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Yuan Z, Huan D, Dou W, Liu S, Lu C, Zhang C, Xia T, Shen J. Alteration in Microcirculation With Osteonecrosis of the Femoral Head: A Study of Dynamic Contrast-Enhanced MRI. Orthopedics 2024; 47:e73-e78. [PMID: 37757750 DOI: 10.3928/01477447-20230922-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is commonly used in clinical practice to detect tumor blood supply, and it has recently been applied to assess skeletal vasculature. In this study, we retrospectively analyzed DCE-MRI data from 37 patients with osteonecrosis of the femoral head to evaluate alterations in microvascular circulation of the femoral head. Time-intensity curves (TICs) in the region of interest were classified into different lesion stages. In the greater trochanter area, extracellular space volume per unit volume of tissue was significantly higher in Association Research Circulation Osseous (ARCO) stage III than in ARCO stage II (P<.05 and power ≥ 0.8), while other parameters showed no statistical difference (P>.05 and/or power < 0.8). In the necrotic area, contrast enhancement ratio and maximum slope of increase were significantly lower in ARCO stage III than in ARCO stage II (P<.05 and power ≥ 0.8), while other parameters showed no statistical difference (P>.05 and/or power < 0.8). In the repair reaction area, all parameters were significantly higher in ARCO stage III than in ARCO stage II (P<.05 and power ≥ 0.8). TIC classification showed that the greater trochanter area mainly exhibited type C (plateau type), the necrotic area mainly exhibited type B (out-flow type), and the repair reaction area mainly exhibited type A (inflow type). We believe that the exchange capacity of the vessels has a much greater impact on femoral head necrosis than the number of vessels, while the generation of the repair area greatly affects the prognosis of femoral head necrosis. These findings suggest that DCE-MRI can provide a good assessment of osteonecrosis of the femoral head perfusion and can serve as a new reference for clinical treatment decisions. [Orthopedics. 2024;47(2):e73-e78.].
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Rozental TD, Watkins IT. Principles and Evaluation of Bony Unions. Hand Clin 2024; 40:1-12. [PMID: 37979981 DOI: 10.1016/j.hcl.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2023]
Abstract
Nonunion is a common and costly problem. Unfortunately, there is no widely agreed upon and standardized definition for nonunion. The evaluation of bony union should start with a thorough history and physical examination. The clinician should consider patient-dependent as well as patient-independent characteristics that may influence the rate of healing and evaluate the patient for physical examination findings suggestive of bony union and infection. Radiographs and clinical examination can help confirm a diagnosis of union. When the diagnosis is in doubt, however, advanced imaging modalities as well as laboratory studies can help a surgeon determine when further intervention is necessary.
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Affiliation(s)
- Tamara D Rozental
- Hand and Upper Extremity Surgery, Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue - Stoneman 10, Boston, MA, 02215, USA.
| | - Ian T Watkins
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA; Division of Hand and Upper Extremity Surgery, Department of Orthopedics, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Mourad C, Omoumi P, Vande Berg B. The Many Faces of Marrow Necrosis. Semin Musculoskelet Radiol 2023; 27:103-113. [PMID: 36868248 DOI: 10.1055/s-0043-1761497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Depending on the age and location within the skeleton, bone marrow can be mostly fatty or hematopoietic, and both types can be affected by marrow necrosis. This review article highlights the magnetic resonance imaging findings of disorders in which marrow necrosis is the dominant feature.Fatty marrow necrosis is detected on T1-weighted images that show an early and specific finding: the reactive interface. Collapse is a frequent complication of epiphyseal necrosis and detected on fat-suppressed fluid-sensitive sequences or using conventional radiographs. Nonfatty marrow necrosis is less frequently diagnosed. It is poorly visible on T1-weighted images, and it is detected on fat-suppressed fluid-sensitive images or by the lack of enhancement after contrast injection.Pathologies historically "misnamed" as osteonecrosis but do not share the same histologic or imaging features of marrow necrosis are also highlighted.
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Affiliation(s)
- Charbel Mourad
- Department of Diagnostic and Interventional Radiology, Hôpital Libanais Geitaoui - CHU, Beyrouth, Lebanon.,Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Patrick Omoumi
- Department of Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Bruno Vande Berg
- Department of Radiology, Musculoskeletal Section, Centre Hospitalier Chretien, CHC, Clinique Mont Legia, Liege, Belgium
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Tang Y, Sin JM, Gitajn IL, Cao X, Han X, Elliott JT, Yu X, Christian ML, Bateman L, Chockbengboun T, Henderson ER, Pogue BW, Jiang S. Dynamic contrast-enhanced fluorescence imaging compared with MR imaging in evaluating bone perfusion during open orthopedic surgery. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2022; 11943:119430C. [PMID: 36061412 PMCID: PMC9430826 DOI: 10.1117/12.2608382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
ICG-based dynamic contrast-enhanced fluorescence imaging (DCE-FI) and intraoperative DCE- magnetic resonance imaging (MRI) have been carried out nearly simultaneously in three lower extremity bone infection cases to investigate the relationship between these two imaging modalities for assessing bone blood perfusion during open orthopedic surgeries. Time-intensity curves in the corresponding regions of interest of two modalities were derived for comparison. The results demonstrated that ICG-based DCE-FI has higher sensitivity to perfusion changes while DCE-MRI provides superior and supplemental depth-related perfusion information. Research applying the depth-related perfusion information derived from MRI to improve the overall analytic modeling of intraoperative DCE-FI is ongoing.
