Distal Epiphysis Research Articles

Carbonate apatite granules with uniformly sized pores that arrange regularly and penetrate straight through granules in one direction for bone regeneration

Abstract Artificial bone substitutes that can solve the problems associated with autogenous bone grafts are essential. In this study, macroporous carbonate apatite (CO3Ap) granules with the same composition as natural bone were implanted into distal epiphysis defects in rabbit femurs. Material resorption and bone regeneration were then evaluated. The macroporous granules were obtained by extruding honeycomb (HC) structure rods containing calcium hydroxide, pulverizing the rods to granules, carbonating them to calcite, and converting them from calcite to CO3Ap. Notably, the HC-type macropores fully penetrated and spanned their diameters of the CO3Ap granules in one direction, as well as being regularly arranged and uniformly sized (120 μm). They facilitated cell penetration into the granules and the induction of angiogenesis. As a result, bone remodeling occurred simultaneously within the granules and on the granule surfaces. Furthermore, the granules were gradually resorbed and replaced by bone. Thus, introducing HC-type macropores into granules is an effective approach for promoting bone regeneration.

Variations in epiphyseal fusion and persistence of the epiphyseal line in the appendicular skeleton of two identified modern (19th-20th c.) adult Portuguese and Italian samples.

The aim of this work is to study age, sex, and population variations in epiphyseal fusion and persistence of the epiphyseal line in the appendicular skeleton of two identified modern (19th-20th c.) adult skeletal samples, using a specifically designed macroscopic scoring method. The use of epiphyseal closure and persistence of the epiphyseal line as an adult-age marker is also discussed. This study examined 981 adult skeletons of both sexes from two identified modern (20th c.) skeletal samples from the Sassari Collection (Museum of Anthropology, University of Bologna, Italy) and the Colecção de Esqueletos Identificados (Museum of Anthropology, University of Coimbra, Portugal). Our scoring method considers a five-degree scale, from nonfusion (Degree 0) to complete fusion (Degree 4). In addition, the persistence of the epiphyseal line, a feature that is not commonly collected during routine anthropological analyses, is taken into account here as Degree 3. Intra- and interobserver errors of 1.2% and 5.2%, respectively, were found, suggesting a good reproducibility of this scoring method. Some sites show variable degrees of epiphyseal fusion still in adult skeletons (e.g., secondary center of ossification of the clavicle, iliac crest, ischial tuberosity, distal epiphysis of the radius and ulna). Population differences have been observed, showing a delay in the complete epiphyseal closure for the Sassari sample compared to the Coimbra sample. Degree 3 seems to be a good adult-age indicator for individuals less than 35-year-old.

Morphological Manifestations of Human Locomotor Bipedality in Femur

The aimis to study the structure of the femur of conditionally healthy modern people, as part of the link of the musculoskeletal system, providing bipedal locomotion.Material and methods.By the original osteometric method was measured 23 structures of 166 femoral bones with full synostosis of epiphysis without evidence of bone pathology. After the introduction of the coefficient of proportionality for linear parameters and the calculation of confidence intervals for each of them, a multilevel factor analysis was carried out, separately for the right and left femoral bones by the maximum likelihood factor analysis method with Equamax normalized rotation.Results.Four levels of the structural organization, which characterized by asymmetry of factor loadings, are identified. The parameters forming the 1st level ensure the transfer of the mechanical load along the limb axis from the head through the intertrochantcric crest to the medial condyle. 2nd level parameters provide rotational movements at the knee joint. Parameters of the 3rd and 4th levels reflecting the function of the rotation of the leg in the hip joint when upright and maintaining the vertical position of the body in the sagittal plane.Conclusion.Thus, the human femur is a multilevel system with asymmetric participation of parameters in its formation. Femur, as part of the musculoskeletal system, has a distinct vertical structural differentiation, which is manifested in the dominance of the right limb in the implementation of the support functions at the level of the proximal epiphysis, and motor functions at the level of the distal epiphysis of the femur.

МОРФОМЕТРИЧНІ ПОКАЗНИКИ СУГЛОБОВОГО ПОКРИТТЯ КОМПОНЕНТІВ КОЛІННОГО СУГЛОБА В НОРМІ, НА РІЗНИХ ТЕРМІНАХ ОПІОЇДНОГО ВПЛИВУ ТА ПРИ ВІДМІНІ


 
 
 The work, presented below, describes the findings of the study of emergence and gradual increase of manifestations of violation of the morphometric indices of the articular cartilage in the distal epiphysis of the femur and proximal epiphyses of the tibia at different terms of experimental opioid exposure (in norm, at the end of the 1st, 2nd, 3rd, 4th, 5th, and 6th weeks and after a two-week withdrawal at the end of the 8th week. The goal was achieved using the morphometric method of measuring the layers of the articular cartiliage of the distal epiphysis of the femur and proximal epiphyses of the tibia in histological preparations obtained at different terms of experimental opioid exposure. Histologic preparations were obtained by applying a generally accepted method.The results of this research will form pathomorphometric basis, which can be applied for a comparative analysis of the dynamics of emergence, development and gradual increase of change in morphometric indices of structural components of the articular cartilage at early stages.
 
