Osteomyeltis of the femur, as a result of scarlet fever
Osteomyelitis is an intensely painful, often disastrous infection of the bone, which can have grave consequences. This case was the sequelae of a case of scarlet fever (a body-wide rash caused by strep throat), and resulted in amputation of the limb. This patient survived, but a large percentage of patients did not. Prior to antibiotics, many who contracted osteomyelitis (due to scarlet fever or other reasons) developed severe bacteremia (bacteria in the bloodstream), which often progressed to sepsis and death.
Think you have strep throat? See a doctor!
An American Text-Book of Surgery, for Practitioners and Students. Ed. William W. Keen & J. William White, 1899.
•Osteoporosis is a disease characterized by the thinning of bones, with a consequent tendency to sustain fractures from minor stresses. Osteoporosis is the most common metabolic bone disease, and its name literally means “porous bone.” Bone is living tissue that is constantly being broken down and replaced. Osteoporosis occurs when the creation of new bone doesn’t keep up with the loss of old bone. The disorder is most common in postmenopausal women over age 50.
•Osteomalacia is a condition in which the bones of an adult progressively soften because of inadequate mineralization of the bone. (In children the condition is called rickets.) Osteomalacia may occur after several pregnancies or in old age, resulting in increased susceptibility to fractures. Symptoms include bone pain, weakness, numbness of the extremities, and spasms of the hands or feet. Depletion of the bone minerals may be caused by lack of dietary vitamin D (or its precursor, ergosterol).
•Paget disease of bone, also called osteitis deformans, chronic disease of middle age, is characterized by excessive breakdown and formation of bone tissue. It is a localized disease that may be unifocal, affecting a single bone, or multifocal, affecting many bones or nearly the entire skeleton. For this reason, it is included among the metabolic bone diseases. Paget disease of bone is common among people of northern European descent, and it is almost nonexistent among people of Asian and African descent. The disease is characterized by excessive bone resorption, which is mediated by osteoclasts (cells that dissolve and absorb bone), and by excessive bone formation, which is mediated by osteoblasts (cells that synthesize bone).
•Marble bone disease also called osteopetrosis or Albers-Schönberg disease is a rare disorder in which the bones become extremely dense, hard, and brittle. Osteopetrosis is marked by increased bone density due to a defect in bone reabsorption by cells called osteoclasts. This leads to accumulation of bone with defective architecture, making them brittle and susceptible to fracture. In some cases, this is also accompanied by skeletal abnormalities. Although symptoms may not initially be apparent in people with mild forms of this disorder, trivial injuries may cause bone fractures due to bone fragility.
A 46-year-old man presented to the emergency department with worsening chronic left knee pain. Fourteen years before presentation, he had sustained a gunshot wound to the left knee. Radiographs obtained at the time of that injury showed a metallic bullet embedded in the posterior weight-bearing surface of the lateral femoral condyle and metallic debris within the joint (Panel A). No surgery was performed to remove the bullet at that time. At the current presentation, the physical examination was notable for a large effusion in the left knee. Repeat radiographs showed that, in addition to changes consistent with arthritis in the joint, the bullet had fragmented into metallic particles throughout the joint and synovium (Panel B). Laboratory studies revealed microcytic anemia, with a hemoglobin level of 9.1 g per deciliter (normal range, 12.9 to 16.8), and an elevated blood lead level (182 μg per deciliter [8.8 μmol per liter]). The Mini–Mental State Examination score was 24 (scores range from 0 to 30, with lower scores indicating poorer cognitive performance). The patient showed no other symptoms of chronic lead poisoning. Intraarticular bullets should be removed surgically at the time of the injury. In addition to causing joint damage, intraarticular bullets can fragment and dissolve in synovial fluid, leading to lead absorption and delayed symptomatic lead poisoning. The patient received chelation therapy. Surgical management with a left knee synovectomy was planned, but the patient left the hospital before surgery and was lost to follow-up.
3D CT reconstruction of a severe spinal fracture that occurred after the individual was involved in a high velocity collision and was ejected from their vehicle. Because of the level of this specific fracture there was minimal cord damage at the site, however this individual also suffered a fracture at the level of their cervical spine which resulted in paralysis.
To construct a building from scratch, you might first build a basic shell or scaffold, then replace that with the permanent structure. Building new bone is similar. An intermediate cartilage structure is established first, only to be converted to solid bone subsequently. This process is supported by a dense network of blood vessels, but exactly how they help is unclear. A new study has found that a particular type of these vessels, known as type H (yellow in the bone section pictured, with vessels stained green and red), help replace the cartilage when it’s time. Specifically, the vessels steer bone growth direction, and endothelial cells lining them lead the cartilage breakdown. Excessive cartilage damage is a hallmark of arthritis, and improving bone repair would benefit countless injured patients, so the next step is asking whether we can control and harness this important function of blood vessels.
