Lower Limb Bones Research Articles

Hepatoid Adenocarcinoma of the Lung

We present the case of an 80-year-old patient hospitalized for the study of a lower limb bone lesion. The biopsy of this lesion was suggestive of liver cancer metastasis. However, the study of the liver did not present any local lesion. In the event of an hepatoid tumor, a study of the digestive tract was performed, without detection of neoplasia. By recurrent respiratory infections, it was hypothesized a tumoral lesion at this level, which was confirmed by later thorax CT and biopsy.

Lower Limb Bone Shortened by 10 Cm and Replantation Extension in Children

Lower Limb Bone Shortened by 10 Cm and Replantation Extension in Children

Using of modern patterns of intraoperative fluid resuscitation in orthopedic oncology

Objective: to study the changes in central hemodynamics, transport and oxygen consumption in patients who underwent planned surgical interventions in oncologic orthopedics us­ing different regimes of intraoperative fluid supply.Methods: study included 70 patients aged 18 to 77 years who underwent surgery under combined anesthesia — spinal injection of bupi­vacaine and intravenous propofol-fentanyl anesthesia. Patients of the 1st group (n = 35) were provided with a restrictive mode of intraoperative fluid administration, 2nd (n = 35) — targeted liquid therapy with careful monitoring of cardiac output and tar­get support of the stroke index at a level of more than 35 ml/ m2, mean arterial pressure not less than 90 mm Hg. art. In patients of the 1st group, cardiac preload was often modeled with norepi­nephrine, the 2nd — it was maintained by short-term infusions of a solution of hydroxyethyl starch.Results: it was established that when the fluid support is limited (group 1), cardiac out­put, vascular tone, and oxygen uptake are significantly reduced. More than 40 % of patients (with 100 % of elderly and senile patients) needed to introduce noradrenaline to stabilize central hemodynamics. Patients of the 2nd group had significantly better cardiac output, vascular tone, oxygen consumption, did not need noradrenaline.Conclusions: purposeful liquid therapy contributes to the stabilization of central hemodynamics indices, pro­vides better oxygen metabolism, which is especially important for elderly and senile patients in patients who are routinely operated in orthopedic oncology for malignant pathology of lower limb bones under combined anesthesia.

Stature estimation using long bone metrics in contemporary Turkish

Creating a biological profile of an individual usually requires their stature estimation. However, until recently, studies on stature estimation among modern Turkish were few and far between. Hence, the current study aims to bridge the gap on the bio-anthropological database in this population. The research includes CT scans of 102 adult individuals (51 males and 51 females) of known stature. Age ranges from 20 to 87 years and body mass from 43 to 134 kg. The maximum lengths of the three longest bones of lower limbs (femur, tibia and fibula) were measured, and stature reconstruction formulae have been generated using linear regression. Results reveal that in males, the femur equation provides the lowest standard error of the estimate (SE = 4.76 cm), followed by the fibula (SE = 4.83 cm). Conversely, the fibula produced the lowest standard error among the females (SE = 5.3 cm), followed by the tibia (SE = 5.46 cm). When all bones were used jointly, the standard error of estimate showed very little improvement for both males (SE = 4.65 cm) and females (SE = 5.03 cm). Stature exhibited statistically significant correlation with sex and long bone lengths but not with age or body mass.

Research Paper: Gender Identification With Knee Bicondylar Width and Vertical Diameter of the Femur Head Based on Radiography Assessment

Background: Some skeletal criteria especially for bones of lower limbs are considerably different between men and women that may help in identifying the gender. We studied two lower limbs parameters, i.e. bicondylar width and vertical diameter of the femoral head based on radiographic assessment in gender identification.Methods: Bicondylar width and vertical diameter of the femoral head of 280 radiographs taken from people aged 30 to 75 years were measured. Additionally, gender and age subgroups were recorded and added to the measured anthropometric parameters in the checklist of the study.Results: The mean width of both left and right bicondylar bones as well as vertical diameter of both left and right femoral heads were significantly different between men and women. Considering two parameters of bicondylar width and vertical diameter of femoral head, the measurements could differentiate gender, with 96.7% sensitivity, 72.2% specificity, and 96.0% accuracy.Conclusion: By measuring bicondylar width and vertical diameter of the femur head, it is possible to determine gender with a high discriminative capability.