 

THE LATENT ASYMMETRY OF THE SYSTEMIC ORGANIZATION OF THE HUMERUS OF THE DOMESTIC BULL (<i>BOS TAURUS</i>) AS EVIDENCE OF THE MORPHOLOGICAL-FUNCTIONAL DIFFERENTIATION OF THE BONES OF THE MAMMALIAN LIMBS

Differences in the degree of development of the bones of the proximal part of the thoracic limbs are associated with the peculiarities of the biomechanics of the mammalian species. Symmetric locomotion is characteristic of Bovinae. In the comparative anatomical aspect, it is of interest to clarify the asymmetry of the anatomical structures that provide this kind of movement. The purpose of the study is the analyze the features of the structure and systemic organization of the humerus of large cloven-hoofed animals with a dorso-stable type of locomotion using the example of a domestic bull. The results of a study of the features of the systemic organization of the anatomical structures of the humerus of the domestic bull based on the measurement of its osteometrical parameters are presented. On each bone of 40 animals, 29 structures were measured. The values of the linear parameters were normalized, the transverse diameter of the bone shaft in the middle of its length was taken as a unit. Further, separately in the group of drugs of the right and left sides, the normalized values of linear and angular parameters were processed by the method of factor analysis. Three factors have been identified that affect the structure of the right humerus, four - on the structure of the left humerus. The parameters present in the system organization of both bones were identified as systemically stable. Analysis of the structure of the anatomical organization of the humerus of the bull allowed to identify five basic systemically stable parameters in the structure of the proximal epiphysis, three in the structure of the diaphysis and eight in the structure of the distal epiphysis. Parameters that are present only in the system organization of one of the bones and indicate an asymmetry in the performance of the function are designated as systemically unstable. There are four unstable parameters at the level of the proximal epiphysis, two at the distal level. The asymmetry of the systemic organization is manifested due to the difference in the implementation of the motor function at the levels of the epiphyses of the bone. As a result of the study, it was found that the basic systemically stable parameters that ensure the transmission of animal weight play a key role in the formation of the systemic organization of the humerus. The asymmetry of systemic organization is manifested due to the difference in the realization of motor function at the levels of the epiphyses of the bone, which indicates the morphological and functional differentiation of the epiphyses of mammals, reflecting the specificity of the type of movement.

PARTIAL TRANSPHYSEAL ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: CLINICAL, FUNCTIONAL, AND RADIOGRAPHIC OUTCOMES

