Drilling is a common surgical procedure for fracture treatment and reconstruction in multiple surgical fields, including orthopaedics, neurology, and dentistry. Drilling delicate tissue (such as bone) with a hard metallic tool is considered notorious for inducing mechanical and thermal damage, which can adversely affect osseointegration and may weaken the bond between the bone and implant, or other fixative devices anchoring the bone. The aim of this study is to explore the benefits of vibrational drilling (VD) in overcoming the complications associated with conventional drilling (CD). Drilling tests were performed on fresh cortical bone with the intention of investigating the effect of a range of frequencies, in combination with drilling speed and feed rate, on biological damage around the drilling region using histological sections of skeletally mature bone. The study examined the most influential factors and optimal combination of parameters for safe and efficient drilling in bone. Results from Taguchi grey relational analysis showed that a lower drilling speed and feed rate combined with a frequency of 20 kHz were favourable parameters for safe drilling in bone. Accordingly, VD using controlled parameters may be an alternative to CD in bone surgical procedures.

Isolation of the causal microorganisms in osteomyelitis presents a major challenge for treating clinicians. Several methods have been proposed to rapidly and accurately identify microorganisms. There has been an increasing interest in using Raman spectroscopy in the field of microbial detection and characterisation. This paper explores the use of Raman spectroscopy identification as one of the most difficult-to-isolate microorganisms causing osteomyelitis. Fresh healthy human bone samples were collected from patients undergoing a total knee replacement. These samples were then inoculated with fresh overnight Pseudomonas aeruginosa (PAO) cultures. Bacteria growth and bone ultrastructural changes were monitored over a period of 6 weeks. The experiment demonstrated ultrastructural bony destruction caused by osteolytic PAO secretions. Raman-specific spectral signatures related to the cellular membranes of PAO structures were spotted indicating survival of bacteria on the bone surface. This study showed the promising ability of Raman spectroscopy to identify the presence of bacteria on the surface of inoculated bone samples over time. It was able to detect the osteolytic activity of the bacteria as well as ultrastructure specific to PAO virulence. This method may have a role as an aid to existing diagnostic methods for fast and accurate bacterial identification in bone infection. Al Ghaithi A, Al Bimani A, Al Maskari S. Investigating the Growth of Pseudomonas aeruginosa and Its Influence on Osteolysis in Human Bone: An In Vitro Study. Strategies Trauma Limb Reconstr 2021;16(3):127–131.

Objectives: Osteomyelitis, characterised by bone inflammation due to microbial infection, presents significant healthcare challenges. While the protective role of biofilm in bacterial immunity and persistence is well-documented, its direct impact on bone degradation in osteomyelitis remains inadequately characterised. This study aimed to comprehensively examine the direct effects of biofilm-forming pathogens on human bone, providing new insights into the mechanisms of bone destruction associated with osteomyelitis. Methods: Bone sections were collected from patients undergoing total knee replacement surgery at Sultan Qaboos University Hospital, Muscat, Oman, between January 2021 and December 2022. The samples were then inoculated with Staphylococcus aureus to simulate in vitro bone infection. Raman spectroscopy and scanning electron microscopy (SEM) were employed to analyse the bacterial interaction with bone tissue. Results: Biofilm-forming pathogens directly contributed to bone degradation, as evidenced by SEM images showing marked trabecular destruction. Raman analysis showed a significant increase in the carbonate-to-phosphate ratio in inoculated samples (61.9%) compared to controls (47%). Additionally, mineral content decreased in inoculated samples, and the carbonate-to-amide I ratio reduced by 47% in inoculated samples and by 80% in controls. The inoculated samples exhibited an 82% shift in collagen cross-linking compared to a 72% shift in controls. Conclusions: This research enhances the comprehension of the mechanisms underlying bone destruction in osteomyelitis and underscores the intricate role of biofilm in disease progression. These findings highlight the importance of biofilm in bone degradation and its potential implications for infection management.

Objectives: Despite the numerous advances in management strategies, treating osteomyelitis in individuals with sickle cell disease (SCD) remains a significant challenge, leading to severe long-term consequences. This study aimed to assess the key factors potentially linked to a complex progression of osteomyelitis in patients diagnosed with SCD. Methods: A cohort of 34 patients was identified and their progress was monitored over a span of 12 months during a 10-year period (2010–2020). The variables under investigation encompassed demographic and clinical traits, laboratory analyses and imaging data, as well as the treatment strategies employed. Results: The risk prediction model pinpointed 5 factors (severity of SCD, involvement of lower limbs, presence of bacteraemia, magnetic resonance image [MRI] findings and utilisation of surgical debridement) that exhibited an area under the curve (AUC) exceeding 0.7. Causative organisms were identified in 9 out of the total 34 patients (26.47%). A total of 17 patients displayed a severe course of SCD (AUC = 7.88), with MRI being highlighted as a valuable contributing factor (AUC = 7.88). Furthermore, 13 patients (38.2%) underwent surgical debridement, a procedure that yielded a statistically significant P value of 0.012 and an AUC of 0.714. Conclusion: Osteomyelitis within the context of severe SCD, particularly when accompanied by lower extremity infection, bacteraemia, positive MRI findings and the need for surgical debridement, emerges as a cluster of risk factors predisposing individuals to osteomyelitis relapse and a more complex disease course.