Bilateral Tibia Research Articles

Improved fatigue properties, bone microstructure and blood glucose in type 2 diabetic rats with verapamil treatment

BackgroundType 2 diabetes mellitus is a global epidemic disease, which leads to a severe complication named increased bone fracture risk. This study aimed to explore if verapamil treatment could improve bone quality of type 2 diabetes mellitus. MethodsRat models of control, diabetes and verapamil treatment with 4/12/24/48 mg/kg/d were established, respectively. Blood glucose was monitored during 12-week treatment, and bilateral tibiae were collected. Microstructural images of bilateral metaphyseal cancellous bone and high-resolution images of cortical bone of left tibial shafts were obtained by micro-computed tomography. Fatigue properties of bone were evaluated via cyclic compressive tests of right tibial shafts. FindingsVerapamil treatment had no significant effect on blood glucose, but blood glucose tended to decline with the increase of verapamil-treated time and dose. Compared with controls, osteocyte lacunar and canal porosities in diabetes and verapamil-treated groups were significantly decreased (P < 0.05), trabecular separation and degree of anisotropy were significantly increased (P < 0.05), while trabecular tissue mineral density, trabecular bone volume fraction and trabecular number in verapamil-treated (48 mg/kg/d) group were significantly higher than those in diabetes (P < 0.05). Compared with diabetes, initial compressive elastic moduli in verapamil-treated (12/24/48 mg/kg/d) groups were significantly increased (P < 0.05), while secant modulus degradations in verapamil-treated (24/48 mg/kg/d) groups were significantly decreased (P < 0.05). InterpretationVerapamil could improve bone microstructure and fatigue properties in type 2 diabetic rats; and high-dose verapamil presented a significant effect on improving bone quality. These findings provided a new possibility for preventing the high bone fracture risk of type 2 diabetes mellitus in clinics.

Isolated congenital absence of bilateral femur: A rare case report with antenatal diagnosis and postnatal follow-up.

We report a rare case of isolated congenital absence of the bilateral femur diagnosed antenatally in an 18-19 weeks fetus on a level II scan. The bilateral femur bones were not visualized with normal bilateral tibia and fibula. The fetus was followed with a routine growth scan at 32-33 weeks along with a fetal MRI, which showed similar findings. The antenatal findings were confirmed clinically as well as with a postnatal follow-up X-Ray (infantogram) of the baby. Trio whole-exome sequencing was performed for the child as well as both the parents, which did not reveal any clinically significant variant that could explain the patient’s phenotype.

P051 A rare mimic of inflammatory arthritis

Abstract Background/Aims Rosai-Dorfman syndrome is a rare disorder, primarily affecting young males, characterised by overproliferation and accumulation of histiocytes. It commonly affects lymph nodes but can affect the nervous system, kidneys and skin. Bone involvement is rare (around 5%) and presents as lytic lesions. Diagnosis can be challenging as many cases spontaneously resolve. In severe cases steroids, radiotherapy or chemotherapy may be used. Methods We present a case of a 34-year-old gentleman with a 4-month history of fatigue, widespread arthralgia and unintentional weight loss. Pain was severe, nocturnal and involved joints and long bones. There was no joint swelling. He had recently had a self-limiting episode of headaches and night sweats that was presumed secondary to a viral infection. He had no rash and no features suggestive of connective tissue disease. He did not smoke or drink alcohol and had no recent travel history. His symptoms responded to NSAIDS but recurred quickly. Results On examination, he had a tender right elbow and tender bilateral tibia. There was no evidence of synovitis. He had no lymphadenopathy. X-rays of elbows and knees showed no effusion or erosions. Viral and autoimmune screens were negative. He had a normocytic anaemia with Hb 108. His CRP was rising at 57, having been 27 when initially referred; this was felt inconsistent with a reactive arthritis. LDH was normal along with normal WBC count. A PET-CT was requested to investigate for malignancy, this showed multiple foci of tracer uptake throughout the skeleton but no lymph node involvement. He was referred to haematology for tissue diagnosis and had two bone biopsies, one of which was suspicious for histiocytosis. A bone marrow biopsy showed non-necrotising histiocytic granulomas. Langerhan's Histocytosis was considered and a repeat PET arranged. This showed progressive increased uptake throughout the skeleton and bone marrow with new lytic lesions. There was tracer uptake in the skin, lung and kidneys, reported as possible Rosai-Dorfman disease. No evidence of primary malignancy was found after extensive investigations. He then developed frontal and occipital skin lesions. MRI head showed dural lesions, suspicious for meningioma. He was referred to dermatology for biopsy of skin lesions. However, the skin and dural lesions spontaneously resolved. This was associated with resolution of fatigue and arthralgia. His CRP settled to 2.8 and anaemia resolved 6 months after presenting. A diagnosis of spontaneously remitting Rosai-Dorfman disease was made in conjunction with the national histiocytosis advisory panel. He remains under surveillance. Conclusion This case highlights a rare presentation of a rare condition. As rheumatologists we often see cases which present a diagnostic challenge. Rosai-Dorfman disease has characteristic appearances on PET and should be considered as a diagnosis in patients with atypical joint pain and abnormal PET-CTs. Disclosure M. Cox: None. M.F. Kazmi: None.