BACKGROUND Partial transphyseal anterior cruciate ligament (ACL) reconstruction is a technique utilized in the skeletally immature population. The femoral tunnel is placed in the distal femoral epiphysis whereas the tibial tunnel is placed in a transphyseal fashion medial to the tibial tubercle. This technique was introduced in an effort to lessen insult to the distal femoral physis of skeletally immature adolescents while also avoiding the technical difficulty of placing an intra-epiphyseal tunnel in the proximal tibia which at times can be non-anatomic. There is limited literature examining this technique. In this study we analyzed the concurrent surgical procedures, re-operation and graft failure rates, and radiographic outcomes in adolescents undergoing partial transphyseal ACL reconstruction. METHODS Consecutive patients undergoing partial transphyseal ACL reconstruction by the two senior authors (NP and CA) were retrospectively reviewed. Inclusion criteria consisted of patients with symptomatic ACL rupture with open distal femoral physes and at least two years of growth remaining by chronologic and physiologic age as determined by growth and pubertal history. All patients received hamstring autograft. Femoral tunnels were drilled in an intra-epiphyseal location utilizing small angle guides under fluoroscopic guidance. Transphyseal tibial tunnels were drilled in standard fashion with a tip-aiming guide while minimizing thermal damage from slow reaming, avoiding horizontal tunnel placement, and using extraphyseal graft fixation to lessen insult to the proximal tibial physis. Radiographic outcomes including bilateral limb length (LL) and alignment as judged by mechanical axis deviation (MAD), mechanical lateral distal femoral angle (mLDFA), and medial proximal tibial angle (MPTA) were measured on long standing anterior-to-posterior (AP) view radiographs. Growth disturbance was defined as = 1 cm leg length discrepancy, = 1 cm difference in MAD, or 5-degree difference in mLDFA or MPTA as compared to the non-operative side and MAD/mLDFA/MPTA outside of established range of normal values. Clinical outcomes including graft failure and need for repeat operation were recorded at each follow-up visit. Operative extremity alignment measurements were compared to non-operative extremity measurements utilizing a paired students t-test. RESULTS Twenty-four patients with average follow up of 31.5 ± 17.1 months met inclusion criteria for this study. Five female and 19 male patients were enrolled consisting of 13 left and 11 right knees. Average age at time of surgery was 12.3 ± 0.9 years (10.1-13.8 years). The average ACL graft size was 7.8 mm ± 0.5 mm (6-9 mm). Ten patients (41.7%) had concurrent meniscal surgery, with seven (29.2%) undergoing partial lateral meniscectomy, two (8.3%) lateral meniscus repairs, and one patient (4.2%) with medial and lateral meniscal repairs. Six patients (25.0%) required re-operation at an average of 29.2 ± 17.3 months (1.5-49.5 months) for removal of hardware (n=3), revision ACL reconstruction (n=2), and meniscus surgery (n=1). Two patients had ACL graft failure (8.3%) during sporting activity and underwent revision ACL reconstruction at 19.7 months and 49.5 months post-operatively. There were no contralateral ACL tears. As shown in Table 1, comparison of the mean alignment and limb length measurements between all patients’ operative to nonoperative extremity revealed no significant difference in femur length, MAD, MLDFA, or MPTA. There was a small but statistically significant difference in operative versus non-operative tibia length (390.2 cm versus 392.4 cm, p=0.0004) and limb length (880.9 cm versus 884.0 cm, p=0.02). In analyzing individual patients’ limb length or alignment differences, five patients (20.8%) were identified with a growth disturbance. One patient had isolated shortening of the operative extremity, two with significant lateral deviation of the MAD, and two with both shortening and lateral MAD translation. No patients had significant side-to-side difference in mLDFA or MPTA. Femoral shortening accounted for the majority of the limb length discrepancy in two of the three patients with significant limb length discrepancy. All patients returned to sport. CONCLUSIONS / SIGNIFICANCE Partial transphyseal ACL reconstruction has a 25.0% re-operation rate, most often for hardware removal, and an 8.3% graft failure rate. Overall, approximately 20% of patients undergoing partial transphyseal ACL reconstruction had a growth disturbance but none required surgical intervention for these disturbances. While the partial transphyseal technique spares the distal femoral physis, femur-dominant limb length discrepancy can still occur. Drilling and graft placement across the tibial physis appears to be safe. Further studies are needed to directly compare the radiographic, functional, and clinical outcomes of partial transphyseal ACL reconstruction with transphyseal and all-epiphyseal techniques in the pediatric population. [Table: see text]

The efficacy of telescopic intramedullary rod for treatment of femur fracture or deformity correction in children with osteogenesis imperfecta

Objective To evaluate the safety and efficacy of telescopic intramedullary rod for treatment of femur fracture or deformity correction in children with osteogenesis imperfecta, and to analysis the result of prevention recurrent fracture as well as the complication. Methods Data of patients who were treated by telescopic intramedullary rod for recurrent femur fracture or curved femoral deformity from March 2015 to December 2015 were prospectively analyzed. There were 39 boys and 26 girls. The average age of the patients was 9 years 2 months, ranging from 3 years 5 months to 13 years 4 month. All the patients had suffered from recurrent femur fractures leading to femoral deformity. The mean angulation angle was 58° (range, 30°-95°). Among 69 sides, there were 21 sides of new fracture and 48 sides of deformity. Sixty-one patients were operated at one side and the other 4 patients were treated bilaterally. According to the modified Sillence classification system, there were 5 cases of type I , 17 type III, 34 type IV, 3 type V, 2 type VI and 4 type XV. Results All the 65 patients were followed up for a mean period of 32 months (range, 15-43). The average healing time of the osteotomy site or fracture site of the femur was 8 weeks (range, 7-12). The patient was encouraged to begin weight bearing and walking when the X-ray film showed healing of the osteotomy or fracture site. By the latest follow up, 80% of the patients could stand and walk independently. The incidence of femur fracture decreased significantly to the level of 0.5±0.2/year, compared to 2.7±1.8/year before operation. All the parents of the children were satisfied with the result of deformity correction. The children’s self care and motion ability improved obviously after operation. During follow up, 6 patients suffered from recurrent fracture of the femur by various degree, 1 of them was treated by open reduction and telescopic rodding surgery, while the other 5 patients were treated conservatively because the fracture displaced or angulated minimally and 4 patients healed uneventfully while 1 patient need plate fixation to augment the axial stability. In 3 patients (1 type IV, 2 type Ⅲ) the intubator failed to elongate with the growth of the distal femoral epiphysis, and in 2 patients the obturator migrated proximally which needed to be re-fixed. Low toxic infections occurred in 2 patients (type VI) which were treated successfully by removal of the rod and antibiotics. Conclusion The telescopic intramedullary rod can maintain the correction of the femur deformity and improve the quality the bone, thus prevent the recurrent fracture of the femur in children with osteogenesis imperfecta effectively. Key words: Child; Osteogenesis imperfecta; Fractures, bone; Internal fixators; Fracture fixation, intramedullary

