Distal Epiphysis Research Articles

Evaluation of the effects of cementless total hip replacement on femoral length in skeletally immature dogs.

To describe percentage length changes in the femur after total hip replacement (THR) performed before skeletal maturity. Retrospective study. Twenty-four dogs younger than 8.5 months which underwent unilateral THR and had radiographic follow up. Preoperative and follow-up radiographs were reviewed. Radiographic measurements included the length of the greater trochanter, femoral diaphysis and distal epiphysis, width of the femur 10 mm distal to the distal aspect of the greater trochanter, width of the femur at 50%, and femoral condylar offset. Percentage changes in length over time were compared among operated and contralateral femurs used as controls. Measurements were collected in triplicate in 10 dogs to evaluate consistency. All repeated measurements had excellent consistency. The percentage increase in length of the greater trochanter was smaller in operated femurs than controls (mean difference: -11.5%, p = .017), but no differences were observed for the femoral diaphysis and distal epiphysis (-1.0%, p = .595), or the femur overall (-2.3%, p = .232). The percentage increase in femoral cortical width was greater in operated femurs than controls, both 10 mm distal to the greater trochanter (4.6% difference, p = .037) and at 50% length (8.5% difference, p = .030). In growing dogs, cementless THR decreased trochanteric growth by approximately 10% but did not change diaphyseal growth and femoral growth. Cementless THR performed in skeletally immature dogs with severe hip problems did not impact femoral length in a clinically relevant fashion.

Radial Longitudinal Deficiency: Description of a Novel Surgical Technique and Clinical Cases

Radial longitudinal deficiency III and IV present as a short upper limb, functional elbow, and wrist with severe radial and palmar angulation, where the carpus articulates with the radial and palmar edge of the ulna, allowing limited mobility in a nonfunctional position. Surgical treatment aims to correct radial angulation and flexed carpal position, often altering carpal positioning over the distal ulna and impacting wrist mobility. In addition, fixation through distal ulnar epiphysis affects its growth. Although these procedures improve appearance, functionality remains suboptimal. This study describes a novel ulnar osteotomy and extensor carpi ulnaris transfer for the correction of wrist deformity in radial longitudinal deficiency with preservation of ulnocarpal motion and epiphyseal growth. The surgical technique, indications, contraindications, and potential complications are described. Three cases with postoperative follow-ups at 36, 12, and 6 months, evaluating deformity and pre/postsurgical wrist mobility ranges, are reported. A correction was achieved in the forearm-hand angle of 71 to 88 degrees of the initial. The total range of movement, between 50 degrees and 80 degrees, was almost the same before and after the operation in the most anatomic position. In one patient, there was a residual deformity at the dorsoradial border, which showed no progression during the last 6 months of follow-up. For patients with radial longitudinal deficiency, functional outcomes with preserved mobility appear to hold greater significance. The technique described in this study enabled deformity correction while maintaining a wide range of motion. The preservation of the physis in a different orientation is an aspect that will need evaluation in long-term follow-up but offers potential treatment options in the future; due to the unknown of the secondary deformity, it is recommended that the long-term results should be awaited before adoption of this technique.

T2-weighted spoiled gradient echo MRI for forensic age estimation: a study on knee growth plates.

The timing of growth plate fusion is a key indicator for age estimation and is primarily used in forensic investigations. On the other hand, non-ionizing techniques such as MRI are being developed to provide safer and more ethical evaluations in forensic casework. This study aims to evaluate the closure process of growth plates in the distal femoral and proximal tibial epiphyses using Multiple Echo Recombined Gradient Echo (MERGE) MRI sequences and provide age estimation data based on staging methods for forensic purposes. We retrospectively analyzed 559 patients (294 males, 265 females, aged 8-25 years) diagnosed with trauma and knee pain at Tepecik Training and Research Hospital from 2016 to 2019. MRI scans were performed using a 1.5-T system with MERGE sequences and evaluated by two observers using a new staging system. Observer agreement was assessed using Cohen's κ test, yielding high agreement values (κ > 0.8). Positive correlations were found between age and ossification stages (p < 0.001). Minimum age thresholds for stages 5a and 5b of the distal femoral epiphysis were 16 and 18 years for females and 17 and 19 years for males, respectively. For the proximal tibial epiphysis, the minimum ages for stages 5a and 5b were 15 years for females and 17 years for males. The MERGE sequence provides a viable method for assessing skeletal maturity in living individuals with significant ethical advantages due to non-ionizing radiation. This study supports the potential application of the MERGE sequence in forensic age estimation, demonstrating high observer agreement and consistency. Future research should focus on comparing different sequences and populations to enhance the methodology's applicability.

