Bony Protrusion Research Articles

Correção de Trigonocefalia Não-Sindrômica e Revisão de Literatura

Introdução: A trigonocefalia consiste no fechamento prematuro da sutura metópica sendo considerada o segundo tipo mais frequente de craniossinostose. Esta condição resulta no crescimento restrito do osso frontal e abaulamento local. O diagnóstico é clínico e o tratamento cirúrgico. Apresentação do caso: Paciente masculino de 7 meses e 30 dias de vida com assimetria craniana. Investigação clínica e por imagem evidenciou hipodesenvolvimento do osso frontal, presença de saliência óssea na linha média frontal, sem outras alterações ao exame neurológico. Encaminhado à cirurgia para correção de trigonocefalia não sindrômica. Discussão: A trigonocefalia compõe o grupo das craniossinostoses, malformações de fechamento prematuro das suturas cranianas. A grande maioria corresponde a casos isolados, não-sindrômicos e envolvem apenas uma sutura. O diagnóstico é clínico, sendo corroborado principalmente pela tomografia computadorizada (TC). O tratamento é cirúrgico e tem como objetivo evitar a progressão das deformidades craniofaciais. A técnica cirúrgica deste relato consiste na incisão coronal em zigue-zague, osteotomia sem avanço e sem remodelamento orbitário, fato que não comprometeu o resultado estético. Além de exigir menor tempo cirúrgico e, por conseguinte, menor perda sanguínea. Conclusão: Este relato mostra-se relevante, uma vez que numerosas variações de técnicas cirúrgicas têm sido propostas. Novos estudos fazem-se necessários para aprimorar o manejo destas malformações e para definir a melhor estratégia cirúrgica a ser empregada.

Calcaneal osteochondroma masquerading as plantar fasciitis: An approach to plantar heel pain - A case report and literature review

BACKGROUNDHeel pain is a common orthopaedic complaint, and if left untreated can be a source of chronic morbidity. Accurate diagnosis can be challenging, owing to the complex anatomy and multiple pain generators present in the foot. We aim to share our clinical experience managing an unusual case of chronic heel pain secondary to osteochondroma.CASE SUMMARYA 41-year-old obese male who works as a porter presented with a long-standing history of left plantar heel pain. He was assessed to have point tenderness over the plantar insertion of the calcaneus as well as a positive Silfverskiöld test. He was treated for plantar fasciitis and tight gastrocnemius but failed conservative therapies as well as surgical intervention. Magnetic resonance imaging revealed the presence of a pedunculated bony protrusion over the plantar aspect of the calcaneus. The decision was made for excision of the osteochondroma, and the patient has been pain-free since.CONCLUSIONOsteochondromas are rarely symptomatic in skeletally mature patients. While most are benign with a very low risk of malignant transformation, surgical excision can yield excellent results and significant pain relief in symptomatic patients.

A study to assess proximal femoral nailing versus dynamic hip screw device in surgical management of intertrochanteric fractures: A comparative study

Background: An inter-trochanteric fracture is a type of hip fracture specifically, which are bony protrusions of femur where the muscles of thigh and hip attach. 50% of all hip fractures caused by falling are inter-trochanteric. Aim: The present study assessed the functional outcomes with DHS and proximal femoral nail (PFN) in inter-trochanteric management of fractures. Materials and Methods: This study was a prospective study which was performed for a period of one year. A total of 40 patients were enrolled during the study. DHS and PFN are the two different implants used for management of intertrochanteric fractures. Results: Functional outcome was better and excellent in PFN (65%) compared to that of DHS (50%). The complications were lesser in Paticipants who were treated by PFN compared to that of participants treated with DHS. Conclusions: Proximal femoral nailing method is preferable method in inter-trochanteric fractures management as it has better functional outcome and lesser complications compared to DHS method.

A novel cephalometric approach aiming to quantify a normal range of bony chin protrusion

A novel cephalometric approach aiming to quantify a normal range of bony chin protrusion

Imitating human soft tissue on basis of a dual-material 3D print using a support-filled metamaterial to provide bimanual haptic for a hand surgery training system.

