TREATMENT OF BONE MARROW EDEMA (BME) OF THE TALUS WITH PULSED - - PowerPoint PPT Presentation

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Aug 29, 2023 266 likes •379 views

IRCCS GALEAZZI, MILANO TREATMENT OF BONE MARROW EDEMA (BME) OF THE TALUS WITH PULSED ELECTROMAGNETIC FIELDS: OUTCOMES IN SIX PATIENTS Nicol Martinelli, Elena Sartorelli, Alberto Bianchi, Carlo Bonifacini, Giovanni Romeo, Francesco Malerba

SLIDE 1

IRCCS GALEAZZI, MILANO

Nicolò Martinelli, Elena Sartorelli, Alberto Bianchi, Carlo Bonifacini, Giovanni Romeo, Francesco Malerba

TREATMENT OF BONE MARROW EDEMA (BME) OF THE TALUS WITH PULSED ELECTROMAGNETIC FIELDS: OUTCOMES IN SIX PATIENTS

SLIDE 2

DISCLOSURE

TREATMENT OF BONE MARROW EDEMA (BME) OF THE TALUS WITH PULSED ELECTROMAGNETIC FIELDS: OUTCOMES IN SIX PATIENTS

My disclosure is in the Final AOFAS Mobile App. I have no potential conflicts with this presentation. Nicolò Martinelli

SLIDE 3

BACKGROUND

IDIOPATHIC BONE MARROW EDEMA

RARE CAUSE OF FOOT PAIN, ALSO CALLED:

TRANSIENT BONE MARROW EDEMA OF THE TALUS

ONLY CASE SERIES REPORTED IN THE LITERATURE
TIME TO SYMPTOM REGRESSION VARIES AMONG THE STUDIES FROM 3 TO 22

MONTHS WITH OR WITHOUT INTERVENTION

It should be distinguished from bone bruises, stress fractures, early avascular necrosis.

Characterized by hypointense T1-weighted images and hyperintense T2-weighted/fat-saturated images at MRI WITHOUT A HISTORY OF TRAUMA SEVERAL SYMPTOMATIC THERAPIES WERE SHOWN NOT TO AFFECT THE COURSE OF THE DISEASE. PROMISING RESULTS WITH IBANDRONATE

SLIDE 4

MATERIAL AND METHODS

6 PATIENTS (5 MALES, 1 FEMALE) AGE 54,2 (RANGE: 38-63)

NO HISTORY OF TRAUMA ROUTINE SEROLOGY WAS NORMAL NO HISTORY OF ALCOHOL ABUSE NO HISTORY OF CORTICOSTEROID MEDICATIONS 1 PATIENT WAS A MODERATE CIGARETTE SMOKER

AOFAS SCORE PRESENTATION: 59.4 (range 40-66) INVALIDATING ANKLE PAIN IN 5 OUT OF 6 PATIENTS

AIM OF THE STUDY: EVALUATE THE SAFETY AND EFFICACY OF PEMS IN THE TREATMENT OF IDIOPATHIC BONE MARROW OEDEMA OF THE TALUS.

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PULSED ELECTROMAGNETIC FIELDS (PEMF)

8 HOURS A DAY (NIGHTIME)

Pulsed Signal at a Frequency of 75Hz ± 5% Signal length.1300sec ± 200msec

FOLLOW UP AFTER 30 DAYS

MRI EVALUATION AT FOLLOW UP

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RESULTS

PRESENTATION AFTER 1 MONTH AFTER 3 MONTHS

5 OUT OF 6 PATIENTS HAD NO SIGNS OF BONE MARROW EDEMA AT THREE MONTHS
SIGNS OF BONE MARROW EDEMA WERE VISIBLE IN 1 PATIENT, WHO WAS ASYMPTOMATIC

AOFAS SCORE PRESENTATION: 59.4 (range 40-66) AOFAS SCORE 3 MONTHS: 94 (range 80-100)

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DISCUSSION

ADVANTAGES:

NO SIDE EFFECTS REPORTED
APPARENTLY SHORTER TIME TO SYMPTOMS REDUCTION
HIGH COMPLIANCE

(NO PREMATURE DISCONTINUATION OF THERAPY)

DISADVANTAGES AND LIMITS:

NO CONTROL GROUP
MODERATE THERAPY COST (ABOUT 20$ A DAY)
LONG THERAPY REQUIRED

(5 PATIENTS FOR 1 MONTH, 1 PATIENT FOR THREE MONTHS)

SMALL PATIENT GROUP

SLIDE 8

CONCLUSION

IDIOPATHIC BONE MARROW EDEMA OF THE TALUS IS A RARE CAUSE OF FOOT PAIN PEMFS MAY FIND A ROLE IN THE TREATMENT OF TRANSIENT BONE MARROW OEDEMA PEMFS MAY REDUCE THE TIME TO SYMPTOM-REGRESSION

(5 OUT OF 6 PATIENTS HAD NO SIGNS OF OEDEMA AFTER 3 MONTHS)

FURTHER STUDIES NEEDED

SLIDE 9

REFERENCES

1) Judd DB, Kim DH, Hrutkay JM. Transient osteoporosis of the talus.Foot Ankle Int 2000;21:134-7. 2) Judd DB, Kim DH, Hrutkay JM. Transient osteoporosis of the talus. Foot Ankle Int 2000;21:134-7. 3) Calvo E, Alvarez L, Fernandez-Yruegas D, Vallejo C. Transient osteoporosis of the foot: bone marrow edema in 4 cases studied with MRI. Acta Orthop Scand 1997;68:577-80 4) Gallant GG, Fisher RL, Sziklas JJ. Transient regional osteoporosis of the ankle and the foot: a report of four cases and review of the literature. Orthop Rev 1994;23:405-9. 5) Midura RJ, Ibiwoye MO, Powell KA. 2005. Pulsed electromagnetic field treatments enhance the healing of fibular osteotomies. J Orthop Res 23:1035–1046. 6) Smith TL, Wong-Gibbons D, Maultsby J. 2004. Microcirculatory effects of pulsed electromagnetic fields. J Orthop Res 22:80–84.