Application of Vieth staging in forensic age estimation in the living using MRI of the distal radial epiphysis.

Forensic age estimation is crucial in various legal and civil contexts, particularly in regions experiencing significant migration and inadequate birth registration systems. This study evaluates the applicability of the Vieth staging system for forensic age estimation in the living using MRI of the distal radial epiphysis. A retrospective analysis was conducted on 620 left wrist MRI scans from individuals aged 9.92 to 29.58 years. The study demonstrated high intra- and inter-observer agreement values (κ = 0.974 and κ = 0.961), confirming the method's reliability. Spearman's rank correlation analysis showed significant positive correlations between age and ossification stage for both sexes. The minimum ages observed for males were 9.92 years at stage 2, 15.00 years at stage 3, 15.00 years at stage 4, 17.00 years at stage 5, and 20.00 years at stage 6. For females, the minimum ages were 10.08 years at stage 2, 12.33 years at stage 3, 14.25 years at stage 4, 16.33 years at stage 5, and 18.42 years at stage 6. The study supports the applicability of the Vieth methodology for forensic age estimation in the living and suggests that MRI could be a non-invasive and potentially effective tool for determining critical age thresholds in forensic contexts. Further research is recommended to refine these methods and explore their applicability across different populations.

Transdermal delivery of bisphosphonates using dissolving and hydrogel-forming microarray patches: Potential for enhanced treatment of osteoporosis

As of 2023, more than 200 million people worldwide are living with osteoporosis. Oral bisphosphonates (BPs) are the primary treatment but can cause gastrointestinal (GI) side effects, reducing patient compliance. Microarray (MAP) technology has the potential to overcome GI irritation by facilitating the transdermal delivery of BPs. This study examines the delivery of alendronic acid (ALN) and risedronate sodium (RDN) using dissolving and hydrogel-forming MAPs for osteoporosis treatment. In vivo testing on osteoporotic female Sprague Dawley rats demonstrated the efficacy of MAPs, showing significant improvements in mean serum and bone alkaline phosphatase levels, bone volume, and porosity compared to untreated bilateral ovariectomy (OVX) controls. Specifically, MAP treatment increased mean bone volume to 55.04 ± 2.25 % versus 47.16 ± 1.71 % in OVX controls and reduced porosity to 44.30 ± 2.97 % versus 52.84 ± 1.70 % in the distal epiphysis of the femur. In the distal metaphysis, bone volume increased to 43.32 ± 3.24 % in MAP-treated rats compared to 24.31 ± 3.21 % in OVX controls, while porosity decreased to 55.39 ± 5.81 % versus 75.69 ± 3.21 % in OVX controls. This proof-of-concept study indicates that MAP technology has the potential to be a novel, patient-friendly alternative for weekly osteoporosis management.

Magnetic Resonance Imaging Has Utility in Clinical Decision-Making for Children and Adolescents With Symptomatic Subfibular Ossicles.

We performed a retrospective study of pediatric patients with lateral ankle pain, recurrent sprains, and radiographs showing SOs who had undergone an MRI as part of their diagnostic work-up.We identified 22 patients from the senior author's registry of pediatric patients with lateral ankle injuries. Eleven were girls, and 11 were boys, ages ranging from five to 19 years.Eleven involved the left ankle; 11 involved the right. Positive MRIs showed a high-intensity signal between the SO and the distal fibular epiphysis; negative MRIs had a low-intensity signal. The main outcome measure was operative versus non-operative treatment. Sixteen of the 22 patients had positive MRIs, and six had negative MRIs. Twelve of the 16 patients with positive MRIs had undergone an operation. All six patients with negative MRIs responded to nonoperative management. MRI has utility in clinical decision-making for symptomatic patients with SOs.Patients with negative MRI sequences responded to nonoperative management.Most patients with positive MRI sequences will require surgery to alleviate their symptoms and return to full activities. IV.