Currently, it is common practice to use three-dimensional (3D) printers not only for rapid prototyping in the industry, but also in the medical area to create medical applications for training inexperienced surgeons. In a clinical training simulator for minimally invasive bone drilling to fix hand fractures with Kirschner-wires (K-wires), a 3D-printed hand phantom must not only be geometrically but also haptically correct. Due to a limited view during an operation, surgeons need to perfectly localize underlying risk structures only by feeling of specific bony protrusions of the human hand. The goal of this experiment is to imitate human soft tissue with its haptic and elasticity for a realistic hand phantom fabrication, using only a dual-material 3D printer and support-material-filled metamaterial between skin and bone. We present our workflow to generate lattice structures between hard bone and soft skin with iterative cube edge (CE) or cube face (CF) unit cells. Cuboid and finger shaped sample prints with and without inner hard bone in different lattice thickness are constructed and 3D printed. The most elastic available rubber-like material is too firm to imitate soft tissue. By reducing the amount of rubber in the inner volume through support material (SUP), objects become significantly softer. Without metamaterial, after disintegration, the SUP can be shifted through the volume and thus the body loses its original shape. Although the CE design increases the elasticity, it cannot restore the fabric form. In contrast to CE, the CF design increases not only the elasticity but also guarantees a local limitation of the SUP. Therefore, the body retains its shape and internal bones remain in its intended place. Various unit cell sizes, lattice thickening and skin thickness regulate the rubber material and SUP ratio. Test prints with higher SUP and lower rubber material percentage appear softer and vice versa. This was confirmed by an expert surgeon evaluation. Subjects adjudged pure rubber-like material as too firm and samples only filled with SUP or lattice structure in CE design as not suitable for imitating tissue. 3D-printed finger samples in CF design were rated as realistic compared to the haptic of human tissue with a good palpable bone structure. We developed a new dual-material 3D print technique to imitate soft tissue of the human hand with its haptic properties. Blowy SUP is trapped within a lattice structure to soften rubber-like 3D print material, which makes it possible to reproduce a realistic replica of human hand soft tissue.

Attrition of rotator cuff without progression to tears during 2-5years of conservative treatment for impingement syndrome.

The purpose of this study was to investigate the natural history of intact rotator cuff in impingement syndrome patients with concomitant spur protruding from the undersurface of acromion. This retrospective study included 119 patients with an intact rotator cuff who underwent conservative treatment for a spur protruding from the undersurface of the acromion. The protruded spur was defined as a trapezoid- or tetragon-shaped bony protrusion with a downward peak extending more than 3mm in length from the baseline drawn along the acromial undersurface on the coronal view of magnetic resonance imaging (MRI) or computed tomography arthrography (CTA). Functional outcomes were evaluated by the visual analogue scale for pain, subjective shoulder value, American Shoulder and Elbow Surgeons score, University of California Los Angeles shoulder score, and active range of motion (ROM). To evaluate cuff integrity, follow-up MRI, CTA, or ultrasound were performed at least 2years after the initial presentation. No new rotator cuff tears were noted in any patient during the follow-up imaging studies. However, 18 patients (15%) underwent arthroscopic acromioplasty during the study period. During the arthroscopic examinations, moderate to severe attrition of the cuff was identified, although no tears were seen. At the final follow-up, pain level and shoulder function, including ROM, showed satisfactory outcomes. Spurs protruding from the acromial undersurface did not lead to rotator cuff tears during 2-5years of conservative treatment. However, attrition of the rotator cuff was found during arthroscopic acromioplasty, suggesting that the protruding spurs caused extrinsic impingement of the cuff. Therapeutic case series Level IV.

Mechanical irritation by protruding bone: A possible cause of breast implant rupture.

Although breast implants have been in clinical use for almost 6 decades and have undergone considerable development during this time, implant rupture is still a dreaded long-term complication. Some obvious external factors, such as trauma, can lead to implant rupture, but many studies have reported a high rate of “spontaneous” implant rupture. Herein, we present two cases with the aim of raising awareness of a new possible cause of “spontaneous” implant rupture: mechanical irritation by bony protrusions.

Radial head resection and hemi-interposition arthroplasty in patients with multiple hereditary exostoses: description of a new surgical technique.