A rare case of bilateral periprosthetic fracture of medial condyle of tibia after total knee arthroplasty

Introduction: Bilateral periprosthetic fractures of medial condyle of tibia after total knee arthroplasty are of rare incidence, as evident from previous literature. The risk factors include morbid obesity, low bone mass or osteopenia, prolonged use of corticosteroids or even trivial trauma leading to stress fractures. Case Report: We reported a case of bilateral periprosthetic fracture tibia after primary total knee arthroplasty in a patient with severe varus knees and morbid obesity. X-Ray [AP view of knee] and orthoscanograms revealed the fracture; SPECT CT showed evidence of aseptic inflammation and component loosening [Type 1B fracture; Felix Classification]. Revision arthroplasty was done with an augmented long-stem implant and the patient was discharged after a normal postoperative phase on the 10th day. Knee movement at 6 months was 0-120 degrees with satisfactory outcome scores on follow-up. Discussion: The incidence of bilateral periprosthetic fractures of tibia after primary knee arthroplasty are of rare occurrence, and often associated with severe varus malalignment and morbid obesity. Obesity leads to excessive joint overloading, and together with varus malalignment may lead to component loosening, requiring revision arthroplasty. Conclusion: Even though bilateral periprosthetic tibial fractures are rare, immediate diagnosis and treatment is necessary, if associated with varus knees and morbid obesity after primary total knee arthroplasty. Reduction of weight is mandatory before primary total knee arthroplasty to improve the functional outcomes and reduce the incidence of revision arthroplasty.

Ilizarov technique in the management of bilateral tibia nonunion in an adult with osteogenesis imperfecta

The purpose of this study is to present our surgical strategy and describe the advantages and outcomes of the Ilizarov method in the treatment of bilateral tibia nonunion in an adult with OI. The major of bone fracture fixation drawback is the difficult placement of nails due to abnormal bony anatomy, non-linear and imperforate canals, marked bowing and unusually short limbs. A female adult aged 18yo with bilateral tibia nonunion affected with OI type V was treated with the Ilizarov method. The tibia was in varus (15° at left, 14° at right) and recurvatum (18° on the left, 27° on the right). Surgical technic was same for both tibia in one-time procedure and it's compounded: primary fibula osteotomy, tibia and osteotomy taking out interfragmentary fibrosis, reduction and fixation by Ilizarov frame. Full weight-bearing was allowed at 3 months. The complications that occurred were minors. Bone's consolidation was obtained at 5 months and the frames were removed at 6 months in the office without anesthesia. At the follow-up visit 5 months after removal, the ASAMI functional and radiological score was excellent on the left side and good on the right side. The use of the Ilizarov method for treating a tibia bilateral nonunion in an adult patient with moderate OI provides good stability. This technique ensures early weight full bearing, above joint motion, and recovery functional necessary to normal bone tissue regeneration. This is an alternative to avoid difficulties and complications due to internal fixation in deformities correction in adults with acquired bone-weakening conditions.

