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Geographic Polyostotic Thermal Osteonecrosis of the Foot and Ankle Caused by Fourth-Degree Burn: a Case Report

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Abstract

We report a case of extensive polyostotic osteonecrosis spanning several bones and joints at the deep margin of a fourth-degree burn. A 41-year-old female presented following an unwitnessed fall with loss of consciousness, with her left foot and ankle positioned close to a space heater for a prolonged period of time. Bone involved in the initial burn was unable to appropriately heal and remodel during recovery, leading to secondary fractures and osteoarthrosis. Subsequent computed tomography (CT) imaging of the left foot and ankle revealed relative sclerosis of bone deep to the site of fourth-degree burn in a distinctive contiguous pattern. The anterior talar dome was involved and went on to collapse by 17 months following the injury with additional secondary osteoarthrosis visible by 24 months. Magnetic resonance imaging (MRI) of the foot and ankle obtained 24 months after the initial injury demonstrated a striking pattern of marrow signal abnormality on both fluid-sensitive and T1-weighted images consistent with osteonecrosis, mirroring the same distribution of involvement seen by CT. This case is being reported to illustrate the unique geographic polyostotic pattern of osteonecrosis that can occur in the setting of a focal thermal injury and how the pattern of bony sclerosis at the depth of injury may be helpful in planning surgical fixation, arthrodesis, or arthroplasty procedures and in predicting future complications.

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References

  1. Moon DK. Epidemiology, cause, and anatomy of osteonecrosis of the foot and ankle. Foot Ankle Clin N Am. 2019;24(1):1–16.

    Article  Google Scholar 

  2. Cohen-Rosenblum A, Cui Q. Osteonecrosis of the femoral head. Orthop Clin North Am. 2019;50(2):139–49.

    Article  Google Scholar 

  3. Malizos KN, Karantanas AH, Varitimidis SE, Dailiana ZH, Bargiotas K, Maris T. Osteonecrosis of the femoral head: etiology, imaging and treatment. Eur J Radiol. 2007;63(1):16–28.

    Article  Google Scholar 

  4. Saini A, Saifuddin A. MRI of osteonecrosis. Clin Radiol. 2004;59(12):1079–93.

    Article  CAS  Google Scholar 

  5. Mulligan ME. How to diagnose enchondroma, bone infarct, and chondrosarcoma. Curr Probl Diagn Radiol. 2019;48(3):262–73.

    Article  Google Scholar 

  6. Augustin G, Zigman T, Davila S, Udilljak T, Staroveski T, Brezak D, et al. Cortical bone drilling and thermal osteonecrosis. Clin Biomech (Bristol, Avon). 2012;27(4):313–25.

    Article  Google Scholar 

  7. Timon C, Keady C. Thermal osteonecrosis caused by bone drilling in orthopedic surgery: a literature review. Cureus. 2019;11(7):e5226.

    Google Scholar 

  8. Lee JM, Choi SH, Park HS, Lee MW, Han CJ, Choi JI, et al. Radiofrequency thermal ablation in canine femur: evaluation of coagulation necrosis reproducibility and MRI-histopathologic correlation. Am J Roentgenol. 2005;185(3):661–7.

    Article  Google Scholar 

  9. Willems WF, Alberton GM, Bishop AT, Kremer T. Vascularized bone grafting in a canine carpal avascular necrosis model. Clin Orthop Relat Res. 2011;469(10):2831–7.

    Article  Google Scholar 

  10. Heimbach D, Engrav L, Grube B, Marvin J. Burn depth: a review. World J Surg. 1992;16(1):10–5.

    Article  CAS  Google Scholar 

  11. Monstrey S, Hoeksema H, Verbelen J, Pirayesh A, Blondeel P. Assessment of burn depth and burn wound healing potential. Burns. 2008;34(6):761–9.

    Article  Google Scholar 

  12. Hayeri MR, Ziai P, Shehata ML, Teytelboym OM, Huang BK. Soft-tissue infections and their imaging mimics: from cellulitis to necrotizing fasciitis. Radiographics. 2016;36(6):1888–910.

    Article  Google Scholar 

  13. Muschitz GK, Schwabegger E, Fochtmann A, Baierl A, Kocijan R, Haschka J, et al. Long-term effects of severe burn injury on bone turnover and microarchitecture. J Bone Miner Res. 2017;32(12):2381–93.

    Article  CAS  Google Scholar 

  14. Balen PF, Helms CA. Bony ankylosis following thermal and electrical injury. Skeletal Radiol. 2001;30(7):393–7.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, University of Colorado School of Medicine, Aurora, CO, 80045, USA

    Jonathan S. Lin & Colin D. Strickland

  2. Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, 80045, USA

    Daniel K. Moon

Authors
  1. Jonathan S. Lin
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  2. Daniel K. Moon
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  3. Colin D. Strickland
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All authors declare that they meet criteria for authorship by contribution to conception and design, acquisition of data, and interpretation. All participated in drafting and critical revisions. All have given final approval for publication.

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Correspondence to Colin D. Strickland.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study. Additional written informed consent was obtained from all individual participants for whom identifying information is included in this article.

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The authors declare no competing interests.

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This article is part of the Topical Collection on Imaging

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Lin, J.S., Moon, D.K. & Strickland, C.D. Geographic Polyostotic Thermal Osteonecrosis of the Foot and Ankle Caused by Fourth-Degree Burn: a Case Report. SN Compr. Clin. Med. 4, 136 (2022). https://doi.org/10.1007/s42399-022-01204-2

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  • DOI: https://doi.org/10.1007/s42399-022-01204-2

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