Degree Of Ossification Research Articles

Osteology of Batrachuperus londongensis (Urodela, Hynobiidae): study of bony anatomy of a facultatively neotenic salamander from Mount Emei, Sichuan Province, China.

The Longdong Stream Salamander Batrachuperus londongensis, living in a mountain stream environment at Mt. Emei in Sichuan Province, China, represents a rare species that is facultatively neotenic in the family Hynobiidae. Although the species has been known to science for some 40 years since its initial discovery in the late 1970s, anatomical details of its osteology remain poorly understood and developmental information is still lacking for the species. This study (1) provides a detailed osteological account of B. londongensis based on micro-CT scanning and clearing and staining of multiple specimens from the type locality; (2) provides a discussion of intraspecific variation related to life-history differences; and (3) presents a discussion on limb features related to morphological evolution of limb patterns correlative with ecological adaptation to mountain stream environments. Osteological comparisons with congeneric species has led to recognition of several diagnostic features that are unique to B. londongensis, including: vomers widely separated from one another, lacking a midline contact; presence of uncommon perichondral ossification of the ascending process of the palatoquadrate as part of the suspensorium; and presence of a prominent posterodorsal process of the scapular blade, which serves as a ligamentous insertion of the levator muscle of the scapula. In addition, some but not all neotenic individuals retain the palatine as a discrete element, indicative of its delayed absorption after sexual maturity. Postmetamorphic and neotenic individuals are strikingly different in the complexity of hyobranchial structures. Neotenes display a high degree of ossification of hyobranchial elements, tend to increase ossification of both hypobranchial I and ceratobranchial I during aging, and retain fully ossified ceratobranchial III and IV; in contrast, these elements remain entirely cartilaginous or are totally lost by resorption in postmetamorphic individuals. In addition, all postmetamorphic forms display an inverted “T”-shaped basibranchial II, whereas neotenes show transformation from a “fork”-shaped to the “T”-shaped configuration after sexual maturity. B. londongensis displays a mosaic of apomorphic and plesiomorphic states in its limb ossifications: presence of a single centrale element in both the manus and pes is a derived condition in Hynobiidae and other families as well, whereas retention of a postminimus in the pes is obviously plesiomorphic within Urodela. Reduction in number of digits from five to four in the pes and possession of a cornified sheath covering the terminal phalanges are also derived features shared with some but not all mountain stream salamanders that are adapted to a similar type of environment.

Comparative skull osteology and preliminary systematic revision of the African lizard genus Heliobolus (Squamata: Lacertidae)

ABSTRACTThe anatomy of African lacertid lizards (Lacertidae: Eremiadini) is poorly known, which has hindered a better understanding of their evolutionary relationships. This applies especially to the East African clade, which includes the genera Nucras, Latastia, Philochortus, Pseuderemias and Heliobolus. We present a detailed description of the skull osteology of the genus Heliobolus using X-ray microcomputed tomography and compare its morphology to the above lacertid taxa. Because the genus Heliobolus includes species of doubtful validity and affinities (Heliobolus neumanni and Heliobolus nitidus), we also present a detailed intrageneric comparison and construct a morphological character matrix that we analyse against a phylogenetic backbone derived from previous molecular studies. Heliobolus lugubris and Heliobolus spekii can be well characterised as a monophyletic group on the basis of a short postorbital and a continuously broad posterior margin of the parietal, differing from H. nitidus and other members of the East African clade in an overall low degree of ossification and reduced ventral extension of the frontal bone. Our preliminary phylogenetic analysis suggests that the genus Heliobolus is currently polyphyletic. We propose that the name H. neumanni be officially retracted, because specimens assigned to this species show very different morphologies relative to each other and are placed in different parts of the tree in our analysis. Also, the type specimen is lost and no specimens were collected from the type locality. H. nitidus shows a signal towards the genus Latastia. A definitive, new generic assignment of H. nitidus must await further investigations based on molecular data.

