Diaphysis Of Long Bones Research Articles

Thickness of the substantia compacta of porcine long bones

Mechanical load on the bone influences bone tissue and its inner tension, subsequently affecting bone formation and its histological structure. A precise understanding of this load and the development of strategies to influence it would contribute to principles of fracture management and to solving other bone pathologies of both humans and animals. The long bones of the thoracic and pelvic limb of a pig were here used as possible models to test new devices and implant materials. The purpose of this study was to investigate the thickness of compact bone of the diaphysis of porcine long bones and to establish ideal insertion points for tensometer probes, where 2.3 mm is the minimal required thickness, and to evaluate the histological structure of the compact porcine bone. A total number of 96 long bones from 12 pigs was investigated. The investigations consisted of morphometric assessment of the diaphysis of the bones by measuring thickness of the compact bone in different segments of the diaphysis and of microscopical evaluation of the compact bone. Macroscopical assessment of the bones revealed that the minimal required thickness of 2.3 mm of compact bone was found only in the middle and distal segment of the humerus, middle segment of the femur, proximally only on cranial aspect. The radius showed suitable thickness on the medial aspect of its proximal segment and on the lateral and caudal aspect of the middle segment. Tibial compact bone is suitable across the whole middle segment and on its lateral and medial aspect of the distal segment. Microscopical structure of the compact bone revealed characteristics of growing/immature bone characterised by both lamellar and osteonic bone. This study confirms the suitability of porcine radius and tibia for tensometer testing. However, one needs to take into account the different thickness of different parts of the bone planning experiments using tensometers.

English

In the management of displaced forearm shafts fractures it is very important to regain the length of the bones, maintaining the radial bow, good apposition and alignment without any malrotation, early mobilization of wrist and elbow to get good results. Closed intra medullary nailing of these fractures can be considered as a good alternative method to the plating. We had devised the forearm fracture table which was very useful in getting a sustained traction reducing the clumsiness, difficulty, incoordination usually experienced in doing closed forearm nailing without the fracture table. In 8 out of 32 cases we could not get closed nailing, mini open nailing was done. In 23 cases where closed nailing was done all the fractures united with mean time for union 15 weeks. The average duration of post operative immobilization in the present study is 4.9 weeks, which ranged from 3 weeks to 8 weeks. The satisfactory and excellent functional results in 21 of 23 cases (91.2%) can be attributed to good and excellent anatomical reduction of the fracture, and early mobilization. INTRODUCTION: The fractures of the shafts of the forearm bones are the one of the most difficult fractures of the shafts of long bones 1 . The shortening, angulation, malunion, malrotation of either of these bones may result in a serious loss of elbow and wrist movements and pronation, supination of the forearm affecting the earning capacity of the individual as well as his day to day activities 2. Even though the deformity may look minimal, the disability is very crippling. The rotations of the forearm, movements of the wrist and elbow help to keep the hand in space so that the whole upper limb can function properly. To avoid the crippling disabilities associated with these fractures, it is very important to regain the length of the bones, good apposition and alignment without any malrotation, maintaining the radial bow, early mobilization of wrist and elbow 3. Any compromise in these will definitely not give good results. Open reduction and internal fixation with dynamic plate and screws is considered the best method to treat the displaced fractures of shafts of forearm in adults 4 . But this technique is very invasive with big operative wounds and big non-cosmetic scars. The risk of refracture after the removal of plates & screws is between 4-25% 5, 6,7,8,9 . Closed intra medullary nailing of these fractures can be considered as a good alternative method. The procedure is minimally invasive and preserves the whole biology of fracture healing 10. Intra medullary nails are load sharing devices and there is secondary bone healing with good callus 11, hence may not need cast immobilization after nail removal. The nail removal is also involves small incisions. So the present study was undertaken to evaluate the results of closed intramedullary nailing for diaphyseal fractures of the forearm bones in adults. In this study the anatomical reduction of the fractures, rate of union, time taken for union, the complications, the functional results in terms of forearm rotations and wrist and elbow movements are studied and the advantages and disadvantages of the procedure are also evaluated. We used a unique indigenously made radiolucent