Poster 278: Low Distal Femoral Epiphysis Height May Be a Risk Factor for Growth Disturbance Following All-inside All-Epiphyseal Anterior Cruciate Ligament Reconstruction

Poster 278: Low Distal Femoral Epiphysis Height May Be a Risk Factor for Growth Disturbance Following All-inside All-Epiphyseal Anterior Cruciate Ligament Reconstruction

Evaluation of anatomical and radiological measurements of the proximal phalanx of the horse

When performing osteosynthesis by screw fixation, it is important to carry out operational planning (choosing the screw of the optimal length and diameter). Choosing the optimal osteosynthesis tactics and the correct screw size allows you to stimulate regeneration and prevent possible complications. The X-ray examination method is included in the mandatory criterion of preoperative examination, which allows you to determine the size of the deformation and bone parameters. The present study is based on the hypothesis that the lifetime X-ray measurement of the bone of the proximal phalanx of a horse (longitudinal and transverse dimensions of the proximal and distal epiphysis and diaphysis, bone length), allows us to justify the size and technique of fixing the screw in the treatment of fractures. Morphometric studies included macroscopic dissection; morphometry of bone preparations; Xray measurement of the putus bone; documentation of the data obtained, photographing. A morphometric study was performed on 20 bone preparations (10 thoracic and 10 pelvic) and 40 X-ray images (20 in lateromedial and 20 in dorso-palmar/plantar projections) of the proximal phalanx of the horse. As a result of the work performed, it was found that the variability of parameters (longitudinal and transverse size of the proximal epiphysis, longitudinal and transverse size of the distal epiphysis; the longitudinal and transverse size of the diaphysis, bone length) of the fetal bone of the thoracic and pelvic limbs in horses for average values has no significant deviations (up to 1%), while the differences between the minimum and maximum values range from 20.0% to 66.6% for values obtained by anatomical method; from 12.2% and 33.3% for the Xray method.

Operative Treatment of Distal Tibial Fractures in Children Managed With Epiphyseal Screws: A Comparison of Outcomes When Screws Are Retained Versus Removed Following Fracture Union.

Fractures of the distal tibial epiphysis in children are often accompanied by articular surface disruption. With increased displacement, internal fixation is frequently performed with an epiphyseal screw to close the fracture gap. Despite limited, high-level clinical evidence to support implant removal, epiphyseal screws are commonly removed after fracture healing due to potentially increased contact forces on the tibiotalar joint. The purpose of this study was to investigate and compare outcomes and complications in children that underwent surgical treatment of distal tibial epiphyseal fractures with placement of an epiphyseal screw(s) and had the implant(s) retained versus removed at a minimum of 2-year postoperative follow-up. Children younger than 18 years from two urban tertiary care centers who underwent operative management of distal tibia Salter-Harris III and IV fractures using epiphyseal screws (2013-2020) were divided into two cohorts: retained epiphyseal screws and implant removed. Demographics, intraoperative, postoperative, and radiographic data were collected. Patient-reported outcomes (PROs) using the Foot and Ankle Ability Measure (FAAM) and Single Assessment Numeric Evaluation (SANE) questionnaires were collected at the final follow-up. Statistical analysis, including power analysis, was performed. Fifty-two children were included (30 males, 22 females) with a mean age of 13.3 years at the time of injury (range, 7.7-16.4 years). Thirty-five children retained the implants; seventeen had implants removed. All completed the FAAM questionnaires at a mean follow-up of 4.4 ± 1.9 years, while 29 completed the SANE questionnaire at a mean follow-up of 4.4 ± 1.7 years. No statistically significant difference in patient demographics, surgical variables, or PROs was observed. Six children experienced complications from the initial surgery, including infections and complex regional pain syndrome, with no difference in complication rates between the cohorts ( P =0.08). Furthermore, no complication was observed as a result of implant removal. Children with retained epiphyseal implants have similar functional outcomes as compared with those who had implants removed after distal tibial epiphyseal fracture fixation and union. Level III-Retrospective comparative study.

