Distal Radial Bone Research Articles

Computed tomography-derived structural analysis for the likelihood of pathologic fracture in canine antebrachial osteosarcoma.

Determining the risk of pathologic fracture in dogs with a primary bone tumor would aid in case selection for in-situ treatment options. Prior research found strong relationships between in vitro strength of canine antebrachii with primary bone tumors and CT-derived metrics. This study assesses the prognosis for pathologic fracture in dogs with distal radial bone tumors using CT-derived structural analysis metrics. CT images of the antebrachium in dogs with aggressive osseous lesions of the radius were used to calculate structural rigidity and failure forces, including axial rigidity (AR), craniocaudal bending rigidity (BR), torsional rigidity (TR), and failure forces for a slightly-curved/asymmetric beam (Fs) or a curved beam (Fc). Metrics were compared with the clinical outcome of radial fracture. Eight of 19 dogs with CT-derived metrics developed a radial fracture. The prognostic potential of the metrics to discriminate fractured and nonfractured bones was analyzed using receiver operating characteristic curves (area under the curve), stepwise logistic regression, and classification regression (CART) analyses. Fc was the most sensitive and specific metric for prognosing fracture occurrence (AUC=0.864). When dog body weight (BW) was included, all five metrics had AUC>0.705. Fc was the best predictor of fracture using stepwise logistic regression and CART analysis, followed by BR. An indication of fracture probability can be determined by normalizing Fc or BR with dog BW or by using the logistic regression equation of either metric with dog BW. Results warrant further analysis of a larger cohort to evaluate fracture likelihood in dogs with antebrachial bone neoplasia.

TREATMENT OF FRACTURES IN COVID-19 PATIENTS

Since February 2020, COVID-19 cases have been registered in many countries around the world. Today, it is clear that the COVID-19 pandemic has challenged the health care system in all countries. Huge financial and human resources are involved in providing care to infected patients. Traumatology is one of the branches of medicine that cannot suspend its activities despite the danger of an epidemic. The level of injuries decreases somewhat during periods of self-isolation and restrictions on social activities, but remains significant. In most cases, patients with acute trauma, if necessary for surgical treatment, were hospitalized for examination and preparation for surgical treatment. A large number of recommendations have been developed, which, however, can be combined in the following four important areas: prevention of unnecessary contacts, patient transfers, operations, limiting the number of consultations, visitors, reducing waiting times, treatment, personal protective equipment. All patients with fractures who can be treated conservatively and on an outpatient basis should not be hospitalized. In a pandemic, such cases should also include fractures in which surgical treatment shortens the patient's recovery time but does not improve the final long-term outcome of treatment, such as fractures of the clavicle, humerus, distal radial bone with acceptable fragment position. Detailed information on the selection of patients of all surgical profiles, screening, location and scope of care, anti-epidemic requirements for staff and patients, maintenance and exchange of medical records, recommendations for the rest of medical staff is contained in the recommendations of the American Academy of Orthopedic Surgeons. Priority A includes interventions that must be performed as a matter of urgency (up to 24 hours). These include open fractures; fractures of the femoral neck in young people; pelvic fractures accompanied by bleeding; fractures with damage to large vessels; compartment syndrome; dislocations; necrotic fasciitis; closed fractures when compromising soft tissues; complex fractures (external fixation only). Priority B includes urgent (up to 48 hours) operations to be performed for fractures of the femoral neck in the elderly, fractures of the talus, fractures of the femoral and tibial shafts and distal femur. All other fracture surgeries are a priority and can be performed within two weeks. All planned operations are prioritized D and E and can be postponed for three months or more. If outpatient treatment is not possible and emergency hospitalization is required for urgent / urgent surgical treatment (eg, femoral fracture), the patient should be screened for COVID-19 as soon as possible. If there is a viral disease clinic, hospitalization should be carried out in a specially designated box (ward / ward) until the patient's status is clarified. If the test is negative, the patient is transferred to the general department for further surgical treatment. The problem of fracture treatment in patients with COVID-19 is very relevant and needs further study. Despite the reduction in the incidence of COVID-19 worldwide, the development of treatment protocols for victims of fractures and respiratory endemic diseases is an urgent task. According to the literature, an individual approach to the treatment of each patient with skeletal bone fractures and COVID-19 significantly improves the results of treatment.