Discordance between MRI and bone scan findings in a child with acute complicated osteomyelitis: Scintigraphic features that contribute to the early diagnosis

Early diagnosis and prompt treatment of acute osteomyelitis are of paramount importance in children because they can prevent irreversible bone damage. Magnetic resonance imaging (MRI) with its superior spatial resolution and lack of ionizing radiation is routinely preferred over bone scan for this purpose. Increased blood flow, hyperemia and focally increased tracer uptake shown by "three phase" bone scan are the typical scintigraphic findings of acute osteomyelitis. In addition, diffuse uptake along the shaft of long bones and focal "cold" lesions are two special features that may be highly suggestive of infective periostitis, soft tissue sepsis and subperiosteal abscess formation, due to the loose attachment of periosteum to bone during childhood. We present a case of complicated osteomyelitis in a child with inconclusive MRI correctly diagnosed on the basis of these special scintigraphic findings resulting in treatment change from double i.v. Vancomycin--Ceftriaxone scheme to surgical intervention.

Histories in Abusive Childhood Fractures: A Case Series

A retrospective review was carried out of the histories given by the carers of children aged from newborn to three years with abusive fractures of the shafts of long bones, regardless of the truth or falsehood of their statements. Textual analysis of the medical and legal records was used to extract and define recurrent themes in a recursive fashion. Statements and reports were studied relating to 18 children under three‐years old with proven child abuse, including 13 boys. Seventeen of the 18 families presented to the health services because of signs of major injuries. Five families spontaneously described a ‘trigger account’, a minor household incident said to have caused the major injury. After repeated questioning, a total of 41 accounts were produced. Thirty two of these were minor household incidents and nine were confessions or accusations of rough handling of the child. The accounts were often vague or uncertain and multiple accounts were often given to explain the same injury. Three accounts were challenged by another carer. The misleading accounts given by parents and carers formed a distinctive ‘narrative’ and can be considered a likely indicator of serious child abuse. Copyright © 2013 John Wiley & Sons, Ltd.‘The accounts were often vague or uncertain and multiple accounts were often given to explain the same injury’.Key Practitioner Messages Carers of children with abusive long bone shaft fractures often give typical histories. At presentation to the health services, they may give no history or they may describe a narrow range of trivial accidents. On further questioning, they may give further accounts including accusations of rough handling. Most accounts show internal reasons for suspicion of their truth. These accounts may be used to identify abusive fractures.‘Most accounts show internal reasons for suspicion of their truth’

Severe osteopathia striata with cranial sclerosis in a female case with whole WTX gene deletion

Osteopathia striata with cranial sclerosis (OSCS) is caused by truncating mutations or deletions in the X linked gene, WTX, and is characterized by sclerotic striations of the metaphyses and diaphyses of long bones, pelvis, and scapula, along with craniofacial hyperostosis. Females typically manifest with craniofacial dysmorphisms including macrocephaly, hypertelorism, depressed nasal bridge, and hypoplastic maxilla, often have cleft palate, and less often extra skeletal anomalies. Here we report on a sporadic female patient with OSCS born at 33 weeks, with coarse facies, an abnormal head shape, cleft palate, pyloric stenosis, a small VSD, and laryngotracheomalacia sufficiently severe to require tracheostomy placement. Characteristic radiologic findings were apparent on skeletal survey and cranial CT. At age 5, she showed mild delays in neurodevelopmental milestones. A deletion of WTX and the adjacent gene ASB12 was detected via MLPA and there was no skewing of the X-chromosome inactivation pattern (58:42). Neurodevelopmental delays can manifest in females with OSCS and deletions at the WTX locus, but deletion of the ASB12 gene in this case suggests it is unlikely to contribute to the pathogenesis of this complication. Implication of ASB12 in the patient's other unique features such as laryngotracheomalacia and pyloric stenosis is also unlikely. This case illustrates an early presentation of severe OSCS in a female without skewing of the X-chromosome inactivation pattern, emphasizing the variable expressivity of this disorder.

