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Journal articles on the topic 'Radiographic healing'
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Kang, Sumi, Se-Won Ha, Ukseong Kim, Sunil Kim, and Euiseong Kim. "A One-Year Radiographic Healing Assessment after Endodontic Microsurgery Using Cone-Beam Computed Tomographic Scans." Journal of Clinical Medicine 9, no. 11 (2020): 3714. http://dx.doi.org/10.3390/jcm9113714.
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This study aimed to evaluate one-year radiographic healing after endodontic microsurgery using CBCT with modified PENN 3D criteria and to compare the outcome with results evaluated using Molven’s criteria. A total of 107 teeth from 96 patients were evaluated one year after endodontic microsurgery by using CBCT scans with modified PENN 3D criteria and periapical radiographs with Molven’s criteria. Both preoperative and postoperative lesion volumes were calculated using ITK-SNAP (free software). Radiographic healing assessment using periapical radiographs and CBCT images, and preoperative and postoperative lesion volume measurements were performed independently by two examiners. The assessment using Molven’s criteria resulted in 75 complete healings, 18 incomplete healings, eight uncertain healings, and six unsatisfactory healings. Based on modified PENN 3D criteria, 64 teeth were categorized as complete healing, 29 teeth as limited healing, six teeth as uncertain healing, and eight teeth as unsatisfactory healing. With the one-year follow-up, CBCT scans showed a lower healing tendency than did periapical radiography. The volumes of apical radiolucency after the surgery were reduced by 77.7% on average at one-year follow up.
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Danielson, Briana, Matthew Barnhart, Adam Watson, Shawn Kennedy, and Steve Naber. "Short-Term Radiographic Complications and Healing Assessment of Single-Session Bilateral Tibial Tuberosity Advancements." Journal of the American Animal Hospital Association 52, no. 2 (2016): 109–14. http://dx.doi.org/10.5326/jaaha-ms-6194.
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The objective of this study is to report on the short-term radiographic complications and bone healing associated with single-session bilateral tibial tuberosity advancements (TTAs). This retrospective study consists of 74 client-owned dogs with bilateral cranial cruciate ligament rupture that underwent consecutive single-session bilateral TTAs. Radiographs from 74 dogs (148 stifles) were evaluated for evidence of postoperative complications. One hundred forty-three of 148 stifles were scored for radiographic healing using a previously described scoring system. Variables evaluated for a relationship with radiographic complications and healing scores were: breed, age, body weight, sex, and TTA plate type. The overall radiographic complication rate was 17.6% (13/74). Twelve of the 13 radiographic complications were considered to be minor and one was major. Increasing body weight and use of a fork implant were statistically significant factors associated with an increased risk of complication. One hundred forty-three stifle radiographs met the inclusion criteria to be assessed for healing. The mean score was 2.96 out of 4.0. The overall radiographic complication rate and healing scores associated with single-session bilateral TTAs were found to be similar to those described for unilateral TTA.
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Wall, Eric J., Matthew D. Milewski, James L. Carey, et al. "The Reliability of Assessing Radiographic Healing of Osteochondritis Dissecans of the Knee." American Journal of Sports Medicine 45, no. 6 (2017): 1370–75. http://dx.doi.org/10.1177/0363546517698933.
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Background: The reliability of assessing healing on plain radiographs has not been well-established for knee osteochondritis dissecans (OCD). Purpose: To determine the inter- and intrarater reliability of specific radiographic criteria in judging healing of femoral condyle OCD. Study Design: Cohort study (Diagnosis); Level of evidence, 3. Methods: Ten orthopedic sports surgeons rated the radiographic healing of 30 knee OCD lesions at 2 time points, a minimum of 1 month apart. First, raters compared pretreatment and 2-year follow-up radiographs on “overall healing” and on 5 subfeatures of healing, including OCD boundary, sclerosis, size, shape, and ossification using a continuous slider scale. “Overall healing” was also rated using a 7-tier ordinal scale. Raters then compared the same 30 pretreatment knee radiographs in a stepwise progression to the 2-, 4-, 7-, 12-, and 24-month follow-up radiographs on “overall healing” using a continuous slider scale. Interrater and intrarater reliability were assessed using intraclass correlations (ICC) derived from a 2-way mixed effects analysis of variance for absolute agreement. Results: Overall healing of the OCD lesions from pretreatment to 2-year follow-up radiographs was rated with excellent interrater reliability (ICC = 0.94) and intrarater reliability (ICC = 0.84) when using a continuous scale. The reliability of the 5 subfeatures of healing was also excellent (interrater ICCs of 0.87-0.89; intrarater ICCs of 0.74-0.84). The 7-tier ordinal scale rating of overall healing had lower interrater (ICC = 0.61) and intrarater (ICC = 0.68) reliability. The overall healing of OCD lesions at the 5 time points up to 24 months had interrater ICCs of 0.81-0.88 and intrarater ICCs of 0.65-0.70. Conclusion: Interrater reliability was excellent when judging the overall healing of OCD femoral condyle lesions on radiographs as well as on 5 specific features of healing on 2-year follow-up radiographs. Continuous scale rating of OCD radiographic healing yielded higher reliability than the ordinal scale rating. Raters showed substantial to excellent agreement of OCD overall radiographic healing measured on a continuous scale at 2, 4, 7, 12, and 24 months after starting treatment.
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Litrenta, Jody, Paul Tornetta, Samir Mehta, et al. "Determination of Radiographic Healing." Journal of Orthopaedic Trauma 29, no. 11 (2015): 516–20. http://dx.doi.org/10.1097/bot.0000000000000390.
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Shekhar, Vijay, and K. Shashikala. "Cone Beam Computed Tomography Evaluation of the Periapical Status of Nonvital Tooth with Open Apex Obturated with Mineral Trioxide Aggregate: A Case Report." Case Reports in Dentistry 2013 (2013): 1–6. http://dx.doi.org/10.1155/2013/714585.
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Management of a tooth with open apex is a challenge to the dental practitioners. Evaluation of the periapical healing is required in such cases by radiographic techniques. The objective of this paper was to assess the healing of a periapical lesion in a non-vital tooth with open apex treated with mineral trioxide aggregate (MTA) obturation using cone beam computed tomography (CBCT). The endodontic treatment of a fractured non-vital discolored maxillary left lateral incisor with an open apex was done with MTA obturation. The clinical and radiographic followup done regularly showed that the tooth was clinically asymptomatic and that the size of the periapical lesion observed by intraoral periapical (IOPA) radiographs and CBCT was decreased remarkably after two years. CBCT and IOPA radiographs were found to be useful radiographic tools to assess the healing of a large periapical lesion in a non-vital tooth with open apex managed by MTA obturation.
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McDonald, Elizabeth, Brian Winters, Rachel Shakked, David Pedowitz, Steven Raikin, and Joseph Daniel. "Effect of Post-Operative Toradol Administration on Bone Healing After Ankle Fracture Fixation." Foot & Ankle Orthopaedics 2, no. 3 (2017): 2473011417S0002. http://dx.doi.org/10.1177/2473011417s000288.
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Category: Ankle, Trauma Introduction/Purpose: Ketorolac has been reported to delay bone healing when administered after spine surgery, and there is hesitancy to use non-steroidal anti-inflammatories (NSAIDs) in the fracture setting despite its reliable ability to relieve surgical pain. The effect of ketorolac administration after foot and ankle surgery has not been well-defined in the literature to date. The purpose of this study is to report clinical and radiographic outcomes for patients treated with a perioperative ketorolac regimen after open reduction and internal fixation (ORIF) of ankle fractures. A secondary purpose is to determine whether there are other patient factors that affect radiographic healing in this population. We hypothesize that the time to radiographic healing with ketorolac use after ORIF of ankle fractures is no different than a historical control. Methods: A retrospective chart review was performed on all patients that received perioperative ketorolac at the time of lateral malleolar, bimalleolar, and trimalleolar ankle ORIF by a single surgeon between 2010 and 2016 with minimum 4 months follow-up. Patients were prescribed 5 days of 10 mg ketorolac every 6 hours. Radiographs were evaluated independently by two blinded fellowship-trained foot and ankle surgeons to assess for radiographic healing of lateral malleolus, medial malleolus, and posterior malleolus fractures at 6, 12, and 16 weeks post-operatively. Two hundred and ninety-four patients were included with an average age of 50 years with 138 males (47%). Literature review was performed to determine an appropriate historical control of time to radiographic healing after ankle ORIF for comparison. Statistical analysis consisted of a linear mixed-effects regression which was performed to estimate the effect of time and covariates, taking into account repeated measurements on the same subject. Results: Radiographic healing was demonstrated by 16 weeks in 221 of 281 (79%) lateral malleolus fractures, 105 of 132 medial malleolus fractures (80%), and 53 of 57 (93%) posterior malleolus fractures (see Figure 1). Median healing times were 12, 11, and 6 weeks for lateral, medial, and posterior malleoli fractures respectively. There was no significant difference in time to radiographic healing of lateral malleolus when compared to a historical control of 16.7 weeks to union. Active tobacco use was an independent risk factor for delayed radiographic healing (p < 0.05). Diabetes mellitus and age greater than 50 years were independent factors associated with faster healing of the lateral malleolus fractures (p < 0.05). Rheumatoid arthritis, oral steroid use, and obesity had no effect on radiographic healing. Conclusion: Perioperative ketorolac use did not affect radiographic healing of ankle fractures after ORIF. As expected, active tobacco use was associated with slower radiographic healing. There is no evidence that ketorolac use further delayed union in smokers, but this may warrant further study. We unexpectedly identified diabetes mellitus and older age as factors associated with faster healing which also warrants further study. This is the first study to date examining the effect of ketorolac on radiographic time to union of ankle fractures. Further study may help determine whether ketorolac helps reduce opioid consumption and improve pain following ORIF of ankle fractures.