Expression and functional proteomic analyses of osteocytes from Xenopus laevis tested under mechanical stress conditions: preliminary observations on an appropriate new animal model.

Hitherto, the role of the osteocyte as transducer of mechanical stimuli into biological signals is far from settled. In this study, we used an appropriate model represented by the cortex of Xenopus laevis long bone diaphysis lacking (unlike the mammalian one) of vascular structures and containing only osteocytes inside the bone matrix. These structural features allow any change of protein profile that might be observed upon different experimental conditions, such as bone adaptation to stress/mechanical loading, to be ascribed specifically to osteocytes. The study was conducted by combining ultrastructural observations and two-dimensional electrophoresis for proteomic analysis. The osteocyte population was extracted from long bones of lower limbs of amphibian skeletons after different protocols (free and forced swimming). The experiments were performed on 210 frogs subdivided into five trials, each including free swimming frogs (controls) and frogs submitted to forced swimming (stressed). The stressed groups were obliged to swim (on movable spheres covering the bottom of a pool on a vibrating plate) continuously for 8 h, and killed 24 h later along with the control groups. Long bones free of soft tissues (periosteum, endosteum and bone marrow), as well as muscles of posterior limbs, were processed and analyzed for proteins differentially expressed or phosphorylated between the two sample groups. The comparative analysis showed that protein phosphorylation profiles differ between control and stressed groups. In particular, we found in long bones of stressed samples that both Erk1/2 and Akt are hyperphosphorylated; moreover, the different phosphorylation of putative Akt substrates (recognized by specific Akt phosphosubstrates-antibody) in stressed vs. control samples clearly demonstrated that Akt signaling is boosted by forced swimming (leading to an increase of mechanical stress) of amphibian long bones. In parallel, we found in posterior limb muscles that the expression of heat shock protein HSP27 and HSP70 stress markers increased upon the forced swimming condition. Because the cortexes of frog long bones are characterized by the presence of only osteocytes, all our results establish the suitability of the X.laevis animal model to study the bone response to stress conditions mediated by this cell type and pave the way for further analysis of the signaling pathways involved in these signal transduction mechanisms.

NEW APPROACH TO SOLVING THE PROBLEM OF COMPLEX REGIONAL PAIN SYNDROME

Aim - to improve the results of treatment of patients with complex regional pain syndrome (CRPS) in bone fractures of the lower extremities by applying a new integrated approach. Methods. A new approach to solving the problem of complex regional pain syndrome in fractures of lower limb bones is proposed, including the use of modern minimally invasive methods for surgical treatment of fractures of the lower limb bones, such as blocked osteosynthesis, Fixion technology, use of angular stability plates, metal structures for osteosynthesis of the proximal femur. All these measures help to minimize the negative effect that is produced on the bone by such factors as prolonged immobilization and absence of early movements of the joints, which will make it possible to perform CRPS prophylaxis in bone fractures of the lower limbs more effectively. If it is not possible to prevent the development of CRPS, then it is necessary to administer complex therapy, including psychoemotional correction, adherence to the regime, proper immobilization, rehabilitation exercises, physiotherapy, medical treatment, hyperbaric oxygenation, and gravitational therapy. Results. Clinical tests, radiography, densitometry, method of statistical analysis and mathematical modeling with elements of evidencebased medicine objectively confirmed the activation of the restorative processes in altered tissues of the lower limbs due to the use of the new complex. Conclusion. The analysis of the obtained data of clinical and functional methods of research has proved that the total value of positive results is 80%.

Can the recovery of lower limb fractures be achieved by use of 3D printing mirror model?