Osteoid Osteoma of the Distal Humerus Mimicking Sequela of Pediatric Supracondylar Fracture: Arthroscopic Resection—Case Report and A Literature Review

Osteoid osteoma (OO) is a small and painful benign osteoblastic tumour located preferentially in the shaft of long bones near the metaphyseal junctions, with a predilection for the lower limbs. Juxta- and intra-articular OOs are rare and even though hip, elbow, and talus are the most commonly reported locations, they may be found in any joint accounting for approximately 13% of all osteoid osteomas. There is usually a significant time delay between symptom initiation and diagnosis when the lesion is present in an uncommon location due to the diagnostic challenge it presents due to the lack of classical clinical signs and/or radiographic features found in the extra-articular lesions. A case of a distal humerus OO of a 15-year-old girl is presented to point out that a confounding factor, such as a previous paediatric supracondylar fracture, may further delay the already difficult diagnosis of a juxta- or intra-articular osteoid osteoma and also to emphasize the possibility of arthroscopic treatment of such lesions.

Nonossifying fibroma presenting as an aneurysmal bone cyst: a case report

IntroductionNonossifying fibroma is a common fibrous bone lesion in children that occurs in the metaphysis of the long bones of the lower extremities. The lesion rarely leads to aneurysmal bone cyst, which is characterized as a blood-filled space.Case presentationWe present the case of a 13-year-old Japanese boy with a complaint of discomfort in the thigh and a small, well-defined, osteolytic lesion with cortical thinning located in the medullary space of the distal diaphysis of the femur. At 10-month follow-up, the size of the lesion had increased. Gadolinium-enhanced magnetic resonance imaging failed to detect any solid area. Curettage and bone graft were performed and confirmed a blood-filled cystic lesion. The pathological diagnosis of the cyst wall was that of nonossifying fibroma, suggesting aneurysmal bone cyst as a secondary change. An aneurysmal bone cyst is rarely found secondary to nonossifying fibroma, and the diaphyseal location is atypical for nonossifying fibroma, both of which made diagnosis challenging.ConclusionThe current case is a reminder to clinicians that, although rare, nonossifying fibroma can be associated with aneurysmal bone cyst, and both can occur in the diaphysis of long bones.

Giant cell tumor involving radial diaphysis

Giant cell tumor (GCT) of the bone is a benign but locally aggressive & destructive lesion. This tumor is usually seen in patients over 20 years of age. Less than 2% are found in part with open epiphysis. The epiphyseal portion of the bone is characteristic site of giant cell tumor. In rare instances, giant cell tumor can occur in the diaphysis of long tubular bone without involving the epiphysis. Although age, clinical and radiological features are helpful, it is still the histology that helps to clinch the diagnosis. It is important to distinguish giant cell tumor of diaphysis from the giant cell rich lesions, more common in this site.

A test of a new method and software for the rapid estimation of cross-sectional geometric properties of long bone diaphyses from 3D laser surface scans

This paper introduces a new methodological approach to the quantification of cross-sectional geometric properties based on 3D laser scan data. A variety of methods have been used to calculate estimates of rigidity in the diaphyses of long bones. CT scan, biplanar radiograph, and periosteal mould techniques have all been applied to collect image data of bone sections to assess biomechanical properties (cross-sectional area and second moments of area). Whilst direct quantification of both endosteal and periosteal contours allows the greatest accuracy, such data correlate highly with a periosteal-only approach that is of greater practical application in many contexts. The advent of non-invasive 3D laser scan technologies presents a method to capture bone surface morphology that can be applied to the study of variation in the cross-sectional properties of human bones. This study tests the correspondence between cross-sectional geometric properties derived from laser scans to those obtained through traditional approaches (periosteal moulding and biplanar radiography). A custom-built program, AsciiSection, is introduced for the automated analysis of biomechanical properties direct from 3D coordinate data. The results indicate that the AsciiSection method is of comparable if not greater accuracy than traditional moulding techniques. The study suggests that there is a strong correlation between mid-diaphyseal cortical bone distribution and cross-sectional geometry calculated using laser scans. The approach provides a viable alternative to traditional techniques for the estimation of biomechanical properties and also allows the collection of rich data and descriptions of morphological variation along the diaphysis.