Multiple hereditary exostoses (MHE) are a rare disorder characterized by the growth of bony protrusions. Elbow involvement is found in a considerable number of patients and varies from the presence of a simple osteochondroma to severe forearm deformities and radial head dislocation. Patients encounter a variety of symptoms, for example, pain, functional impairment, and cosmetic concerns. Several types of surgical procedures, therefore, can be offered, ranging from excision of symptomatic osteochondromas to challenging reconstructions. In this paper, we will discuss the essential basics of visualizing, planning, and treatment options of forearm deformities in MHE. In more detail, we will describe our current surgical technique as a salvage procedure for Masada type II forearm deformities in patients with MHE.

Probing for congenital nasolacrimal duct obstruction.

Probing for congenital nasolacrimal duct obstruction.

An Unusual Etiology of Chest Pain in a Patient With a History of Left-Sided Congenital Diaphragmatic Hernia

Abstract Congenital diaphragmatic hernia (CDH) is a discontinuity of the diaphragm in which abdominal viscera herniates into the chest (Hedrick & Adzick, 2016). A 16-year-old female patient with a past medical history of a left-sided CDH presented with severe pain to her left upper quadrant and chest. An initial diagnosis was made of a recurrent CDH and subsequent herniation of the left kidney into the thoracic space. Intraoperatively, her previous diaphragmatic repair was found to be intact, but a sharp bony protrusion, determined to be an exostosis of the posterior lateral aspect of one of her ribs, was noted. Rongeurs of this lesion resulted in resolution of this patient's symptoms.

Surgical treatment of carpal boss by simple resection: Results in 25 cases at a mean of 8 years’ follow-up

Carpal boss is a symptomatic bony protrusion on the dorsal surface of the wrist at the base of the 2nd and/or 3rd metacarpal. The goal of this study was to assess the reliability and safety of simply resecting the exostosis. From 1994 to 2014, 29 cases of carpal boss were treated by simple resection. Twenty-five of these patients were subsequently assessed by telephone questionnaire at a mean of 8 years’ follow-up (range 1.1 to 20 years). There were no cases of recurrence; however, 1 patient reported carpometacarpal instability requiring fusion, 5 years after surgery. Eight of the 24 patients without fusion (33%) reported moderate episodic pain (visual analog scale [VAS] pain: mean, 2.3/10, range 1 to 4). Range of motion improved in 8 cases (33%), was unchanged in 11 (46%) and decreased in 5 (21%). Twenty patients (83%) had no functional impairment; 4 reported impairment during unusual hand movements. Fifteen patients considered themselves cured (60%), 9 considered their status improved (36%) and one – the patient who required fusion – considered his status unchanged. Patients were very satisfied with the procedure in 15 cases (60%) and satisfied in 10 (40%). In all cases, features of dysplasia were present and associated with secondary osteoarthritis limited to the area of impingement. The single failure was most likely due to excessive bone resection. Simple exostosis resection is sufficient to effectively treat carpal boss. Fusion should be reserved for the rare cases of secondary metacarpal instability.

Trattamento della spina calcaneare

Plantar fasciitis, also known as “heel spur” because of the bony protrusion easily seen on X-ray examinations, is a common occurrence, not always easy to diagnose. This syndrome can be associated with pain after extensive walking or prolonged stand-in position and can worsen as the plantar fascia elongates. Heel spur is normally detected using several diagnostic tests such as X-rays, MRI and CT scans. This injury usually responds well to conservative, non-surgical treatment, and can therefore be treated with rest, so as to allow the inflammation to subside. If conservative treatment fails, surgery may be necessary. Surgical techniques include release of the plantar fascia and removal of the spur, if needed.

Chondrogene Knochentumoren

Primary cartilage-forming tumors of the bone are frequent entities in the daily work of skeletal radiologists. This article describes the correlation of pathology and radiology in cartilage-forming skeletal tumors, in particular, enchondroma, osteochondroma, periosteal chondromas, chondroblastoma and various forms of chondrosarcoma. After reading, the radiologist should be able to deduce the different patterns of cartilage tumors on radiographs, CT, and MRI from the pathological aspects. Differentiation of enchondroma and chondrosarcoma is afrequent diagnostic challenge. Some imaging parameters, e. g., deep cortical scalloping (more than two thirds of the cortical thickness), cortical destruction, or asoft-tissue mass, are features of asarcoma. Osteochondromas are bony protrusions with a continuous extension of bone marrow from the parent bone, the host cortical bone runs continuously from the osseous surface of the tumor into the shaft of the osteochondroma and the osteochondroma has acartilage cap. Chondromyxoid fibromas are well-defined lytic and eccentric lesions of the metaphysis of the long bones, with nonspecific MRI findings. Chondroblastomas have astrong predilection for the epiphysis of long tubular bones and develop an intense perifocal bone marrow edema. Dedifferentiated chondrosarcomas are bimorphic lesions with alow-grade chondrogenic component and ahigh-grade noncartilaginous component. Most chondrogenic tumors have apredilection with regard to site and age at manifestation.