Morphological assessment of the stylohyoid complex variations with cone beam computed tomography in a Turkish population.

The aim of this investigation was to evaluate the length, thickness, sagittal and transverse angulations and the morphological variations of the stylohyoid complex (SHC), to assess their probable associations with age and gender, and to investigate the prevalence of it in a wide range of a Turkish sub-population by using cone beam computed tomography (CBCT). The CBCT images of the 1000 patients were evaluated retrospectively. The length, thickness, sagittal and transverse angulations, morphological variations and ossification degrees of SHC were evaluated on multiplanar reconstructions (MPR) adnd three-dimensional (3D) volume rendering (3DVR) images. The data were analysed statistically by using nonparametric tests, Pearson's correlation coefficient, Student's t test, c2 test and one-way ANOVA. Statistical significance was considered at p < 0.05. It was determined that 684 (34.2%) of all 2000 SHCs were elongated (> 35 mm). The mean sagittal angle value was measured to be 72.24° and the mean transverse angle value was 70.81°. Scalariform shape, elongated type and nodular calcification pattern have the highest mean age values between the morphological groups, respectively. Calcified outline was the most prevalent calcification pattern in males. There was no correlation between length and the calcification pattern groups while scalariform shape and pseudoarticular type were the longest variations. We observed that as the anterior sagittal angle gets wider, SHC tends to get longer. The most observed morphological variations were linear shape, elongated type and calcified outline pattern. Detailed studies on the classification will contribute to the literature. (Folia Morphol 2018; 77, 1: 79-89).

Evolution of facial innervation in anomodont therapsids (Synapsida): Insights from X-ray computerized microtomography.

Anomodontia was the most successful herbivorous clade of the mammalian stem lineage (non-mammalian synapsids) during the late Permian and Early Triassic. Among anomodonts, Dicynodontia stands apart because of the presence of an osseous beak that shows evidence of the insertion of a cornified sheath, the ramphotheca. In this study, fourteen anomodont specimens were microCT-scanned and their trigeminal canals reconstructed digitally to understand the origin and evolution of trigeminal nerve innervation of the ramphotheca. We show that the pattern of innervation of the anomodont "beak" is more similar to that in chelonians (the nasopalatine branch is enlarged and innervates the premaxillary part of the ramphotheca) than in birds (where the nasopalatine and maxillary branches play minor roles). The nasopalatine branch is noticeably enlarged in the beak-less basal anomodont Patranomodon, suggesting that this could be an anomodont or chainosaur synapomorphy. Our analyses suggest that the presence or absence of tusks and postcanine teeth are often accompanied by corresponding variations of the rami innervating the caniniform process and the alveolar region, respectively. The degree of ossification of the canal for the nasal ramus of the ophthalmic branch also appears to correlate with the presence of a nasal boss. The nasopalatine canal is absent from the premaxilla in the Bidentalia as they uniquely show a large plexus formed by the internal nasal branch of the maxillary canal instead. The elongated shape of this plexus in Lystrosaurus supports the hypothesis that the rostrum evolved as an elongation of the subnarial region of the snout. Finally, the atrophied and variable aspect of the trigeminal canals in Myosaurus supports the hypothesis that this genus had a reduced upper ramphotheca.

Tenosynovial chondromatosis of the wrist presenting with acute carpal tunnel syndrome: A case report

We report a case of synovial chondromatosis of the wrist that manifested as acute carpal tunnel syndrome. The patient successfully underwent carpal tunnel release, tenosynovectomy and resection of dorsal and volar ossified bodies embedded in the tenosynovium overlying the wrist. Final histopathology confirmed the diagnosis of synovial chondromatosis. The patient's symptoms of pain, numbness, and paresthesia in a median nerve distribution resolved completely and the patient resumed full-time work in the service industry 4-weeks postoperatively with no functional limitations. This case highlights the importance of maintaining a broad differential in the approach to wrist pain and the role of magnetic resonance imaging in the diagnosis of synovial chondromatosis given its variable degree of ossification.