INTRAMEDULLARY INTERLOCKING NAILING WITHOUT IMAGE INTENSIFIER AND ORTHO TABLE

Interlocking nails are the gold standard treatment of fractures of shaft of long bones of lower limbs. It is also frequently performedfor most of the humerus fractures. The procedure is commonly performed using an image intensifier and orthotable. These are expensive andare not readily available in peripheral/field hospitals especially in resource – poor countries. Design: Retrospective study. Setting: FieldHospital Muzaffarabad and Combined Hospital Kharian. Period: Sep 2007 to July 2011. Patients & Methods: 138 consecutive cases offractures of femur, tibia and humerus shafts fixed with I/M I/L Nails in a field hospital. Reduction was achieved by open method in 87 (96.66%)cases of femur, 24 (60%) case of tibia and 5(62.5%) of humerus. Results: There were 34 females and 100 males’ ratio 1:2.94. All the cases wereadults with mean age 38.2 years and range was 16-78 years. Bones fixed were femur (90) 65.21%, tibia (40) 28.21%, and humerus (8) 5.70%.Fracture line was transverse in 104 (75.3%) and communited 10 (7.2%). Fractures were closed 112 (81.2%) and 26 (18.8%) of case. Recentfractures were 122 (88.4%) and old non united 16 (11.6%). Mean follow up period was 06 months - range 3 months to 1 ½ years. Complicationswere failure to achieve distal interlocking 6 cases, infection 3 cases. Union time averaged 3.5 months. Conclusions: It is therefore concludedthat I/M I/L nailing can be done without image and traction table.

Osteopatia hipertrófica em sete cães

Os achados clínico-patológicos de sete casos de osteopatia hipertrófica em cães foram estudados. Os cães afetados apresentavam sinais clínicos indicativos de envolvimento ósseo e lesões macroscópicas principalmente nos ossos longos dos membros. As lesões consistiram de neoformação óssea periosteal detectada em exame radiográfico, na inspeção óssea durante a necropsia e, com grande nível de detalhamento, em espécimes ósseos macerados. A proliferação óssea observada era parcialmente circunferencial e ocorreu principalmente na diáfise dos ossos longos. Era constituída por trabéculas ósseas de tamanho e espessura irregulares que estavam dispostas de forma perpendicular ao córtex ósseo original. Em todos os casos as lesões de osteopatia hipertrófica foram associadas a neoplasmas pulmonares (primários ou metastáticos).

Intra-articular osteoid osteoma in the proximal ulna combined with radial head subluxation: a case report

Osteoid osteoma is a relatively common benign bone tumor that was first described by Jaffe in 1935. Its typical clinical feature is pain, which is worse at night and relieved by nonsteroidal anti-inflammatory drugs (NSAIDs). Typical radiologic findings are a nidus with a small radiolucent area within an extensive reactive cortical thickening. This tumor has a predilection for the diaphysis or metaphysis of long bones, with 50-60% occurring in the femur or tibia. However, localization in the elbow is a very rare presentation, and shows an atypical picture that causes both diagnostic delay and therapeutic problems. We herein report a case of a 19-year-old man who had pain and limited motion of the left elbow as a result of osteoid osteoma at the sigmoid notch of the proximal ulna. Anterior subluxation of the radial head was also observed by simple radiographs. En bloc resection and synovectomy resulted in pain relief, motion recovery, and reduction of the subluxated radial head. The patient consented when asked if data concerning his case could be submitted for publication.

Comparison between Different Modalities of Treatment of Ewing Sarcoma

Background: Ewing sarcoma is the most common primary malignant tumour in patients younger than 10 years of age. The incidence is less than 1 per 1 million per year. Usually it is located in the diaphysis of long bones. Prognosis of these tumours has improved dramatically since the introduction of multi-agent chemotherapy, from an erstwhile 10% survival rate to the current 70% for patients with non-metastatic Ewing sarcoma. Method: A retrospective review of patients with histologically confirmed Ewing sarcoma who were treated in the Department of Orthopaedics, B.S. Medical College during the time period from April 2000 to March 2012 was performed. Patients were divided into two groups: Group A included those treated by External Beam Radiotherapy (EBRT) + chemotherapy while Group B included the patients treated with surgery + chemotherapy. Results were analysed depending on the survival rates. Kaplan-Meier survival curves were compared using log-rank test and a multivariate Cox proportional hazards model was calculated. Result: The survival curves of both the groups were not found to be significantly different. Conclusion: Treatment of Ewing tumour has multiple options. No one treatment modality is superior. Survival rates of patients treated by radiation + chemotherapy are not significantly different from those treated with surgery + chemotherapy.