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Affiliation(s)
- Yue Tang
- Thayer school of Engineering, Dartmouth College, Hanover, NH
| | - Jessica M. Sin
- Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - I. Leah Gitajn
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Xu Cao
- Thayer school of Engineering, Dartmouth College, Hanover, NH
| | - Xinyue Han
- Thayer school of Engineering, Dartmouth College, Hanover, NH
| | | | - Xiaohan Yu
- Thayer school of Engineering, Dartmouth College, Hanover, NH
| | | | - Logan Bateman
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | | | - Eric R. Henderson
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Brian W. Pogue
- Thayer school of Engineering, Dartmouth College, Hanover, NH
| | - Shudong Jiang
- Thayer school of Engineering, Dartmouth College, Hanover, NH
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Doll J, Waizenegger S, Schmidmaier G, Weber MA, Fischer C. Contrast-Enhanced Ultrasound: A Viable Diagnostic Tool in Predicting Treatment Failure after Non-union Revision Surgery for Upper- and Lower-Limb Non-unions. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:3147-3158. [PMID: 34433520 DOI: 10.1016/j.ultrasmedbio.2021.07.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/19/2021] [Accepted: 07/26/2021] [Indexed: 06/13/2023]
Abstract
Non-unions remain a major complication in the treatment of long-bone fractures and affect quality of life considerably. Both early detection and treatment of non-unions are essential to secure subsequent fracture union. Sufficient vascularization plays a key role in the healing process. The aim of this prospective study was to quantify the microperfusion within non-unions by means of contrast-enhanced ultrasound (CEUS) as early as 12 wk after non-union surgery and to examine the prognostic capability of CEUS in predicting treatment failure. Among 112 patients who had undergone non-union surgery, consolidation within 36 mo was achieved in 89 patients ("responders"), whereas 23 patients showed persistent non-unions ("non-responders") and required further surgery. CEUS quantification parameters such as peak enhancement, wash-in area under the curve and wash-in perfusion index revealed significantly higher perfusion levels in "responders" compared with "non-responders" (p < 0.05). Receiver operator characteristic curve analysis revealed that persistent fracture non-unions could be predicted with a sensitivity/specificity of 88.7%/72.2% in lower-limb non-unions and a sensitivity/specificity of 66.7%/100.0% in upper-limb non-unions. CEUS is a suitable diagnostic tool in predicting treatment failure as early as 12 wk after non-union surgery and should be integrated into the clinical routine when deciding on revision surgery at an early stage.
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Affiliation(s)
- Julian Doll
- Centre for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Ultrasound Centre, Heidelberg Trauma Research Group (HTRG), Heidelberg University Hospital, Heidelberg, Germany.
| | - Stefan Waizenegger
- Centre for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Ultrasound Centre, Heidelberg Trauma Research Group (HTRG), Heidelberg University Hospital, Heidelberg, Germany
| | - Gerhard Schmidmaier
- Centre for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Ultrasound Centre, Heidelberg Trauma Research Group (HTRG), Heidelberg University Hospital, Heidelberg, Germany
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Paediatric Radiology and Neuroradiology, University Medical Centre Rostock, Rostock, Germany; Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Christian Fischer
- Centre for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Ultrasound Centre, Heidelberg Trauma Research Group (HTRG), Heidelberg University Hospital, Heidelberg, Germany; Arcus Sports Clinic, Pforzheim, Germany
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Thippeswamy PB, Nedunchelian M, Rajasekaran RB, Riley D, Khatkar H, Rajasekaran S. Updates in postoperative imaging modalities following musculoskeletal surgery. J Clin Orthop Trauma 2021; 22:101616. [PMID: 34660193 PMCID: PMC8502706 DOI: 10.1016/j.jcot.2021.101616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 09/25/2021] [Accepted: 09/26/2021] [Indexed: 11/18/2022] Open
Abstract
Postoperative imaging following orthopaedic surgeries is essential in assessing complications post-surgery and also helps plan further treatment. Combining a high degree of clinical insight with appropriate imaging can guide the treating clinician to the correct diagnosis. Imaging is quite challenging because of surgery-related soft tissue changes, especially in the early postoperative period and the presence of metal implants resulting in image scatter and metal artifacts. Newer modalities and advances in imaging have helped overcome shortcomings and assess better, especially in procedures that involve implants. Collaborative decision-making involving radiologists and clinicians has shown to be beneficial and is the way forward. This narrative review discusses the utility of imaging in evaluating postoperative complications following musculoskeletal surgeries with specific relation to trauma, arthroplasty, and tumour by discussing commonly encountered clinical scenarios.
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Affiliation(s)
- Pushpa Bhari Thippeswamy
- Department of Radiology, Ganga Medical Centre & Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, India
| | - Meena Nedunchelian
- Department of Radiology, Ganga Medical Centre & Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, India
| | - Raja Bhaskara Rajasekaran
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMS), Nuffield Orthopaedic Centre, Windmill Road, Oxford, OX3 7LD, UK
- Corresponding author. 17, Horwood Close, Headington, Oxford, OX3 7RF, UK.
| | - Dylan Riley
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMS), Nuffield Orthopaedic Centre, Windmill Road, Oxford, OX3 7LD, UK
| | - Harman Khatkar
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMS), Nuffield Orthopaedic Centre, Windmill Road, Oxford, OX3 7LD, UK
| | - Shanmuganathan Rajasekaran
- Department of Orthopaedics & Spine Surgery, Ganga Medical Centre & Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, India
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Nicholson JA, Yapp LZ, Keating JF, Simpson AHRW. Monitoring of fracture healing. Update on current and future imaging modalities to predict union. Injury 2021; 52 Suppl 2:S29-S34. [PMID: 32826052 DOI: 10.1016/j.injury.2020.08.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/22/2020] [Accepted: 08/07/2020] [Indexed: 02/02/2023]
Abstract
Fracture nonunion causes considerable patient morbidity and an associated burden to society. Traditional reliance on radiographs to monitor union has limitations as bridging callus of long bone fractures can take three or more months to occur. Computed Tomographic (CT) scanning is becoming increasingly popular and can evaluate bridging callus in the late stages of healing to confirm union. The use of dynamic contrast enhanced Magnetic Resonance Imaging (MRI) and advances in nuclear imaging may yield benefits in the assessment of the infected nonunion. Emerging evidence supports the use of ultrasound to detect bridging callus prior to radiographic confirmation and it may be of use to predict patients at high risk of nonunion. This paper is part of a Supplement supported by The Osteosynthesis and Trauma Care Foundation (OTCF).