Cochlear obliteration following a translabyrinthine approach and its implications in cochlear implantation.

The most frequent sequelae following a translabyrinthine approach for vestibular schwannoma resection is complete hearing loss on the affected side. Such patients could benefit from a cochlear implant, provided that two essential requisites are met before surgery: a preserved cochlear nerve and a patent cochlea to accommodate the electrode array. The goal of our study is to determine the prevalence and extent of cochlear ossification following a translabyrinthine approach. Postoperative MRI of 41 patients were retrospectively reviewed. Patients were classified according to the degree of cochlear obliteration into three groups (patent cochlea, partially obliterated cochlea and totally obliterated cochlea). The interval between surgery and the first MRI was studied as well as its relationship with the rate of cochlear ossification. At first postoperative MRI (mean interval of 20 months), 78% of patients showed some degree of cochlear ossification. Differences were found in the time interval between surgery and first MRI for each group, showing a smaller interval of time the patent cochlea group (p > 0.05). When MRI was performed before the first year after surgery, a larger rate of patent cochlea was found (p > 0.05). The present study suggests that cochlear ossification is a time-depending process, whose grounds are still to be defined.

T2-weighted spoiled gradient echo sequence (MERGE): A different perspective on the forensic age estimation

Introduction Age estimation methods using MRI are dependent on staging systems used in T1, T2 and fast spin-echo proton density-weighted sequences. The staging system created by Dedouit [1] from images obtained by fast spin-echo proton density-weighted MRI sequences depends on the assessment of horizontal cartilage hyperintensity. Images obtained by this method, detecting 1.5 mm hyperintensity thickness, and in some cases, detecting continuity of hyperintensity could be challenging. The purpose of this preliminary study was to investigate the utility of T2-weighted spoiled gradient echo sequence in determining the degree of ossification of epiphyses. Material and methods In this study, fast spin-echo proton density-weighted and MERGE T2-weighted spoiled gradient echo sequences of the knee of 25 patients (10–30 years, 10 female and 15 male) were evaluated using Dedouit et al.’s [1] five-stage method. Results The horizontal cartilages assessed with MERGE exhibited hyperintensity and clearly visible borders ( Fig. 1 ). Stage 2 and 3 were easily distinguishable and the epiphyseal scar line observed in stage 5 (complete fusion) was easily observed in contrast to the fast spin-echo proton density-weighted sequence. The hyperintense line that was assessed in fast spin-echo proton density-weighted sequence in stage 3 cases was seen as continuous and intermittent hypointense line in MERGE sequence. It was suggested that substages may be necessary for the distinction of stage 3 and 4. Discussion At present, due to the ethical concerns, non-ionized methods (ultrasound and MRI) are more frequently used in living individuals’ age estimations. MRI assessments in spoiled T2-weighted spoiled gradient echo sequence for age determination may be advantageous in the examination of epiphyseal lines and may produce different options in staging.

Reconstruction of Mandibular Segmental Detects Using Transport Disk Distraction Osteogenesis.

Distraction osteogenesis (DO) has become an important alternative for bone defect reconstruction. The study aims to investigate the clinical feasibility and efficiency of transport disc DO (TDDO) for reconstruction of segmental defect of mandible and further dental implant treatment. A serial of 6 patients diagnosed with ameloblastoma or keratocystic odontogenic tumor were included in this study. Computed tomography (CT) scanning and panoramic radiograph were performed for preoperative evaluation and surgery planning. Transport disc DO was applied simultaneously with tumor resection for reconstruction of mandibular defects. The postoperative panoramic radiographs and CT scans were taken for evaluation of the ossification level. Then a second surgery was performed for removal of the distraction apparatus. Bone graft and rigid internal fixation were also used to fill the gap between the transport disc and the stump of the residual ramus. Further dental implant treatment was also finished or in progress. All patients finished the whole treatment period, and no distraction device failure or tumor recurrence occurred. The distraction length ranged from 35 to 48 mm and the whole treatment period of TDDO ranged from 21 to 33 weeks. High degree of ossification was confirmed at the end of treatment by postoperative radiographs and intraoperative observation. Infection occurred in 1 of the 6 patients, and the symptom was controlled by surgical dressing change and flushing. Results of final facial profile in all patients were good. Three patients finished dental implant treatment with good occlusion. Results in this study suggest the clinical feasibility and efficiency of TDDO for reconstruction of segmental defect of mandible and further dental implant treatment.

