Nonsurgical Treatment of Osteomyelitis of the Hallux Sesamoids: A Case Series and Literature Review

Mauler, Flavien; Wanivenhaus, Florian; Böni, Thomas; Berli, Martin

doi:10.1053/j.jfas.2017.01.025

Cited by 7 publications

(9 citation statements)

References 31 publications

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“…Finally, our hospital is set in a resource-rich country. Many centers worldwide either lack access to MRI, or tend to overuse it [16,17]. Our 12% prevalence regarding the use of MRI can be considered an intuitive balance between both.…”

Section: Discussionmentioning

confidence: 99%

X-Ray Versus Magnetic Resonance Imaging in Diabetic Foot Osteomyelitis: A Clinical Comparison

Gariani

Lebowitz

Kressmann

et al. 2021

CDR

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Objective: Radiographic imaging is an important diagnostic tool in diabetic foot osteomyelitis (DFO). It is unknown whether DFO cases diagnosed with conventional X-ray versus positive Magnetic Resonance Imaging (MRI) differ regarding epidemiology and treatment outcome. Theoretically, signs of inflammation on MRI without bone lesions might be easier to treat and predominate among selected clinical variables. Methods: Our clinical pathway for diabetic foot infections discourages the use of MRI for the diagnosis of DFO. We compared the epidemiology and therapy of non-amputated DFO with positive features on conventional X-ray, MRI, or both. Radiology specialists interpreted the images. The intraoperative aspect of bone during amputation and the results of bone cultures were considered gold standard for DFO diagnosis. Results: We prospectively followed 390 DFO episodes in 186 adult patients for a median of 2.9 years and performed 318 conventional X-rays (median costs 100 Swiss Francs; 100 US$) and 47 (47/390; 12%) MRI scans (median 800 Swiss Francs; 800US$). Among them, 18 episodes were associated with positive MRI findings but lacked bone lesions on X-ray. After debridement, the median duration of systemic antibiotics was 28 days for MRI-only episodes and 30 days for X-ray-positive cases (Wilcoxon-ranksum-test; p=0.26). The corresponding median numbers of surgical debridements were 1 and 1; and remission was achieved in 25% and 27%, respectively. In multivariate logistic regression analysis, MRI-only episodes did not alter remission rate (odds ratio 0.5, 95%CI 0.1-5.2). Conclusions: According to our clinical pathway, DFO episodes with positive MRI findings only did not differ epidemiologically and did not influence the choice of therapy nor remission rate.

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Section: Discussionmentioning

confidence: 99%

X-Ray Versus Magnetic Resonance Imaging in Diabetic Foot Osteomyelitis: A Clinical Comparison

Gariani

Lebowitz

Kressmann

et al. 2021

CDR

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“…Pathological conditions involving sesamoids are rare and diverse, including acute fractures (especially in the medial sesamoid) and stress fractures, ischemia (predominantly in the peroneal sesamoid) [1,8], due to their extraosseous and predominantly plantar vascularization [9], sesamoiditis, and acute or chronic infections (osteomyelitis), the latter being very infrequent [1,10].…”

Section: Discussionmentioning

confidence: 99%

“…Osteomyelitis of sesamoids occurs with equal incidence in both medial and lateral sesamoids, and it is a rare condition with only a few case reports in the literature [10,11]. It has two well-defined etiologies.…”

Section: Discussionmentioning

confidence: 99%

“…aureus and Pseudomonas aeruginosa as causative agents, often occurring in patients with a history of diabetes mellitus (DM) [11]. The hematogenous distribution origin, in which the pathogen is exclusively Staphylococcus aureus, is limited to paediatric and adolescent cases [10,12]. The onset of the condition is typically subtle, with mild pain and swelling in the area, tempting conservative management with antibiotics, immobilisation, and offloading.…”

Section: Discussionmentioning

confidence: 99%

“…The onset of the condition is typically subtle, with mild pain and swelling in the area, tempting conservative management with antibiotics, immobilisation, and offloading. However, up to 83% ultimately require surgery [10].…”

Section: Discussionmentioning

confidence: 99%

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