THE NATURAL HISTORY OF TYPE VII ALL INTRA-EPIPHYSEAL FRACTURES OF THE LATERAL MALLEOLUS

Background: Inversion-type ankle injuries are common in pediatric athletes, often resulting in lateral malleolar fractures (1). Ogden described the Type VII lateral malleolar physeal fracture as an injury in which the fracture line is totally within the secondary ossification center of the distal fibular epiphysis (2). The purpose of this paper is to report on the outcomes of 31 children participating in various types of sports activities who had sustained a Type VII fracture of the lateral malleolus. Methods: Here we report the results of an IRB approved prospective (longitudinal) cohort study carried out at a tertiary care pediatric hospital from March 2012 to December 2017. Eligible patients were those with a type VII (all epiphyseal) fracture of the lateral malleolus, either treated initially or seen in follow-up by the senior author. Exclusion criteria included those patients with all other lateral malleolar injuries and those with negative radiographs. Thirty-one children were enrolled during the study interval. Type VII fractures were classified as either transverse, oblique, or tip avulsion, depending on the trajectory and location of the fracture line within the secondary center of ossification of the lateral malleolus. We recorded the following demographic data: sex of the patient, age at the time of injury, mechanism of injury, sport involved, weight bearing status at the time of injury, treatment of the injury, and time from injury to release to sports activity. Children were permitted to return to sports when they had no discomfort on palpation and an ankle range of motion was equal to the uninvolved side. The primary outcome focus was radiographic status of the fracture at the time of the last clinical evaluation. Results: Thirty-one children with a Type VII fracture of the lateral malleolus were enrolled during the study interval. There were 8 girls and 23 boys. The average age at the time of injury was 107 months (˜9 years.) All the children had sustained a supination inversion-type injury while participating in a full spectrum of sports activities. Twenty-five children were initially unable to bear weight, and 6 could walk but with a limp. Twenty-six children were treated with a weight-bearing cast and crutches, and five of those who could bear weight were treated with a cast boot. Four fractures were oblique, 8 were transverse, and 19 were tip avulsions. All the children were asymptomatic and had a negative drawer test when cleared for sports participation at an average time of 3.5 months (range 2.5 to 4) after injury. Eighteen children had radiographs showing uneventful healing of the fractures (Figure 1) when released to full activity, but 13 (31%) healed with formation of a discrete os subfibulare (Figure 2.) The 18 fractures that healed uneventfully were located above the distal third of the fibular epiphysis. All of the 13 that healed with an os subfibulare were located either at the distal tip of the fibula (4) or at the anterior distal aspect of the tip (9) corresponding to the area of attachment of the ATFL. Conclusions: All of children sustaining a Type VII fracture of the lateral malleolus were able to return to full sports activities. Eighteen of the 31 Type VII fractures (58%) healed uneventfully. However, 13 (42%), healed with the formation of an os subfibulare. Since the presence of an os subfibulare has been associated with recurrent ankle instability and pain (3), it may be prudent to observe and even recommend ankle rehabilitation exercises for these children to help prevent long-term problems. [Figure: see text][Figure: see text] Su AW, Larson AN. Pediatric Ankle Fractures: Concepts and Treatment Principles. Foot Ankle Clin. 2015;20(4):705-719.26589088. Ogden JA. Injury to the growth mechanisms of the immature skeleton. Skeletal Radiol. 1981;6(4):237-253.7292021. Pill SG, Hatch M, Linton JM, Davidson RS. J Bone Joint Surg Am. 2013;95: e115(1-6) d http://dx.doi.org/10.2106/JBJS.L.00847 .

