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New knowledge of osteoclastic function and new treatments to reduce osteolytic activity have combined to yield new degrees of biochemical control over the increased rate of bone resorption and formation that characterized osteitis deformans (OD; Paget's disease). We have briefly outlined current concepts, and provided an example of the role radionuclide imaging can play in delineating the skeletal areas involved in this disease.
Statistically the posttraumatic osteitis shows a clear tendency to decrease from 1972-76 in comparison with 1982-86 (AO/ASIF-documentation). The incidence of infection varies considerably according to the different anatomical location of fractures. More recently atypical manifestations became of more importance and ask for differentiated bacteriological examinations. A close postoperative follow-up and exact wound-observations enable an immediate and adequate therapy in case of an infection.
We present the case of a woman with classical osteitis fibrosa cystica generalisata von Recklinghausen, caused by a single adenoma of the left inferior parathyroid gland. After six months with increasing bone pain, pathological fractures and cystic lesions radiologically, hyperparathyroidism was diagnosed by persistent elevated levels of serum calcium, and elevated levels of PTH. Surgical extirpation of the parathyroid adenoma caused a period with severe hypocalcemia followed by complete clinical restitution. The diagnosis should be considered in any case of persistent bone pain and uncharacteristic fatigue.
Chronic laminitis with severe rarefactive osteitis was diagnosed in a nine month old Simmental fattening bull. The condition was observed in all eight weight bearing digits. Clinical, radiological and pathomorphological examinations revealed osteolysis and downward rotation of all the distal phalanges. The condition appears to resemble the several cases of laminitis in Jersey cattle, which have been attributed to hereditary factors. In this case, however, the genetic background was unavailable for evaluation.
Specific treatment of osteitis deformans (OD, Paget's disease of bone) is indicated when symptoms are associated with signs (biochemical or by bone scintigraphy) of active disease. OD in the base of the skull and osteolytic lesions in weight-bearing bones should be treated irrespective of symptoms. The effect of calcitonin (CT) on symptoms and skeletal blood-flow is achieved rapidly and healing of osteolytic lesions may occur. However, CT is only effective in approximately 60%, is discontinued due to side effect in 20% of patients, and must be administered parenterally. EHDP (Etidronate) is administered orally but the use of even small doses carries a risk of mineralisation defect and possibly fracture. EHDP should, therefore, be given intermittently and should not be used in osteolytic lesions of weight-bearing bones. Second-generation bisfofonates are devoid of this side effect and are very effective in OD. The effect of mithramycin is only transient and because of the risk of serious side effects the use should be restricted to severe cases of OD resistant to the other lines of treatment.
A total of 16 cases only have been reported in the world specialized literature. This is a new case, of a patient aged 20 years, a male working in the metallurgical industry. This is the first case reported in our country. Clinically the patient presented a painful global swelling of the median third of the clavicula on the left side. Biological constant were normal. Radiographic investigations revealed an increase in volume and a condensation of the median part of the clavicula, and scintigraphical studies revealed an intense incorporation of the radioisotope. Histopathologic studies showed lamellar and spongious bone tissue, with a normal trabecular structure, although considerably thickened. Data for the differential diagnosis are presented, and in the first place those concerning intra-sterno-clavicular hyperostosis, sterno-costo-clavicular arthrosis, chronic subacute osteitis, avascular necrosis of the clavicular epiphysis (Friedrich disease), and Tietze syndrome. The etiopathogenesis of this rare benign clinico-radiologic entity remains unknown.
The paper is concerned with clinicoroentgenological analysis of postoperative osteitis of the pubic bones (OPB) in 29 patients with urological diseases. The development of OPB follows operative complications, mainly of pyoinflammatory type. Clinically OPB develops as a pyoinfectious process. X-ray signs present a picture of inert osteomyelitis of the pelvic bones, caused by low virulent urinary infection. Its characteristic feature is superficial spreading of osseous destruction to a large extent with the affection of the adjacent of the pelvic joints. The probable routes of infection dissemination are venous (in injury of the pelvic plexus veins) and by continuity (as a result of urinary pelvic cellulitis).
The authors describe 4 female patients with Osteitis Condensans Ilii (OCI): 3 of them were pluriparous, ranging 32-36 years of age; while the remaining was nulliparous and 20 years old, with a previous trauma suffered in the iliac bone. Due to the inefficacy of the medical and physical treatment, two patients underwent surgical resection of the osteitic bone; then followed by a 45 days cast immobilization and a 3-4 months with restricted load. The other 2 patients were successfully treated with Indomethacin (a 100 mg/day cycle for a month, followed by a maintainance cycle with 300 mg/day for 3 months). The diagnostic aspects are then discussed, pointing out that absence of any peripheric neurologic damage, normal bone scan, female sex and younger age are the relevant characteristics for the diagnosis of OCI.