Early failure of all polyethylene tibial components in bilateral total knee arthroplasty: A case report

Introduction: Outcomes of Total Knee Arthroplasty (TKA) performed with modern all polyethylene (AP) tibial components have been reported to be comparable with or better than those TKAs performed using metal-backed modular (MBM) tibial components in several medium and long term studies. As AP components also provide substantial cost savings, there has been increase in their use in primary TKA. In spite of such good results, failure of AP tibial components has been reported.Case Presentation: A sixty three year old lady operated for bilateral cruciate retaining PFC Sigma TKA utilizing AP tibial components without patellar resurfacing in 2011 presented to us in December 2014 with two-year history of severe pain in both knees and inability to walk or stand. She had marked varus deformity of both knees. Radiological examination revealed fracture of the medial tibial plateau with failure of AP tibial component and marked varus deformity. She was treated with bilateral staged revision TKA which resulted in a satisfactory outcome. Conclusion: This case report describes previously unreported complication of AP tibial component following cruciate retaining bilateral AP tibia PFC Sigma TKA in a patient of varus osteoarthritis of knee joint. Early collapse of medial tibial plateau leading to failure of bilateral TKA, which could be attributed to under correction of varus deformity and instability, was managed with bilateral revision TKA using tibial metaphyseal sleeves which led to a very satisfactory outcome and excellent five year follow up.

Primary malignant multiple osteogenic sarcomas: a rare clinical image.

We present the case of a 12-year- old male patient, who came to the emergency department with a complaint of pain in bilateral knee joints, pain in bilateral lower legs, multiple swelling over the bilateral knee joint and in the leg region, difficulty in walking, stiffness in the bilateral knee joint since he was one year. There is no medical significant history regarding the disease condition. On physical examination, the swelling was in the region of the metaphysic of the distal end of the bilateral femur and proximal end of the bilateral tibia, skin over the swelling was shiny with tenderness and margins were irregular, on the biopsy and X-ray findings patient was diagnosed as primary malignant multiple osteogenic sarcomas. The patient was referred to the dermatology department for further management.

Radiation-free Insertion of Interlocked Intramedullary Tibial Nail in Closed Extra-articular Displaced Tibial Shaft Fractures in an Emergency Setup.

Interlocking nailing is considered a gold standard surgical treatment of mid-shaft closed diaphyseal tibial fractures. With increasing exposure of orthopaedic surgeons to radiation, we propose a solution to this health hazard through a study wherein we perform the surgery without any radiation or C-arm exposure. This prospective study was done at GMC Jammu from January 2017 to February 2020 and included 218 patients, with 18 patients having bilateral tibia fractures in the age group 15 to 58 years (mean of 37.6 years), including 63.7% males (n=139) and 36.3% females (n=79). The 236 extra-articular closed tibial mid-diaphyseal fractures were operated on and intramedullary tibial nailing was performed without a single C-arm exposure. Postoperative x-rays were done and reduction assessed by standard acceptable criteria. Among 236 cases in which nailing was done, 227 (96%) patients were successfully distally locked, including 128 (56.3%) locked through the jig and 99 (43.6%) by "hit and trial method." All cases met acceptability criteria set for management of tibia by nailing. 1.This study strengthens the proof that closed extra-articular diaphyseal fractures of the tibia can be managed by nailing without using the C-arm with excellent results. 2.The C-arm is always available for cases where distal locking could not be achieved. 3. The technique has a great role in centres with limited facilities of intra-operative radiography in emergency operation theatres.

The Effect of Genetically Modified Lactobacillus plantarum Carrying Bone Morphogenetic Protein 2 Gene on an Ovariectomized Rat.

ObjectiveOsteoporosis result from age-related decline in the number of osteoblast progenitors in the bone marrow. Probiotics have beneficial effects on the host, when administered in appropriate amounts. This study investigated the effects of probiotics expressing specific genes, especially the effects of genetically modified bone morphogenetic protein (BMP)-2-expressing Lactobacillus plantarum CJNU 3003 (LP) on ovariectomized rats. MethodsTwenty-eight female Wistar rats (250–300 g, 12 weeks old) were divided into four groups : the sham (control), the ovariectomy (OVX)-induced osteoporosis group (OVX), the OVX and LP (OVX/LP), OVX and genetically modified BMP-2-expressing LP (OVX/LP with BMP) groups. The three groups underwent bilateral OVX and two of these groups were administered two different types of LP via oral gavage daily. At 16 weeks post-OVX, blood was collected from the heart and the bilateral tibiae were extracted and were scanned by ex-vivo micro-computed tomography and stained with hematoxylin-and-eosin (H&E) and Masson’s trichrome stain for pathological assessment. The serum levels of osteocalcin (OC), rat C-telopeptide of type I collagen (CTX-I), BMP-2, and receptor activator of nuclear factor-ĸB ligand (RANKL) were measured. ResultsThe 3D-micro-computed tomography images showed that the trabecular structure in the OVX/LP with BMP group was maintained compared with OVX and OVX/LP groups. No significant differences were detected in trabecular thickness (Tb.Th) between control and OVX/LP with BMP groups (p>0.05). Furthermore, a tendency toward increased BMD, trabecular bone volume, Tb.Th, and trabecular number and decreased trabecular separation was found in rats in the OVX/LP with BMP groups when compared with the OVX and OVX/LP groups (p>0.05). The H&E and Masson’s trichrome stained sections showed a thicker trabecular bone in the OVX/LP with BMP group compared with the OVX and OVX/LP groups. There was no difference in serum levels of OC, CTX and RANKL control and OVX/LP with BMP groups (p>0.05). In contrast, significant differences were found in OC and CTX-1 levels between the OVX and OVX/LP with BMP groups (p<0.05). ConclusionOur results showed that the expression of genetically modified BMP-2 showed inhibition effect for bone loss in a rat model of osteoporosis.