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Affiliation(s)
- J A Nicholson
- Department of Orthopaedic and Trauma Surgery, Edinburgh Royal Infirmary, Little France, Edinburgh EH16 4SU, United Kingdom.
| | - L Z Yapp
- Department of Orthopaedic and Trauma Surgery, Edinburgh Royal Infirmary, Little France, Edinburgh EH16 4SU, United Kingdom
| | - J F Keating
- Department of Orthopaedic and Trauma Surgery, Edinburgh Royal Infirmary, Little France, Edinburgh EH16 4SU, United Kingdom
| | - A H R W Simpson
- Department of Orthopaedic and Trauma Surgery, Edinburgh Royal Infirmary, Little France, Edinburgh EH16 4SU, United Kingdom
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Fischer C, Miska M, Jung A, Weber MA, Saure D, Schmidmaier G, Weimer A, Moghaddam A, Doll J. Posttraumatic Perfusion Analysis of Quadriceps, Patellar, and Achilles Tendon Regeneration With Dynamic Contrast-Enhanced Ultrasound and Dynamic Contrast-Enhanced Magnetic Resonance Imaging: Preliminary Results. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:491-501. [PMID: 32785982 DOI: 10.1002/jum.15424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 04/12/2020] [Accepted: 06/12/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES The healing process of tendons after surgical treatment of tendon ruptures mainly depends on the perfusion of the tendon and its surrounding tissue. Dynamic contrast-enhanced ultrasound (DCE-US) and dynamic contrast-enhanced MRI (DCE-MRI) can provide additional information about the local microperfusion. In this pilot study, the feasibility of these techniques to assess the vascularization during tendon regeneration was evaluated. METHODS Between 2013 and 2015, 23 patients with surgical treatment of traumatic rupture of quadriceps, patellar, and Achilles tendons were involved. All patients received clinical follow-up examinations at 6, 12, and at least 52 weeks postoperatively. Dynamic contrast-enhanced US and DCE-MRI examinations were performed 6 and 12 weeks postoperatively. Dynamic contrast-enhanced US perfusion was quantified by the parameters peak enhancement, wash-in area under the curve, rise time, and initial area under the curve. Correlations between these parameters were examined via the Spearman rank correlation. The clinical and functional outcomes were assessed via the Lysholm Knee Score and Knee and Osteoarthritis Outcome Score at 12 and 52 weeks postoperatively. RESULTS Fourteen patients with quadriceps (n = 8), patellar (n = 4) and Achilles (n = 2) tendon ruptures with complete follow-up were available. The microperfusion could be successful assessed. We could detect a strong correlation of DCE-US (peak enhancement) parameters with DCE-MRI (initial area under the curve) parameters after 6 and 12 weeks. CONCLUSIONS In this pilot study, DCE-US was able to visualize the microperfusion of healing tendons with a strong correlation with DCE-MRI. Our initial results are in favor of DCE-US as a potential quantitative imaging tool for evaluating the vascularization in tendon regeneration as a complementary method.
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Affiliation(s)
- Christian Fischer
- Center of Orthopedics, Trauma Surgery, and Spinal Cord Injury, Heidelberg Trauma Research Group, Heidelberg University Hospital, Heidelberg, Germany
| | - Matthias Miska
- Center of Orthopedics, Trauma Surgery, and Spinal Cord Injury, Heidelberg Trauma Research Group, Heidelberg University Hospital, Heidelberg, Germany
| | - Andreas Jung
- Center of Orthopedics, Trauma Surgery, and Spinal Cord Injury, Heidelberg Trauma Research Group, Heidelberg University Hospital, Heidelberg, Germany
| | - Marc-André Weber
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology, and Neuroradiology, University Medical Center Rostock, Rostock, Germany
| | - Daniel Saure
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | - Gerhard Schmidmaier
- Center of Orthopedics, Trauma Surgery, and Spinal Cord Injury, Heidelberg Trauma Research Group, Heidelberg University Hospital, Heidelberg, Germany
| | - Andreas Weimer
- Center of Orthopedics, Trauma Surgery, and Spinal Cord Injury, Heidelberg Trauma Research Group, Heidelberg University Hospital, Heidelberg, Germany
| | - Arash Moghaddam
- Center of Orthopedics, Trauma Surgery, and Spinal Cord Injury, Heidelberg Trauma Research Group, Heidelberg University Hospital, Heidelberg, Germany
- Aschaffenburg Trauma and Orthopedic Research Group, Center for Trauma Surgery, Orthopedics, and Sports Medicine, Aschaffenburg, Germany
| | - Julian Doll
- Center of Orthopedics, Trauma Surgery, and Spinal Cord Injury, Heidelberg Trauma Research Group, Heidelberg University Hospital, Heidelberg, Germany
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Doll J, Streblow J, Weber MA, Schmidmaier G, Fischer C. The AMANDUS Project PART II-Advanced Microperfusion Assessed Non-Union Diagnostics with Contrast-Enhanced Ultrasound (CEUS): A Reliable Diagnostic Tool for the Management and Pre-operative Detection of Infected Upper-Limb Non-unions. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:478-487. [PMID: 33342619 DOI: 10.1016/j.ultrasmedbio.2020.11.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/19/2020] [Accepted: 11/23/2020] [Indexed: 06/12/2023]
Abstract
The management of upper-limb non-unions can be challenging, especially when infection is existent. Thus, pre-operative detection of infection plays a relevant role in non-union treatment. This study investigated in a large cohort the diagnostic potential of contrast-enhanced ultrasound (CEUS) as stand-alone method for differentiating between aseptic and infected upper-limb non-unions. Osseous perfusion of 50 upper-extremity non-unions (radius/ulna, n = 20; humerus, n = 22; clavicle, n = 8) was prospectively assessed with CEUS before revision surgery. The perfusion was quantified via time-intensity curves and peak enhancement (in arbitrary units). Significant perfusion differences between aseptic and infected non-unions could be detected (peak enhancement, p < 0.001). The sensitivity and specificity for the detection of infected upper-limb non-unions were 80% and 94.3% (cutoff peak enhancement: 130.8 arbitrary units). CEUS reliably differentiates between aseptic and infected upper-limb non-unions. Consequently, CEUS should be integrated into the daily diagnostic routine algorithm to plan non-union revision surgery more precisely as a single- or multi-step procedure.