Introduction: The mirror imaging 3D printing model can be used a as a reference for anatomical reduction in unilateral lower limb fractures. However, the premise of using mirror technology is that the bilateral lower limb bones are similar enough. Because one side had a fracture, it was impossible to compare this directly to the other side. Usually, surgeons think that the bilateral bones are symmetrical and use mirror technology without judging their symmetry. MethodsIn patients with a unilateral lower limb bone fracture, we measured the long axis and short axis of the three selected transverse sections of the bilateral long bone for comparison to judge the symmetry of the bilateral long bones on CT images. Then, we printed a life-size normal mirror image of the long bone that is similar to the affected side. The model was used as a reference for the anatomical reduction of fractures and preoperative practice. ResultsSeventy-eight patients with lower limb bone fracture were included in this study. 24 groups of data were generated according to the same level and same axis. There were significant differences between the short axis of the left and right femoral condyle 5cm from the intercondylar keel (p=0.011), and the short axis of the distal tibia 15cm from the ankle dome (p=0.026). There was no significant difference between the left and right sides in the other 22 groups. Of all of the patients in our research, 3 patients decided to forego the surgical treatment and the operation was performed on the model instead, and the lengths of 2 patients showed deviation in actual operations, preventing anatomical reduction. The remaining 73 patients used the pre-bended plates and screws from preoperative practice in the actual operations, and postoperative X-ray examinations showed that the length of the deviation was within the permissible range. ConclusionThe “Comparison of long axis and short axis of three equidistant transverse sections” method makes it easy to judge the symmetry of the bilateral long bones, and prevents the blindness of preoperative planning using the contralateral mirror model directly.

Aneurysmal Bone Cyst of Clavicle in a Six-Year-Old Male Child

Aneurysmal Bone Cyst (ABCs) is a cystic expansile lesion which is usually found in solitary locations in the metaphysis of long bones. The most common locations of ABC are long bones of lower limbs. There is little knowledge about the presence of this tumor in Clavicle. Here we present a case of a six year old male child who presented with complaint of swelling in left shoulder for four months. There was a dilemma in the diagnosis of the swelling due to its unusual presentation and appearance. The Fine Needle Aspiration Cytology was also inconclusive. The diagnosis of ABC was made only by excision biopsy. The Clavicle regenerated to nearly normal anatomy at 15 weeks follow up period. The patient is asymptomatic now and is able to perform all daily activities without any restrictions. The uniqueness of this case lies in the fact that this is the first case where ABC has been reported in Clavicular region in young Asian male of less than 10 years age.
 Keywords: ABC, Bone tumor, Expansile lesion.

The effect of combined resistance exercise training and vitamin D3 supplementation on musculoskeletal health and function in older adults: a systematic review and meta-analysis

ObjectivesIn older adults, there is a blunted responsiveness to resistance training and reduced muscle hypertrophy compared with younger adults. There is evidence that both exercise training and vitamin D supplementation...

The first Neanderthal remains from an open-air Middle Palaeolithic site in the Levant

The late Middle Palaeolithic (MP) settlement patterns in the Levant included the repeated use of caves and open landscape sites. The fossil record shows that two types of hominins occupied the region during this period—Neandertals and Homo sapiens. Until recently, diagnostic fossil remains were found only at cave sites. Because the two populations in this region left similar material cultural remains, it was impossible to attribute any open-air site to either species. In this study, we present newly discovered fossil remains from intact archaeological layers of the open-air site ‘Ein Qashish, in northern Israel. The hominin remains represent three individuals: EQH1, a nondiagnostic skull fragment; EQH2, an upper right third molar (RM3); and EQH3, lower limb bones of a young Neandertal male. EQH2 and EQH3 constitute the first diagnostic anatomical remains of Neandertals at an open-air site in the Levant. The optically stimulated luminescence ages suggest that Neandertals repeatedly visited ‘Ein Qashish between 70 and 60 ka. The discovery of Neandertals at open-air sites during the late MP reinforces the view that Neandertals were a resilient population in the Levant shortly before Upper Palaeolithic Homo sapiens populated the region.