Gait speed and spasticity are independently associated with estimated failure load in the distal tibia after stroke: an HR-pQCT study

(1) To examine the influence of stroke on distal tibia bone properties and (2) the association between these properties and clinical outcomes in people with chronic stroke. Sixty-four people with stroke (age, 60.8 ± 7.7years; time since stroke, 5.7 ± 3.9years) and 64 controls (age: 59.4 ± 7.8years) participated in this study. High-resolution peripheral quantitative computed tomography (HR-pQCT) was used to scan the bilateral distal tibia, and estimated failure load was calculated by automated finite element analysis. Echo intensity of the medial gastrocnemius muscle and blood flow of the popliteal artery were assessed with ultrasound. The 10-m walk test (10MWT), Fugl-Meyer Motor Assessment (FMA), and Composite Spasticity Scale (CSS) were also administered. The percent side-to-side difference (%SSD) in estimated failure load, cortical area, thickness, and volumetric bone mineral density (vBMD), and trabecular and total vBMD were significantly greater in the stroke group than their control counterparts (Cohen's d = 0.48-1.51). Isometric peak torque and echo intensity also showed significant within- and between-groups differences (p ≤ 0.01). Among HR-pQCT variables, the%SSD inestimated failure load was empirically chosen as one example of the strong discriminators between the stroke group and control group, after accounting for other relevant factors. The 10MWT and CSS subscale for ankle clonus remained significantly associated with the %SSD in estimated failure load after adjusting for other relevant factors (p ≤ 0.05). The paretic distal tibia showed more compromised vBMD, cortical area, cortical thickness, and estimated failure load than the non-paretic tibia. Gait speed and spasticity were independently associated with estimated failure load. As treatment programs focusing on these potentially modifiable stroke-related impairments are feasible to administer, future studies are needed to determine the efficacy of such intervention strategies for improving bone strength in individuals with chronic stroke.

Quantitative evaluation of bone marrow fat content and unsaturated fatty index in young male soccer players using proton magnetic resonance spectroscopy (1H-MRS): a preliminary study.

Marrow fat exists as a distinct adipose tissue and plays a critical role in affecting both the quantity and quality of bone. However, the effect of soccer training on marrow fat has been rarely reported. This study aims to evaluate and characterize the marrow fat content and composition in different bone areas of soccer players and age-matched healthy subjects using proton magnetic resonance spectroscopy (1H-MRS). Between May 2020 and June 2020, 20 professional soccer players (20.7±0.9 years) and 20 age-matched healthy subjects (21.2±0.8 years) were enrolled in this cross-sectional study. The 1H-MRS were acquired from the 3rd lumbar vertebrae, bilateral femoral necks, and distal tibias of all subjects using a single-voxel point-resolved spatially localized spectroscopy (PRESS) sequence. Four soccer players underwent a second magnetic resonance (MR) examination within a 30-minute interval after the initial scan to evaluate test-retest reproducibility. Inter- and intra-observer measurement reliabilities were assessed using 10 randomly selected spectra from the soccer players group. All spectra were processed using the jMRUI software package (http://www.jmrui.eu/). Quantified water and lipid signals were used to calculate fat content (FC) and the unsaturated fatty index (UI). Compared with healthy subjects, we found that soccer players had a lower FC in L3 and bilateral femoral necks and higher UI in the left femoral neck (P<0.05). All FC and UI values of the bilateral distal tibias showed no significant differences between the two groups (P>0.05). The UI values of the right femoral neck or distal tibia were markedly higher than the left side in both inactive subjects and soccer players (P<0.05, except for the femoral neck in players), and there were notable ΔUI differences in the lower limbs between the soccer players and the healthy subjects (P<0.05). Soccer practice can be considered a positive sport that contributes to decreasing FC in lumbar vertebrae and femoral necks and increasing the UI in femoral necks. Quantitative MRS provides an ideal modality to predict marrow fat metabolism caused by mechanical stimulation.