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Affiliation(s)
- Julian Doll
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, HTRG-Heidelberg Trauma Research Group, Ultrasound Center, Heidelberg University Hospital, Heidelberg, Germany.
| | - Jan Streblow
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, HTRG-Heidelberg Trauma Research Group, Ultrasound Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany; Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Gerhard Schmidmaier
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, HTRG-Heidelberg Trauma Research Group, Ultrasound Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Christian Fischer
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, HTRG-Heidelberg Trauma Research Group, Ultrasound Center, Heidelberg University Hospital, Heidelberg, Germany
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Jeon S, Jang J, Lee G, Park S, Lee SK, Kim H, Choi J. Assessment of neovascularization during bone healing using contrast-enhanced ultrasonography in a canine tibial osteotomy model: a preliminary study. J Vet Sci 2020; 21:e10. [PMID: 31940689 PMCID: PMC7000898 DOI: 10.4142/jvs.2020.21.e10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 10/16/2019] [Accepted: 11/09/2019] [Indexed: 01/08/2023] Open
Abstract
Blood perfusion of skeletal muscle and callus was evaluated using contrast-enhanced ultrasonography (CEUS) in a canine osteotomy model to determine the applicability of CEUS in the assessment of neovascularization during fracture healing and to compare the vascular signals on CEUS between external skeletal fixation and cast-applied dogs. In 6 Beagle dogs, a simple transverse osteotomy was performed at the left tibial shaft and external skeletal fixation (n = 3) or a cast (n = 3) was applied. Radiography, power Doppler ultrasonography (power Doppler), and CEUS were performed until complete union was achieved. On CEUS, vascular changes were quantitatively evaluated by measuring peak intensity (PI) and time to PI in the soft tissue and callus and by counting the vascular signals. Vascular signals from the soft tissue were detected on power Doppler and CEUS on day 2. Significantly more vascular signals were detected by CEUS than by power Doppler. On CEUS, PI in the surrounding soft tissue was markedly increased after the fracture line appeared indistinctively changed on radiography in all dogs. In the cast-applied dogs, vascular signals from the periosteal and endosteal callus were detected on CEUS before mineralized callus was observed on radiography. CEUS was useful in assessing the vascularity of soft tissue and callus, particularly in indirect fracture healing, and provided indications of a normally healing fracture.
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Affiliation(s)
- Sunghoon Jeon
- College of Veterinary Medicine and BK21 Plus Project Team, Chonnam National University, Gwangju 61186, Korea
| | - Jaeyoung Jang
- Haemaru Referral Animal Hospital, Seongnam 13590, Korea
| | - Gahyun Lee
- College of Veterinary Medicine and BK21 Plus Project Team, Chonnam National University, Gwangju 61186, Korea
| | - Seungjo Park
- College of Veterinary Medicine and BK21 Plus Project Team, Chonnam National University, Gwangju 61186, Korea
| | - Sang Kwon Lee
- College of Veterinary Medicine and BK21 Plus Project Team, Chonnam National University, Gwangju 61186, Korea
| | - Hyunwook Kim
- Haemaru Referral Animal Hospital, Seongnam 13590, Korea
| | - Jihye Choi
- College of Veterinary Medicine and BK21 Plus Project Team, Chonnam National University, Gwangju 61186, Korea.
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Abstract
Nonunions represent a very heterogeneous, rare and sometimes very complex disease picture. The causes, localization and degree of expression show a very high variability, which makes it difficult to establish uniform treatment standards. Nevertheless, the process of bone healing is subject to some essential factors, which should be ensured for a successful treatment. Over the years these factors have been better researched and were taken into consideration for the diamond concept, which was first published by Giannoudis et al. in 2007. This provides the physician with a concept that does not neglect the heterogeneity of the disease picture and is an aid to decision making for the treatment regimen in individual cases in order to guarantee the best biological and mechanical conditions. The diamond concept is nowadays widely used and many studies have already demonstrated a successful application. It must be understood as a framework, in which the various treatment options available (bone substitute materials, mesenchymal stem cells, osteosynthesis procedures etc.) are incorporated into the individual factors and therefore provides the physician with a certain freedom of choice in the selection of tools. Additionally, it is not a rigid corset and subject to medical scientific progress in its factors, so that it is exciting to see which new developments will be incorporated in the future.