Transrectal ultrasonographic assessment of the fetal proximal phalanx: A new tool to assess fetal age and bone development in horses

Fetal age in Quarter Horses can be predicted within 2 weeks from 100- to 200- days of gestation using femur length, biparietal diameter (cranium diameter) and eye approximated volume. However, as pregnancy advances, the femur and cranium become too large to be imaged in their entirety using ultrasound and the corresponding biometric parameters can no longer be measured. In this longitudinal study, the proximal phalanx (P1) was evaluated as a novel biometric parameter for late gestation to predict fetal age and bone maturation. Transrectal ultrasound was performed in ten pregnant mares with known ovulation dates, every two weeks from 240- days of gestation until parturition. P1 was imaged in 69 % of the examinations. Inability to image P1 was due to obstructive positioning such as carpal or fetlock flexion, or posterior presentation of the fetus. Advancing fetal age did not affect visibility of P1. P1 length correlated significantly with days of gestation and a correlation equation was established: y = 0.3837x -69.55 where y is the predicted value of P1 length and x is the day of gestation (with day 0 being the day of ovulation). When P1 length was equal to or larger than the width of the ultrasound image (52.5 mm), 90 % of mares (9/10) were above 300- days of gestation. Ossification of the proximal and distal epiphysis of P1 typically appeared between 277- and 303 -days of gestation (mean: 288 days). The proximal epiphysis did not close before parturition whereas the distal one closed between 306- and 333-days of gestation (mean: 320 days). P1 epiphyseal appearance and closure occurred chronologically reflecting bone maturation. Radiographic findings at birth and prenatal ultrasound findings were in agreement, apart from timing of P1 distal epiphyseal closure. In conclusion, P1 length can be used as a new fetal biometric parameter to assess fetal age and growth after 240- days of gestation. The knowledge of P1 bone maturation process in utero as a marker for fetal bone development, may also be valuable in clinical decision-making when considering inducing parturition in the mare.

Closed reduction with percutaneous Kirschner wire fixation for delayed treatment of distal humeral epiphyseal fracture separation

Background: Fracture separation of the distal humeral epiphysis in children is a relatively uncommon injury, predominantly occurring in children under 3 years. It has a high risk of treatment delays. This study aims to evaluate outcomes in the management of fracture separation of the distal humeral epiphysis treated seven or more days post-initial injury. Methods: A retrospective analysis was conducted on patients diagnosed with fracture separation of the distal humeral epiphysis between November 2016 and October 2023. Inclusion criteria encompassed patients with delayed presentation of fracture separation of the distal humeral epiphysis who underwent surgical intervention seven or more days following the initial injury. Demographic data were collected, and fractures were categorized using the modified DeLee classification. Plain radiographs facilitated the assessment of the carrying angle and postoperative Baumann angle. Clinical outcomes were evaluated using the Flynn criteria. Results: The study included 12 patients who met the inclusion criteria. The average age at the time of injury was 1.59 years. According to the modified DeLee system, fracture classification identified one type I fracture, eight type II fractures, and three type III fractures. The average duration from injury to surgery was 11.8 days. The mean surgical duration was 21.5 min. The average follow-up period was 40.7 months. One patient exhibited cubitus varus development. Based on the Flynn criteria, outcomes were as follows: seven patients had excellent outcomes, four had good outcomes, and one had a poor outcome. Conclusion: Closed reduction with percutaneous K-wire fixation represents a minimally invasive approach suitable for children diagnosed with fracture separation of the distal humeral epiphysis seven or more days post-initial injury. Most of these patients experienced favorable outcomes. Level of evidence: IV

Hybrid external fixator for treatment of a tibial proximal comminuted diaphyseal fracture in a foal

AbstractA 15‐day‐old colt was presented with grade 5 lameness (American Association of Equine Practitioners ‐ lameness scale), oedema of the right pelvic limb and stifle joint instability. A radiographic examination revealed a complete comminuted fracture of the proximal right tibia. To treat this, a surgical reduction was performed using a hybrid external fixator. The hybrid external fixator consisted of two rings placed above the proximal and distal epiphyseal plates, respectively, which were then linked with threaded rods. Within 24 hours of the surgery, the foal started weight‐bearing again. After 6 days, the hybrid external fixator rings were distracted by 1 mm per day for 17 days, which helped to increase the bone length. Once the hybrid external fixator was removed, a small shortening of the tibia (1 cm) was observed compared to the contralateral limb, but the epiphyseal cartilage was maintained.