Bone formation effect of highly concentrated tricalcium phosphate biocomposite screws in a rabbit osteoporosis model.

The purpose of this study was to determine the efficacy of highly concentrated tricalcium phosphate (TCP) biocomposite screws on local bone formation in a rabbit model of osteoporosis induced by bilateral ovariohysterectomy (OHE). Fourteen 24-week-old female New Zealand rabbits (weight, 3-3.5 kg) were divided into two groups: (1) OHE and biodegradable poly(lactic-co-glycolic acid) (PLGA) without ß-TCP plate or screw insertion (OHE/Bio ScRew [BSR]) group and (2) OHE and biocomposite PLGA with highly concentrated ß-TCP plate and screw insertion (OHE/highly concentrated ß-triCalcium phosphate [HCCP]). Both groups underwent bilateral OHE and had two different types of screws and plates inserted at the proximal tibia. Bilateral tibiae were extracted at 25 weeks post-OHE. The extracted tibiae were scanned with ex vivo microcomputed tomography (micro-CT). Parameters including bone mineral density (BMD), trabecular bone volume (BV/TV), trabecular number (Tb.N), trabecular thickness (Tb. Th), and trabecular separation (Tb. Sp) were evaluated after staining the tibial samples with hematoxylin and eosin (H&E) and Masson's trichrome. We then performed pathological assessments. Micro-CT images revealed improved new bone formation near the implant in the OHE/HCCP group with higher values of BMD, BV/TV, and Tb.N but lower values of Tb. Th and Tb. Sp than the OHE/BSR group. Analyses of H&E and Masson's trichrome staining showed better new bone formation around the implant in the OHE/HCCP group than in the OHE/BSR group. The use of highly concentrated TCP biocomposite screw and plate might improve local bone formation and facilitate osteoconductivity in an osteoporotic rabbit model.

Bone density, microarchitecture and strength in elite figure skaters is discipline dependent

ObjectivesIn elite figure skaters, to determine if there was a difference in volumetric bone mineral density and bone strength between 1) figure skaters and population-based normative data, 2) single or pair skaters and ice dancers, and 3) the landing and takeoff legs. DesignCross-sectional. MethodsFigure skaters had their non-dominant distal radius and bilateral tibia scanned using high-resolution peripheral quantitative computed tomography. Volumetric bone mineral density was determined at the total, cortical and trabecular compartments, and finite element analysis estimated bone strength. Normative data was used to compare the total bone mineral density of figure skaters to a population-based cohort. Independent t-tests compared differences between skating discipline, and paired t-tests compared skeletal parameters for the landing and takeoff leg. ResultsTwenty elite skaters (mean age 22 ± 6.2; female = 11, male = 9) completed scans. Compared with the general population, the mean percentile rank for skaters' total volumetric bone mineral density was below normal at the radius (27th percentile) and normal at the tibia (54th percentile). Single or pair skaters had more robust bone in the landing compared with their takeoff leg. Specifically, the landing leg had higher total bone mineral density (2.8%) and trabecular bone mineral density (6.5%), and superior bone strength (8.5%) than the takeoff leg (p < 0.05). ConclusionsVolumetric bone mineral density and strength differences in figure skaters were discipline dependent. Side-to-side differences were observed in single and pair skaters where the landing leg is denser, larger and stronger than the takeoff leg.

A Girl with Limp and Rash on the Palms and Soles.

A Girl with Limp and Rash on the Palms and Soles.

Bone infarct (osteonecrosis) as late side effect of steroid in acute lymphoblastic leukemia survivor

Survivors of acute lymphoblastic leukemia (ALL), though cured of their primary disease may suffer from long-term complications such as bone infarction contributing to a major morbidity. Here, we report a very rare case of bone infarct in bilateral tibia and femur of a patient of acute lymphoblastic leukemia, post completion of maintenance chemotherapy. With this case report, we suggest that appropriate preventive measures are necessary to decrease the risk of this very rare morbidity.