ОСОБЛИВОСТІ МОРФОЛОГІЧНИХ КОМПОНЕНТІВ ХРЯЩОВОГО ПОКРИТТЯ КОЛІННОГО СУГЛОБА НА МІКРОСТРУКТУРНОМУ ТА УЛЬТРАСТРУКТУРНОМУ РІВНЯХ НАПРИКІНЦІ ДВОХТИЖНЕВОЇ ВІДМІНИ ЕКСПЕРИМЕНТАЛЬНОГО ОПІОЇДНОГО ВПЛИВУ


 
 
 
 The work, presented below, compares pathomorphological changes of the articular cartilage in the distal epiphysis of the femur and proximal epiphyses of the tibia at the end of the 56th day in rats after two - week opioid withdrawal at the micro- and ultrastructural levels. The goal was achieved by micro- and ultrastructural visualization of the components of the articular cartilage. Specimen preparation for electron and light microscopy was done according to the generally accepted methods.The results of this study will form the basis for developing a comprehensive therapeutical approach in management of lesions of structural components of the articular cartilage in opioid chondrodystrophy.
 
 
 

Modeling the possibility of occurrence of overactive bladder in women of different ages, depending on anthropo-somatotypological indicators or hormonal background with the help of discriminant analysis

One of the most important problems of modern urogynecology is the improvement of the treatment-diagnostic algorithm and prevention of overactive bladder syndrome (OAB). The purpose of the work is to construct and analyze discriminant models of the possibility of OAB occurrence in pregnant women of different age groups depending on the characteristics of anthropo-somatotypological indicators or hormonal background. 75 pregnant women with clinical signs of OAB syndrome and 60 healthy pregnant women had hormonal screening in the 1st and 3rd trimester of pregnancy and at 16 weeks postpartum using radioimmunoassay and immune enzyme methods (estradiol, progesterone, thyroid stimulating hormone and testosterone levels were determined). The anthropometry was carried out according to the method of V. V. Bunak, the components of the somatotype were determined according to the method of J. Carter and B. Heath, as well as the components of the body composition according to the method of J. Matiegka and the American Institute of Nutrition (AIN). By age, all pregnant women were divided into 3 subgroups: І - from 17 to 25 years, ІІ - from 26 to 35 years, ІІІ - from 36 to 41 years. A discriminant analysis of the possibility of OAB occurrence, depending on the anthropo-somatotypological or hormonal indices in women of different age groups, was conducted using the licensing program “Statistica 5.5”. When taken into account anthropo-somatotypological indices in women aged from 17 to 25 years, the model is correct in 86.7% of cases; in women aged from 26 to 35 years - in 90.9% of cases; in women between the ages of 36 and 41 years - in 89.3% of cases. Between healthy and OAB patients, women aged from 17 to 25 years discriminating variables are the width of the distal epiphysis of the shoulder (which has the greatest contribution to discrimination), conjugata externa, the muscle component of the body weight by AIN and the forearm's girth in the upper third; women from 26 to 35 years - dist. Іntеrtrochantericа, the width of the distal epiphyses of the forearm (the greatest contribution to discrimination), hip circumference, conjugata externa, mesomorphic component of the somatotype according to by Heath-Carter, fat mass component of the body by Matiegka, the forearm's girth in the upper third and the shoulder girth; women of age from 36 to 41 years - the width of the distal epiphysis of the leg (which has the greatest contribution to discrimination) and the length of the body. In general, the aggregate of all variables has a low level of discrimination between healthy and sick with OAB women between the ages of 17 and 25 (Wilkes Lambda statistics = 0.531; F = 5.521; p <0.01) and 36-41 years (Wilkes Lambda statistics = 0.445; F = 15.62; p <0.001), while among women between the ages of 26 and 35 - the average level of discrimination (Wilkes Lambda statistics = 0.386; F = 13.52; p <0.001). When taken into account characteristics of the hormonal background in women of all ages, the model is correct in 100% of cases. Between healthy and OAB patients, of 17-25 years age, discriminant variables are estradiol levels at 16 weeks of postpartum (with the largest contribution to discrimination) and prolactin levels in the first trimester of pregnancy; women aged from 26 to 35 years - estradiol levels at 16 weeks of postpartum (the most contributing to discrimination), testosterone in the third trimester of pregnancy, estradiol in the third trimester of pregnancy, prolactin in the third trimester of pregnancy, estradiol in the first trimester of pregnancy, and testosterone levels in the first trimester of pregnancy; women aged from 36 to 41 years - estradiol in the third trimester of pregnancy (has the largest contribution to discrimination) and estradiol in the 16 weeks of postpartum period. In general, the totality of all variables has a low level of discrimination between healthy and sick at OAB women between the ages of 17 and 25 (Wilkes Lambda statistics = 0.619; F = 131.4; p <0.001) and ages 26-35 (Wilks Lambda statistics = 0.493; F = 224.9; p <0.001), while among women between the ages of 36 and 41 - the average level of discrimination (Wilkes Lambda statistics = 0.371; F = 207.4; p <0.001). Thus, with the aid of discriminant analysis, reliable models of the possibility of OAB occurrence, based on anthropo-somatotypological or hormonal indices in women of different age groups, are constructed. In all age groups, the greatest contribution to discrimination between healthy and sick with OAB pregnant women, in most cases, make parameters of the width of distal epiphyses of long limb bones or the level of estradiol.

