Brucella cervical spondylitis complicated by spinal cord compression: a case report

A case of 65-year-old farmer who presented with Brucella-related cervical spondylitis is described. Because of the advanced form of the infection resulted in neurological impairment, cervical vertebra corpectomy and debridement of the paravertebral granulomatous tissue deposits were performed followed by stabilization with anterior plating and bone grafting. In addition, double antimicrobial chemotherapy regimen was administered for 12 weeks. After one year, follow up evaluation demonstrated resolution of the infection. The authors recommend that brucellosis should be included in the differential diagnosis of cervical spondylitis, particularly in patients who reside in countries where the zoonosis is still endemic

Ulnar Nerve Compression in the Cubital Tunnel by an Epineural Ganglion: A Case Report

Abstract Epineural ganglia are considered to be a usual cause of peripheral nerve compression. In this report, we present a rare case of ulnar nerve compression by an epineural ganglion in the cubital tunnel. A 28-year-old right-handed female secretary developed progressive pain, numbness, and weakness in her right elbow, forearm, and hand for 6 months. Atrophy of the adductor pollicis and the first dorsal interosseous muscles was apparent. Clinical examination revealed a cystic mass at the posterior side of the elbow. Magnetic resonance imaging identified a ganglion while electrophysiologic studies revealed a severe conduction block of the ulnar nerve at the elbow. During surgery a 2-cm diameter epineural ganglion was identified compressing the ulnar nerve and was excised using microsurgery techniques. Two months postoperatively, the clinical recovery of the patient was very satisfactory, although the postoperative electrophysiologic studies demonstrated a less dramatic improvement

The subchondral bone in articular cartilage repair: current problems in the surgical management

As the understanding of interactions between articular cartilage and subchondral bone continues to evolve, increased attention is being directed at treatment options for the entire osteochondral unit, rather than focusing on the articular surface only. It is becoming apparent that without support from an intact subchondral bed, any treatment of the surface chondral lesion is likely to fail. This article reviews issues affecting the entire osteochondral unit, such as subchondral changes after marrow-stimulation techniques and meniscectomy or large osteochondral defects created by prosthetic resurfacing techniques. Also discussed are surgical techniques designed to address these issues, including the use of osteochondral allografts, autologous bone grafting, next generation cell-based implants, as well as strategies after failed subchondral repair and problems specific to the ankle joint. Lastly, since this area remains in constant evolution, the requirements for prospective studies needed to evaluate these emerging technologies will be reviewed

Η συγκριτική επίδραση της βραχυχρόνιας χορήγησης της ροφεκοξίμπης, της μελοξικάμης, της ινδομεθακίνης και της πρεδνιζολόνης στην πώρωση των καταγμάτων: πειραματική μελέτη σε λευκούς κόνικλους New Zealand