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Bush, M. A., C. Whiting, S. J. Langley-Hobbs, and J. V. Hermer. "Healing of patellar fractures in two kittens." Veterinary and Comparative Orthopaedics and Traumatology 25, no. 02 (2012): 155–59. http://dx.doi.org/10.3415/vcot-11-04-0055.
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SummaryTwo kittens aged between four and five months were presented having sustained patellar fractures. In both cases, healing was subsequently documented radiographically; this has not been reported previously in the literature.One kitten had bilateral patellar fractures – the symptomatic right stifle was treated with a pin and tension-band-wire which later failed, at which point partial patellectomy was performed. The fracture of the left patella was minimally displaced and was treated conservatively. A radiograph of the left patella taken eleven months after initial presentation showed complete healing of the fracture. The second case was treated surgically with a circumferential wire; healing of the fracture was demonstrated radiographically at twelve weeks postoperatively. Radiographic images taken five weeks postoperatively had shown some narrowing of the fracture gap.These two cases demonstrate that bony union of patellar fractures can be documented, given a long enough duration of radiographic follow-up; circumferential wire was an effective treatment in a displaced fracture, and conservative treatment resulted in complete healing of a minimally displaced fracture.
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Ramski, David E., Theodore J. Ganley, and James L. Carey. "A Radiographic Healing Classification for Osteochondritis Dissecans of the Knee Provides Good Interobserver Reliability." Orthopaedic Journal of Sports Medicine 5, no. 12 (2017): 232596711774084. http://dx.doi.org/10.1177/2325967117740846.
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Background: Recent studies have examined radiographic factors associated with healing of osteochondritis dissecans (OCD) lesions of the knee. However, there is still no gold standard in determining the healing status of an OCD lesion. Purpose: We examined temporally associated patterns of healing to (1) evaluate the practicality of a classification system and (2) elucidate any associations between healing pattern and patient age, sex, lesion location, treatment type, and physeal patency. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: We retrospectively screened 489 patients from 2006 to 2010 for a total of 41 consecutive knee OCD lesions that met inclusion criteria, including at least 3 consecutive radiographic series (mean patient age, 12.8 years; range, 7.8-17.1 years; mean follow-up, 75.1 weeks). Radiographs were arranged in sequential order for ratings by 2 orthopaedic sports medicine specialists. Healing patterns were rated as boundary resolution, increasing radiodensity of progeny fragment, combined, or not applicable. Repeat ratings were conducted 3 weeks later. Results: Patients were most commonly adolescent males aged 13 to 17 years, with a medial femoral condyle lesion that was treated operatively. Interobserver reliability of the healing classification was good (intraclass correlation coefficient, 0.67; 95% CI, 0.55-0.79). Boundary and radiodensity healing was observed for all ages, sexes, lesion locations, treatment types, and physeal patency states. Conclusion: This study evaluated a valuable radiographic paradigm—boundary resolution, increasing radiodensity of progeny fragment, or combined—for assessment of OCD lesion healing. The proposed system of healing classification demonstrated good inter- and intraobserver reliability. Healing patterns were not significantly associated with any particular age, sex, lesion location, treatment type, or physeal patency status. The development of a classification system for knee OCD may eventually improve clinical assessment and management of OCD lesions.
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McDonald, Elizabeth, Brian Winters, Kristen Nicholson, et al. "Effect of Postoperative Ketorolac Administration on Bone Healing in Ankle Fracture Surgery." Foot & Ankle International 39, no. 10 (2018): 1135–40. http://dx.doi.org/10.1177/1071100718782489.
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Background: In an effort to minimize narcotic analgesia and its potential side effects, anti-inflammatory agents offer great potential provided they do not interfere with bone healing. The safety of ketorolac administration after foot and ankle surgery has not been well defined in the current literature. The purpose of this study was to report clinical healing and radiographic outcomes for patients treated with a perioperative ketorolac regimen after open reduction and internal fixation (ORIF) of ankle fractures. Methods: A retrospective review was performed on all patients that received perioperative ketorolac at the time of lateral malleolar, bimalleolar, and trimalleolar ankle ORIF by a single surgeon between 2010 and 2016 with minimum 4 months follow-up. Patients received 20 tablets of 10 mg ketorolac Q6 hours. Radiographs were evaluated independently by 2 blinded fellowship-trained orthopedic foot and ankle surgeons to assess for radiographic healing. A total of 281 patients were included, with a median age of 51 years and 138 males (47%). Statistical analysis consisted of a linear mixed-effects regression. Results: In all, 265/281 (94%) were clinically healed within 12 weeks and 261/281 (92%) were radiographically healed within 12 weeks. Within the group of patients that did not heal within 12 weeks, mean time to clinical healing was 16.9 weeks (range = 14-25 weeks), and mean time to radiographic healing was 17.1 weeks (range = 14-25 weeks). In patients taking ketorolac, there were no cases of nonunion in our series (n = 281) and no significant difference found between fracture patterns and healing or complications ( P = .500). Conclusions: Perioperative ketorolac use was associated with a high rate of fracture union by 12 weeks. This is the first study to examine the effect of ketorolac on radiographic time to union of ankle fractures. Additional studies are necessary to determine whether ketorolac helps reduce opioid consumption and improve pain following ORIF of ankle fractures. Level of Evidence: Level IV, case series.
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Farrow, Charles S. "CALVING CHAIN FRACTURES: Radiographic Assessment of Healing." Veterinary Clinics of North America: Food Animal Practice 15, no. 2 (1999): 221–30. http://dx.doi.org/10.1016/s0749-0720(15)30179-1.
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Gardner, Gregory C., and John C. Hunter. "Clinical images: Radiographic healing of osseous sarcoidosis." Arthritis & Rheumatism 52, no. 7 (2005): 2225. http://dx.doi.org/10.1002/art.21102.
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Gandhi, Jigar S., Kunbo Park, Divya Talwar, and John Todd R. Lawrence. "Complete Radiographic Healing and Related Factors in Juvenile Osteochondritis Dissecans of the Talus." Orthopaedic Journal of Sports Medicine 6, no. 7_suppl4 (2018): 2325967118S0012. http://dx.doi.org/10.1177/2325967118s00123.
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Objectives: Rates of healing following treatment of juvenile osteochondritis dissecans (OCD) of the talus remain scarce. Additionally, there is a paucity of research into the outcomes associated with the treatment of these lesions. The purpose of this study was to evaluate radiographic healing of talar dome OCDs in adolescents. Methods: This was a retrospective review of patients ≤18 years of age with talar OCD from a single pediatric institution within a 12-year period. Charts and radiographs were reviewed for demographics and clinical data, lesion’s location and dimensions, and physeal status. The final radiologic healing was evaluated at 1-year follow-up. Complete and incomplete healing groups were compared using multivariable logistic regression models to examine the predictive effects for the independent variables. A nomogram was produced from the study sample to allow predictions to be made in individual patients. Results: Ninety-two lesions in 74 patients with mean age of 13.1 years (range 7.1 to 18.0 years) were analyzed. 60.8% of the patients were female. Thirty-three (41.8%) lesions were treated conservatively, and 59 (58.2%) were treated surgically (drilling, debridement, microfracture, bone grafting, or loose body removal). Thirty-nine (42.4%) lesions demonstrated complete healing. Patients with complete healing were younger ( p 0.032) and had lower BMIs ( p 0.006) compared to those with incomplete healing. In a multivariate regression model, the factors that correlated significantly were the age, BMI, Berndt and Harty’s stage at presentation and type of treatment (observation vs. surgical). Location and dimension of the lesion, physeal status (open vs. closed), presenting symptoms, and type of surgical procedure showed no association with likelihood of healing. A nomogram was developed using the independent variables that correlated significantly with the likelihood of complete radiographic healing (Figure 1). Conclusion: Complete radiologic healing of juvenile OCDs was more likely in patients with younger age and lower BMI. Although the difference in outcome between various surgical treatment types was not statistically significant, initial management with surgery was more likely to result in a complete healing compared to observation alone. To our knowledge, this is the first time a nomogram predicting outcome in terms of complete radiographic healing has been developed for juvenile OCD lesions of the talus. Besides its potential role in treatment decision making process, this nomogram can be used to counsel patients and their families with regard to the prognosis for healing. [Figure: see text]
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Ricciardi, Benjamin F., Scott R. Nodzo, Kathryn Oi, Yuo-yu Lee, and Geoffrey H. Westrich. "Radiographic Outcomes of Cable-Plate versus Cable-Grip Fixation in Periprosthetic Fractures of the Proximal Femur." HIP International 27, no. 6 (2017): 584–88. http://dx.doi.org/10.5301/hipint.5000496.