Magnetic resonance imaging-based evaluation of ossification of the medial clavicular epiphysis in forensic age assessment.

Evaluation of the degree of ossification of the medial clavicular epiphysis plays a crucial role in determining with an adequate degree of probability whether legally relevant age boundaries after the age of 17 have been crossed. In view of the need to avoid unnecessary radiation exposure, establishing non-X-ray methods for investigating the clavicle has long been a key objective in forensic age assessment research. Based on magnetic resonance imaging examinations in a large sample of healthy subjects, the current study for the first time presents statistical measures which allow inferences to be drawn for forensic age assessment in both sexes. We undertook a prospective study of a reference sample of 334 female and 335 male German volunteers aged from 12 to 24 using a 3-T MRI scanner. A 3D FFE (fast field echo) T1-weighted sequence with fat saturation was acquired. To stage ossification of the medial clavicular epiphysis, we used the clavicular ossification staging systems described by Schmeling et al. and Kellinghaus et al. Ossification stage IIIc offers a means in both sexes of demonstrating that the age of 18 has been attained prior to complete ossification of the epiphyseal plate. In both sexes, if a subject has reached ossification stage IV, it can be stated that he or she has attained the age of 21. Magnetic resonance imaging is a valid diagnostic procedure for determining the ossification stage of the medial clavicular epiphysis.

Effect and mechanism of total flavone of epimedium on primary callus formation in ovariectomized rats with fractures

To explore the effects and related mechanisms of total flavone of epimedium treatment(TFE)on primary callus for mation in ovariectomized rats. Forty male SD rats weighted from 209 to 246 g and aged 6 to 8 weeks were selected. Six weeks after ovariectomy a femur fracture model with middiaphyseal segment fracture was established, estimated and randomly divided into TFE group (150 mg·kg⁻¹·d⁻¹) and control group(received saline). HE staining was used to evaluate the morphologic difference of primary callus during the bone callus healing between these two groups. The relative expression of Runt-related transcription factor 2(Runx2) mRNA in the callus was identified by real-time polymerase chain reaction. Immunohistochemical technique was used to observe the Casein kinase 2-interacting protein 1(CKIP-1) protein level in the callus of the two groups. Maximum fracture load was tested by three point bend test. The BMD, primary callus volume, trabecular member(Tb.N) and trabecular thickness(Tb.Th) were higher in TFE group than that in control group(P<0.001). The Tb.N and Tb.Th of primary callus were higher in TFE group than control group (P=0.001). The volume and bone volume/tissue volume of primary callus were in TFE group than control group(P<0.01). The trabecular separation(Tb.Sp) of primary callus were in control group higher than TFE group(P<0.01). The HE staining of the 6 week slices showed that the degree of cartilage ossification in callus of the TFE group was significantly higher than that in control group under high magnification. Real-time PCR revealed that the comparative expression of Runx2 mRNA in control group was higher than that in TFE group(P<0.001); the positive number of CKIP-1 was less in TFE group than that in control group (P<0.001). TFE could increase the maximum load of the primary callus (P<0.001). TFE can promote the cartiage ossification of callus in ovariectomized rats, enhancing the bone strength and bone quality in the process of fracture healing via the CKIP-1/Runx2 pathway.