Extra-articular, Intraepiphyseal Drilling for Osteochondritis Dissecans of the Knee: Characterization of a Safe and Reproducible Surgical Approach.

Background:Osteochondritis dissecans (OCD) is an idiopathic focal condition affecting the subchondral bone of joints, and it is increasingly prevalent among the active young adult population. For lesions that have failed nonoperative management, transarticular drilling and extra-articular drilling are surgical options. Although the extra-articular approach preserves the articular cartilage, it is technically challenging and could benefit from a study of surgical approach.Purpose:To use 3-dimensional modeling of magnetic resonance imaging (MRI) scans from skeletally immature individuals to characterize safe tunnel entry points, trajectories, and distances from the physeal and articular cartilage along the course of the distal femoral epiphysis to the OCD target in their most common location of the medial femoral condyle (MFC).Study Design:Descriptive laboratory study.Methods:A total of 17 MRI scans from skeletally immature patients were used to create 3-dimensional models of the knee joint. Virtual representations of an OCD lesion were placed in the lateral aspect of the MFC; cylinders simulating tunnel length, diameter, and trajectory were superimposed onto the models; and measurements were taken.Results:Two safe tunnels were identified, 1 anterior and 1 posterior to the medial collateral ligament (MCL). The anterior tunnel had a diameter of 10.3 ± 1.4 mm, skin entry point of 16.9 ± 12.1 mm anterior and 7.1 ± 5.9 mm superior to the medial epicondyle, bony entry point of 12.1 ± 3.5 mm anterior and 2.4 ± 3.5 mm inferior to the medial epicondyle, and tunnel length of 31.8 ± 3.7 mm. The posterior tunnel had a diameter of 7.8 ± 1.8 mm, skin entry point of 9.4 ± 5.1 mm posterior and 26.0 ± 14.0 mm superior to the medial epicondyle, bony entry point of 8.6 ± 2.6 mm posterior and 5.1 ± 4.2 mm superior to the medial epicondyle, and tunnel length of 33.5 ± 4.5 mm.Conclusion:This anatomic characterization study identifies and defines 2 safe and reproducible tunnel approaches, 1 anterior and 1 posterior to the MCL, for drilling or creating tunnels to OCD lesions of the MFC in an extra-articular fashion.Clinical Relevance:The study findings provide valuable anatomic references for surgeons performing extra-articular drilling or tunneling of OCD lesions.

Minimally invasive internal fixation for extra-articular distal radius fracture: Comparison between volar plate and intramedullary nail

IntroductionThere are numerous internal fixation techniques for distal radius fracture, using pins, plates or nails. Some authors have developed minimally invasive procedures. The aim of the present study was to compare two minimally invasive internal fixation techniques for unstable extra-articular distal radius fracture in women over 50 years of age: volar plate (minimally invasive plate osteosynthesis: MIPO), and intramedullary nail. HypothesesThe main study hypothesis was that the incision scar left by minimally invasive internal fixation is smaller using MIPO than an intramedullary nail. The secondary hypotheses were that the two techniques do not differ in terms of pain, functional score, strength, range of motion and radiologic indices. Material and methodThe series comprised nineteen A2.2 and one A2.1 fractures in 20 female patients with a mean age of 72 years. The first 10 (group 1) received minimally invasive internal fixation of the distal radius by MIPO, and the other 10 (group 2) by intramedullary nail locked onto the distal radius epiphysis and diaphysis. ResultsThe main study hypothesis was confirmed: the incision scar left by minimally invasive internal fixation was smaller using MIPO than an intramedullary nail (mean, 14.3mm vs. 32.8mm). Some of the secondary hypotheses were also confirmed: there were no differences between the two techniques in terms of pain at 6 months, QuickDASH, PRWE (Patient-Reported Wrist Evaluation), range of motion or ulnar variance; two were not confirmed: pain at 6 weeks was less with intramedullary nails, and palmar slope was better with MIPO. Discussion and conclusionThe main study hypothesis was confirmed: the incision scar left by minimally invasive internal fixation was smaller using MIPO than an intramedullary nail. In conclusion, the present findings showed that internal fixation of unstable extra-articular fracture in over 50-year-olds gave better clinical results at 6 weeks using an intramedullary nail, while MIPO required smaller incision. Level of evidenceIII, retrospective study.