Short-Term Treatment With Teriparatide Restores Independent Ambulation in a Patient With Glucocorticoid-Induced Osteonecrosis of the Knees and Ankles

Teriparatide is a well-established treatment for osteoporosis. It is emerging as a promising treatment for osteonecrosis of the jaw and may be superior to alendronate for treating glucocorticoid-induced osteonecrosis of the femoral head and reduce collapse progression. However, few studies have investigated its efficacy in treating steroid-induced osteonecrosis affecting other sites such as the knee and ankle. Osteonecrosis treatment at these sites in early stages is limited to protected weight bearing and pain management. Surgical management is required for advanced stages. This case describes an unusual presentation of steroid-induced osteonecrosis in the bilateral lower extremities and illustrates the potential benefit of teriparatide as an alternative to surgery in managing this debilitating condition. A 25-year-old male with a history of a heart transplant for viral myocarditis was admitted to the hospital for severe bilateral lower extremity pain. His post-transplant course was complicated by giant cell myocarditis, treated with a prednisone taper from 80 mg to 7.5 mg daily over the course of one year. MRI showed diffuse osteonecrosis in the distal femora, medial femoral condyles, bilateral proximal tibias, left distal tibia, and bilateral ankles. A bone density test showed only mildly low bone mass with Z-scores of -0.8 at the right femur, -1.3 at the left femur and -1.3 at the lumbar spine. Due to progressive osteonecrosis on imaging and a decline in functional status over the next two months, following a discussion of risks, benefits and alternatives, he was started on daily teriparatide injections. Prior to therapy, he was using a walker and had difficulty ambulating more than a few feet. Within a month of teriparatide initiation, he reported improvement in both pain and mobility, and was able to walk independently into clinic. MRI two months later demonstrated no new lesions and significant improvement in previously necrotic areas. Our case highlights the importance of considering osteonecrosis at atypical locations in patients on chronic glucocorticoid therapy. It also demonstrates a promising role for teriparatide in treating steroid-induced osteonecrosis atypical sites and without concurrent osteoporosis.

Anatomical landmark localization via convolutional neural networks for limb-length discrepancy measurements

Measurement of limb-length discrepancy (LLD) from a radiograph is a cognitively simple but time-consuming task. To develop a convolutional neural network (CNN) to localize anatomical landmarks from full-length lower-extremity radiographs in predicting LLD. The author searched a hospital's image database to identify studies performed between Feb. 1, 2016, and Sept. 30, 2019. Inclusion criteria were: (1) patients ≤21years old, (2) study indication of LLD, (3) full-length lower-extremity anteroposterior radiographs performed on the EOS system, and (4) imaging field-of-view that included entire bilateral femurs and tibias. The six requisite ground truth anatomical landmarks for measuring LLD from each radiograph - bilateral top of femoral heads, medial femoral condyles, and center of tibial plafonds - were manually labeled by a pediatric radiologist. For each landmark, a two-dimensional heatmap was generated to encode the pseudo-probability of a landmark being at a particular spatial location. A CNN was developed that regressed across a collection of these heatmaps for landmark localization and bone length predictions. The study cohort consisted of 504 full-length lower-extremity radiographs from 359 patients with wide ranging skeletal deformities and in situ hardware. Evaluation of this CNN showed that the mean point-error for the predicted top of femoral head, medial femoral condyle, and center of tibial plafond were 0.37cm, 0.39cm and 0.42cm, respectively. The mean absolute error for the predicted femoral, tibial and limb lengths, and LLD were 0.33cm, 0.30cm, 0.30cm, and 0.36cm, respectively. Predicted bone lengths correlated strongly with ground truth. This prototype CNN delivered promising results in predicting bone lengths from full-length lower-extremity radiographs and offers the potential use of a computer algorithm to predict LLD.

Large Individual Bilateral Differences in Tibial Torsion Impact Accurate Contralateral Templating and the Evaluation of Rotational Malalignment.