Primary intraosseous papillary intralymphatic angioendothelioma of the distal femoral epiphysis: a case report with literature review.

Papillary intralymphatic angioendothelioma (PILA) is an exceptionally rare metastasizing soft tissue tumor. It tends to arise in the subcutaneous tissues of distal extremities in children. Only four intraosseous PILA cases have been reported until now in English language literature. We present a case of PILA arising in the distal femoral epiphysis of a 50-year-old female patient. It started as a relentless pain in her left knee. A plain radiography revealed a radiolucent area in the left internal femoral condyle. Computerized tomography revealed a 1-cm lytic lesion with a sclerotic rim. Magnetic resonance images showed a significant bone marrow edema signal focused on a 1-cm subchondral lesion suggestive of an intraarticular osteoid osteoma. Histologically, the tumor contained vascular channels covered by a single endothelial layer with intraluminal papillary endothelial structures lined with hobnail cells. Immunohistochemically, the cells were positive for ERG, CD31, and D2-40. The tumor underwent cryoablation and 6months later, after local recurrence or tumor persistence, a wide tumor resection was referred. After 7years of follow-up, the patient displayed neither local recurrence nor distant metastases. Primary intraosseous PILAs are exceedingly rare tumors that should be considered in the differential diagnosis of vascular bone tumors.

New fracture patterns distal epiphysis femur in youth: Update of current classification

IntroDistal growth core fractures of the femur are the third most common fracture in patients older than 10 years. These fractures result from high-energy trauma and have a high risk of evolving into growth disorders. The classification most used to describe these types of fractures is that described by Salter and Harris. Special clinical cases often occur in clinical practice that are not described in the classifications used. In our study, we analyzed and further focused on new fracture patterns related to pediatric epiphyseal detachments not easily described by the normal classifications currently used in the literature. Materials and methodsFrom January 2020 to December 2022, we treated 2 male clinical cases with epiphyseal detachments of the distal femur that could not be classified according to the Salter and Harris classification. age of the patients was 10 and 11 years, respectively; for both patients, the traumatic mechanism was a direct trauma to the right knee at high speed using an electric scooter; Serious clinical and radiographic follow-ups were performed at month 1, month 3, month 6, month 12, and month 24 from the date of surgery. DiscussionDistal femur fractures represent a challenge for the orthopedics because they have a high incidence of complications. In our experience, there has been an increase in this type of injury caused using recently developed electric vehicles, which can reach considerable speeds. The Salter Harris classification is among the most widely used for fractures involving the growth physis. This classification proved to be rather limiting in the present case, so we decided to classify the fracture as 'Salter Harris III equivalent'. ConclusionsThe fracture examined is a very rare fracture of the distal femur and is not reflected in the classifications currently in use. The patient presented an excellent clinical and radiographic result after surgery with the presence of a shortening of the affected femur in relation to the contralateral one, which suggests that the growth deficit may continue and increase over time for which reason future studies until skeletal maturity will be necessary to quantify the damage to the growth physis.

Living with a tumor: A case of osteosarcoma involving the medullary region in Phrynops cf. P. geoffroanus (Testudines: Chelidae).