Treatment of proximal scaphoid waist nonunions with vascularized bone graft from the distal radius or medial femoral condyle.

Fractures of the proximal scaphoid waist are more prone to nonunion than distal scaphoid fractures. Thirty-nine patients (five females, 34 males; mean age 31years) who had operation for proximal scaphoid waist nonunion between 2017 and 2020 were retrospectively analysed. Patients received a free vascularized medial femoral condyle graft (Group 1: 18 patients) or distal radial bone graft based on a 1,2 intercompartmental supraretinacular artery pedicle (Group 2: 21 patients). In Group 1, union was achieved in 17 of 18 cases, with mean time to union of 13weeks and mean operation time was 221 minutes. In Group 2, union was achieved in 19 of 21 cases, with mean time to union of 15weeks and mean operation time was 100 minutes. The radiological and functional results of both groups were similar. We recommend a distal radial bone graft based on the 1,2 intercompartmental supraretinacular artery pedicle for proximal scaphoid waist nonunions since the operation is shorter, technically more manageable and requires less microsurgical experience.Level of evidence: III.

Фізіотерапія в комплексній реабілітації хворих із переломами дистального метаепіфіза променевої кістки

Узагальнено досвід консервативного лікування 36 хворих із переломами дистального метаепіфіза променевої кістки. Проведення безболісної корекції, використання тракційного пристрою, системи напівжорсткої фіксації дозволили вже в ранньому іммобілізаційному періоді почати активні реабілітаційні заходи — кінезо- і фізіотерапію, пневмомасаж. Проводилась медикаментозна профілактика нейродистрофічного синдрому. Після зняття фіксуючої пов’язки продовжувалися інтенсивні реабілітаційні заходи, що дозволило досягти добрих результатів у більшості хворих.

Failed Trapeziectomy Treated by Thumb Metacarpal Base Arthrodesis: A Case Series.

Trapeziometacarpal joint arthritis is a prevalent condition with a preponderance to women. Most cases are asymptomatic, but typical symptoms are pain, reduced dexterity, and functional decline. Trapeziectomy is the most common surgical treatment in the United Kingdom for patients who remain significantly symptomatic despite nonoperative measures, and this generally produces acceptable outcomes; however, a proportion of patients remain significantly symptomatic. The authors present a case series of 4 patients who underwent successful thumb metacarpal base to index metacarpal base arthrodesis with either distal radial or iliac crest bone grafting. Three of these patients had persisting symptoms after a primary trapeziectomy and 1 patient had gross subluxation of the thumb related to rheumatoid arthritis. Technically, this is a simple procedure to perform. All patients had improved symptoms with satisfactory functional outcomes and an improved cosmetic appearance of the hand.

Characteristics of lower limb injuries in non-fatal road traffic accidents: a retrospective analysis of forensic medical examinations

Background. Fractures of the lower limbs are one of the most common injuries in road traffic accidents, however, the frequency and localization of fractures, as well as associated trauma, are not well understood. The purpose of the study was to conduct a retrospective analysis of forensic medical examinations of victims with the road traffic injuries of the lower limbs. Results. The research material was 100 reports of forensic medical examinations of victims with fractures of the femur and/or shin bones resulting from a non-fatal road traffic accidents. The study found that the average age of the victims was 41.5 ± 18.8 years (18 - 81 years). The main contingent of those injured was pedestrians (82%). In victims, the most common injury was polytrauma; closed limb fractures were more common. Hip fractures of various localization were found in 39%, shin fractures - in 59%, ankle fractures - in 12%. Closed head injury with a concussion of the brain of a mild degree (23%), closed fractures of the ribs (3%), self-healing dislocation of the humerus (1%), diaphyseal fractures of the forearm (3%), distal radial bone fractures (7%), and fractures of styloid process of the ulna (2%) were also noted. Conclusions. The main victims of road traffic accidents are pedestrians with polytrauma. The most common localization of fractures of the lower extremities is the diaphysis of the femur and the diaphysis of the shin bones.