Rare hatchling specimens of Araripemys Price, 1973 (Testudines, Pelomedusoides, Araripemydidae) from the Crato Formation, Araripe Basin

Hatchling turtles are rare in the fossil record. Here we report two incomplete juvenile specimens of the genus Araripemys from the Aptian (ca. 115 Ma) Crato Formation (Araripe Basin, Brazil). Although the description of this material does not completely elucidate the ontogeny of this taxon, the analysis of these specimens yield relevant information about diagnostic features of the genus, showing their presence in hatchling such as: skull with nearly oval shape in dorsal view; closely spaced orbits; cervical vertebrae with long vertebral body indicating the presence of a long neck; the extension and the angle of curvature of the axillary (obtuse angle); and unguals arrow-shaped. The small size of the specimens (40–50 mm) and their poor degree of ossification including unfused costal bones indicate that both represent hatchling individuals. The paleoenvironment of the Crato Formation was similar to mangroves, which is corroborated by the presence of juvenile turtles and fishes, anurans and insects. Araripemys barretoi was also recorded in the Romualdo Formation, which represents a lagoon. The fact that this turtle is found in these quite distinct paleoenvironments suggests that this species could be tolerant to distinct salinities levels.

Gestation length and racing performance in 115 Thoroughbred foals with incomplete tarsal ossification.

Incomplete ossification of the cuboidal bones of the carpus and tarsus in foals has the potential for significant consequences including chronic lameness and decreased athletic ability. To determine if the degree of ossification of the cuboidal bones is associated with gestational length and if the diagnosis of incomplete ossification is a predictor of performance in Thoroughbred racehorses. Retrospective cohort study. The medical records of Thoroughbred foals less than 90 days of age from 1994 to 2011 were examined and records containing tarsal radiographs identified. Radiographs of the tarsus were examined for signs of incomplete ossification and those that were incompletely ossified graded on a scale of 1-4 using a modification of a previously reported index, with Grade 1 being the least ossified and Grade 4 being the most. Gestational length was determined by examining breeding records and foaling dates reported to the Jockey Club. Race records for 2- and 3-year-old affected foals and their maternal siblings were obtained and compared. Foals with Grades 1 and 2 ossification were usually premature (gestation length <325 days), but Grades 3 and 4 were not. Foals with Grades 2 and 3 ossification were significantly less likely to race than their maternal siblings and Grades 1, 2, 3 and 4 foals earned less money. A larger sample size of foals with Grade 1 ossification would increase the power of the study. Foals radiographed at an older age may have had lower ossification scores if radiographed earlier. Incomplete ossification, especially Grades 1 and 2, is associated with a short gestation length. Foals with Grades 2 and 3 incomplete ossification were less likely to race and Grades 1, 2 and 3 earned around $30,000 less than their maternal siblings.

ANALYSIS OF RESULTS OF THE INTERVERTEBRAL TOTAL DISK ARTHROPLASTY OF THE LUMBAR SPINE BY M6-L PROSTHESIS: A MULTICENTER STUDY

Background: Pain in the lower back is an urgent health issue in industrialized countries. The dominant cause of pain in the lumbosacral spine is the degeneration of the inter vertebral discs (I VD). The total prosthetics I VD is a modern method of surgical treatment of I VD degenerative diseases, an alternative method of rigid stabilization.Aim: To analyze the results of surgical inter vention (I VD prosthesis M6-L implantation) in patients with I VD degeneration of lumbar spine at the 6, 12, 24, and 36 months after the surger y.Materials and methods: The study included 156 patients (92 men, 64 women) aged 23 to 45 years who under went a single-level discectomy with implantation of an artificial IVD prosthesis M6-L at the bases of three neurosurgical centers. For dynamic assessment, clinical parameters (pain intensity from the visual analogue pain scale (VAS), quality of life according to the Oswestry index, subjective satisfaction with the result of surgical treatment on the Macnab scale) and instrumental data (amplitude of movements in the operated spinal-motor segment, degree of heterotopic ossification according to McAfeeSuchomel classification) were applied at 6, 12, 24, and 36 months after surger y.Results: The mean value of the quality of life for the Oswestr y index before surger y was 40.2±6.9%, after ― 12.3±6.1% (t-test, p0.001). The mean value of the level of pain according to VAS before surger y was 6.9±1.6 cm; after surger y ― 1.3±1.2 cm (t-test, p0.001). The average range of motion in the operated segment at baseline was 36.8±2.6°, within 36 months after the operation increased up to 41.2±2.9°. During the entire period of obser vation the initial (13.4%) or moderate (10.2%) signs of heterotopic ossification were revealed. Conclusions: The use of prosthetic I VD M6-L can significantly reduce the level of pain, improve the life quality, and maintain the physiological range of motion in the operated spinal motion segment with a low level of adverse outcomes.

