IRCCS GALEAZZI, MILANO TREATMENT OF BONE MARROW EDEMA (BME) OF THE TALUS WITH PULSED ELECTROMAGNETIC FIELDS: OUTCOMES IN SIX PATIENTS Nicolò Martinelli, Elena Sartorelli, Alberto Bianchi, Carlo Bonifacini, Giovanni Romeo, Francesco Malerba
DISCLOSURE TREATMENT OF BONE MARROW EDEMA (BME) OF THE TALUS WITH PULSED ELECTROMAGNETIC FIELDS: OUTCOMES IN SIX PATIENTS Nicolò Martinelli My disclosure is in the Final AOFAS Mobile App. I have no potential conflicts with this presentation.
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
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.
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
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: AOFAS SCORE 3 MONTHS: 59.4 (range 40-66) 94 (range 80-100)
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
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
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.
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