorsus should be considered as a possible etiological agent in patients with osteoarticular pathology and a history of exposure to domestic animals.

关键词： Capnocytophaga Case report osteomyelitis Septic arthritis Osteoarticular infection

osteomyelitis post acromioclavicular joint reconstruction

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Chinese Journal of Traumatology 2019年第3期22卷 182-186页

作者： Raymond DK.Yeak Hafiz Daud Nasir M. Nizlan Department of Orthopaedic Surgery Faculty of Medicine and Health SciencesUniversiti Putra Malaysia43400 SerdangSelangorMalaysia Department of Orthopaedic Surgery Hospital SerdangJalan Puchong43000 KajangSelangorMalaysia

Acromioclavicular joint (ACJ) injury is a common shoulder injury. There are various techniques of ACJ reconstruction. Superficial infection after ACJ reconstruction is not an uncommon complication. However, osteomyelitis post ACJ reconstruction has never been highlighted as a possible complication. Our patient is a 31-year-old male who sustained a Rockwood 5 ACJ dislocation and had anatomical ACJ reconstruction with autogenous gracilis and semitendinosus graft. Our technique involved the anatomical reconstruction of the ACJ and the coracoclavicular ligament with the usage of two bioscrews and the temporary stabilisation of the ACJ with two k-wires. As in any orthopaedic surgery, infection is often disastrous especially when the surgery involves implants. It can be disastrous with high morbidity to the patient as well as a costly complication to treat. Therefore, we wish to highlight this case as despite its rarity, osteomyelitis can be devastating to the patient and should be prevented if possible.

关键词： Acromioclavicular joint dislocation Acromioclavicular joint reconstruction Infection osteomyelitis Complication