Study Design. Retrospective case series. Objective. The aim of this study was to examine the spontaneous incidence rate and features of pyogenic vertebral osteomyelitis in osteoporotic vertebral fracture (OVF). Summary of Background Data. Pyogenic vertebral osteomyelitis is a rare complication of OVF. We experienced some cases of vertebral body infection after OVF. Methods. In this retrospective, single-center study, clinical data were collected by chart review. We examined the number of cases of pyogenic vertebral osteomyelitis following OVF between April 2014 and August 2018. Further, we examined the mechanism of injury, age, sex, duration from the diagnosis of OVF to the diagnosis of vertebral body infection, C-reactive protein level at the time of diagnosis of OVF, medical history, primary infection site, and serious events. Results. The spontaneous incidence rate of complications was 0.7% (4/554). In all cases (two males and two females), fall history was present and vertebral body infection was not suspected to be present at the point of injury. The average age was 81.8 (range, 75–89, SD, 5.7) years. The average duration from the diagnosis of OVF to the diagnosis of vertebral body infection was 55.0 (range, 16–132, SD, 52.4) days. The average C-reactive protein level at the time of diagnosis of OVF was 11.5 (range, 0.5–29.7, SD, 12.7) mg/L. Medical history included rheumatoid arthritis (n = 1), diabetes mellitus (n = 1), malignant tumor (stage IV) (n = 1), and brain infarction (n = 2). The primary sources of infection were pneumonia (n = 3), and urinary tract infection (n = 1), and all patients experienced bacillemia at/after the diagnosis of fracture. All patients died due to septic shock. Conclusion. The spontaneous incidence rate of vertebral body infection among OVF patients was 0.7%; however, the occurrence of this complication led to serious events. Clinicians should pay attention to the possibility of bacillemia in elderly or immunocompromised OVF patients. Level of Evidence: 4
Rationale:A spinal subdural hematoma (SDH) is rarely complicated with an intracranial SDH. We found only 7 cases of spontaneous concurrent lumbar spinal and cranial SDHs, in which lumbar symptoms occurred before head symptoms.Patient concerns:We describe a 77-year-old man with spontaneous concurrent spinal and cranial SDHs, in whom the spinal SDH was identified 30 days before the intracranial chronic SDH.Diagnosis:Magnetic resonance imaging showed a spinal SDH at L4/L5. There was no paralysis, and the patient was managed conservatively. About 30 days after the onset of back pain, he experienced tinnitus and visual hallucination. Brain computed tomography showed a chronic SDH and midline shift.Interventions:Burr-hole evacuation was performed, and the patient's condition improved.Outcomes:At 5 months of follow-up, there was no recurrence of the spinal or intracranial SDH.Lessons:It is important to consider the possibility of intracranial hemorrhage when a spinal SDH is identified.
Background Atypical fractures may occur due to the combined effect of severely suppressed bone turnover (SSBT) caused by long-term bisphosphonate treatment and chronic repetitive bone microdamage. Atypical fracture of the ulna due to SSBT is a rare entity; there is no standardized treatment strategy for this condition. We successfully treated a patient with atypical fracture of the ulna. Herein, we present this patient, review the relevant literature, and discuss the treatment strategy. Case presentation An 84-year-old woman presented with atypical fracture of the left ulnar shaft due to SSBT. She had a history of bisphosphonate therapy (ibandronate and alendronate) since more than 10 years; her bone turnover was severely suppressed. We performed open reduction and internal fixation (ORIF) using dual plate with some additional treatments. These included drilling and decortication, use of autogenous bone graft, low-intensity pulsed ultrasound (LIPUS) treatment, and administration of teriparatide. Finally, bone union was observed at 11 months after surgery. Conclusions Based on the literature review and our experience with this case, ORIF alone may not be adequate to achieve bone union; drilling, decortication, and use of cancellus bone graft is important to achieve favorable outcomes. Administration of teriparatide and LIPUS may facilitate early bone union, although further studies are required to provide more definitive evidence. Furthermore, ORIF using dual plate may help avoid implant failure owing to the long time required for bone union.
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