Background: The use of nonsteroidal anti-inflammatory drugs in the management of pain due to a fracture is common clinical practice. There is clear evidence in the literature that classic nonsteroidal anti-inflammatory drugs delay fracture healing. The goal of our study is to determine the effect of short-term administration of specific COX-2 inhibitors in fracture healing. Methods: A nondisplaced osteotomy of the mid-diaphysis of the right ulna was performed in 40 adult male New Zealand rabbits. Rabbits were divided in five groups: control, prednisolone (2.5 mg/Kg/day im), indomethacin (2 mg/Kg/day per os), meloxicam (0.3 mg/Kg/day im) and rofecoxib (0.5 mg/Kg/day per os). Drugs were administered for five days only, starting on the day of surgery. Fracturehealing was assessed radiographically in a weekly basis. Rabbits were killed six weeks postoperatively, both ulnae were obtained and were subjected to biomechanical tests (three point bending) and histomorphometric measurements. Results: At six weeks there was clear delay in healing in the groups of prednisolone and indomethacin, radiographically, biomechanically andhistologically. The biomechanical parameters were 36-51% lower in the prednisolone group and 29-37% lower in the indomethacin group, compared to the control (p0.05). The mildest delay in fracture healing was observed in the rofecoxib group, in which the values of stiffness (3% lower) and toughness (22% higher) and the values of six out of thirteen histomorphometric parameters had no statistically significant differences (p>0.05) compared to the control. Conclusions: Our study shows that short-term administration of selective COX-2 inhibitors did not affect the state stages of secondary non-osteonal bone healing and that the mild delay observed in the early stages of healing is both dosedepended and reversible. The more selective the anti-COX-2 is, the less negative effect on bone healing is observed. Clinical Relevance: Our data suggest that ifthere is a need for anti-inflammatory drugs administration in fracture, selective COX-2 inhibitors should be preferred and administration should be as short-term as possible.Σκοπός: Η χρήση των αντιφλεγμονωδών φαρμάκου στην αντιμετώπιση του μετακαταγματικού άλγους και φλεγμονής είναι καθημερινή κλινική πρακτική και έχει οδηγήσει στην ελάττωση της ανάγκης χρήσης οπιοειδών. Από την σύγχρονη και παλαιότερη βιβλιογραφία, υπάρχουν σαφείς ενδείξεις ότι τα κλασσικά αντιφλεγμονώδη επηρεάζουν αρνητικά την εξέλιξη της πώρωσης και τη ποιότητα του παραγόμενου πώρου. Σκοπός της παρούσας πειραματικής εργασίας είναι η συγκριτική μελέτη της επίδρασης της βραχυχρόνιας χορήγησης παραδοσιακών ΜΣΑΦ και εκλεκτικών COX-2 αναστολέων στην πώρωση. Υλικό — Μέθοδος: Χρησιμοποιήθηκε το πειραματικό μοντέλο οστεοτομίας της μεσότητας της διάφυσης της δεξιάς ωλένης σε 40 λευκούς κονίκλους New Zealand. Τα πειραματόζωα χωρίστηκαν σε 5 ομάδες: τις ομάδες ελέγχου, πρεδνιζολόνης (2,5 mg/kg im), ινδομεθακίνης (2 mg/kg per os), μελοξικάμης (0,3 mg/kg im) και ροφεκοξίμπης (0,5 mg/kg per os). Σε όλες τις ομάδες χορηγήθηκαν συνολικά 5 δόσεις φαρμάκων, μία δόση την ημέρα του χειρουργείου και κατόπιν, από μία δόση τις επόμενες 4 μετεγχειρητικές ημέρες. Η πώρωση παρακολουθούταν ακτινολογικώς σε εβδομαδιαία βάση, τα πειραματόζωα θυσιάζονταν στις 6 εβδομάδες μετεγχειρητικά και λαμβάνονταν η χειρουργημένη δεξιά ωλένη καθώς και η αριστερή ακέραια ωλένη που χρησιμοποιούταν ως μάρτυρας. Τα οστικά δοκίμια υποβάλλονταν κατόπιν σε εμβιομηχανικές δοκιμασίες (παραμόρφωση 3 σημείων) και ιστομορφομετρική εξέταση. Αποτελέσματα: Από τα αποτελέσματά μας προέκυψε σαφής καθυστέρηση της πώρωσης στις ομάδες της πρεδνιζολόνης και της ινδομεθακίνης, τόσο εμβιομηχανικά όσο και ιστολογικά. Το φορτίο θραύσης πώρου ήταν 51% μικρότερο στην ομάδα της πρεδνιζολόνης και 37% μικρότερο στην ομάδα της ινδομεθακίνης συγκρινόμενο με την ομάδα ελέγχου (ρ0,05). Η ηπιότερη καθυστέρηση της πώρωσης παρατηρήθηκε στην ομάδα της ροφεκοξίμπης, στην οποία οι τιμές της ακαμψίας οστού (3% μικρότερη) και ενέργειας θραύσης (22% μεγαλύτερη) καθώς και 7 από τις 13 ιστομορφομετρικές παραμέτρους δεν είχαν στατιστικά σημαντικές διαφορές με την ομάδα ελέγχου (ρ>0,05). Συμπεράσματα: Από τα αποτελέσματά μας προέκυψε ότι όσο εκλεκτικότερος αναστολέας της COX-2 είναι ένα αντιφλεγμονώδες, τόσο λιγότερο επηρεάζει αρνητικά τις διεργασίες της πώρωσης. Όταν χρειάζεται να χορηγηθούν ΜΣΑΦ μετά από κάταγμα, προτείνεται η βραχυχρόνια χορήγηση ενός εκλεκτικού COX-2 αναστολέα

Do steroids, conventional non-steroidal anti-inflammatory drugs and selective Cox-2 inhibitors adversely affect fracture healing?

Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most commonly used drugs worldwide. They are prescribed for orthopaedic conditions such as osteoarthritis, soft-tissue injuries and fractures. The new generation of NSAIDs, selective cyclooxygenase-2 (COX-2) inhibitors, exhibit analgesic and anti-inflammatory effects equivalent or superior to conventional NSAIDs, while reducing the prevalence of adverse gastrointestinal events. Several reports from animal and in vitro studies have demonstrated impaired bone healing in the presence of conventional NSAIDs, as measured by a variety of different parameters. More recently, initial studies investigating the effects of selective COX-2 inhibitors on bone healing have yielded similar results, while other reports showed minor or no impairment of the healing process. The purpose of the present review article is the thorough review and analysis of the past 50-year literature and the attempt to get some conclusions about the effect of NSAIDs and selective COX-2 inhibitors on fracture healing and the clinical significance of their use in the management of postoperative and post-fracture pain

The effects of the short-term administration of low therapeutic doses of anti-COX-2 agents on the healing of fractures - An experimental study in rabbits

We have evaluated the effect of the short-term administration of low therapeutic doses of modern COX-2 inhibitors on the healing of fractures. A total of 40 adult male New Zealand rabbits were divided into five groups. A mid-diaphyseal osteotomy of the right ulna was performed and either normal saline, prednisolone, indometacin, meloxicam or rofecoxib was administered for five days. Radiological, biomechanical and histomorphometric evaluation was performed at six weeks. In the group in which the highly selective anti-COX-2 agent, rofecoxib, was used the incidence of radiologically-incomplete union was similar to that in the control group. All the biomechanical parameters were statistically significantly lower in both the prednisolone and indometacin (p = 0.01) and in the meloxicam (p = 0.04) groups compared with the control group. Only the fracture load values were found to be statistically significantly lower (p = 0.05) in the rofecoxib group. Histomorphometric parameters were adversely affected in all groups with the specimens of the rofecoxib group showing the least negative effect. Our findings indicated that the short-term administration of low therapeutic doses of a highly selective COX-2 inhibitor had a minor negative effect on bone healing