The authors report a case of mycotic osteitis of the upper maxillary bone due to Candida Albicans occurring in a 56 year old female patient under treatment for chronic myeloid leukemia. The etiologically difficult diagnosis could only be confirmed after deep surgical biopsy with mycological study of a fragment. A review of the literature confirmed the rarity of upper maxillary involvement by Candida Albicans. Particularly when there is isolated involvement and no evidence of a distant primary focus. The differential diagnosis essentially includes centro-facial malignant granuloma.
Osteitis deformans is a bone disease of still unknown aetiology which shows characteristic symptoms in the maxillofacial region. An increase in size of the entire calvarium and also of single bones of the facial skeleton belongs to these symptoms. A triad may be seen in the jawbone: osteoporosis, foci of densification and cementum hyperplasia. No possibility of treatment was known in the past. Nowadays, the use of cytostatics, calcitonin and diphosphonates seems to be promising.
In 10 cases of posttraumatic osteitis or osteomyelitis gentamicin-PMMA minichains have been used for treatment after radical local debridement. In 8 cases infection could be controlled completely by this regimen, one case needed adjuvant systemic antibiotic treatment and only one case with proved primarily gentamicin-resistant beta-haemolytic-streptococcus could be controlled after removal of PMMA-minichain by systemic antibiotic treatment. 3 to 9 months after therapy all infections were still under control.
Ten patients had a wedge resection of the symphysis pubis for the treatment of symptoms of osteitis pubis that had been recalcitrant to non-operative treatment for at least six months. Preoperatively, the average duration of symptoms was thirty-two months. The symptoms included a waddling gait and crepitus, pain, and tenderness over the symphysis pubis. The early radiographic signs of the disease were rarefaction of the adjacent pubic bones and widening of the symphysis pubis. Later signs included sclerosis and narrowing of the symphyseal joint space. Pathological examination of the resected joint revealed chronic inflammatory reaction in all patients. At an average of fourteen months postoperatively, all of the patients had marked improvement and were fully active. However, at an average of ninety-two months postoperatively, three of the ten patients were not satisfied with the result. One patient needed bilateral sacro-iliac arthrodesis for pain that was caused by instability.
Osteitis deformans is a focal disease of the osteoclasts characterised by increased bone resorption subsequently followed by increased bone formation leading to abnormal bone. A viral etiology seems increasingly probable, but remains unproven. 5-30% of the patients present with symptoms such as pain, deformity and fracture. Hearing loss, nerve- or root-compression, arthrosis and hyperuricaemia may complicate the disease while malignant degeneration, hypercalcemia and high output cardiac failure are rare. The diagnosis is based on X-ray findings but biopsy may be necessary in selected cases. The extent of the disease is revealed by bone scintigraphy and the activity of the disease reflected by urine hydroxyproline excretion and serum alkaline phosphatase.
A 3-year-old boy during a picnic collected caterpillars of Macrothylasia rubi. He developed dermatitis and was generally ill during some days. Edema developed on the affected hand and reduced the mobility. Osteitis developed corresponding to all falangeal bones on his right hand. The changes disappeared following immobilisation of the severely affected hand.
Thirteen cases of pustulotic arthro-osteitis are reported: 3 children and 10 adults. The clinical and radiological aspects of this rare entity are discussed as well as the classification of this disease in the context of seronegative spondyloarthropathies.
A case of imported Histoplasma duboisii osteitis in a visitor from Africa to Switzerland is described. The diagnosis was by histology confirmed by culture. Infection of other organs was ruled out. Amphotericin B therapy and its side effects are discussed.
Posttraumatic soft tissue and bone defects can pose problems for the surgeon. Autogenous bone from the iliac crest may be used to fill bone defects. To achieve bone healing, a well vascularized recipient site for the graft is important. Local muscle flaps or distant microvascular flaps improve vascularity by introducing a fresh blood supply. Cellular and humoral antibodies are more effective and allow quicker revascularisation of the transplanted graft. 49 soft tissue defects were treated by local muscle flaps. In 14 cases the soleus, in 28 the gastrocnemius, in three the tibialis anterior, in two the abductor hallucis, and in two the gracilis muscle was transposed. 38 cases had posttraumatic osteitis, in eight the defect was merely a soft tissue defect and in three due to tumour excision. In 24 patients a combination of soft tissue repair and cancellous bone grafting was performed. Four flaps failed because of total or partial necrosis. In all cases full weight bearing on the leg with good soft tissue cover was achieved.
Treatment of 346 patients with open fractures of the shin bone has been analyzed. In 45.9% of the patients there were symptoms of pyo-necrotic osteitis. The author makes a conclusion that preserving tactics should be chosen for this complication with regard of the described stages of the process and the general stage of organism.