Download treatment of bone marrow edema (bme)

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:
59.4 (range 40-66)
AOFAS SCORE 3 MONTHS:
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
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2000;21:134-7.
2) Judd DB, Kim DH, Hrutkay JM. Transient osteoporosis of the talus. Foot Ankle Int
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