New Fixation Method Using Two Crossing Screws and Locking Plate for Cubitus Varus Deformity in Young Adult Elbow: Case Report

Many types of osteotomy have been proposed for the treatment of cubitus varus deformity of the elbow, and various methods for fixation of the osteotomy site have also been described. However, no method has been perfect. We treated two cases of cubitus varus elbow deformity with step-cut osteotomy using a new fixation method with two crossing screws and an anatomically designed locking plate. Active assisted elbow range of motion (ROM) exercise was permitted at postoperative 3 days, after removal of the drainage. Preoperative and postoperative humerus-elbow-wrist angles and ranges of motion of the two patients were compared. At 3 months followup, each patient had recovered the preoperative elbow ROM, and achieved the complete bony union of the osteotomy site and proper correction of the cubitus varus deformity. In addition, the appropriate remodeling of the lateral bony protrusion was observed. Therefore, we introduce a new fixation method for achievement of stable fixation allowing immediate postoperative elbow motion after corrective osteotomy for cubitus varus deformity in young adults.

力学試験と超弾性モデルの適用によるウレタンフォームマットレスの骨突起部圧分散メカニズムの解明

力学試験と超弾性モデルの適用によるウレタンフォームマットレスの骨突起部圧分散メカニズムの解明

Revealing Two New Species of theRhinella margaritiferaSpecies Group (Anura, Bufonidae): An Enigmatic Taxonomic Group of Neotropical Toads

Abstract: The level of species richness of amphibians found in Brazil is the greatest in the world. Despite increasing anthropic pressures on the Brazilian Cerrado and Amazon biomes, several new anuran species are described each year. In this study, two new species of Rhinella found in Brazil are described and assigned to the Rhinella margaritifera species group, based on morphological features. Rhinella sebbeni sp. nov. occurs in forested environments in the Cerrado biome and is characterized by the combination of the following features: snout–vent length (SVL; range = 48.5–59.7 mm in males, and 54.7–66.7 mm in females); presence of bony protrusion at the angle of jaws and rostral keel at the tip of snout; skin on the dorsum with a few granules, but more concentrated on the flanks; parotoid gland is well delineated and small and elliptical in shape showing a lateral line of tubercles. Rhinella gildae sp. nov. is found in southern Amazonia and is characterized by the combination of following features: ...

Many species, one health

Frogs infected with the flatworm Ribeiroia could be extras in a horror movie. Their bodies are a tangled mess, sprouting extra limbs and joints, and covered with strange skin webbings and bony protrusions. No longer able to walk or swim, they have become easy prey for hungry birds and that’s exactly what the parasite is counting on.

Evaluation of dystrophic calcinosis in juvenile dermatomyositis and systemic sclerosis

Background: Dystrophic calcification is associated with juvenile dermatomyositis and progressive systemic sclerosis. The clinical diagnosis is established with detection of subcutaneous and petrous nodules. Conventional x-ray methods may evidence calcium deposits; however, in the case of incipient deposits x-ray may be insufficient. There are studies that use Tc99-MPD labeled bone scintigraphy to identify dystrophic calcification. Objectives: Estimate the frequency of dystrophic calcification in patients with juvenile dermatomyositis and progressive systemic sclerosis and CREST syndrome, and the concordance between the diagnosis of dystrophic calcification obtained by physical exploration and that obtained by scintigraphy. Patients and methods: A comparative, observational, and transverse study conducted in patients of one and the another gender, between 5 and 17 years of age, with diagnosis of juvenile dermatomyositis, progressive systemic sclerosis, and CREST syndrome to detect dystrophic calcification by physical exploration and scintigraphy. Fisher’s exact test was performed to evaluate the association between the two diagnostic methods, and the Kappa test was used for the level of concordance and analysis of distribution by group and extent of dystrophic calcification. The sensitivity and specificity of scintigraphy in detecting dystrophic calcification in soft tissues, bony protrusions, costal arches and vertebrae were also estimated. Results: The overall incidence of calcinosis was 80%. In 16 patients dystrophic calcification was detected by dermatological physical exploration and in 9 patients by scintigraphy. No association or concordance was found between the findings from physical exploration and scintigraphic findings. The latter have 37.5% sensitivity for detection of dystrophic calcification in soft tissues and 43.8% in bony protrusions, and are suitable for detection in costal arches. Conclusions: Dermatological exploration and scintigraphy are complementary tools for detecting dystrophic calcification.