The individual Geoffroy's side-necked turtle, Phrynops cf. P. geoffroanus, was diagnosed postmortem with osteosarcoma associated with the forelimb through morphological and histological analysis. Osteosarcoma stands as the most prevalent primary malignant bone tumor in tetrapods. The tumor presents itself as a large mass in the distal epiphysis, characterized by spicular outgrowths and a rugose external texture. Histologically, the afflicted humerus displayed a high degree of vascularity and exhibited an extensive bone resorption process involving the medullary and endosteal regions. Notably, a clear transition between the bone marrow and cortical bone was absent, indicative of a remodeling process featuring Haversian bone system apposition. Additionally, the diaphyseal region displayed the progression of neoplastic bone tissue along the bone. For comparative purposes, we describe a humeral thin section from a healthy specimen revealing compact primary bone interrupted by cyclical growth marks which differs from the continuous growth observed in the neoplastic humerus. To assess the neoplastic bone growth rate at the mid-diaphysis level, phylogenetic eigenvector maps (PEM) were employed, utilizing osteocyte density and vascular density as explanatory variables. The findings indicated that the osteosarcoma exhibited a slow-growing nature, suggesting that the turtle had to live with this condition for years. As the neoplasia continued to expand, it likely led to disadvantages for the pathological Phrynops individual due to humeral deformity. Furthermore, malignancy was associated with angiogenesis and the invasion of the medullary region by neoplastic bone tissue, raising the likelihood of metastasis as an additional factor contributing to the individual's sickness. The presence of numerous vascular canals in the diaphyseal thin section suggested a low-grade central osteosarcoma. It is worth noting that osseous neoplasms are rarely documented in Testudines, making this case of osteosarcoma in a South American freshwater chelid specimen a unique and rare occurrence.

Intercalary Resection of the Tibia for Primary Bone Tumors: Are Vascularized Fibula Autografts With or Without Allografts a Durable Reconstruction?

Intercalary Resection of the Tibia for Primary Bone Tumors: Are Vascularized Fibula Autografts With or Without Allografts a Durable Reconstruction?

Comparison of exposure of the radius afforded by the craniomedial and craniolateral open surgical approaches in dog cadavers.

Management of antebrachial fractures in dogs typically involves open reduction and bone plate stabilisation of the radius performed using either a craniomedial approach (CMA) or craniolateral approach (CLA). The aim of this cadaveric study was to compare radial exposure afforded via the craniomedial and craniolateral approaches, without and with releasing the abductor digiti I longus (ADIL) muscle. The CMA and CLA were performed on alternate paired cadaver forelimbs with the subsequent release (CMA) or elevation (CLA) of the ADIL muscle (n = 12). The percent area of exposure was calculated in defined longitudinal radial segments (LRSs) and hemi-circumferential radial segments (HRSs) using digitally uploaded images. A non-parametric rank sum test was used for statistical analysis (p < 0.05). While both the CMA and CLA provided sufficient exposure for radial cranial plate placement in the mid-to-distal diaphyseal region (50-80% LRSs), the CMA afforded greater exposure to the distal metaphysis (80-90% LRS). The CLA was advantageous in exposing the proximal diaphysis (20-50% LRSs) and distal epiphysis (90-100% LRS). Exposure of the distal diaphyseal, metaphyseal, and epiphyseal regions (80-100% LRSs) was impeded by the ADIL muscle. A tenotomy of the tendon of insertion of the ADIL muscle increased exposure afforded by the CMA in the distal metaphyseal and epiphyseal regions. The exposure afforded by the CLA in the distal diaphyseal and metaphyseal regions was significantly improved by elevating the origin of the ADIL muscle. The results of this study provide useful clinical information when surgeons are deciding which approach to use for cranial radial plating.

Trabecular architecture of the distal femur in extant hominids.