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Gitajn IL, Slobogean GP, Henderson ER, von Keudell AG, Harris MB, Scolaro JA, O’Hara NN, Elliott JT, Pogue BW, Jiang S. Perspective on optical imaging for functional assessment in musculoskeletal extremity trauma surgery. JOURNAL OF BIOMEDICAL OPTICS 2020; 25:JBO-200070-PER. [PMID: 32869567 PMCID: PMC7457961 DOI: 10.1117/1.jbo.25.8.080601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 08/12/2020] [Indexed: 06/11/2023]
Abstract
SIGNIFICANCE Extremity injury represents the leading cause of trauma hospitalizations among adults under the age of 65 years, and long-term impairments are often substantial. Restoring function depends, in large part, on bone and soft tissue healing. Thus, decisions around treatment strategy are based on assessment of the healing potential of injured bone and/or soft tissue. However, at the present, this assessment is based on subjective clinical clues and/or cadaveric studies without any objective measure. Optical imaging is an ideal method to solve several of these issues. AIM The aim is to highlight the current challenges in assessing bone and tissue perfusion/viability and the potentially high impact applications for optical imaging in orthopaedic surgery. APPROACH The prospective will review the current challenges faced by the orthopaedic surgeon and briefly discuss optical imaging tools that have been published. With this in mind, it will suggest key research areas that could be evolved to help make surgical assessments more objective and quantitative. RESULTS Orthopaedic surgical procedures should benefit from incorporation of methods to measure functional blood perfusion or tissue metabolism. The types of measurements though can vary in the depth of tissue sampled, with some being quite superficial and others sensing several millimeters into the tissue. Most of these intrasurgical imaging tools represent an ideal way to improve surgical treatment of orthopaedic injuries due to their inherent point-of-care use and their compatibility with real-time management. CONCLUSION While there are several optical measurements to directly measure bone function, the choice of tools can determine also the signal strength and depth of sampling. For orthopaedic surgery, real-time data regarding bone and tissue perfusion should lead to more effective patient-specific management of common orthopaedic conditions, requiring deeper penetrance commonly seen with indocyanine green imaging. This will lower morbidity and result in decreased variability associated with how these conditions are managed.
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Affiliation(s)
- Ida L. Gitajn
- Dartmouth-Hitchcock Medical Center, Department of Orthopaedics, Lebanon, New Hampshire, United States
| | - Gerard P. Slobogean
- University of Maryland, Orthopaedic Associates, Baltimore, Maryland, United States
| | - Eric R. Henderson
- Dartmouth-Hitchcock Medical Center, Department of Orthopaedics, Lebanon, New Hampshire, United States
| | - Arvind G. von Keudell
- Brigham and Women’s Hospital, Department of Orthopaedic Surgery, Boston, Massachusetts, United States
| | - Mitchel B. Harris
- Massachusetts General Hospital, Department of Orthopaedic Surgery, Boston, Massachusetts, United States
| | - John A. Scolaro
- University of California, Irvine, Department of Orthopaedic Surgery, Orange, California, United States
| | - Nathan N. O’Hara
- University of Maryland, Orthopaedic Associates, Baltimore, Maryland, United States
| | - Jonathan T. Elliott
- Dartmouth-Hitchcock Medical Center, Department of Surgery, Lebanon, New Hampshire, United States
| | - Brian W. Pogue
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
| | - Shudong Jiang
- Dartmouth College, Thayer School of Engineering, Hanover, New Hampshire, United States
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Jiang JS, Hua Y, Zhou XJ, Shen DD, Shi JL, Ge M, Geng QN, Jia ZZ. Quantitative Assessment of Tumor Cell Proliferation in Brain Gliomas with Dynamic Contrast-Enhanced MRI. Acad Radiol 2019; 26:1215-1221. [PMID: 30416002 DOI: 10.1016/j.acra.2018.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 10/12/2018] [Accepted: 10/13/2018] [Indexed: 02/06/2023]
Abstract
RATIONALE AND OBJECTIVES This study aimed to investigate whether volume transfer constant (Ktrans) and volume of extravascular extracellular space per unit volume of tissue (Ve) derived from dynamic contrast-enhanced magnetic resonance imaging (DCE MRI) could quantitatively assess the tumor proliferation index (Ki-67) of gliomas noninvasively. MATERIALS AND METHODS The preoperative DCE MRI data of 69 patients with pathologically confirmed glioma (28, 8, and 33 cases in grades Ⅱ, Ⅲ, and Ⅳ) were retrospectively reviewed. The maximal Ktrans and Ve were measured in the tumor body. The immunohistochemistry was used to detect the expression of Ki-67 proteins in glioma specimens. The Mann-Whitney U test was applied to analyze the differences in Ktrans, Ve, and Ki-67 index across histologically defined glioma grades. Spearman correlation was performed between Ktrans, Ve, and Ki-67 index. The receiver operating characteristic curve analysis was used to determine the cutoff values of Ktrans and Ve in distinguishing different Ki-67 index expression levels. RESULTS Ktrans, Ve, and Ki-67 index of grade Ⅱ (0.027 min-1, 0.065, 4.04%) were significantly lower than those of grade Ⅲ (0.093 min-1, 0.297, 25.13%) and Ⅳ (0.100 min-1, 0.299, 25.37%). Both Ktrans and Ve significantly correlated with the Ki-67 index in all tumors and high-grade gliomas (HGGs, grade Ⅲ and Ⅳ). The receiver operating characteristic curve analysis revealed that the cutoff values for Ktrans (0.079 min-1) and Ve (0.249) provided the best combination of sensitivity and specificity to distinguish the gliomas with high Ki-67 index from those with low Ki-67 index. CONCLUSION The DCE MRI-derived parameters were valuable in assessing the tumor cell proliferation in HGG noninvasively.