Impact of electromagnetic radiation exposure during pregnancy on embryonic skeletal development in rats

Objective: To evaluate the teratogenic effect of mobile phone radiation exposure during pregnancy on embryonic skeletal development at the common used mobile phone frequency in our environment. Methods: Sixty female Sprague-Dawley rats were distributed into three experiment groups; control and two exposed groups (1 h/day, 2 h/day exposure groups) (n=20/ each group) and exposed to whole body radiation during gestation period from day 1- day 20. Electromagnetic radiofrequency signal generator was used to generate 1 800 MHz GSM-like signals at specific absorption rate value 0.974 W/kg. Animals were exposed during experiment in an especial designed Plexiglas box (60 cm × 40 cm × 30 cm). At the end of exposure duration at day 20 of pregnancy animals were sacrificed and foetuses were removed, washed with normal saline and processed to Alizarin red and Alcian blue stain. Skeleton specimens were examined under a stereo microscope and skeleton’s snaps were being carefully captured by built in camera fixed on the stereo microscope. Results: Intrauterine exposure to electromagnetic radiation lead to variation in degree of ossification, mineralization, formation of certain parts of the skeleton majorly in head and lesser in other parts. Deformity and absence of formation of certain bones in the head, ribs, and coccygeal vertebrae were recorded in skeleton of foetuses from exposed dams compare to control group. Conclusions: The electromagnetic radiation exposure during pregnancy alter the processes of bone mineralization and the intensity of bone turnover processes, and thus impact embryonic skeleton formation and development directly.

Assessment of midpalatal suture ossification using cone-beam computed tomography.

Background and ObjectiveThe degree of ossification of the midpalatal suture is an important factor in the selection of treatment procedure, especially in young individuals. Considering the discrepancies in the results of studies on the exact time of the closure of this suture, the present study was undertaken to evaluate ossification and morphology of the suture with the use of CBCT.MethodsIn the present cross-sectional study, the CBCT images of the maxilla in 144 Iranian subjects (72 males, 72 females) with an age range of 10 to 70 years, referring to a private radiology center in Sari, Iran, were evaluated. The CBCT images were evaluated in the axial cross-sectional slice at 1 mm intervals to determine morphology and the maturation stage of the suture and its degree of ossification. The six developmental stages that were observed were as follows: stage A, a direct line without disturbances; stage B, a scalloped appearance in the suture; stage C, two parallel lines with a scalloped appearance that were connected at some points; stage CD, the anterior portion was similar to stage C, and the posterior region was similar to stage D; stage D, ossification only in the palatine bone; stage E, complete ossification of the suture. The degree of ossification of the suture was calculated with the use of the ratio of the length of the ossified segment to the entire length of the suture. Data were analyzed with Spearman’s correlation test, Chi-squared test, t-test, ANOVA, Mann-Whitney U, and Kruskal-Wallis test. Intra-observer agreement was calculated with the use of weighted kappa coefficient. Data were analyzed with SPSS 17.ResultsThere was a strong correlation between the age groups and the developmental stages of the midpalatal suture in both genders (r=0.681, p<0.001). The ossification process occurred in the posterior to anterior direction in 98% of the cases. There was a significant relationship between aging and the degree of ossification (p<0.001); however, the difference was not significant between the two genders (p=0.193).ConclusionAlthough the rate of suture closure increased with aging, age was not a reliable factor alone to determine the developmental stage of the suture. Use of CBCT is necessary in all the patients to determine the degree of ossification and morphology of the midpalatal suture.