To determine individual bilateral differences (IBDs) in tibial torsion in a diverse population. Computed tomography scans of uninjured bilateral tibiae were used to determine tibial torsion and IBDs in torsion using 4 measurement methods. Age, sex, and self-identified race/ethnicity were also recorded for each subject. Mean tibial torsion and IBDs in torsion were compared in the overall cohort and when stratified by sex and race/ethnicity. Simple and multiple linear regression models were used to correlate demographic variables with tibial torsion and IBDs in torsion. One hundred ninety-five patients were evaluated. The mean tibial torsion was 27.5 ± 8.3 degrees (range -3 to 47.5 degrees). The mean IBD in torsion was 5.3 ± 4.0 degrees (range 0-23.5 degrees, P < 0.001). 12.3% of patients had IBDs in torsion of ≥10 degrees. In the regression analysis, patients who identified as White had greater average torsion by 4.4 degrees compared with Hispanic/Latinx patients (P = 0.001), whereas age and sex were not significantly associated with absolute torsion. Demographics were not associated with significant differences in IBDs in torsion. Tibial torsion varies considerably and individual side-to-side differences are common. Race/ethnicity was associated with differences in the magnitude of tibial torsion, but no factors were associated with bilateral differences in torsion. The results of this study may be clinically significant in the context of using the uninjured contralateral limb to help establish rotational alignment during medullary nail stabilization of diaphyseal tibia fractures. In addition, these findings should be considered in the evaluation of tibia rotational malalignment. Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Osteogenic effect of low-intensity pulsed ultrasound and whole-body vibration on peri-implant bone. An experimental in vivo study.

The aims of this study were (i) to compare the osteogenic impact of low-intensity pulsed ultrasound (LIPUS) and low-magnitude high-frequency (LMHF) loading achieved with whole-body vibration (WBV) on peri-implant bone healing and implant osseointegration in rat tibiae, and (ii) to examine their combined effect on these processes. Titanium implants were inserted in the bilateral tibiae of 28 Wistar rats. Rats were randomly divided into four groups: LIPUS+WBV, LIPUS, WBV, and control. LIPUS was applied to the implant placement site for 20min/day on 5days/week (1.5MHz and 30mW/cm2 ). WBV was applied for 15min/day on 5days/week (50Hz and 0.5g). In the LIPUS+WBV group, both stimuli were applied under the same stimulation conditions as in the LIPUS and WBV groups. After 4weeks of treatment, peri-implant bone healing and implant osseointegration were assessed using removal torque (RT) tests, micro-CT analyses of relative gray (RG) value, and histomorphometrical analyses of bone-to-implant contact (BIC) and peri-implant bone formation (BV/TV). The LIPUS+WBV group had significantly greater BIC than the WBV and control groups. Although there were no significant intergroup differences in RT, RG value, and BV/TV, these variables tended to be greater in the LIPUS+WBV group than the other groups. The combination of LIPUS and LMHF loading may promote osteogenic activity around the implant. However, further study of the stimulation conditions of LIPUS and LMHF loading is necessary to better understand the osteogenic effects and the relationship between the two stimuli.

Application of modified closed biopsy in rabbit model of VX2-transplanted bone tumor

BackgroundThis study was aimed to explore the application value of modified closed biopsy technique in puncture biopsy of rabbit VX2 transplanted bone tumor model.MethodsVX2 tumor was transplanted into the bilateral tibia of 30 rabbits through the tibial plateau to make the model of VX2 transplanted bone tumor. Seven days after modeling, the proximal tibia biopsy was performed under the guidance of X-ray, and the biopsy specimen was examined pathologically. The left leg was biopsied with modified closed biopsy technique (experimental group), and the right leg was biopsied with hollow needle (control group). After 14 days of modeling, all rabbits were killed after X-ray examination around the puncture hole, and the soft tissue around the puncture hole was taken for pathological examination, and the expression levels of PCNA and CD34 in the tissue extract were detected by enzyme-linked immunosorbent assay (ELISA).ResultsBy the end of the experiment, a total of 3 rabbits died, and finally, 27 rabbits were included in the study. Tumor cells were detected in all the intramedullary specimens obtained by puncture biopsy. On the 14th day after modeling, X-ray showed that the occurrence rate of periosteal reaction and extraosseous high-density shadow around the puncture hole was 14.81% (4/27) in the experimental group and 40.74% (11/27) in the control group. The difference was statistically significant (P<0.05). The pathological results of soft tissue around the puncture hole showed that the tumor cell metastasis rate was 29.63% (8/27) in the experimental group and 100% (27/27) in the control group, and the difference was statistically significant (P<0.05). The expression levels of PCNA and CD34 in the experimental group were lower than those in the control group (P < 0.05).ConclusionBoth the modified closed biopsy technique and needle aspiration biopsy can provide sufficient biopsy tissue for the diagnosis of VX2-transplanted bone tumor in rabbits. At the same time, the improved closed biopsy technique has a certain application value in preventing local metastasis of tumor cells along the puncture channel.