Evaluation of dystrophic calcinosis in juvenile dermatomyositis and systemic sclerosis

Background: Dystrophic calcinosis is associated with juvenile dermatomyositis and systemic sclerosis. Clini- cal diagnosis is performed through the detection of sub- cutaneous, hard nodules. Conventional radiographic studies may demonstrate calcium deposits, however, with very early lesions X-rays may prove insufficient. There are a few studies where scintilliography has been used to identify dystrophic calcinosis. Objectives: To estimate the frequency of dystrophic calcinosis in patients with juvenile dermatomyositis and systemic sclerosis/CREST syndrome. To estimate the concordance between the diagnoses of dystrophic calcinosis obtained by physical examination and scin- tigraphy. Patients and Methods: Observational, transversal and comparative study in which patients of both genders, between 5 and 7 years of age with the diagnoses of juvenile dermatomyositis and systemic sclerosis/CREST syndrome were included in order to detect dystrophic calcinosis by physical examination and scintigraphy. Fisher’s exact test was used to evaluate the association between both diagnostic methods, Kappa test was used to evaluate the level of concordance between both methods and a distribution by group analysis was used to analyze the extent of dystrophic calcinosis with both methods. Sensitivity and specificity for scintigraphic findings in soft tissues, bony protrusions , ribs and vertebrae was also estimated. Results: The frequency of dystrophic calcinosis was 80%. Dystrophic calcinosis was detected through physical examination in 16 patients and through scin- tigraphy in 9 patients. No association or concordance was found between the clinical and the scintigraphic findings. Scintigraphy has a 37.5% sensitivity for the detection of dystrophic calcinosis in soft tissues and 43.8% in bony protrusions, but is ideal for its detec- tion in the ribs. Conclusions: Both, physicial examination and scin- tigraphy are complementary tools for the detection of dystrophic calcinosis.

Ultrasound assessment of the elbow joint in infants and toddlers and its clinical significance

Ultrasound can be used for the diagnosis of elbow injuries in infants and toddlers. However, ultrasound is highly operator-dependent and accurate ultrasound examinations require a complete understanding of the complex anatomy of the elbow joint. To report the normal ultrasound anatomy of the elbow, particularly of the humeroulnar joint, in infants and toddlers. Thirty subjects aged <3 years with no history of elbow injuries underwent ultrasound examinations of the elbow joint from six directions: (i) lateral to the humeroradial joint; (ii) anterior to the humeroradial joint; (iii) posterior to the humeroradial joint; (iv) medial to the humeroulnar joint; (v) anterior to the humeroulnar joint; and (vi) posterior to the humeroulnar joint. The appearance of the humeroradial joint observed from three directions was similar and resembled a pair of double fists ("double-breast sign"). The appearance of the humeroulnar joint observed from three directions was different, which is related to the irregular morphology of the medial sides of the humerus and ulna. Anteroposteriorly, the coronoid and olecranon epiphyses and coronoid fossa appear anteriorly and the olecranon and trochlear epiphyses and olecranon fossa appear posteriorly, resembling a "check-mark sign". The medial epicondyle, cubital tunnel and distal humerus appear together ("double-hump sign"). The "anterior hump" is the medial epicondyle and is always higher than the "posterior hump", which is the bony protrusion on the articular surface of the distal humerus. The ultrasound signal of cortical bone in the metaphysis of the distal humerus is continuous with that of the epiphysis of the medial epicondyle. Ultrasound is useful for the diagnosis of elbow injuries in infants and toddlers.