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Background Newer generation cable-plate designs are commonly used for periprosthetic proximal femur fractures; however, comparisons relative to cable-grips remain limited. The aim of this study was to compare radiographic healing rates of cable-plate versus cable-grip fixation for periprosthetic proximal femur fractures. Patients and methods Consecutive patients with an acute or chronic Vancouver A, B1, or B2 periprosthetic proximal femur fracture undergoing trochanteric fixation with a cable-plate (n = 46 cases) or cable-grip (n = 24 cases) system were identified retrospectively from a single-centre hospital database (mean follow-up 28 months [range 6-89 months]). Demographics, radiographic fracture healing, and complications were compared between the 2 groups. Radiographic union rates were not different between the cable-grip versus cable-plate group (67% vs. 76% respectively; p = 0.4). Healing rates of greater trochanteric fractures alone were not different between the cable-plate versus cable-grip groups (75% vs. 71% respectively; p = 0.38). The cable-plates were used for a more diverse range of fracture patterns relative to the cable-grips. Results An increased number of cables was associated with radiographic healing (odds ratio 14 [95% confidence interval 2-64]; p = 0.01), and body mass index had a negative correlation with radiographic healing (odds ratio −0.4 [95% confidence interval 0.5-0.9]. Conclusions Similar rates of periprosthetic fracture healing were seen using a cable-grip versus cable-plate system; however, the cable-plate system could be used for a more diverse range of fracture patterns.
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Craig, Andrew, Philip G. Witte, Tristram Moody, Karen Harris, and Harry W. Scott. "Management of feline tibial diaphyseal fractures using orthogonal plates performed via minimally invasive plate osteosynthesis." Journal of Feline Medicine and Surgery 20, no. 1 (2017): 6–14. http://dx.doi.org/10.1177/1098612x17692470.
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Objectives The objective was to assess the medium- and long-term outcomes (radiographic and owner questionnaire) of feline tibial diaphyseal fractures with orthogonal plate fixation via a minimally invasive plate osteosynthesis (MIPO) approach. Methods Medical records and radiographs of cats that had tibial diaphyseal fractures stabilised with orthogonal plates were obtained (2012–2016). Immediate postoperative radiographs were reviewed to assess the construct configuration and follow-up radiographs (where available) were used to assess bone healing and implant-related complications. An owner-completed questionnaire (feline musculoskeletal pain index [FMPI]) was used at a minimum of 6 months following surgery to assess the cats’ ability to perform normal activities. Results Eight feline tibial diaphyseal fractures met the inclusion criteria. One major complication was observed, most likely due to an operative technical error. There were no further complications following revision surgery. Six of the eight cases that had radiographic follow-up either had clinical bone union or showed evidence of bone healing. All cases were classified as successful according to FMPI. Conclusions and relevance Orthogonal plating of feline tibial diaphyseal fractures via an MIPO approach resulted in successful outcomes and a lower complication rate compared with previously reported techniques.
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Moraes, Leonardo V. M., Stéfani C. Kelly, James R. Jones, et al. "Early Weight-Bearing Does Not Compromise Postoperative Healing in Jones Fracture ORIF." Foot & Ankle Orthopaedics 4, no. 4 (2019): 2473011419S0031. http://dx.doi.org/10.1177/2473011419s00312.
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Category: Midfoot/Forefoot, Trauma Introduction/Purpose: Several controversies persist regarding fracture treatment of the fifth metatarsal base. Due to its low blood supply, Jones fracture has an inherent difficulty of consolidation, and may devolop complications such as delayed union, non- union and refracture. Usually the Jones fracture treatment is done with extended period of non-weightbearing with either nonoperative or operative treatment. The surgery is indicated particularly in athletes or in the setting of nonunion or fracture displacement. The purpose of the present retrospective case series is to assess postoperative outcomes among patients who weight bear earlier than standard practice. Methods: We performed a retrospective analysis of the medical and radiographic records from patients who had undergone operative IM fixation of an acute isolated Jones fracture from May 2013 and August 2018. Patients were permitted to weight- bear as tolerated. Demographic information, such as age, gender, body mass index, the use of tobacco, presence of medical comorbidities, and the time of radiographic union were evaluated. Standardized radiographs at 2 weeks, 6 weeks, 3 months and 6 months after surgeries were chosen for evaluation. Radiographic union was defined as bridging in 2 of 3 (medial, lateral, plantar) cortices. Results: Twenty one patients were included for analysis. Of these, 14 had at least one comorbidity present at time of operation. Average BMI was 37.6, and average age was 44.8. One patient (4.8%) was lost to follow up, and therefore did not have radiographic results available for review at any appointment. At 6 weeks, 16 of 21 patients showed signs of radiographic healing; 8 were completely healed, and 8 were incomplete. One patient (4.8%) had nonunion, which was documented at 6 week, 3 month, and 6 month readings. None of the 21 patients experienced any other postoperative complications, including infection, wound dehiscence, sepsis, DVT, implant failure, or need for revision surgery. Conclusion: Patients who were subjected to early weight-bearing after fifth metatarsal Jones fracture surgery had satisfactory fusion rates with no additional postoperative complications, even despite having high average BMI and multiple comorbidities. We believe that patients can be treated with early weightbearing as tolerated after operative fixation of an acute Jones fracture, and achieve satisfactory outcomes comparable those associated with traditional postoperative protocols.
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Kawai, T., S. Murakami, H. Hiranuma, and M. Sakuda. "Radiographic changes during bone healing after mandibular fractures." British Journal of Oral and Maxillofacial Surgery 35, no. 5 (1997): 312–18. http://dx.doi.org/10.1016/s0266-4356(97)90402-2.
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Porter, David A., Melissa Duncan, and Susan J. F. Meyer. "Fifth Metatarsal Jones Fracture Fixation with a 4.5-mm Cannulated Stainless Steel Screw in the Competitive and Recreational Athlete." American Journal of Sports Medicine 33, no. 5 (2005): 726–33. http://dx.doi.org/10.1177/0363546504271000.
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Background Fifth metatarsal Jones fractures are common in the athletic population. Optimal screw selection for operative treatment has not been determined. Hypothesis A 4.5-mm cannulated screw used for fixation of the fifth metatarsal Jones fractures in athletes is an effective treatment approach. Study Design Case series; Level of evidence, 4. Methods The authors studied 23 consecutive athletes (24 feet) who were treated surgically with a 4.5-mm cannulated screw for fifth metatarsal fractures (Jones fracture) with clinical and radiographic assessments. Results There have been no refractures to date. Clinical healing was 100%. The mean percentage healing as shown on radiographs was 98.9%, with a range of 90% to 100%. All athletes returned to sport at a mean time of 7.5 weeks (range, 10 days to 12 weeks). Two athletes experienced a “reinjury” without need for operative treatment. All athletes were recommended to wear orthoses until their competitive careers were completed. Conclusion Fixation with a stainless steel 4.5-mm cannulated screw gives 100% clinical healing and near-100% healing as shown on radiographs. Clinical Relevance The 4.5-mm cannulated screws can yield reliable and effective healing as evidenced by clinical assessment and radiographs of fifth metatarsal Jones fractures in athletes.
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Smith, Douglas G., Brett C. Barnes, Andrew K. Sands, Edward J. Boyko, and Jessie H. Ahroni. "Prevalence of Radiographic Foot Abnormalities in Patients with Diabetes." Foot & Ankle International 18, no. 6 (1997): 342–46. http://dx.doi.org/10.1177/107110079701800606.
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Clinicians are increasingly aware that mechanical aspects of foot deformities, such as Charcot changes, clawtoes, bunion deformities, or cavus or planus foot deformities, might have an impact on the occurrence, potential healing, and recurrence of foot ulcers. We report the prevalence of plain radiographic changes and attempt to rate the severity of those deformities in the feet of 456 diabetic veteran medicine clinic enrollees. All 456 radiographs were reviewed by orthopaedic surgeons to specifically identify Charcot changes, presence of arterial calcification, dislocation of the lesser toe metatarsophalangeal joints, hallux interphalangeal joint dislocation, and radiographic evidence of previous surgery. Radiographs of 428 patients were taken while weightbearing, and these were reviewed to quantify hallux valgus angles, intermetatarsal 1–2 angles, fifth metatarsalproximal phalangeal angles, second metatarsal lengths, lateral talocalcaneal and talar-first metatarsal angles, and claw toe deformities. The prevalence of Charcot changes was 1.4% (six subjects), and all had radiographic evidence of midfoot Charcot changes. Other deformities, such as clawtoes, hallux valgus, lesser toe joint dislocations, and alterations in arch height, are more common in veterans with diabetes.
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Jeffcoat, M. K., and M. S. Reddy. "Digital Subtraction Radiography for Longitudinal Assessment of Peri-Implant Bone Change: Method and Validation." Advances in Dental Research 7, no. 2 (1993): 196–201. http://dx.doi.org/10.1177/08959374930070021101.