Dok-1 and Dok-2 deficiency induces osteopenia via activation of osteoclasts

Osteoporosis causes fractures that lead to reduction in the quality of life and it is one of the most prevalent diseases as it affects approximately 10% of the population. One of the important features of osteoporosis is osteopenia. However, its etiology is not fully elucidated. Dok-1 and Dok-2 are adaptor proteins acting downstream of protein tyrosine kinases that are mainly expressed in the cells of hematopoietic lineage. Although these proteins negatively regulate immune system, their roles in bone metabolism are not understood. Here, we analyzed the effects of Dok-1 and Dok-2 double-deficiency on bone. Dok-1/2 deficiency reduced the levels of trabecular and cortical bone mass compared to wildtype. In addition, Dok-1/2 deficiency increased periosteal perimeters and endosteal perimeters of the mid shaft of long bones. Histomorphometric analysis of the bone parameters indicated that Dok-1/2 deficiency did not significantly alter the levels of bone formation parameters including mineralizing surface/bone surface (MS/BS), mineral apposition rate (MAR) and bone formation rate (BFR). In contrast, Dok-1/2 deficiency enhanced the levels of bone resorption parameters including osteoclast number (N.Oc/BS) and osteoclast surface (Oc.S/BS). Analyses of individual osteoclastic activity indicated that Dok-1/2 deficiency enhanced pit formation. Systemically, Dok-1/2 deficiency increased the levels of urinary deoxypyridinoline (Dpyr). Search for the target point of the Dok-1/2 deficiency effects on osteoclasts identified that the mutation enhanced sensitivity of osteoclast precursors to macrophage colony-stimulating factor. These data revealed that Dok-1 and Dok-2 deficiency induces osteopenia by activation of osteoclasts.

Femoral Involvement by Langerhans Cell Histiocytosis Following Total Hip Arthroplasty

Langerhans cell histiocytosis (LCH), formerly called “eosinophilic granuloma,” is a benign bone neoplasm that is rare in adults. It is a cellular lesion with histiocytes, plasma cells, small lymphocytes, neutrophils, giant cells, foam cells, and eosinophilic leukocytes1. The disease typically presents during childhood, with >90% of cases occurring between the ages of five and fifteen years. LCH typically presents as a lytic medullary lesion with sharply defined margins, most commonly in the skull and in the diaphyses of long bones. The pelvis is affected in 5% to 17% of reported cases2,3. We report an unusual case of LCH presenting in the femur of a healthy young adult man following primary total hip arthroplasty for presumed idiopathic osteonecrosis. Inspection of the joint at the time of the initial surgery demonstrated no findings that were thought to warrant formal histological investigation of bone at the arthroplasty site. One year later, repeat radiographs demonstrated changes mimicking a periprosthetic infection. The prosthesis was removed, and histological examination of tissue curetted from the lytic lesions adjacent to the prosthetic femoral stem demonstrated findings consistent with a diagnosis of LCH. Cultures of curetted tissue from the same site revealed no bacterial, mycobacterial, or fungal growth. The patient, treated initially as if he had an infection at the site of the arthroplasty, underwent placement of an antibiotic cement spacer followed by revision total hip arthroplasty. At the most recent follow-up evaluation, there had been no recurrence of the LCH and the hip prosthesis was functioning well. In retrospect, LCH, which was present at revision, could have been present at the primary operation and could have been diagnosed if tissue specimens had been submitted for histological examination. This experience underscores the importance of maintaining a high index of suspicion for unexpected diagnoses …

Letter To the Editor: Unexplained Fractures: Child Abuse or Bone Disease: A Systematic Review