Management of infected non-union of lower limb long bone fractures using ilizarov technique: a study of outcomes

<p class="abstract"><strong>Background:</strong> Nonunion of long bone fractures is a common condition treated by an orthopaedic surgeon. Many nonunions can be treated effectively by internal fixation with or without bone grafting but, an infected nonunion can prove to be a tough challenge. The Ilizarov method is effective in managing infected nonunion of long bones. This study aims to assess the outcome of management of infected nonunions of long bones of lower limb with Ilizarov Ring fixator using bone and functional results as per Association for the Study and Application of Methods of Ilizarov (ASAMI) Scoring System.</p><p class="abstract"><strong>Methods:</strong> We retrospectively analysed 18 patients (16 Male: 2 Female; Mean age 43.2 years) managed with Ilizarov technique for an infected tibial or femoral nonunion between 01 January 2013 and 31 December 2014. They were followed up for an average of 25.4 months after removal of fixator. They were assessed for functional and Bone (radiological) outcomes using the Association for the Study and Application of Methods of Ilizarov (ASAMI) criteria.<strong></strong></p><p class="abstract"><strong>Results:</strong> 17 limbs were salvaged and union could be achieved. One limb required amputation due to severe persistent intractable infection. None required any additional skeletal stabilisation after removal of fixator frame except casting in a few patients for a period of 6 weeks. Mean time to union was 211.83 days (range 136 - 320days/median 184) or 7.01 months. As per the ASAMI score, Bone results were excellent in 10, good in 5, fair in 2 and poor in 1. Functionally 7 were graded as excellent, 6 as good, 3 as fair and 1 as poor and 1 patient underwent amputation.</p><p><strong>Conclusions:</strong> The Ilizarov’s method remains one of the most versatile and successful means of achieving bone healing in infected nonunions of long bones of lower limbs with additional benefits of correcting bone defects, deformities and limb length inequalities. </p>

Outcome of vascular repair in lower limb fractures with vascular injury

Lower limb fractures with an associated vascular injury are a challenging management problem for the orthopedic and vascular surgeon. The effect of an associated vascular injury on fracture healing has not been enlightened much. Functional outcome following lower extremity vascular injury when assessed through limb salvage rates underestimates the of functional disability of the survived limb. Methods: We studied 36 patients with fracture/dislocation of the long bones of lower limb with vascular injury, where in the limb was salvaged, between June 2009 to June 2012. Information regarding the mangled extremity severity score, ISS, revised trauma score, presence of circulatory, motor, sensory deficits was assessed. 8 patients had femur fracture with injury to the femoral artery, 28 patients had tibia & with injury to either popliteal artery, anterior or posterior tibial artery. All patients underwent vascular repair & skeletal fixation in the form of external fixator initially flap when required. Results: From 2008-2011, 36 patients were studied. The mean age 35. A total of 6 patients had an amputation performed post vascular repair at a later date. Patients requiring amputation were significantly older than those without amputation. Fractures with an associated injury to the posterior tibial artery had a significantly higher nonunion rate and a greater number of weeks to union than fractures without this vascular injury. Poor outcomes (gangrene, amputation, or death) were associated with a Mangled Extremity Severity Score greater than or equal to 6. Conclusion: Good early vascular repair, adequate stabilization of the fractures & early rehabilitation gives good results.

Development of a Large Animal Model of Non-Weight-Bearing

Decreased weight-bearing (WB) is commonly recommended to treat lower limb bone and joint disorders. The availability of a large animal model of decreased or non–weight–bearing (NWB) would be invaluable to study its effects on bone and joint healing. We report here the development of a piglet model of NWB following the induction of ischemic osteonecrosis of the femoral head. The purpose of this study was to assess the feasibility, effectiveness, and complications of various methods to induce decreased or NWB on a hind limb of piglets. The methods used to decrease WB on a hind limb evolved from an Ehmer sling to patellar and/or Achilles tenotomies to below and above knee amputations (AKAs). The Ehmer sling (n=2) was not tolerated by the piglets and tenotomies (n=3) were ineffective in decreasing WB after 4 weeks. A below knee amputation-induced NWB in 4 out of 7 animals but the 3 remaining animals were found to weight bear on the residual limb which developed a pressure sore, and were later converted to an AKA. AKA induced NWB in all animals (n=8). At 8 weeks, a significantly decreased femoral head deformity was observed in the AKA amputation group (n=8) compared with the WB control group (n=8) indicating the protective effect of NWB (P<0.001). A bony overgrowth was observed at the end of the residual bone in all amputated animals. In conclusion, AKA method consistently induced NWB in immature pigs.

Stature Estimation from Lower Limb Anthropometry using Linear Regression Analysis: A Study on the Malaysian Population.