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The purpose of this paper is to present a digital subtraction technique for the assessment of peri-implant bone change over time in vivo. Digital subtraction radiography may be used to detect areas of bony change that have occurred between radiographic examinations, and image processing algorithms have been developed which can relate the magnitude of the change on the subtraction image to a reference wedge, thereby allowing calculation of the mass of the lesion. This manuscript will present two algorithms for the assessment of osseous change. The method was validated in monkeys by means of small bony chips placed intra-orally prior to the first radiograph. The chips were removed, a second radiograph taken, and the images subtracted. Each algorithm was used to isolate the lesion and calculate change in bone mass. Overall, there was excellent correlation between the calculated lesion mass (in milligrams) and actual lesion mass (r2 > 0.9). The utility of the method was demonstrated by comparison of the results of subtraction radiography in successful implants and in implants that did not integrate during the healing phase.
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Nagahiro, Yukari, Daichi Katori, Norihiro Muroi, et al. "Clinical Efficacy of Bone Reconstruction Surgery with Frozen Cortical Bone Allografts for Nonunion of Radial and Ulnar Fractures in Toy Breed Dogs." Veterinary and Comparative Orthopaedics and Traumatology 31, no. 03 (2018): 159–69. http://dx.doi.org/10.1055/s-0038-1631878.
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Objective To evaluate the effectiveness of frozen cortical bone allografts (FCBA) in the treatment of severe radial and ulnar atrophic nonunion fractures. Animals Toy breed dogs with nonunion of radial and ulnar fractures (n = 15). Methods Severe atrophic nonunion fractures were treated with FCBA (eight infected and seven non-infected fractures). Radiographs obtained immediately after surgery, and 1, 2, 3, 6 and 12 months later were evaluated and scored for the periosteal reaction at the bone regeneration sites, the healing process in the bone connection areas at both the proximal and distal sites, and the bone remodelling process within the allografts. Results Improvements in the fracture-healing process and weight-bearing function were observed in all cases. Radiographic scores at the bone connection areas and within the allograft improved significantly over time (p < 0.05). There were not any significant differences in radiographic scores between the infected and non-infected groups. Clinical Significance Bone reconstruction with FCBA is effective in the treatment of radial and ulnar nonunion fractures associated with large bone defects, regardless of the infection status of the surgical site.
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Jurado Patrón, Oscar David, Andrés Vargas López, Elma María Vega Lizama, Gabriel Alvarado Cárdenas, María Eugenia López Villanueva, and Marco Antonio Ramírez Salomón. "Radiographic characteristics in the periapical healing post endodontic treatment in patients of the Autonomous University of Yucatan, School of Dentistry." Nova Scientia 10, no. 21 (2018): 379–90. http://dx.doi.org/10.21640/ns.v10i21.1592.
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Introduction: The radiographic control of the root canal treatment can evaluate the healing of the periapical lesions. The objective of this study was to determinate the characteristics of the radiographic healing that was observed after one year, during follow-up sessions; so, the healing of the lesions according to the periapical pathology at the beginning of the treatment and the causes of failure of the endodontic treatments were recorded.Method: This is a prospective, observational, descriptive and longitudinal study, carried out in patients who attended control one year after endodontic treatment through the Periapical Index (PAI).Results: A total of 395 teeth of patients who underwent endodontic treatment one year prior to data collection, 87 presented radiogaphically observable periapical lesions; of these, 40 (45.97%) attended the control at one year. The frequency of cases in which some degree of radiographic healing was observed one year after treatment was 97.46%. The pathology with more cases of complete healing was periodontitis with sinus tract. In general, 84.61% of the cases decreased two levels in their PAI after one year. The 100% of the cases of failure presented vertical root fractures.Conclusion: The frequency of periapical healing after endodontic treatment is high. The main cause for the failure of the treatments documented in this study was the lack of coronal restoration that caused vertical fractures.
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Souza, T. F. B., G. T. N. M. Ferrreira, S. S. Sakamoto та ін. "Healing and expression of growth factors (TGF-β and PDGF) in canine radial ostectomy gap containing platelet-rich plasma". Veterinary and Comparative Orthopaedics and Traumatology 25, № 06 (2012): 445–52. http://dx.doi.org/10.3415/vcot-10-10-0146.
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SummaryObjectives: To evaluate bone healing in an experimental radial ostectomy in dogs treated with autologous platelet-rich plasma (PRP), through histological, densitometric, radiographic studies, as well as expression of growth factors in the ostectomy gap.Methods: Twenty-one dogs were randomly divided into either a control or a PRP group. All underwent unilateral ostectomy of the radius to generate a gap of 2.0 mm, that was stabilized with external skeletal fixation. The ostectomy gap was either filled with PRP or left empty as a control. The radiographic and densitometric studies were performed after surgery, then at intervals until 60 days during the post-surgery period. Histological and immunohistochemical evaluations were performed at seven or 60 days post-surgery. Analyses were performed using a statistical analysis system, and the level of significance was set at p <0.05.Results: The median radiographic healing score in the PRP group increased significantly between day 0 and day 60. Furthermore, at 60 days, the median healing score and the proportion of healed ostectomies in the control group (score 1; 1/6 healed) and the PRP group (score 5; 4/5 healed) were significantly different. There were differences between groups in radiographic and densitometric values at days 45 and 60. The histological evaluation showed advanced bone healing at 60 days in the PRP group and signs of delayed union in the control group.Clinical relevance: Platelet-rich plasma can be used as an adjuvant therapy because it may promote better bone healing of a radial ostectomy treated with external skeletal fixation in dogs.
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Steinheimer, D., R. D. Park, B. E. Powers, et al. "Comparison of Cemented and Non-cemented Allografts in Dogs with Osteosarcoma." Veterinary and Comparative Orthopaedics and Traumatology 11, no. 04 (1998): 178–84. http://dx.doi.org/10.1055/s-0038-1632543.
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SummaryThis study compares the radiographic and histological appearance of cemented and non-cemented massive cortical allografts in dogs that underwent a limb sparing procedure for osteosarcoma of the distal radius. Treatment consisted of removal of the affected bone and pancarpal arthrodesis using non-cemented (n = 13) or cemented (n = 47) fresh-frozen allografts. Allografts were evaluated using a radiographic and histological scoring system and compared statistically between groups. Allografts with better healing received a higher radiographic score and a lower histological score. The mean radiographic scores, for proximal union and distal union, were significantly greater in the non-cemented group at most evaluation periods. Complications after the operation included screw, plate, allograft and host bone failure, infection and local tumour recurrence. Screw failure in the allograft and allograft failure were significantly more common in the non-cemented group. Histological examination was performed on 44 dogs and cement increased the mean combined histological scores, and mean healing scores of the distal host-graft interface significantly. The use of cemented allografts significantly decreases complications associated with implant loosening or allograft failure but may slightly delay allograft healing. At this point, the clinical relevance of the delay in healing is questionable and the benefits of intramedullary PMMA would appear to outweigh this relative delay in healing.This study evaluated 60 radial allografts after limb sparing procedures using a standardized radiological and histological scoring system. The use of cemented allografts significantly decreased complications associated with implant loosening or allograft failure but may slightly delay allograft healing.
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Hunter, Allison, Charles Pitts, Tyler Montgomery, et al. "Postoperative Aspirin Use and Its Effect on Bone Healing in the Treatment of Ankle Fractures." Foot & Ankle Orthopaedics 4, no. 4 (2019): 2473011419S0003. http://dx.doi.org/10.1177/2473011419s00036.
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Category: Ankle, Trauma Introduction/Purpose: There is hesitancy to administer nonsteroidal anti-inflammatories (NSAIDs) within the postoperative period following fracture care due to concern for delayed union or nonunion. However, aspirin (ASA) is routinely used for chemoprophylaxis of deep vein thrombosis (DVT) and is gaining popularity for use after treatment of ankle fractures. We examine the incidence of nonunion of operative ankle fractures and risk of DVT in patients who did and did not receive postoperative ASA. We hypothesize that time to clinical and radiographic union and the risk of DVT are no different. Methods: A retrospective chart review was performed on all patients treated between 2008 and 2018 for ankle fractures requiring operative fixation by three Foot and Ankle fellowship trained orthopaedic surgeons at a single institution with a minimum of 3 months follow up. Demographics, preoperative comorbidities, and postoperative medical and surgical complications were compared between patients who did and did not receive ASA postoperatively. For both groups, union was evaluated by clinical exam as well as by radiograph. Results: 506 patients met inclusion criteria: 152 received ASA and 354 did not. Radiographic healing at 6 weeks was demonstrated in 95.9% (94/98) and 98.6% (207/210) respectively (p-value .2134). There was no significant difference in time to radiographic union between groups. The risk of postoperative DVTs in those with and without ASA was not significantly different (0.7% (1/137) vs 1.2% (4/323), respectively; p-value .6305). Conclusion: Postoperative use of ASA does not delay radiographic union of operative ankle fractures or affect the rate of postoperative DVT. This is the first and largest study to examine the effect of ASA on time to union of ankle fractures.
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Dalopoulou, Athina, Nikolaos Economides, and Vasilis Evangelidis. "Extrusion of Root Canal Sealer in Periapical Tissues - Report of Two Cases with Different Treatment Management and Literature Review." Balkan Journal of Dental Medicine 21, no. 1 (2017): 12–18. http://dx.doi.org/10.1515/bjdm-2017-0002.