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Abstract
INTRODUCTION Non-union of a long bone fracture remains a challenge in orthopaedic and trauma surgery. In the current study, we sought to determine the clinical effectiveness of tibial non-union treatment utilizing an antibiotic-coated intramedullary nail (Expert Tibia Nail (ETN) PROtect®) regarding prevention and treatment of infection and the clinical outcome. PATIENTS AND METHODS 36 patients suffering from tibial non-unions that were treated with the ETN PROtect® in the course of non-union treatment between February 2010 and March 2015 were included in this clinical observational study. Clinical and radiological examinations were performed preoperatively as well as 4, 6 and 12 weeks and 6 and 12 months postoperatively as part of a standardized follow-up program. Data regarding perioperative complications, weight-bearing capacity, radiological signs of consolidation and subjective health status were assessed at each time point. Laboratory parameters such as C-reactive protein (CRP) and leukocyte count were collected preoperatively in order to assess the patients' risk profile for infection. RESULTS Patients had an average of 6.2 previous surgeries and 22 patients (61.1%) had a positive bacterial culture from intraoperatively removed tissue during the first operative treatment. 29 patients (80.6%) achieved full weight-bearing after an average of 7.7 months, furthermore 80.6% of patients achieved osseous consolidation. 3 deep infections occurred, including one amputation. Subjective health status increase based on the SF-12 questionnaire during our follow-up program. CONCLUSION The results from the current study indicate that the use of the ETN PROtect® in the applied non-union therapy has a high clinical effectiveness regarding osseous consolidation and time to weight bearing. In addition, the use of gentamicin-coated nails in the treatment of tibial non-unions might contribute to both successful treatment of the underlying infection and prevention of perioperative infection. The gentamicin-coated nail may serve as a beneficial adjunct treatment in the applied non-union therapy in addition to all established techniques in the treatment of infected non-unions.
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Roth TD, Ladd LM, Kempton LB. Fracture Healing and Imaging Evaluation. CURRENT RADIOLOGY REPORTS 2017. [DOI: 10.1007/s40134-017-0221-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Gondim Teixeira PA, Leplat C, Chen B, De Verbizier J, Beaumont M, Badr S, Cotten A, Blum A. Contrast-enhanced 3T MR Perfusion of Musculoskeletal Tumours: T1 Value Heterogeneity Assessment and Evaluation of the Influence of T1 Estimation Methods on Quantitative Parameters. Eur Radiol 2017; 27:4903-4912. [DOI: 10.1007/s00330-017-4891-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 04/13/2017] [Accepted: 05/11/2017] [Indexed: 12/31/2022]
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Budzik JF, Lefebvre G, Behal H, Verclytte S, Hardouin P, Teixeira P, Cotten A. Bone marrow perfusion measured with dynamic contrast enhanced magnetic resonance imaging is correlated to body mass index in adults. Bone 2017; 99:47-52. [PMID: 28347909 DOI: 10.1016/j.bone.2017.03.048] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 03/03/2017] [Accepted: 03/07/2017] [Indexed: 01/02/2023]
Abstract
Bone marrow metabolism is complex and far from being fully understood. Novel aspects, such as the roles of bone marrow adiposity and vascularisation in bone metabolism currently attract attention. There is also a growing interest in the influence obesity might have on bone metabolism. Our objective was to determine the effect of BMI on bone marrow perfusion parameters using dynamic contrast-enhanced magnetic resonance imaging. This prospective monocentric study was approved by our local Ethics committee. Written consent was obtained. The right hip of 59 adults under 60years old (mean age 37.5) was imaged with a dynamic 3D T1 spoiled gradient echo magnetic resonance imaging sequence. Mean BMI was 24.8 (+/-4.4). Perfusion parameters were measured in the acetabulum and femoral neck, in the greater trochanter, in the femoral head epiphysis and in the subcutaneous adipose tissue. Associations between perfusion parameters and BMI were studied using a linear mixed model adjusted for age and sex effects. Our results showed that as the BMI increased, the exchanges between blood and bone marrow appeared more important (increased Ktrans and Kep values, p=0.018 and p=0.002 respectively) and the intramedullary blood flow appeared increased (lower time to peak values, p=0.0002). In the subcutaneous fat, as the BMI increased, the vascularization decreased (lower area under the curve and initial slope values, p=0.019 and p=0.013 respectively). These results suggest that there is a relation between bone marrow perfusion and BMI, and that subcutaneous fat and bone marrow fat have different microvascular behaviours. Researchers must be aware of the effect of BMI on bone marrow perfusion parameters when they build a MR research protocol and analyse their data. A better understanding of these findings may provide the basis for the management of obesity-related bone changes.
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Affiliation(s)
- Jean-François Budzik
- Lille Catholic Hospitals, Imaging Department, Lille Catholic University, Lille, France; PMOI Physiopathology of Inflammatory Bone Diseases, EA 4490, Lille, France.
| | - Guillaume Lefebvre
- Lille Regional University Hospital, Musculoskeletal Imaging Department, University of Lille Nord de France, Lille, France.
| | - Hélène Behal
- Lille Regional University Hospital, Biostatistics Department, University of Lille Nord de France, Lille, France.
| | - Sébastien Verclytte
- Lille Catholic Hospitals, Imaging Department, Lille Catholic University, Lille, France.
| | - Pierre Hardouin
- PMOI Physiopathology of Inflammatory Bone Diseases, EA 4490, University of Lille Nord de France, Lille, France.
| | - Pedro Teixeira
- Nancy Regional University Hospital, Imaging Department, University of Lorraine, Nancy, France.
| | - Anne Cotten
- Lille Catholic Hospitals, Imaging Department, Lille Catholic University, Lille, France; PMOI Physiopathology of Inflammatory Bone Diseases, EA 4490, University of Lille Nord de France, Lille, France.