Stature is one of the characteristics that could be used to identify human, besides age, sex and racial affiliation. This is useful when the body found is either dismembered, mutilated or even decomposed, and helps in narrowing down the missing person's identity. The main aim of the present study was to construct regression functions for stature estimation by using lower limb bones in the Malaysian population. The sample comprised 87 adult individuals (81 males, 6 females) aged between 20 to 79 years. The parameters such as thigh length, lower leg length, leg length, foot length, foot height and foot breadth were measured. They were measured by a ruler and measuring tape. Statistical analysis involved independent t-test to analyse the difference between lower limbs in male and female. The Pearson's correlation test was used to analyse correlations between lower limb parameters and stature, and the linear regressions were used to form equations. The paired t-test was used to compare between actual stature and estimated stature by using the equations formed. Using independent t-test, there was a significant difference (p< 0.05) in the measurement between males and females with regard to leg length, thigh length, lower leg length, foot length and foot breadth. The thigh length, leg length and foot length were observed to have strong correlations with stature with p= 0.75, p= 0.81 and p= 0.69, respectively. Linear regressions were formulated for stature estimation. Paired t-test showed no significant difference between actual stature and estimated stature. It is concluded that regression functions can be used to estimate stature to identify skeletal remains in the Malaysia population.

Finite element analysis on the effect of lateral wedge insole intervention on the contact characteristics of the subtalar joint

To establish a three-dimensional finite element model of the lower limb bones, and investigate the changes of the contact characteristics of the subtalar joint after using laterally wedge insole intervention. Using the reverse modeling technology, the lower limb bones of normal adult volunteers was scanned by CT. Mimics 10.0 and Geomagic Studio 6.0 software were used to reconstruct the 3D morphology of bones and external soft tissue of the feet. The laterally wedge insole was designed in ProE 5.0. And then all the models were imported into Hyperwork 10.0 and meshed, and given the material properties. The finite element analysis was carried out in ABAQUS 6.9. A three-dimensional finite element model of the lower extremity was established, which was consisted of 95 365 nodes and 246 238 elements. The contact area of the standing state of the lower joint was larger than that of the anterior middle joint surface. The peak stress was concentrated in the anterior lateral part of the posterior articular surface, and the average stress value was(3.85±1.03) MPa. Compared with the model of 0°, the contact area of the subtalar joint was reduced accordingly. There was a significant correlation between anterior middle joint |r|=0.964, P=0.008, and posterior articular |r|=0.978, P=0.002. The equivalent stress of 0° model distributed from(3.07±1.14) MPa to(3.85± 1.03) MPa, which had no statistically difference. Compared with the 0° model, the equivalent stress of the anterior and middle joint surfaces of the 8° model was significantly reduced(P<0.05), but the peak stress of the posterior articular surface was significantly increased(P<0.05). In the 12° model, the peak stress was sharply increased to(10.51±3.53) MPa. Compared with 8° model, there was no statistically difference(P<0.05). Although the peak stress was slightly increased in 16° model, but compared with 12° model, there was no statistically differences(P>0.05). Although a certain valgus can be obtained in subtalar by wearing LWI, the result comes at the cost of the stress concentration on posterior surface. Through this study, we can find that LWI with 8° tilt angle could provide appropriate valgus moment without causing excessive concentration. Therefore, in order to avoid secondary ankle complications, we should not increase the tilt angle blindly.

Titanium elastic percutaneous nails for pediatric long bone shaft fractures: current concept

Introduction: The objective of this study was to determine the effectiveness and the complications associated with elastic stable intramedullary nailing in long bone fractures in children.Methods: This study was conducted in the Department of Orthopaedic surgery in M. M. Medical College from July 2006 to November 2009. Eighty two patients were recruited from Emergency and out patient department having closed fracture of long bones of upper and lower limbs. All patients were operated under general or spinal anaethesia. All patients were followed for twelve months.Results: All children achieved union in a mean time of 10 weeks (range from 6 - 16 weeks) depending on the type of long bone. Full weight bearing was possible in a mean time of 8.8 weeks. Mean duration of hospital stay was 9.8 days. The mean follow-up period was 28 months (17-48 months). Complications were recorded in 5 (6.09%) patients and included: two entry site skin irritations, one protrusion of the wires through the skin and two delayed union. The results were excellent in 97.310% and good in 2.44% patients.Conclusion: We concluded that this technique is advantageous because of early mobilization (early weight bearing), less complication with good results and is economical.Bangladesh Journal of Medical Science Vol.16(1) 2017 p.61-68

