Search Results
Abstract
Osteonecrosis is acknowledged as a relatively uncommon disorder caused by various factors, including autoimmune diseases, drug-induced diseases, inherited metabolic disorders, coagulation disorders, and underlying malignancies. To our knowledge, no previous research has investigated osteonecrosis stemming from extracorporeal membrane oxygenation. Herein, we report a rare case of postperipheral venoarterial extracorporeal membrane oxygenation–induced multifocal osteonecrosis in the foot and ankle that demonstrated a low serpiginous peripheral signal on T1-weighted images and a double-line sign on fat-suppressed or T2-weighted magnetic resonance images. Conservative treatment was applied, and the patient was mostly recuperated after 6 months.
Hallucal Sesamoid Osteonecrosis
An Overlooked Cause of Forefoot Pain
Four cases of osteonecrosis of hallucal sesamoids are reported here. Surgical excision of necrotic sesamoid tissue yielded satisfactory results, with the patients reporting no residual pain. Although it has not been frequently addressed in the literature, avascular necrosis of the sesamoid bones should be considered in the differential diagnosis of persistent forefoot pain. (J Am Podiatr Med Assoc 95(3): 277–280, 2005)
Osteonecrosis is acknowledged as a relatively uncommon disorder caused by various factors, including autoimmune diseases, drug-induced diseases, inherited metabolic disorders, coagulation disorders, and underlying malignancies. To our knowledge, no previous research has investigated osteonecrosis stemming from extracorporeal membrane oxygenation. Herein, we report a rare case of postperipheral venoarterial extracorporeal membrane oxygenation–induced multifocal osteonecrosis in the foot and ankle that demonstrated a low serpiginous peripheral signal on T1-weighted images and a double-line sign on fat-suppressed or T2-weighted magnetic resonance images. Conservative treatment was applied, and the patient was mostly recuperated after 6 months.
Freiberg’s Disease
Quantitative Assessment of Osteonecrosis on Three-Dimensional CT
Background:
The extent of necrosis is the main determining factor in the outcome of osteonecrosis. There is no method for measuring the extent of osteonecrosis of the metatarsal head in Freiberg’s disease. The purpose of this study was to determine the reliability and prognostic ability of a new method for measurement of the extent of osteonecrosis in Freiberg’s disease on three-dimensional computed tomography.
Methods:
A retrospective review of 11 cases with symptomatic Freiberg’s disease in ten patients (5 males and 5 females; mean age, 27 years) undergoing computed tomography between July 2005 and September 2007 was performed. Two investigators (K.A.C. and H.K.O.) used a new method to measure the necrotic extent of the metatarsal head: the necrotic angle ratio of necrotic arc angle to normal arc angle of the articular surface on the sagittal reconstruction image of computed tomography. The interobserver reliability was determined for computed tomography measurement. Correlation between the Smillie staging using radiographs and the necrotic angle ratio on computed tomography was also evaluated.
Results:
One patient presented with stage I disease (Smillie staging), one with stage II, two with stage III, five with stage IV, and two with stage V, respectively. The necrotic angle ratio of the metatarsal head was 14% in stage I, 21% in stage II, 34% in stage III, 43% in stage IV, and 53% in stage V. The interobserver reliability for computed tomography measurement was high (Cronbach α=0.96). We found the increase of the necrotic extent in proportion to the Smillie stage. The Smillie staging using radiographs and the necrotic angle ratio on computed tomography were significantly correlated. (P<0.05)
Conclusions:
Three-dimensional computed tomography measurement of the necrotic extent of the metatarsal head is a reliable and useful method in evaluating the staging of Freiberg’s disease and may eventually help to optimize treatment. (J Am Podiatr Med Assoc 101(4): 335–340, 2011)
Diagnostic Imaging of the Mueller-Weiss Syndrome
Findings of a Rare Condition of the Foot
We report three patients with diagnostic imaging findings that are consistent with Mueller-Weiss syndrome. Mueller-Weiss syndrome is a rare condition that involves osteonecrosis of the navicular bone in an adult. The characteristic findings for Mueller-Weiss syndrome include a dorsomedial dislocation along with the collapse of the lateral navicular bone, resulting in a comma-shaped configuration. Through these three case studies, we aim to familiarize both foot and ankle specialists and radiologists with the diagnostic imaging findings for Mueller-Weiss syndrome.
A 17-year-old boy presented with a totally dislocated talus and open bimalleolar ankle fracture dislocation. After thorough debridement and irrigation, the talus and bimalleolar fracture were reduced and fixed. At 21 months after surgery, he could walk using regular shoes without any aid but with moderate pain in the sinus tarsi during activities. No evidence of osteonecrosis or infection was seen in the last radiograph, except for a small degree of narrowing in the talonavicular joint. Reimplantation and fixation of pantalar dislocation seems to have an acceptable outcome.
Unenhanced magnetic resonance imaging diagnoses osteonecrosis on the basis of loss of fatty marrow and the presence of edema. Enhanced magnetic resonance imaging, however, directly assesses marrow perfusion and allows earlier prediction of osteonecrosis after a bunionectomy.
Background:
Freiberg’s infraction is an osteochondrosis that is characterized by osteonecrosis of the metatarsal head, with pain and tenderness around the metatarsophalangeal joint. We sought to evaluate the outcome of joint debridement and metatarsal remodeling for the treatment of advanced-stage Freiberg’s infraction.
Methods:
Between March 1, 2006, and April 30, 2011, 14 patients (eight females and six males) with symptomatic unilateral Freiberg’s disease refractory to conservative treatment (Smillie stages IV and V) underwent joint debridement with metatarsal head remodeling by two surgeons. To evaluate functional outcome, American Orthopaedic Foot and Ankle Society and 36-Item Short Form Health Survey forms were completed by the patients preoperatively and postoperatively at months 3, 6, and 12. Active-assisted range-of-motion exercise was allowed after 4 weeks of short-leg walking cast wear, and weightbearing on the forefoot was allowed as tolerated.
Results:
Mean patient age was 27.0 years (range, 16–53 years), and mean follow-up was 40.2 months (range, 14–54 months). Mean ± SD American Orthopaedic Foot and Ankle Society and 36-Item Short Form Health Survey scores were 46.8 ± 8.95 and 28.9 ± 4.3 preoperatively and 76.2 ± 9.5 and 45.6 ± 7.7 1 year after surgery, respectively. There was a significant increase in both scores (P ≤ .001).
Conclusions:
In advanced-stage Freiberg’s infraction of the second metatarsal, joint debridement and metatarsal head remodeling is a safe and simple therapeutic option, and it provides better quality of life for patients. (J Am Podiatr Med Assoc 103(3): 185–190, 2013)
It is unusual to find such extensive deformity of the navicular in a bilateral and symmetrical fashion. The apparent lack of significant trauma coupled with the patient's unremarkable medical history led the authors to an exclusionary diagnosis of spontaneous osteonecrosis. While changes are clearly evident on plain film radiography, computed tomography and magnetic resonance imaging provide the clinician with a more detailed picture of the extent of destruction.