Distal radial cortical bone thickness correlates with bone mineral density and can predict osteoporosis: a cohort study

PurposeThe purpose of this study was to evaluate the correlation of the bone mineral density (BMD) of the hip and lumbar spine with the distal radius cortical thickness (DRCT) measured on anteroposterior radiographs and establish a method for predicting osteoporosis. MethodsWe assessed 147 patients aged ≥50 years with distal radius fractures who underwent wrist radiographs and dual-energy X-ray absorptiometry. The DRCT was measured and calculated at two levels of the distal radius of the injured wrist on the radiographs. ResultsThe intra-rater and inter-rater reliability of measures was excellent (intraclass correlation coefficient >0.85). In the Pearson correlation and simple linear regression analyses, the DRCT was positively correlated with hip BMD (r = 0.393, P < 0.01) and lumbar spine BMD (r = 0.529, P < 0.01). Each 1-mm increase in DRCT was associated with a 0.051-g/cm2 increase in hip BMD (R2 = 0.154, P < 0.01) and a 0.080-g/cm2 increase in lumbar spine BMD (R2 = 0.280, P < 0.01). A DRCT of 5.1 mm was selected as the cutoff point for predicting osteoporosis, with the highest Youden index of 0.560, 83.3% sensitivity, 72.7% specificity, and a 66.7% negative predictive value. ConclusionCortical thickness measurements obtained from anteroposterior wrist radiographs were positively correlated with hip and lumbar spine BMD measurements. This technique is suggested as a rapid, inexpensive, and sensitive method for predicting osteoporosis. Level of evidenceDiagnostic II

Comparison of Intravenous Regional Anesthesia with Single-Cuff Forearm Tourniquet and Hematoma Block and Traditional Method in Patients with Distal Radius Fractures; A Randomized Clinical Trial.

Objective:To investigate the effect of intravenous regional anesthesia with single-cuff forearm tourniquet and hematoma block on intraoperative and postoperative pain intensity of patients with distal radial bone fracture.Methods:In this randomized clinical trial, a total number of 52 patients with distal radius fractures were randomly assigned to receive either a traditional Bier block with 3 mg.kg-1 lidocaine (D group) or a single-cuff forearm tourniquet intravenous regional anesthesia with 1.5 mg.kg-1 lidocaine and a hematoma block with 10 mL 0.5% bupivacaine (S group). Pain intensity score of numerical rating scale (NRS) was measured hourly for 6 hours, then every two hours till 12th hour and every 4 hours until 24th postoperative hour. Total morphine consumption in the first 24 hours after surgery, its side effects and the patients’ global satisfaction were assessed in each group.Results:Mean total morphine consumption during the first 24 hours after surgery was 11.68±7.88 mg in group D and 7.12±4.42 mg in group S (p=0.13). Pain intensity score of NRS both during recovery room and surgical ward stay was less in S group compared to D group (0.016 and 0.02, respectively).Conclusion:Intravenous regional anesthesia with single cuff forearm tourniquet and hematoma block compared to the traditional Bier block reduced intraoperative and postoperative pain intensity more effectively in patients with distal fracture of the radius bone and also reduced morphine consumption during the first 24 hours after surgery.

Ipsilateral elbow and distal radial injuries: Experience with management

Simultaneous occurrence of injury to ipsilateral distal humerus/elbow and distal radial and/or radioulnar bone at wrist is extremely uncommon. Most of the textbooks do not mention this combination of injury. This fracture combination was studied in 42 children as a multicentric study where the peak age incidence was 10 years (range: 6–15 years); injury was common in males and on the right side in most of the cases. Open fractures were seen in 12 cases where injury resulted due to fall from height on an outstretched hand. Thirty of these injuries were treated conservatively and 12 by surgery. The study discusses the problems in management and complications observed thereof. A flowchart has been recommended based on experience.