Calcified Spinal Meningiomas.

To analyze outcomes of patients surgically treated for calcified spinal meningiomas and to determine factors associated with surgical morbidity. Between January 2000 and June 2013, a total of 54 patients underwent surgical resection of a spinal meningioma: 37 of these cases showed various degrees of calcification, confirmed by histopathologic analysis. The clinical evaluation was performed according to the American Spinal Injury Association Impairment Scale. At the last follow-up, neurologic status improved in 19 cases and remained unchanged in 20 cases; just 1 case worsened. According to the American Spinal Injury Association Impairment Scale, neurologic status was classified into 3 levels: poor (A+ B), fair (C), and good (D+ E). Neurologic status improvement (NSI) during postoperative time (considered as a transition from one lower level to the higher) was analyzed in relationship to the patient's age, length of clinical history, spine level, meningioma's position inside the spinal canal, and its degree of calcification. A statistically significant relationship between NSI and the degree of ossification of the meningioma was observed. in particular, a direct relationship with microcalcified meningiomas and an inverse relationship with ossified meningiomas. No relationship was observed between NSI and patient's age, length of clinical history, and the site of the lesion into the vertebral canal. The univariate analysis confirms that the degree of calcification affects the outcome, because extensive tumor calcification is associated with an increased surgical morbidity probably.

Denosumab-treated giant cell tumor of bone. Its histologic spectrum and potential diagnostic pitfalls

Giant cell tumor (GCT) of bone is a locally aggressive, rarely metastasizing primary bone neoplasm that occurs most frequently in the epiphysis of long bones of young adults. It is composed of round, oval, or elongated mononuclear cells admixed with osteoclast-like giant cells that express receptor activator of nuclear factor κB (RANK). The mononuclear stromal cells express RANK ligand, a mediator of osteoclast activation. Denosumab, a monoclonal antibody that reduces tumor associated bone lysis by inhibiting the action of RANK ligand, has been used to treat selected cases of GCT. We reviewed the clinical records and histologic slides of 9 patients with GCT who had received denosumab therapy and were subsequently surgically treated. There were 5 men and 4 women aged 20 to 66 years (mean, 36 years). Duration of treatment varied from 2.5 to 13months (mean, 5.9 months). In all cases, different degrees of ossification, fibrosis, depletion of giant cells, and proliferation of mononuclear cells were seen. With this combination of changes, denosumab-treated GCT may mimic other lesions such as fibrous dysplasia, juvenile ossifying fibroma, nonossifying fibroma, and osteoblastoma. Less frequent but more relevant is the presence of cellular atypia or patterns of ossification that resemble an undifferentiated pleomorphic sarcoma, a conventional osteosarcoma, or a low-grade central osteosarcoma. The presence of clinical and radiologic response to denosumab, along with the lack of high mitotic activity, atypical mitotic figures, extensive necrosis, or a permeative pattern of growth, represents clues to achieve a correct diagnosis.

Long-term follow-up for ossification of autologous bone plug and skin sinking after periosteum-preserved burr hole surgery.