Extant great apes are characterized by a wide range of locomotor, postural and manipulative behaviours that each require the limbs to be used in different ways. In addition to external bone morphology, comparative investigation of trabecular bone, which (re-)models to reflect loads incurred during life, can provide novel insights into bone functional adaptation. Here, we use canonical holistic morphometric analysis (cHMA) to analyse the trabecular morphology in the distal femoral epiphysis of Homo sapiens (n = 26), Gorilla gorilla (n = 14), Pan troglodytes (n = 15) and Pongo sp. (n = 9). We test two predictions: (1) that differing locomotor behaviours will be reflected in differing trabecular architecture of the distal femur across Homo, Pan, Gorilla and Pongo; (2) that trabecular architecture will significantly differ between male and female Gorilla due to their different levels of arboreality but not between male and female Pan or Homo based on previous studies of locomotor behaviours. Results indicate that trabecular architecture differs among extant great apes based on their locomotor repertoires. The relative bone volume and degree of anisotropy patterns found reflect habitual use of extended knee postures during bipedalism in Homo, and habitual use of flexed knee posture during terrestrial and arboreal locomotion in Pan and Gorilla. Trabecular architecture in Pongo is consistent with a highly mobile knee joint that may vary in posture from extension to full flexion. Within Gorilla, trabecular architecture suggests a different loading of knee in extension/flexion between females and males, but no sex differences were found in Pan or Homo, supporting our predictions. Inter- and intra-specific variation in trabecular architecture of distal femur provides a comparative context to interpret knee postures and, in turn, locomotor behaviours in fossil hominins.

Does the intercondylar approach provide a better outcome for chondroblastoma of the distal femur in skeletally immature patients?

The epiphyseal approach to a chondroblastoma of the intercondylar notch of a child's distal femur does not provide adequate exposure, thereby necessitating the removal of a substantial amount of unaffected bone to expose the lesion. In this study, we compared the functional outcomes, local recurrence, and surgical complications of treating a chondroblastoma of the distal femoral epiphysis by either an intercondylar or an epiphyseal approach. A total of 30 children with a chondroblastoma of the distal femur who had been treated by intraregional curettage and bone grafting were retrospectively reviewed. An intercondylar approach was used in 16 patients (group A) and an epiphyseal approach in 14 (group B). Limb function was assessed using the Musculoskeletal Tumor Society (MSTS) scoring system and Sailhan's functional criteria. At final follow-up, the mean MSTS score was 29.1 (SD 0.9) in group A and 26.7 (SD 1.5) in group B (p = 0.006). According to Sailhan's criteria, the knee function was good and fair in 14 (87.5%) and two (12.5%) patients of group A, and eight (57.1%) and six (42.9%) patients of group B, respectively (p = 0.062). The lesion had recurred in one patient (6.2%) in group A and four patients (28.6%) in group B. Limb shortening > 1 cm was recorded in one patient (6.2%) from group A and six patients (42.8%) from group B. Joint degeneration was noted in one patient from group A and three patients from group B. An intercondylar approach to a chondroblastoma of the middle two-quarters of the distal femoral epiphysis results in better outcomes than a medial or lateral epiphyseal approach: specifically, better limb function, a lower rate of recurrence, and a lower rate of physeal damage and joint degeneration.

Development and Validation of Flaxseed Lignan-Enriched Set-Type Fermented Milk to Manage Postmenopausal Osteoporosis

A functional set dahi (fermented milk analogous to yoghurt) with a desirable probiotic (Lactiplantibacillus plantarum A5) count of 9.36 log CFU/mL and excellent techno-functional attributes (DPPH: 41.95% RSA, firmness: 485.49 g, sensory overall acceptability: 8.51) was developed to contain 260 mg of SDG in 20 g of dahi. Twenty-four female Albino Wistar rats (3 months old, &gt;180 g) were ovariectomized (OVX) and divided into three groups: OVX control, OVX and control dahi, and OVX and SDG-enriched dahi. The animal study found that ovariectomy decreased serum calcium, oestrogen, and bone ash calcium levels by 32.27, 30.95, and 48.46 percent, respectively, compared to the sham group (n = 8), while daily administration of SDG-enriched dahi (20 g) for eight weeks restored them. The proximal tibial metaphysis and distal femoral epiphysis micro-CT study showed that the ovariectomy lowered bone mineral density (BMD) by 11.06% and 9.18%, respectively, and lowered Trabecular thickness (Tb. Th) by 12.66% and 11.86%, respectively, while increasing Trabecular separation (Tb. Sp.) by 90.69% and 87.70%, respectively, compared to the sham control-group rats. SDG-enriched dahi improved BMD by 16.06 and 12.24% and Tb. Th by 35.32 and 19.62%, respectively, and decreased Tb. Sp by 47.04 and 47.22%, respectively, in OVX rats. The results suggest that the developed set dahi may help treat postmenopausal osteoporosis.