Riccardo Iundusi

Osteoporosis and sarcopenia: the connections

Osteoporosis and sarcopenia are the most frequent musculoskeletal disorders affecting older people. Osteoporosis is a widespread disorder affecting millions of individuals of all ethnic backgrounds worldwide, particularly among older women. It is characterized by reduced bone mass and microarchitectural deterioration of bone tissue, with a consequent increase in the risk of fracture. Sarcopenia is considered to be one of the major factors responsible for functional limitations and motor dependency in elderly persons. In age-related muscle atrophy, a decrease in muscle fiber size and number, and a preferential loss of type II fibers have been reported. A decrease in the circulating levels of specific hormones (e.g., estrogen, testosterone, growth hormone, and insulin-like growth factor-1) has been shown to be associated with sarcopenia and this appears to play an important role in its pathogenesis.

Open medial dislocation of the ankle without fracture

A 20-year-old man sustained an open medial dislocation of the ankle without an associated fracture after a low-energy inversion injury. Prompt debridement and reduction with primary wound closure of the skin were performed without suture of the capsule. Immobilisation in a non-weight-bearing cast for 30 days followed by ankle bracing for two weeks and subsequent physiotherapy, produced full functional recovery by three months. At follow-up at one year there was a full range of pain-free movement, although the radiographs and MR scan showed early post-traumatic degenerative change at the medial aspect of the tibiotalar and the calcaneocuboid joints.

Focus on Diffusion MR Investigations of Musculoskeletal Tissue to Improve Osteoporosis Diagnosis: A Brief Practical Review

Nowadays, a huge number of papers have documented the ability of diffusion magnetic resonance imaging (D-MRI) to highlight normal and pathological conditions in a variety of cerebral, abdominal, and cardiovascular applications. To date, however, the role of D-MRI to investigate musculoskeletal tissue, specifically the cancellous bone, has not been extensively explored. In order to determine potentially useful applications of diffusion techniques in musculoskeletal investigation, D-MRI applications to detect osteoporosis disease were reviewed and further explained.

Stress fractures in the elderly: different pathogenetic features compared with young patients

Stress fractures mainly occur in the lower limb as a result of cyclic submaximal stresses. Most commonly affected by this specific type of fractures are young athletes, military or elderly subjects with metabolic bone diseases like osteoporosis. In consideration of the heterogeneity of affected patients is presumable that there are different pathogenic mechanisms. In young person bone tissue, although metabolically intact, is not able to withstand the stresses to which it is chronically subjected, also because of muscle fatigue. This leads to a macrostructural failure and to the development of “fatigue” fractures. Instead, in elderly patients, there are numerous physiological conditions that determine a bone metabolism alteration. This is the main reason for the structural changes in trabecular and cortical bone, which is reflected in reduced biomechanical strength. In addition, muscular situation, such as muscle fiber atrophy, is unable to correctly support bone tissue, leading to the development of insufficiency fractures.

Traumatic Burst Fracture with Spinal Channel Involvement Augmentation with Bioactive Strontium-Hydroxyapatite Cement

In November 2011 a 75-year-old man was admitted to our emergency department with a low back pain caused by a traumatic L1 vertebral collapse with backward projection of posterior wall superior third. The indication for neurosurgical instrumentation was placed, although he refused the treatment. Hence he was treated conservatively without a significant improvement up to January 2012 when, still refusing surgery, he accepted to undergo percutaneous vertebroplasty with a novel bioactive injectable strontium-hydroxyapatite cement. Vertebroplasty was performed without complications. A CT scan, performed the day after the procedure, ruled out extravertebral cement leakage. Pain improvement was significant (preprocedure VAS 10, one-week VAS 4) with a gradual decrease up to three months when it stabilized at 2. CT examination after 1 year showed a good cement osseointegration with osteophytic spurs bridging the superior endplate of the level involved to the inferior one of the level above. The new bone ingrowing property of the strontium-hydroxyapatite containing cement permits to extend the treatment indication also to unstable collapses in which the risk of pseudoarthrosis is very high. In this reported case we evaluated the potential role of percutaneous vertebroplasty in traumatic burst fracture with spinal channel involvement.

Surgical Therapy: Vertebro-Cifoplastic: – Pros and Cons

Vertebral compression fractures (VCFs) are the most common complication of osteoporosis. They result in significant mortality and morbidity and prolonged pain for patients. Vertebroplasty (PVP) and kyphoplasty (PKP) have recently been introduced for the treatment of osteoporotic patients who have prolonged pain following VCFs not responding to conservative treatment. Both procedures are based on the injection of a bone cement, usually polymethyl methacrylate (PMMA), into the fractured vertebra for the mechanical stabilization of VCFs and for pain relief. These procedures may be useful for osteoporotic patients who have prolonged pain following acute vertebral fracture and seem to determine a rapid and sustained pain relief with a better quality of life. Short-term complications, mainly the result of leakage extravasation of cement, include increased pain and damage from heat or pressure to the spinal cord or nerve roots as well as embolism problem. Proper patient selection and good technique should minimize complications, but, rarely, open surgery is needed. Long-term benfits have not yet been shown but potentially include prevention of recurrent pain at the treated level(s) with both procedures and with kyphoplasty restoration of height loss and spinal deformity, an improvement in level of function, and avoidance of chronic pain and restriction of internal organs. Controlled trials are needed to determine both short-term and long-term safety and efficacy of vertebroplasty and kyphoplasty.

Anatomical variation: T1 spina bifida occulta. Radiological findings

We report a 26-year-old male patient who was admitted to our emergency department after a traffic accident and who suffered from neck pain. We have found accidentally a dorsal spinous process schisis, a very rare vertebral abnormality, that we recognized in the X-rays imaging performed for the study of the lung parenchyma.