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Fischer C, Nissen M, Schmidmaier G, Bruckner T, Kauczor HU, Weber MA. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for the prediction of non-union consolidation. Injury 2017; 48:357-363. [PMID: 28088373 DOI: 10.1016/j.injury.2017.01.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 01/06/2017] [Accepted: 01/07/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Non-union perfusion can be visualized with dynamic contrast-enhanced (DCE) MRI. This study evaluated DCE-MRI to predict non-union consolidation after surgery and detect factors that affect bone healing. MATERIALS AND METHODS Between 2010 and 2015 non-union perfusion was prospectively quantified in 205 patients (mean age, 51.5 years, 129 men, 76 women) before intervention and at 6, 12, 26, 52 and more weeks follow-up. DCE-MRI results were related to the osseous consolidation, the ability to predict successful outcome was estimated by ROC analysis. The relevance of the body mass index (BMI) and the non-union severity score (NUSS) to the healing process was assessed. RESULTS Tibial (n=99) and femoral (n=76) non-unions were most common. Consolidation could be assessed in 169 patients, of these 103 (61%) showed eventual healing and demonstrated higher perfusion than in failed consolidation at 6 (p=0.0226), 12 (p=0.0252) and 26 (p=0.0088) weeks follow-up. DCE-MRI at 26 weeks follow-up predicted non-union consolidation with a sensitivity of 75% and a specificity of 87% (false classification rate 19%). Higher BMI (p=0.041) and NUSS (p<0.0001) were associated with treatment failure. CONCLUSIONS DCE-MRI perfusion analysis after non-union surgery predicts successful outcome and could facilitate the decision of early intervention. NUSS and BMI are important prognostic factors concerning consolidation.
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Affiliation(s)
- Christian Fischer
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, HRTG, Heidelberg, Germany.
| | - Mareike Nissen
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, HRTG, Heidelberg, Germany
| | - Gerhard Schmidmaier
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, HRTG, Heidelberg, Germany
| | - Thomas Bruckner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Marc-André Weber
- Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
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Fischer C, Preuss EM, Tanner M, Bruckner T, Krix M, Amarteifio E, Miska M, Moghaddam-Alvandi A, Schmidmaier G, Weber MA. Dynamic Contrast-Enhanced Sonography and Dynamic Contrast-Enhanced Magnetic Resonance Imaging for Preoperative Diagnosis of Infected Nonunions. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:933-942. [PMID: 27036169 DOI: 10.7863/ultra.15.06107] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 08/13/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES Bone regeneration depends on perfusion of the fracture tissue, whereby hypervascularity is associated with infection, which itself causes nonunions. To date, nonunion perfusion has not been assessed with contrast-enhanced sonography. The aim of this study was to evaluate the potential of contrast-enhanced sonography in the analysis of nonunion tissue perfusion. METHODS Nonunion vascularity of 31 patients before revision surgery was prospectively examined with qualitative contrast-enhanced sonography and dynamic contrast-enhanced magnetic resonance imaging (MRI). Time-intensity curves from 2-minute contrast-enhanced sonographic video clips were generated, and parameters such as wash-in rate, rise time, and peak enhancement were quantified. On dynamic contrast-enhanced MRI, the initial area under the enhancement curve was quantified. Preoperative radiographs, computed tomograms, the clinical nonunion score, laboratory infection features, as well as contrast-enhanced sonographic and dynamic contrast-enhanced MRI perfusion were correlated with microbiological results from the nonunion tissue. RESULTS Both qualitative and quantitative contrast-enhanced sonography showed significant differences between infected and aseptic nonunions (P = .015 and .020). The qualitative dynamic contrast-enhanced MRI analysis was not significant (P= .244), but after quantification, a strong correlation (P = .007) with microbiological results was noted. A receiver operating characteristic analysis calculated ideal cutoff values for quantitative contrast-enhanced sonography and dynamic contrast-enhanced MRI so that their combination detected infected nonunions with sensitivity and specificity of 88.9% and 77.3%, respectively. Clinical, radiologic, and laboratory examinations did not correlate with microbiological results (P > .05). CONCLUSIONS Contrast-enhanced sonography can visualize the vascularity of nonunions in real time, while quantification software allows for a semiobjective evaluation of bone perfusion. The correlations of both quantitative contrast-enhanced sonography and dynamic contrast-enhanced MRI with microbiological results show their high value for differentiation of infected from aseptic nonunions.
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Affiliation(s)
- Christian Fischer
- Center for Orthopedics, Trauma Surgery, and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany.