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Summary Background: Extrusion of root canal sealers may cause damage to the surrounding anatomic structures. Clinical symptoms like pain, swelling and paresthesia or anesthesia may be present. The purpose of this presentation is to describe two cases of root canal sealer penetration into periapical tissues. A different treatment management was followed in each case. Case reports: A 55 year-old man underwent root canal retreatment of the right mandibular first molar tooth due to a periapical lesion. Postoperative periapical radiographs revealed the presence of root canal sealer (AH26) beyond the apex in the distal root in proximity to the mandibular canal. The patient reported pain for the next 7 days. Radiographic examination after 1 year showed complete healing of the periapical area and a small absorption of the root canal sealer. A 42 year-old woman was referred complained of swelling and pain in the area of the right maxillary first incisor. Radiographic examination showed extrusion of root canal sealer in the periapical area associated with a periapical lesion. Surgical intervention was decided upon, which included removal of the sealer, apicoectomy of the tooth and retrograde filling with MTA. After 1 year, complete healing of the area was observed. Conclusion: In conclusion, cases of root canal sealer extrusion, surgical treatment should be decided on only in association with clinical symptoms or with radiographic evidence of increasing periapical lesion.
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McCrory, J. L., E. Morag, A. J. Norkitis, et al. "Healing of Charcot fractures: skin temperature and radiographic correlates." Foot 8, no. 3 (1998): 158–65. http://dx.doi.org/10.1016/s0958-2592(98)90052-9.
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Kälebo, Peter, and Karl-Gustav Strid. "Radiographic videodensitometry for quantitative monitoring of experimental bone healing." British Journal of Radiology 62, no. 742 (1989): 883–89. http://dx.doi.org/10.1259/0007-1285-62-742-883.
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Kim, Youngwoo, Chiaki Tanaka, Hiroshi Tada, Hiroshi Kanoe, and Takaaki Shirai. "Radiographic features of teriparatide-induced healing of femoral fractures." Bone Reports 3 (December 2015): 11–14. http://dx.doi.org/10.1016/j.bonr.2015.04.003.
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Messer, Diana L., Brent H. Adler, Farah W. Brink, Henry Xiang, and Amanda M. Agnew. "Radiographic timelines for pediatric healing fractures: a systematic review." Pediatric Radiology 50, no. 8 (2020): 1041–48. http://dx.doi.org/10.1007/s00247-020-04648-7.
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Maidman, Samuel, Jason Bariteau, Stephanie Boden, Allison Boden, and Shay Tenenbaum. "Radiographic predictors for improved outcomes after hammertoe correction surgery." Foot & Ankle Orthopaedics 3, no. 3 (2018): 2473011418S0032. http://dx.doi.org/10.1177/2473011418s00329.
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Category: Lesser Toes Introduction/Purpose: Hammertoe deformities are common, often painful deformities of the lesser foot and are known to severely affect daily activities. When patients seek surgical management, x-rays are utilized for diagnosis, evaluation for surgical candidacy, and selection of the operative technique. Postoperatively, radiographs are retaken to assess bone health, healing status, and alignment. Despite the frequent use of radiographs pre- and post-operatively, radiographic results are not necessarily indicative of clinical presentation or surgical outcomes. The aim of this study is to identify specific radiographic parameters that are predictive of improved pain and function after surgical correction of hammertoe deformity. Methods: Prospectively collected data was reviewed on 51 consecutive patients who underwent operative correction of hammertoe deformity. Patient demographics, comorbidities, and post-surgical complications were recorded from their electronic medical records. Clinical outcomes were assessed utilizing preoperative and postoperative Visual Analogue Scale (VAS) and Short Form Health Survey Physical Component (SF-36 PCS) scores with a minimum of six-month follow-up. Radiographs were scored by a foot & ankle fellowship-trained orthopaedic surgeon to assess preoperative severity, postoperative joint fusion, and both pre- and postoperative joint instability and arthritis. Data was examined using a multivariable analysis. Results: Preoperatively, 15.7% (8/51) of patients had a deformity classified radiographically as mild, 37.3% (19/51) as moderate, and 47.1% (24/51) as severe. Additionally, 60.8% (31/51) had joint instability, 17.7% (9/51) had joint dislocation, and 7.8% (4/51) had joint arthritis. Postoperatively, 74.5% had PIP joint fusion, 35.3% (18/51) had joint arthritis, and 9.8% (5/51) had joint instability. A significant association was found between PIP joint fusion and improved SF-36 PCS scores (p=.004). Preoperative anticoagulant therapy was associated with reduced rates of PIP joint fusion (p=0.02). There was no association found between the other demographic or radiographic parameters, and no parameters were associated with improvement in VAS scores. Conclusion: After undergoing surgical correction of hammertoe deformity, postoperative PIP joint fusion was the only variable determined to be indicative of improved physical function. However, pre- and postoperative metatarsophalangeal joint arthritis nor instability was predictive of outcomes. This work informs foot & ankle specialists that healing of the PIP joint is critical to successful hammertoe surgery.
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Younes, Ronald, Ibrahim Nasseh, Pierre Lahoud, Elie Wassef, and Maroun Dagher. "Bone Lid Technique Using a Piezoelectric Device for the Treatment of a Mandibular Bony Lesion." Case Reports in Dentistry 2017 (2017): 1–4. http://dx.doi.org/10.1155/2017/9315070.
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Different techniques for the enucleation of jaw cyst lesion in the oral and maxillofacial regions have been proposed, including the bone lid technique. The purpose of this case report is to describe the case of a cystic lesion, approached with the bone lid technique performed using a piezoelectric device, with an 8-month clinical and radiographic follow-up. A 14-year-old male patient was treated for a suspicious lesion detected on a panoramic radiograph. The concerned area was surgically accessed, and a radiographically predetermined bony window was drawn, and the beveled bony lid was removed. The underlying lesion was enucleated and sent for pathology as a routine procedure, and the removed bony lid was repositioned in situ and secured with a collagen tape. Healing was uneventful with limited swelling and reduced pain. A complete radiographic bone healing at the previously diseased site was confirmed with an 8-month cone beam computed tomography (CBCT) scan with no buccal bone resorption nor ridge collapse. The bone lid technique with a piezoelectric device was noninvasive and atraumatic in this case. Further studies are needed and could lead to the adaptation of this approach as a possible standard of care.
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Brady, J., B. M. Hardy, O. Yoshino, A. Buxton, A. Quail, and Z. J. Balogh. "The effect of haemorrhagic shock and resuscitation on fracture healing in a rabbit model." Bone & Joint Journal 100-B, no. 9 (2018): 1234–40. http://dx.doi.org/10.1302/0301-620x.100b9.bjj-2017-1531.r1.
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Aims Little is known about the effect of haemorrhagic shock and resuscitation on fracture healing. This study used a rabbit model with a femoral osteotomy and fixation to examine this relationship. Materials and Methods A total of 18 male New Zealand white rabbits underwent femoral osteotomy with intramedullary fixation with ‘shock’ (n = 9) and control (n = 9) groups. Shock was induced in the study group by removal of 35% of the total blood volume 45 minutes before resuscitation with blood and crystalloid. Fracture healing was monitored for eight weeks using serum markers of healing and radiographs. Results Four animals were excluded due to postoperative complications. The serum concentration of osteocalcin was significantly elevated in the shock group postoperatively (p < 0.0001). There were otherwise no differences with regard to serum markers of bone healing. The callus index was consistently increased in the shock group on anteroposterior (p = 0.0069) and lateral (p = 0.0165) radiographs from three weeks postoperatively. The control group showed an earlier decrease of callus index. Radiographic scores were significantly greater in the control group (p = 0.0025). Conclusion In a rabbit femoral osteotomy model with intramedullary fixation, haemorrhagic shock and resuscitation produced larger callus but with evidence of delayed remodelling. Cite this article: Bone Joint J 2018;100-B:1234–40.
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Rutkowski, James L., David A. Johnson, Nicholas M. Radio, and James W. Fennell. "Platelet Rich Plasma to Facilitate Wound Healing Following Tooth Extraction." Journal of Oral Implantology 36, no. 1 (2010): 11–23. http://dx.doi.org/10.1563/aaid-joi-09-00063.
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Abstract Following tooth removal bone formation normally takes 16 weeks and may result in less than adequate volume for the necessary reconstruction. Platelet rich plasma (PRP) has been promoted as an effective method for improving bone formation. Its use is often expensive, time consuming, or not clinically convenient for the patient and/or clinician. This study examines a simple method for obtaining a “Buffy Coat”-PRP (BC-PRP) and its effect on bone healing following the removal of bilateral mandibular 3rd molars. Subtraction digital radiography and CT scan analysis were used to track changes in radiographic density at PRP treated sites in comparison to ipsilateral non-PRP treated sites. PRP treated sites demonstrated early and significant increased radiographic density over baseline measurements following tooth removal. The greatest benefit of PRP is during the initial 2-week postoperative healing time period (P &lt; .001). During weeks 3 though 12, BC-PRP treatment resulted in significant (P &lt; .0001) increases in bone density compared to control, but there was no significant interaction between time and treatment (P &gt; .05). For the entire time period (0–25 weeks) PRP treatment was significant (P &lt; .0001) and time was significant (P &lt; .0001) but there was no significant interaction (P &gt; .05) between the effect of PRP treatment and time. It required 6 weeks for control extraction sites to reach comparable bone density that PRP treated sites achieved at week 1. Postoperative pain, bleeding, and numbness were not significantly affected by BC-PRP application. Results suggest that this simple technique may be of value to clinicians performing oral surgery by facilitating bone regeneration following tooth extraction.