THE VALUE OF THE TYPE OF ANIMAL LOCOMOTION DURING THE FORMATION OF THE SYSTEMIC ORGANIZATION OF THE SHOULDER BONES ON THE EXAMPLE OF ORYCOLAGUS CUNICULUS, L. 1873

In order to study the systemic organization of the shoulder bone by factor analysis separately for the groups of right and left humerus bones 40 skeletons of the rabbit were investigated. The study found that the humerus of the rabbit is adapted to the reception and transmission of weight loads, it is characterized by morphofunctional differentiation of epiphyses, which is manifested by a large number of correlations within the distal epiphysis. The distal epiphysis of the left humerus to a greater extent than the distal epiphysis of the right bone takes part in the translation of weight.

On the Divergence in the Structure of the Human Femur and Some Tetrapods

The aim of the study was to study the divergence in the structure of the human femur and some mammals tetrapods.Material and methods. The osteometric study was conducted on 404 thighs of modern human, Bos taurus Taurus, L. 1758, Canis lupus familiaris, L. 1758, Oryctolagus cuniculus, L. 1758. 28 homologous structures on each bone were measured. The coefficient of proportionality took into account the influence of animal weight on the formation of the skeleton. The transverse diameter of the shaft in the middle of the bone length was taken as a unit.Results. As a result, it was found that the main differences in the structure of the femur are associated with an increase in its relative length, the width of the proximal epiphysis, an increase in the head, a decrease in the angles of the anteversion and the diaphyseal angle, a decrease in the bending of the femoral shaft anteriorly and an increase in its relative sagittal diameter. If the constancy of the width of the distal epiphysis of the increased width of the articular surface of the patella and the width of the intercondylar fossa, increased the relative size of the lateral condyle, the size of epicondyles decreased.

Avulsion of the Accessory-Carpal Ligaments and Sagittal Fracture of the Ulnar Carpal Bone in a Foal

AbstractA 45-day-old foal presented for weight bearing lameness. Radiography revealed an abnormal radiolucent line associated with the proximal ulnar carpal bone and a separate curvilinear mineral opacity palmaromedial to the distal radial epiphysis. Computed tomography illustrated a sagittal, biarticular, non-displaced fracture of the ulnar carpal bone with small separate fragments associated with the accessory-ulnar and accessory-radial carpal ligaments. The foal was treated conservatively with rest and adjunct intra-articular hyaluronic acid. The lameness resolved within 90 days. Full range of motion of the carpus returned within 120 days following an active rehabilitation protocol. This report details avulsion of the accessory-carpal ligaments and sagittal fracture of the ulnar carpal bone secondary to presumed hyperextension injury.

Inhibiting STAT3 in a murine model of human breast cancer-induced bone pain delays the onset of nociception.

Aggressive breast cancer subtypes utilize system xc−, a membrane antiporter, to import cystine for glutathione synthesis and maintenance of redox homeostasis, in turn releasing glutamate as a metabolic pro-nociceptive by-product. Metastatic breast cancers establish themselves at distal sites including bone, where changes in extracellular glutamate levels contribute to cancer-induced bone pain. We previously established that stearically blocking system xc− activity with sulfasalazine delays the onset of nociceptive behaviours and that xCT, the functional antiporter subunit, is positively regulated by signal transducer and activator of transcription 3 (STAT3). In the current investigation, a murine xenograft cancer-induced bone pain model was applied to examine whether pharmacological inhibition of phosphorylated STAT3 (pSTAT3) induces changes in nociception. A high glutamate-releasing, xCT/pSTAT3 over-expressing human breast cancer cell line was selected for injection into the distal epiphysis of the right femur of female nude mice. A 14-day regimen of intraperitoneal injections with either vehicle or the novel STAT3 inhibitor DR-1–55 commenced three weeks after initial intrafemoral bone injection. Nociceptive behaviours were temporally monitored by automated von Frey, dynamic weight bearing and open-field testing for the duration of the study, beginning at the baseline. Prior to sacrifice and at ethical end point, tumour-induced osteolytic lesions were radiographically assessed. Treatment with DR-1–55 significantly delayed the onset and severity of spontaneous and induced nociceptive behaviours, also decreasing human SLC7A11 (xCT) mRNA levels in tumour-bearing limbs without altering osteolysis. In addition, two pro-inflammatory cytokines released by this cell line, interleukin 6 and interleukin 1β, were also down-regulated at the mRNA level in response to DR-1–55 treatment in vivo, with lower human interleukin 6 levels detected in the host circulation. This study demonstrates that targeting pSTAT3 may be a viable therapeutic means to manage cancer-induced bone pain, alone or in combination with stearic system xc− blockers.