Background:The demand of a burr hole surgery for chronic subdural hematoma (CSDH) is increasing in the global aging society. Burr hole-derived autologous bone dusts are not associated with extra costs compared with other commonly used synthetic materials. In addition, postoperative calvarium ossification requires periosteum-mediated blood supply, which is lacking after using avascular synthetic materials. Based on these findings, we hypothesized that the combination of the bone plugs and the preserved periosteum during burr hole surgeries for CSDH would induce efficient calvarium ossification.Methods:We evaluated the long-term effects of bone plugs on the degree of ossification and cosmetic appearance of the skin covering the burr hole sites. We included 8 patients (9 burr holes) who received the autologous bone dust derived from burr holes. As the control group, 9 burr holes that did not receive any burr hole plugs were retrospectively selected. These burr holes were evaluated by computed tomography (CT) scan for the calvarium defect ratios, CT value-based ossification, and the degree of skin sinking.Results:Ossification was observed in all the bone plugs by the bone density CT scans; they maintained their volume at 12 months after the surgeries. The calvarium defect ratios (volume ratios of the unossified parts in the burr holes) gradually increased during the first 6 months and reached 0.44 at 12 months. The mean CT values also increased from 527 HU to 750 HU for the first 6 months and reached 905 HU at 12 months. The degrees of skin sinking at the burr hole sites with the bone plugs were 1.24 mm whereas those without the bone plugs were 2.69 mm (P = 0.004).Conclusion:Application of burr hole-derived autologous bone dust is associated with better ossification and objective cosmetic result following burr hole surgery after CSDH.

First experiences with the Fitmore® hip stem: Early results of the 16-month monitoring.

Fitmore® hip stem belongs to the group of short stem prostheses with the metaphysar stabilization, with its shape and form that protects the bone mass in the greater trochanter region and the distal part of the femur. The aim of this paper was to present the early postoperative results in patients with implanted Fitmore® hip stem and point out some of the advantages. A series of 10 patients with implanted Fitmore® hip stem, was included in this study. The average age of the patients was 54.5 (48–65) years. There were 5 women and 5 men. The total monitoring time was 16 months. To rate the condition of the hip joint we used The Western Ontario and Mc Master Universities Arthritis Index (WOMAC) score. We also monitored the degree of hip pain, hip flexion, heterotopic ossification and indentation in the stem of the prosthesis. After 12 months of monitoring 9 (90%) of the patients had no pain in the thigh region, and only 1 (10%) experienced mild pain. The hip flexion rose from the average 89° to postoperative 114°. WOMAC score rose as well, from 49 to 94 average points. Indentation in the stem was registered 3 months after the operation in 2 (20%) of the patients – in one of the patients the indentation was 3 mm and in the other patient 5 mm. After the 16-month monitoring, the results were excellent. The monitoring period was short though it should be continued and the results should be presented after 5 and then after 10 years. Early results of the implantation Fitmore stem showed good bone ingrowth with excellent functional result.

The influence of heterotopic ossification on clinical and radiological outcomes after total lumbar disc replacement with M6-L prosthesis: a multicenter study

Objective . To assess the degree of influence of heterotopic ossification on the motion amplitude of the operated segment and on clinical outcomes in patients after total intervertebral disc replacement. Material and Methods . Results of total replacement of the intervertebral disc with the M6-L prosthesis were analyzed in 74 patients aged 23–45 years. Follow-up period was 36 months. The motion amplitude of operated segments and the degree of heterotopic ossification were estimated. Clinical outcomes were analyzed based on pain syndrome severity according to the VAS and on the level of the back pain-related quality of life according to the Oswestry index. Results . Signs of heterotopic ossification were found in 27 (36.4%) patients: Grade I – in 11 (14.8 %), Grade II – in 14 (18.9 %), and Grade III – in 2 (2.7 %). The mean values of the motion amplitude of operated segments, VAS score and Oswestry index in the group of patients without signs of heterotopic ossification were 11.2° ± 2.7°, 2.8 ± 1.2 cm and 17.3 ± 6.5 %, respectively, and those in the group of patients with signs of heterotopic ossification – 11.5° ± 1.2°, 3.4 ± 1.8 cm and 19.8 ± 7.3 %, respectively. Conclusion . Heterotopic ossification following total lumbar disc replacement occurs in 36.4 % of cases. High grade of heterotopic ossification reliably affects the amplitude of segment motion, though there was no significant influence on clinical results in patients.