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Kim, Seung-Ju, Hyun-Soo Park, Dong-Woo Lee, and Jae-Won Lee. "Does short-term weekly teriparatide improve healing in unstable intertrochanteric fractures?" Journal of Orthopaedic Surgery 26, no. 3 (2018): 230949901880248. http://dx.doi.org/10.1177/2309499018802485.
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Slow recovery after hip fracture has been associated with negative consequences. Thus, there is medical need to improve healing and functional recovery after intertrochanteric fracture. The aim of this study was to measure whether short-term teriparatide would improve healing in intertrochanteric fractures after internal fixation as measured by (1) clinical scores, (2) radiographic fracture healing, and (3) complication rates. We retrospectively reviewed 96 patients (average age, 82 years) who underwent closed reduction and internal fixation with proximal femoral nail (PFN) for unstable intertrochanteric fractures between 2014 and 2016. Of the 96 patients, 56 patients were treated with a PFN alone (group 1). These patients were compared with 46 patients for whom the same device was used and a weekly subcutaneous injection of PTH 1-34 (teriparatide) was prescribed postoperatively (group 2). Questionnaire surveys or telephone interviews were conducted, and patients completed a self-report Harris hip score and visual analog scale scores. The radiological time to fracture healing was assessed as the primary end point. Postoperative complication rates were compared. Functional outcomes at 6 months after surgery were similar in both groups. There were no differences between groups in the proportion of patients achieving radiographic fracture healing. The frequency of patients reporting adverse events was 20% (10 of 50) in group 1 versus 17% (8 of 46) in group 2 ( p = 0.744). Short-term teriparatide did not improve radiographic signs of fracture healing of an intertrochanteric fracture and reduce the incidence of complications. The effect of teriparatide on fracture healing remains uncertain. Further multicenter prospective studies are needed to demonstrate objective long-term results of parathyroid hormone therapy in patient with hip fracture. Level of Evidence: Level IV, therapeutic study.
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Ehnevid, Helge, Leif E. Jansson, Sven F. Lindskog, and Leif B. Blomlöf. "Periodontal Healing in Relation to Radiographic Attachment and Endodontic Infection." Journal of Periodontology 64, no. 12 (1993): 1199–204. http://dx.doi.org/10.1902/jop.1993.64.12.1199.
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Atwan, Yousif, and Emil H. Schemitsch. "Radiographic evaluations: Which are most effective to follow fracture healing?" Injury 51 (May 2020): S18—S22. http://dx.doi.org/10.1016/j.injury.2019.12.028.
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Szechinski, J. W., M. A. Grigorian, A. J. Grainger, et al. "Femoral Neck and Intertrochanteric Fractures: Radiographic Indicators of Fracture Healing." Orthopedics 25, no. 12 (2002): 1365–68. http://dx.doi.org/10.3928/0147-7447-20021201-14.
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Kieves, N. R., C. S. MacKay, K. Adducci, et al. "High energy focused shock wave therapy accelerates bone healing." Veterinary and Comparative Orthopaedics and Traumatology 28, no. 06 (2015): 425–32. http://dx.doi.org/10.3415/vcot-15-05-0084.
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SummaryObjectives: To evaluate the influence of shock wave therapy (SWT) on radiographic evidence of bone healing after tibial plateau leveling osteotomy (TPLO).Methods: Healthy dogs between two to nine years of age that underwent TPLO were randomly assigned to receive either electro- hydraulic SWT (1,000 shocks) or sham treatment (SHAM). Treatment or SHAM was administered to the osteotomy site immediately postoperatively and two weeks postoperatively. Three blinded radiologists evaluated orthogonal radiographs performed eight weeks postoperatively with both a 5-point and a 10-point bone healing scale. Linear regression analysis was used to compare median healing scores between groups.Results: Forty-two dogs (50 stifles) were included in the statistical analysis. No major complications were observed and all osteo -tomies healed uneventfully. The median healing scores were significantly higher at eight weeks postoperatively for the SWT group compared to the SHAM group for the 10-point (p <0.0002) and 5-point scoring systems (p <0.0001).Clinical significance: Shock wave therapy applied immediately and two weeks post -operatively led to more advanced bone healing at the eight week time point in this study population. The results of this study support the use of electro-hydraulic SWT as a means of accelerating acute bone healing of canine osteotomies. Additional studies are needed to evaluate its use for acceleration of bone healing following fracture, or with delayed union.
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Abubakar, Adamu Abdul, Ahmed Khalaf Ali, Sahar Mohammed Ibrahim, et al. "Generation of Open Metatarsal Fracture in Rats: A Model for Secondary Fracture Healing." SciMedicine Journal 2, no. 4 (2020): 197–211. http://dx.doi.org/10.28991/scimedj-2020-0204-2.
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A fracture model in rats for the study of secondary bone healing was described. Standard open midshaft transverse metatarsal fracture was produced with bone cutting forceps in 28 rats. The commonly open and close fracture models utilized for bone and mineral researches are associated with varying degree of complications ranging from a high degree of fracture comminution to severe associated soft tissue injury which interferes with the healing process. We hypothesized that fracture model in rat third metatarsal bone could be associated with low -post-surgical complications and could be a reproducible model. To test this, open mid-shaft transverse fractures were created on the metatarsals of 28 rats. The objectives of the study were to evaluate the fracture complications, to determine the nature of fracture produced, evaluate the fracture consolidation during healing periods, and to assess the histological and radiographic healing of the fracture. The fracture produced in the mid metatarsal shaft of all rats was 100% transverse, 73% located at the midshaft. Minimal fracture angulations were recorded (0.48 ± 0.09o; 0.78 ± 0.17o) for anterior-posterior and lateral views respectively. Minimal soft tissue injury was recorded immediately post-surgery, but no infection and the delayed union was observed. Varying degrees of weight-bearing lameness was also recorded but seized at day six onward post-operative. Callus index observed was peaked at week 2 and 3 (2.02 ± 0.1, 1.99 ± 0.13) respectively but declined to 1.10 ± 0.04 at week 7 during the consolidation period. The fracture line disappeared completely at week 7. The histological and radiographic healing scores were (3.5 ± 0.13 and 3.75 ± 0.25) respectively (out of the maximum healing score of 4) at week 7 post-operative. There was a positive correlation between the histological and radiographic healing scores. The metatarsal fracture model is considered to be a suitable model for in vivo study of secondary fracture healing. Doi: 10.28991/SciMedJ-2020-0204-2 Full Text: PDF
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Miller, Marvin, Adrienne Stolfi, and David Ayoub. "Findings of metabolic bone disease in infants with unexplained fractures in contested child abuse investigations: a case series of 75 infants." Journal of Pediatric Endocrinology and Metabolism 32, no. 10 (2019): 1103–20. http://dx.doi.org/10.1515/jpem-2019-0093.
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Abstract Background Infants who present with multiple unexplained fractures (MUF) are often diagnosed as victims of child abuse when parents deny wrongdoing and cannot provide a plausible alternative explanation. Herein we describe evidence of specific and commonly overlooked radiographic abnormalities and risk factors that suggest a medical explanation in such cases. Methods We evaluated such infants in which we reviewed the radiographs for signs of poor bone mineralization. We reviewed medical, pregnancy and family histories. Results Seventy-five of 78 cases showed poor bone mineralization with findings of healing rickets indicating susceptibility to fragility fractures that could result from a wide variety of causes other than child abuse. We found risk factors that could explain the poor bone mineralization: maternal and infant vitamin D deficiency (VDD), decreased fetal bone loading, prematurity and others. Most infants had more than one risk factor indicating that this bone disorder is a multifactorial disorder that we term metabolic bone disease of infancy (MBDI). Maternal and infant VDD were common. When tested, 1,25-dihydroxyvitamin D levels were often elevated, indicating metabolic bone disease. Conclusions Child abuse is sometimes incorrectly diagnosed in infants with MUF. Appreciation of the radiographic signs of MBDI (healing rickets), risk factors for MBDI and appropriate laboratory testing will improve diagnostic accuracy in these cases.
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Al-Nahlawi, Talal, Maisour Ala Rachi, and Amjad Abu Hasna. "Endodontic Perforation Closure by Five Mineral Oxides Silicate-Based Cement with/without Collagen Sponge Matrix." International Journal of Dentistry 2021 (September 7, 2021): 1–8. http://dx.doi.org/10.1155/2021/4683689.