| | - Eva-Maria Preuss
- Center for Orthopedics, Trauma Surgery, and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
| | - Michael Tanner
- Center for Orthopedics, Trauma Surgery, and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
| | - Thomas Bruckner
- Institute of Medical Biometry and Informatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Martin Krix
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Erick Amarteifio
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Matthias Miska
- Center for Orthopedics, Trauma Surgery, and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
| | - Arash Moghaddam-Alvandi
- Center for Orthopedics, Trauma Surgery, and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
| | - Gerhard Schmidmaier
- Center for Orthopedics, Trauma Surgery, and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
| | - Marc-André Weber
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
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Moghaddam A, Ermisch C, Schmidmaier G. Non-Union Current Treatment Concept. ACTA ACUST UNITED AC 2016. [DOI: 10.17795/soj-4546] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Moghaddam A, Zietzschmann S, Bruckner T, Schmidmaier G. Treatment of atrophic tibia non-unions according to 'diamond concept': Results of one- and two-step treatment. Injury 2015; 46 Suppl 4:S39-50. [PMID: 26542865 DOI: 10.1016/s0020-1383(15)30017-6] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND The successful treatment of atrophic tibia non-unions and tibia non-unions with large bone defects or infections is a major challenge in orthopedic and trauma surgery. This article evaluates the use of the 'diamond concept' using a one-step or two-step procedure according to 'Masquelet technique' in the treatment of atrophic tibia non-unions. METHODS Between February 2010 and March 2014, 102 patients with atrophic non-unions were treated according to the 'diamond concept' in our center. Ninety-nine were available for follow-up. Forty-nine received a one-step treatment (Group 1, G1) and 50 patients received a two-step treatment according to the 'Masquelet technique' (Group 2, G2). Clinical and radiological parameters were measured preoperatively as well as 4, 6, and 12 weeks and 6 and 12 months postoperatively. In order to evaluate the subjective health of patients, we used the SF-12 questionnaire. Data analysis was performed one year after treatment. RESULTS The rate of consolidation in G1 was 84% and 80% in G2. The time to heal in G2 was 8.6 ± 2.9 months, which is significantly longer than in G1 being 6.9 ± 3.1 months. In comparison patients in G1/G2 had an average of 3.2/6.7 previous major surgeries. In G1, 4 of 8 patients who did not heal successfully showed positive intraoperative cultures. In G2, 26 patients (52%) initially presented with positive cultures. The results of the SF-12 questionnaire improved in both groups during the postoperative follow-up, but showed no significant differences between groups. In 29 patients a gentamycin-coated nail was used for reosteosynthesis. These patients showed by trend a lower rate of complications at a higher rate of consolidation. CONCLUSIONS Our study showed that the 'diamond concept' is a suitable method for safely and effectively treating non-unions with large defects or infections. The use of an antibiotic-coated nail provides a therapeutic benefit. For large bone defects of infected non-unions the two-step procedure after Masquelet is an efficient way to eradicate the infection and treat the bone defect successfully.
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Affiliation(s)
- Arash Moghaddam
- HTRG - Heidelberg Trauma Research Group, Trauma and Reconstructive Surgery. Center for Orthopedics, Trauma Surgery and Spinal Cord Injury. Heidelberg University Hospital, Schlierbacher Landstraße 200a, D-69118 Heidelberg, Germany.
| | - Severin Zietzschmann
- HTRG - Heidelberg Trauma Research Group, Trauma and Reconstructive Surgery. Center for Orthopedics, Trauma Surgery and Spinal Cord Injury. Heidelberg University Hospital, Schlierbacher Landstraße 200a, D-69118 Heidelberg, Germany
| | - Thomas Bruckner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 305, D-69120 Heidelberg, Germany
| | - Gerhard Schmidmaier
- HTRG - Heidelberg Trauma Research Group, Trauma and Reconstructive Surgery. Center for Orthopedics, Trauma Surgery and Spinal Cord Injury. Heidelberg University Hospital, Schlierbacher Landstraße 200a, D-69118 Heidelberg, Germany
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Griffith JF. Functional imaging of the musculoskeletal system. Quant Imaging Med Surg 2015; 5:323-31. [PMID: 26029633 DOI: 10.3978/j.issn.2223-4292.2015.03.07] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 02/28/2015] [Indexed: 12/17/2022]
Abstract
Functional imaging, which provides information of how tissues function rather than structural information, is well established in neuro- and cardiac imaging. Many musculoskeletal structures, such as ligaments, fascia and mineralized bone, have by definition a mainly structural role and clearly don't have the same functional capacity as the brain, heart, liver or kidney. The main functionally responsive musculoskeletal tissues are the bone marrow, muscle and nerve and, as such, magnetic resonance (MR) functional imaging has primarily addressed these areas. Proton or phosphorus spectroscopy, other fat quantification techniques, perfusion imaging, BOLD imaging, diffusion and diffusion tensor imaging (DTI) are the main functional techniques applied. The application of these techniques in the musculoskeletal system has mainly been research orientated where they have already greatly enhanced our understanding of marrow physiology, muscle physiology and neural function. Going forwards, they will have a greater clinical impact helping to bridge the disconnect often seen between structural appearances and clinical symptoms, allowing a greater understanding of disease processes and earlier recognition of disease, improving prognostic prediction and optimizing the monitoring of treatment effect.
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Affiliation(s)
- James F Griffith
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
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Oh J, Jeon S, Choi J. Contrast-enhanced ultrasonography to assess blood perfusion of skeletal muscles in normal dogs. J Vet Med Sci 2015; 77:783-8. [PMID: 25754794 PMCID: PMC4527499 DOI: 10.1292/jvms.14-0328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This study evaluated perfusion of skeletal muscle using contrast enhanced ultrasonography in humerus, radius, femur and tibia in normal dogs. Contrast enhanced ultrasonography for each region was performed after injecting 0.5 mL and 1 mL of contrast medium (SonoVue) in every dog. Blood perfusion was assessed quantitatively by measuring the peak intensity, time to the peak intensity and area under the curve from the time-intensity curve. Vascularization in skeletal muscle was qualitatively graded with a score of 0-3 according to the number of vascular signals. A parabolic shape of time-intensity curve was observed from muscles in normal dogs, and time to the peak intensity, the peak intensity and area under the curve of each muscle were not significantly different according to the appendicular regions examined and the dosage of contrast agent administered. This study reports that feasibility of contrast enhanced ultrasonography for assessment of the muscular perfusion in canine appendicular regions.
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Affiliation(s)
- Juyeon Oh
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Chonnam National University, Gwangju 500-757, South Korea
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