Osteoid Osteoma in acromion of scapula: a case report

Background: Osteoid osteoma is a benign tumor, predominantly affects the younger age group with characteristic nocturnal symptoms, relieved by rest and anti-inflammatory drugs. It can affect any bone; the most common site is shaft of long bones of lower limb (90%). It is quite uncommon to find osteoid osteoma in acromion of scapula. Case Presentation: We describe a case of 46 year old male, presented with pain in left shoulder that simulated left shoulder joint arthritis. The diagnosis of osteoid osteoma involving acromion of scapula was made on bone scan. Tc99m MDP SPECT-CT images showed a distinct focus of increased uptake in the acromion of left scapula with characteristic central lucent nidus on CT images. Conclusion: Though Osteoid osteoma in acromion is very rare, shoulder pain in middle age group, when evaluated on nuclear medicine floor, should be evaluated with correlative SPECT-CT images to rule out such rare bony pathologies.

Intraosseous lipoma of ilium: A rare case report with review of literature

Intraosseous lipoma (IL) is a rare benign bone lesion, and it constitutes about 0.1% of all bone tumors. The majority of cases are located in the metaphyseal region of the long bones in the lower limbs. We report a rare case of lipoma of the ilium in a 12-year-old male child presenting with mass over the right gluteal region. Meticulous marginal dissection was done, and a pedunculated mass originating from the lower right sacroiliac region was excised in toto. The case was an atypical example of an IL with a large outgrowth involving sacroiliac region with inconclusive magnetic resonance imaging and needle biopsy findings.

Habitual levels of higher, but not medium or low, impact physical activity are positively related to lower limb bone strength in older women: findings from a population-based study using accelerometers to classify impact magnitude

SummaryThis study assessed the effect of accelerometry-measured higher impacts resulting from habitual weight-bearing activity on lower limb bone strength in older women. Despite higher impacts being experienced rarely in this population-based cohort, positive associations were observed between higher vertical impacts and lower limb bone size and strength.IntroductionWe investigated whether the benefit of habitual weight-bearing physical activity (PA) for lower limb bone strength in older women is explained by exposure to higher impacts, as previously suggested by observations in younger individuals.MethodsFour hundred and eight women from the Cohort for Skeletal Health in Bristol and Avon (COSHIBA), mean 76.8 years, wore tri-axial accelerometers at the waist for a mean of 5.4 days. Y-axis peaks were categorised, using previously identified cutoffs, as low (0.5–1.0 g), medium (1.0–1.5 g), and higher (≥1.5 g) impacts. Mid and distal peripheral quantitative computed tomography scans of the tibia and radius were performed, as were hip and lumbar spine Dual X-ray Absorptiometry (DXA) scans. Regressions between (log transformed) number of low, medium and high impacts, and bone outcomes were adjusted for artefact error grade, age, height, fat and lean mass and impacts in other bands.ResultsEight thousand eight hundred and nine (4047, 16,882) low impacts were observed during the measurement week, 345 (99, 764) medium impacts and 42 (17, 106) higher impacts (median with 25th and 75th quartiles). Higher vertical impacts were positively associated with lower limb bone strength as reflected by cross-sectional moment of inertia (CSMI) of the tibia [0.042 (0.012, 0.072) p = 0.01] and hip [0.067 (0.001, 0.133) p = 0.045] (beta coefficients show standard deviations change per doubling in impacts, with 95 % confidence interval). Higher impacts were positively associated with tibial periosteal circumference (PC) [0.015 (0.003, 0.027) p = 0.02], but unrelated to hip BMD. Equivalent positive associations were not seen for low or medium impacts.ConclusionsDespite their rarity, habitual levels of higher impacts were positively associated with lower limb bone size and strength, whereas equivalent relationships were not seen for low or medium impacts.