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Endodontic perforations are common accidents that occasionally happen as a result of misuse or difficult anatomy of some teeth; it may lead to teeth loss unless a good management is provided. Bioceramic (silicate-based) cements like mineral trioxide aggregate have a big role in management of such accidents. This case report aimed to evaluate the ability of five mineral oxides cement “5MO” in sealing two root canal perforations (furcation and postdrill perforations) and inducing clinical and radiographic healing in the periodontal tissues with/without the use of collagen sponge matrix. A 58-year-old healthy female was referred to our dental office complaining of severe pain in the upper left premolars’ region. Periapical radiographic examination revealed unsatisfactory root canal treatment of the teeth #24 and #25 with a furcation perforation and a postdrill perforation, respectively. Cone-beam computed tomography “CBCT” scans confirmed the findings of the periapical radiography and revealed the presence of radiolucent lesions surrounding the apex of both teeth #24 and #25. The treatment plan was a nonsurgical root canal retreatment by endodontic access through the full-ceramic crowns. After three years of follow-up, CBCT scans revealed a complete healing and bone formation on both premolars. This case report indicates the use of 5MO cement for endodontic perforations management.
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Coughlin, Michael J., Bertil W. Smith, and Paul Traughber. "The Evaluation of the Healing Rate of Subtalar Arthrodeses, Part 2: The Effect of Low-Intensity Ultrasound Stimulation." Foot & Ankle International 29, no. 10 (2008): 970–77. http://dx.doi.org/10.3113/fai.2008.0970.
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Background: Arthrodeses of hindfoot joints is commonly used to treat a multitude of painful conditions and deformity. Use of adjuvant low-intensity ultrasound bone stimulation has demonstrated promising results in the treatment of acute fractures and fracture nonunions. The purpose of this 12-month prospective study was to evaluate the healing rate and clinical results of patients undergoing primary subtalar arthrodeses with adjuvant low-intensity ultrasound bone stimulation. Materials and Methods: Fifteen consecutive patients participated in the study. Routine radiographs and CT scans were obtained, and clinical outcomes gathered. The clinical and radiographic data were compared to a similar cohort of patients previously reported on that had not received ultrasound bone stimulation. Results: The patients who received ultrasound bone stimulation showed a statistically significant faster healing rate on plain radiographs at 9 weeks ( p = 0.034) and CT scan at 12 weeks ( p = 0.017). A 100% fusion rate was noted. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score was also improved at 12 months postoperatively, a finding that was statistically significant ( p = 0.026). Conclusion: This is the first paper, to our knowledge, to prospectively evaluate ultrasound bone stimulation in primary hindfoot arthrodesis patients. We were able to show significantly improved radiographic as well as clinical outcomes compared with a similar cohort of patients who did not receive adjuvant ultrasound stimulation. We believe that low-intensity ultrasound bone stimulation is indicated in primary hindfoot fusions, particularly in those patients at higher risk for nonunion. Level of Evidence: II, Prospective Comparative Study
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Tisano, Breann, Henry B. Ellis, Charles W. Wyatt, and Philip L. Wilson. "OSTEOCHONDRAL ALLOGRAFTING IN THE SKELETALLY IMMATURE KNEE: HIGH RATES OF INCORPORATION AND EXCELLENT EARLY OUTCOMES." Orthopaedic Journal of Sports Medicine 9, no. 7_suppl3 (2021): 2325967121S0011. http://dx.doi.org/10.1177/2325967121s00116.
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Background: While an excellent option for osteochondral defects in the adult knee, outcomes following fresh osteochondral allograft (OCA) the skeletally immature are limited. Purpose: To compare radiographic and patient reported outcomes (PROs) in mature and skeletally immature adolescents following OCA of the knee. Methods: An IRB-approved review of fresh size-matched OCA treatment of knee lesions in patients aged < 19 years within a pediatric sports medicine practice from 1/2006-3/2019 was completed. Following exclusion of patients with less than 12 months follow-up, demographics, lesion characteristics, reoperations, and PROs were evaluated. A novel grading scale (k= 0.832) was utilized to evaluate radiographic OCA incorporation: A=complete, B= >50%, or C= <50% healed. Results: Forty-four patients [15.5 years (9.6-19.8) treated with OCA of the distal femur or patella (LFC= 18, MFC=17, Trochlea=6, Patella=3), 24 with open and 20 with closed physes, with 2.2 year follow up (range 1-5.3 years) were evaluated. Overall average graft size was 4.76cm2 and did not differ significantly between groups. Thirty-nine patients underwent at least one prior procedure to the ipsilateral knee, most frequently for attempted osteochondral lesion healing (77%), followed by realignment (22.7%), and meniscal pathology (15.9%). Graft failure occurred in only one skeletally immature patient with a trochlear lesion. Those with open physes were more likely to demonstrate complete graft incorporation (66.6%, p=0.001). 21(88%) patients with open physes and 17(85%) patients with closed physes had radiographic healing grades of A or B one year post-operatively. There was no difference in healing grade based on graft size, depth, or location within the knee. There was no difference in pre-operative PROs or activity scores. At final follow-up, open physes OCA patients demonstrated better KOOS scores (KOOS daily living 97.0 vs 89.5, p=0.02; KOOS pain 95.7 vs 84.6, p= 0.04; KOOS quality of life 157.2 vs 59.6, p= 0.005). Final activity scores did not vary by skeletal maturity (Pedi-IKDC 75.8 vs 77.99; Pedi-FABS 17.2 vs 13.5,) or radiographic healing grade. Daily living and pain scores were better in those with more radiographic healing (KOOS daily living 98.6 vs 86,2, p= 0.02; KOOS pain 96.7 vs 82.3, p= 0.048). Conclusion: Fresh osteochondral allograft treatment in the young knee may be expected to yield good early results. Despite relatively large graft size, when indicated for patients with open physes, equivalent or improved healing and patient reported outcomes may be expected.
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Christiano, Anthony V., Christian A. Pean, Philipp Leucht, Sanjit R. Konda, and Kenneth A. Egol. "Scoring of radiographic cortical healing with the radiographic humerus union measurement predicts union in humeral shaft fractures." European Journal of Orthopaedic Surgery & Traumatology 30, no. 5 (2020): 835–38. http://dx.doi.org/10.1007/s00590-020-02635-0.
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McLaughlin, R., J. Hoskinson, and Dominique Griffon. "Effects of a Bone Inducing Agent Derived from a Cultured Human Osteosarcoma Cell Line after Orthotopic and Heterotopic Implantation in the Dog." Veterinary and Comparative Orthopaedics and Traumatology 09, no. 01 (1996): 22–8. http://dx.doi.org/10.1055/s-0038-1632497.
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SummaryBIA, a Bone Inducing Agent extracted from a cultured human osteosarcoma cell line (Saos–2), is highly osteoinductive in the skeletal muscle of athymic mice and promotes early osseous union of stabilized femoral non-unions in rats. To evaluate its effect in dogs, ten milligrams of BIA mixed with an equal amount of pure bovine collagen type I was compared with 20 mg of bovine collagen alone, a gelatin capsule alone, and fresh autogenous cancellous graft, after orthotopic and heterotopic implantation in Beagles.For osteoinductive bioassays, each implant was placed in the latissimus dorsi muscle of five Beagles for six weeks. Bone formation was evaluated by thoracic radiographs every two weeks and by high detail radiographs and histology six weeks after implantation. To evaluate the effects of BIA after orthotopic implantation, four cortical defects were created in each left femur of four Beagles. One defect on each femur was randomly filled with BIA plus collagen, collagen alone, a gelatin capsule alone, or autogenous cancellous graft. Radiographic evaluation of the femurs was performed every two weeks for eight weeks. Healing of the defects was assessed with high detail radiographs, dual energy X-ray absorptiometry, histology and histomorphometry eight weeks after implantation.Ten mg of BIA did not induce bone formation six weeks after heterotopic implantation and did not promote bone healing after orthotopic implantation in the dogs. The discrepancy between these results and those obtained in rodents may be related to immunogenic factors or to the dose of BIA used in this study.BIA, a Bone Inducing Agent extracted from a cultured osteosarcoma cell line is highly osteoinductive in rodents. BIA was evaluated and compared with autogenous cancellous bone graft and bovine collagen after orthotopic and heterotopic implantation in Beagles. Each implant was placed in the latissimus dorsi muscle of five Beagles and in femoral cortical defects of four Beagles. Bone formation was evaluated by radiography, dual energy X-ray absorptiometry, histology and histo-morphometry. BIA did not induce bone formation after heterotopic implantation and did not promote bone healing after orthotopic implantation in dogs.
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Lomakin, M. V., I. I. Soloshchanskii, A. A. Pokhabov, and H. U. Bisultanov. "Method for quantitative assessment of surgical wound healing (for example, the hole of a removed tooth). Part I." Parodontologiya 25, no. 4 (2020): 349–56. http://dx.doi.org/10.33925/1683-3759-2020-25-4-349-356.