Qafzeh 10 child (Israël) dated to the Middle Palaeolithic and the diagnostic of a chondroblastoma on the distal femoral epiphysis

L’identification de lésions pathologiques sur les os de sujets non-adultes datés du Paléolithique moyen en Eurasie est de loin moins documentée que celle intéressant les adultes. Dans ce contexte, la fréquence et la nature des altérations pathologiques identifiées sur des sujets immatures dans le site de Qafzeh en Basse Galilée prend toute sa valeur, allant des lésions mineures aux anomalies congénitales et traumatiques. Nous présentons sur un fémur d’enfant de ce site un cas de tumeur épiphysaire qui est décrite comme rare chez les enfants actuels et discutons son diagnostic différentiel.

Early morphological changes in the knee joint of rats after opioid exposure

The objective is to study early morphological changes of rats’ knee joint after experimental opioid exposure. Materials and methods. Research material is mature, non-breeding male rats 4.5 months old (n = 16) with body weight 80 g. Animals were divided into 2 groups: experimental and control. The experimental group of rats (n = 10) got the injection of nalbuphine hydrochloride intramuscularly, one time per day during 7 days; initial dose – 8 mg/kg. The condition of chronic opioid exposure has been modeled. The rats of control group (n = 6) got the injection of physiological solution intramuscularly during 7 days. The distal epiphysis of rat thigh and proximal epiphysis of rat tibia taking into account the preservation of topographical correlation of the knee joint structural components have been used for histological analysis. Following decalcination, the histologic specimens have been stained with hematoxylin, eosin, azure and azan by Heidenhain. The thickness of the cover synovial layer of articular cartilage has been measured. Results. The architectonics of articular cartilage distorts, the cover synovial layer of articular cartilage gets thinner due to experimental action of opiates. There is also tendency towards volume decrease of chondrocytes in proliferation zone and thickness loss of the cartilage. Conclusions. At the early stage of opioid exposure the structure abnormality of laboratory rats’ knee joint can be seen in the synovial layer and in the zone of chondrocytes proliferation. These research data can be a prerequisite for opioid chondropathy.

The Humerus of Proterotheriidae (Mammalia, Litopterna) and Its Systematic Usefulness: The Case of “Proterotherium berroi” Kraglievich, 1930

Proterotheriidae constitute a group of small-medium native South American ungulates with high diversity during the early Miocene and the late Miocene (Santacrucian and Huayquerian SALMAs). Recent studies demonstrated the wide dental variability, useful in the discrimination of the species. The aim of this work is to analyze the humerus as a postcranial element that is usually not found in association with cranial remains, and to evaluate (qualitatively and quantitatively) its systematic usefulness. We used the only known specimen of “Proterotherium berroi”, re-describing and re-illustrating it. The Principal Components Analysis resulted in 2 components explaining 86% of the variance. The PCA showed a differentiation between the largest species—Diadiaphorus majusculus and Anisolophus floweri—and the remaining ones (an intermediate group consisting of “Proterotherium”, Tetramerorhinus, Eoauchenia, Proterotheriidae indet., and the smallest, Thoatherium minusculum). We establish that, although there are slight morphological differences in the distal epiphysis of the humeri of Proterotheriidae, they mostly correspond to gradual changes in characters with continuous variations not linked to any particular taxonomic entity. These are not enough to assure a generic or specific determination, except for Eoauchenia. The differences in humeri size are considerable and they could be used as a criterion for discriminating Diadiaphorus and Anisolophus, to which the largest specimens would belong. We consider “P. berroi” a probable synonym of Neolicaphrium recens, but we ratify that a reliable systematic determination is only possible if it is based on cranial or dental remains.

Forensic age estimation in living individuals by 1.5T magnetic resonance imaging of the knee: a retrospective MRI study

ABSTRACT Our aim is to analyse proximal tibial epiphysis and distal femoral epiphysis patterns according to the Dedouit staging method using 1.5 T magnetic resonance imaging (MRI) with fast spin echo (FSE) for proton density images. In addition, we discuss the results in relation to the literature for forensic age estimation. In this study, images belonging to 195 female and 277 male patients ranging in age from 10 to 30 years who had a knee MRI for any reason in our Radiology Clinic between January 2014 and December 2016 were retrospectively evaluated. According to the Dedouit et al. five-stage method, they were evaluated by two radiologists. The κ value was calculated for intra-observer and inter-observer compliance. The evaluation of knee epiphysis patterns from MRI is an alternative, efficient, radiation-free and non-invasive method that is helpful in forensic age estimation. In particular, stage 5 in distal femoral epiphysis can determine the 21st year of life in both sexes, and proximal tibial epiphysis could present evidence of age 18 in males. It should be used for evaluation in addition to other methods for determining skeletal system maturity.