Letter To the Editor: Unexplained Fractures: Child Abuse or Bone Disease: A Systematic Review

MRI Manifestation and Early Diagnosis of Bone Infarct: A Rare Complication of Steroid Therapy for Pemphigus

The objective of the study was to analyse the magnetic resonance imaging (MRI) manifestation of bone infarction and explore the value of such imaging in early diagnosis. In bone infarction, aseptic osteonecrosis occurs in the metaphysis and diaphysis of long bones. The “Double line” sign in MRI is most characteristic of this lesion and is seen as high signal intensity in the inner zone along with lowsignal-intensity line in the outer zone in a T2 weighted image. In clinically suspected patients, MRI can be used for early diagnosis. Here we describe a case of pemphigus resulting from steroid therapy leading to development of bone infarction in the metadiaphyseal region of the femur and tibia.

Characterization of the Spatial Arrangement of Secondary Osteons in the Diaphysis of Equine and Canine Long Bones

The blood supply of bone cells in compact bone is provided primarily by blood vessels located within Haversian canals forming the centre of osteons. Mid-diaphysial cross-sections of radii and third metacarpal bones from two horses and radii from two mature dogs were studied using reflective light microscopy to quantify the spatial ordering of canals and compared to a computational model. The distributions of canals were analyzed using: 1) the autocorrelation function (ACF), which describes the probability of finding two canals separated by a given distance and 2) the shortest distance distribution (SDD), which describes the probability that a site within bone is located at a given distance from the nearest canal. The order in the investigated horse radii, as characterized by the oscillations of the ACF, was found to be independent of the anatomical location although, in the metacarpal bone the order was higher in the lateral than in the cranial location. Among the dogs, marked differences were only found in the ACF. An analysis of the SDD demonstrates that ordering of canals minimizes the distance of osteocytes from a blood vessel. This suggests that the efficiency of the blood supply can be adapted through differences in the order of the Haversian canals. In our model, the ordering of canals is achieved via an exclusion zone around each canal, imposed upon newly formed osteons. Simulations demonstrate that differences in the observed order can be explained by either a larger size or a larger variability of this exclusion zone.

Une tumeur surrénalienne inhabituelle : tumeur d’Ewing

We report the case of a voluminous tumor of the adrenal diagnosed in a young pregnant woman at 26(th) week of amenorrhea. Morphologically, a soft white tumor with haemorragic areas was observed, made of sheets of monomorphous, medium sized, spindle-shaped to polygonal, with high mitotic activity. Tumorous cells expressed cytokeratins AE1/AE3, EMA, and CD99 (expression of vimentin is not relevant). Contemplated diagnoses included poorly differentiated synovialosarcoma, sarcomatoid carcinoma and Ewing tumor. Thanks to molecular biology, showing the specific transcript of Ewing/peripheral primitive neuroectodermal tumor (pPNET) EWS/FLI1, the diagnosis of this atypical tumor in an unusual location was performed. Indeed, 75% of Ewing tumors involve bones (especially, the diaphysis of long bones) and 20 to 25% soft tissues. Primitive visceral involvement is rare; less than 10 cases of adrenal involvement have been reported. The hypothesis that Ewing cell's origin is a mesenchymal stem cell, which may derive from neural crest cell, could explain the uncommon adrenal involvement. Diagnosis of Ewing tumor is based on pathologic and molecular findings, especially in atypical cases.

Case of Ewing’s Sarcoma Misdiagnosed as a Periapical Lesion of Maxillary Incisor

Ewing’s sarcoma (ES) belongs to the group II neuroectodermal tumors. They usually occur in diaphyses of long bones, ribs, and pelvis and are rare in head and neck bones, with only 30 cases reported. The mandible is more affected than the maxilla. ES is also the second most common primary malignant bone tumor found in children, after leukemia and osteosarcomas, but they are rare in adults. The following is a report of a new case of ES localized in the maxilla occurring in a 25-year-old man who had been misdiagnosed with an odontogenic infection. The patient was treated successfully, with a 2-year follow-up, by using a combination of aggressive systemic chemotherapy and surgery with primary reconstruction of the defect, avoiding the use of radiotherapy.