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Relevance. Surgical stages of the dental implant restoration are an indispensable part of the treatment procedures. However, underestimation of residual/ available alveolar bone volume after tooth extraction may challenge implantation planning. Socket healing process might depend on either a surgical technique, or local or systemic preexisting factors, that this study should present as quantitative data. Purpose is to develop a technique for quantitative assessment of a surgical wound healing, e.g. an extraction socket.Materials and methods. The study included 42 patients after extraction of different teeth during the preparatory procedures for further dental arch restoration with implants. Follow-ups, clinical data, laboratory and radiographic findings determined clinical, radiographic, and information values – dependent and independent variables as quantifiable clinical parameters – biomarkers; they were statistically analyzed.Results. The conducted analysis revealed correlation dependence between selected parameters. Highly significant interrelationship allowed calculating the overall success rate of wound/ socket healing after tooth extraction. A regression model was developed to explain 76% healing success rate.Conclusion. Thus, factors and conditions determining the healing of a surgical bone wound, e.g. an extraction socket, consistently affect each other. Numerical sequences of real-life processes characterize the extent and highly significant interrelations and allow predicting the mutual impact of the factors.
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Field, John, and Greg Ruthenbeck. "Qualitative and Quantitative Radiological Measures of Fracture Healing." Veterinary and Comparative Orthopaedics and Traumatology 31, no. 01 (2018): 001–9. http://dx.doi.org/10.3415/vcot-17-03-0042.
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The formulation of appropriate postoperative strategies, following fracture repair, currently involves an understanding of radiological and clinical outcome measures. This study has evaluated several modalities used to assess the progression of bone healing in a sheep tibial segmental defect model. Measures of defect optical density and volumetric data including bone density (BD), bone volume (BV) and bone mass (BM) were compared with qualitative data involving visual appraisal of radiographs [% bridging callus and modified radiographic union score tibia (mRUST)] and a clinical outcome measure (locomotory function). Percent bridging callus and mRUST measures displayed strong correlation (r = 0.999), while locomotory function was weakly correlated with bridging callus (r = 0.029) and mRUST (r = 0.046). There was moderate to strong correlation between the qualitative and quantitative data. Bone density, BV and BM showed strong correlations within this dataset (BD–BV, r = 0.814; BD–BM, r = 0.818; BV–BM, r = 1.000). Likewise, optical density measures were strongly correlated with BD (r = 0.824), BV (r = 0.957) and BM (r = 0.959). The utilization of both qualitative and quantitative data, in assessment of the progression of fracture healing, has provided valuable insight. Measures of optical density have been shown to make a substantial contribution to this assessment and which should be considered for use in studies evaluating fracture healing.
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Itzep, Nelda, Siddharth Jadhav, Celeste K. Kanne, and Vivien A. Sheehan. "Spontaneous Healing of Avascular Necrosis of the Femoral Head in Sickle Cell Disease." Blood 132, Supplement 1 (2018): 4924. http://dx.doi.org/10.1182/blood-2018-99-119328.
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Abstract Background. Avascular necrosis (AVN) is a serious complication of sickle cell disease (SCD) that can lead to significant morbidity including chronic pain and physical impairment with treatment depending on the patient's pain severity and functional limitation. Patient age, hemoglobin levels, and abnormal rheology, particularly high blood viscosity, or thickness, and percentage of dense red blood cells, defined as cells >1.11 mg/mL have been identified as risk factors for the development of AVN, but their contributions to the subsequent clinical course has not been described. The natural history of AVN has been described as chronic and progressive without significant surgical or physical therapy based intervention. However, this description was established before widespread MRI use in diagnosis, or hydroxyurea (HU). A new evaluation of the natural history of AVN is needed. Objective: Review the natural history of AVN at our institution in patients for whom repeat imaging is available, and determine if patient demographics, treatment type, and laboratory data, including rheological values, predict of clinical course. Methods. We identified all patients with a diagnosis of AVN with diagnostic and follow-up imaging studies (pelvic X-rays or MRI of the hip), receiving care at Texas Children's Hospital Hematology Center 2006 to 2018, and collected demographic, treatment, rheological and clinical laboratory data. Patient radiographic images at diagnosis and follow up were reviewed and scored by a board certified pediatric radiologist using the Steinberg criteria. Laboratory values for each patient were collected as available from time of diagnosis through to the date of follow up imaging. Longitudinal patient blood samples were collected for rheological measurements under an IRB approved protocol. Whole blood viscosity was measured on a cone and plate viscometer (DV3T Rheometer, AMETEK Brookfield, Middleboro, MA, USA) at 45 and 225 s-1 at 37oC within 4 hours of sample collection in an EDTA vacutainer tube. Percent dense red blood cells (%DRBCs) were measured by an ADVIA 120 Hematology System (Siemens Medical Solutions USA, Inc., Malvern, PA, USA). Statistical analysis comparing groups with and without radiographic improvement was performed using a two-tailed Student's t-test. Results. 16 patients had repeat imaging, allowing for assessment of radiographic improvement (Table1). All were diagnosed via X ray or MRI of the pelvis. Five of 16 patients had resolution or significant radiographic improvement of AVN without orthopedic intervention or prolonged physical therapy, while 11 patients had stable or worsening disease. In the group with radiographic improvement, the mean age was 9.9 years (SD=2.5) and 14.6 years (SD=2.2) in the group without radiographic improvement (p= 0.002). Five patients underwent core decompression with bone marrow aspirate concentrate injection; one progressed to complete femoral head collapse while the rest had stable or worsening disease. Mean hemoglobin (Hb), fetal hemoglobin (HbF), percent DRBCs, whole blood viscosity, and extent of AVN at diagnosis by Steinberg criteria were not statistically different between the patients that showed improvement and those that did not. Conclusions. Our results challenge the paradigm of untreated AVN in SCD as an inexorably progressive disease. Here we present 5 cases of significant radiographic improvement of AVN without surgical or significant physical therapy interventions. Conversely, 5 AVN cases treated with core decompression remained stable or worsened. Given our small cohort, we were unable to establish laboratory or rheological predictors of spontaneous resolution. However, patients in the radiographic improvement group were younger than patients with progressive disease. HU has shown promise in improving vascular complications in SCD patients however more research is needed to delineate its role as a modifier of AVN natural history as it was not correlated with the improved group in our study (all our study patients were on HU either prior to diagnosis or started during the follow up period). Given the findings that significant radiographic improvement is possible with minimal or no intervention, providers should closely weigh the risks and benefits of observation versus surgical intervention, particularly in young patients with SCD. Disclosures No relevant conflicts of interest to declare.
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Bhat, Sham, S. Sharan, and Imneet Madan. "Healing of root resorption: a case report." Journal of Clinical Pediatric Dentistry 27, no. 3 (2003): 235–38. http://dx.doi.org/10.17796/jcpd.27.3.5n213546817741x7.
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External resorption is sequelae of necrotic periodontal membrane over a large area of root following an injury to the tooth. This usually occurs after severe dental injuries such as intrusion, severe luxations or exarticulation injuries complicated by a prolonged extra oral period. This case report presents a clinical and radiographic follow up (13 months) of treatment of inflammatory external root resorption on maxillary central incisor using Vitapex®. Gradual healing of resorption was observed radiographically with no tenderness or pathological mobility.
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Tsujii, Akira, Yasukazu Yonetani, Kazutaka Kinugasa, et al. "Outcomes More Than 2 Years After Meniscal Repair for Radial/Flap Tears of the Posterior Lateral Meniscus Combined With Anterior Cruciate Ligament Reconstruction." American Journal of Sports Medicine 47, no. 12 (2019): 2888–94. http://dx.doi.org/10.1177/0363546519869955.
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Background: Meniscal function after repair of radial/flap tears of the posterior horn of the lateral meniscus (LM) with anterior cruciate ligament reconstruction (ACLR) has not been comprehensively investigated. Purpose: To evaluate not only the clinical and radiographic outcomes of patients with repair of radial/flap tears of the posterior LM with ACLR but also the healing status of the repaired meniscus and changes of chondral status with second-look arthroscopy. Study Design: Case series; Level of evidence, 4. Methods: From January 2008 to April 2016, 41 patients of a consecutive series of 505 primary anatomic ACLR cases had a concomitant radial/flap tear of the posterior horn of the LM and underwent side-to-side repair with an inside-out or all-inside technique. All patients were followed for >2 years, evaluated clinically and radiologically (radiograph and magnetic resonance imaging [MRI]), and compared with a control group without any concomitant injuries that underwent ACLR. Of the 41 patients, 30 were assessed by second-look arthroscopy 2 years postoperatively. Results: The mean follow-up times of the study and control groups were 3.4 and 3.9 years, respectively. The study group showed no significant differences in clinical findings, lateral joint space narrowing on radiograph, and coronal extrusion on MRI as compared with the control group, whereas sagittal extrusion on MRI progressed significantly in the study group (1.2 ± 1.5 mm vs 0.32 ± 1.0 mm, P < .001). Eighteen patients (60%) obtained complete healing; 9 (30%) showed partial healing; and 3 (10%) failed to heal on second-look arthroscopy. Changes of chondral status in the femoral condyle showed no significant difference between the groups ( P = .29). However, chondral status of the lateral tibial plateau worsened significantly in the study group ( P = .0011). Conclusion: The clinical and radiographic outcomes after repair of radial/flap tears of the posterior horn of the LM as combined with anatomic ACLR were successful and comparable with those after isolated ACLR without any other injuries at a mean postoperative follow-up of 3.4 years, except for sagittal extrusion on MRI. Chondral lesions of the lateral tibial plateau deteriorated regardless of meniscal healing at 2 years postoperatively. Surgeons should keep in mind that chondral injuries might progress over the midterm.