ЕNDOPROSTHESIS AFTER FRACTURE OF PROXIMAL HUMERUS IN ELDERLY PATIENTS – 3-YEAR EXPERIENCE

The proximal humerus is the third most common fracture location in elderly patients after the proximal femoral bone and the distal radial bone. In order to restore the anatomy and bring it as close to normal as possible, blood reposition with internal fixation is a method of choice for unstable fractures. However, surgical treatment is difficult and problematic because of disturbed approach to the fracture and the large fragmentation of pieces. A proximal shoulder bone fracture, which disturbs blood supply of the humeral head, may require placement of prosthesis. Hemiarthroplasty is a logical attitude in such cases, but analysis of functional results and complications has identified a certain number of risk factors limiting indications. Strict analysis of patient characteristics and of fracture type is an essential prerequisite to deciding against treatment by immobilization or osteosynthesis. Results in hemiarthroplasty are primarily dependent on respecting the rules of the art, which aim at stable anatomic osteosynthesis of the surrounding structures so as to restore normal shoulder function. The critical steps are the adjustment of implant height and retroversion, reduction and fixation of tuberosities and good management of the postoperative course. The recent development of fracture-dedicated shoulder implants should improve results. In elderly patients, when local conditions are unsuitable to hemiarthroplasty, a reverse prosthesis may be used, with an adapted surgical technique. Whatever the type of prosthesis, implantation for proximal humerus fracture is a demanding operation with definitive impact on the functional evolution of the shoulder. Following reports of results for shoulder prosthesis in proximal humerus fracture from 1970, several attempts were made to reproduce the encouraging initial findings. Most found good results in terms of pain, but much less satisfactory functional outcome. Analyzing the causes of failure identified risk factors and enabled solutions to be suggested. Among these, one of the first was to select indications, eliminating baseline situations of poor prognosis. Following good results reported in arthropathy involving rotator cuff tear and in revision of hemiarthroplasty for fracture, reverse prostheses were recommended as an alternative attitude in case of proximal humerus fracture in elderly subjects. This particular indication is currently under assessment.This article presents results of a 3-year experience in shoulder endoprothesis after fracture of proximal humerus in elderly patients at Orthopaedics and Traumatology Department, St. Anna General Active Treatment Hospital – Varna, between 2016 and 2018. In this time period, 79 shoulder endoprothesis have been implanted, 68 of which have been actively and carefully observed in the first 12 months of the post-surgery recovery. For the treatment of functional results was utilized Constant Shoulder Score (CSS) that aided following patients’ condition, pain levels, as well as functioning and shoulder movements. Results suggest that in the time span of one year, 51% of the patients show excellent overall recovery state and 38% are in good overall recovery state. These fine results of post-surgery shoulder functioning are in large part due to precise surgery techniques and detailed pre-surgical diagnosis and planning.

Is Dual Energy X-ray Absorptiometry of the Distal Radial Bone a Valid Osteoporosis Screening Test?

骨粗鬆症の診断において二重エネルギーX線吸収法（DXA）での骨密度（BMD）測定は腰椎と大腿骨近位で行うことが推奨されているが、健診の現場では橈骨遠位部で行うことも多い。そこで、健診における骨粗鬆症スクリーニングとしての橈骨DXAの妥当性について検討した。検討対象は2014年10月から2017年11月の期間に健診の橈骨DXAで要精検となり、1年以内に腰椎と大腿骨のDXAを行った49～87歳の女性30名である。同一DXA装置で橈骨遠位部1/3、腰椎、大腿骨近位部のBMDを測定し、若年成人平均値に対する％値でそれぞれの較差と相関を検討した。橈骨と腰椎および橈骨と大腿骨の％YAMには有意な相関があった（r＝0.6055，p＝0.0004およびr＝0.5490，p＝0.0017）が、橈骨と腰椎の％YAMには－10.1ポイント（p＜0.0001、95％信頼区間－13.8～－6.5）の、橈骨と大腿骨では－9.5ポイント（p＜0.0001、95％信頼区間－13.3～－5.8）の有意な較差が認められた。腰椎と大腿骨を標準とした場合、偽陽性率は33％と23％となる。一方、腰椎と大腿骨では有意差は認めなかった。橈骨％YAMが低値であった原因のひとつに偽陰性例が対象に含まれなかったことが考えられた。FRAXによる骨折リスクと橈骨の％YAMの相関は腰椎、大腿骨と同程度であった（それぞれr＝－0.6292，－0.5498，－0.5864）。以上より、骨粗鬆症による腰椎や大腿骨頸部の脆弱性骨折リスクのスクリーニング画像検査は腰椎・大腿骨近位部のDXAがgold standardであるが、橈骨DXAも偽陽性・偽陰性の可能性に留意して実施する限りは有用であると思われた。

Sexual Dimorphism in Cortical and Trabecular Bone Microstructure Appears During Puberty in Chinese Children.

Distal forearm fractures during growth are more common in males than females. Because metaphyseal cortical bone is formed by coalescence of trabeculae emerging from the periphery of the growth plate, we hypothesized that the later onset of puberty in males produces a longer delay in trabecular bone formation and coalescence, which leaves a transient phase of high cortical porosity, low matrix mineral density, and high trabecular density relative to females. We quantified the nondominant distal radial microstructure using high-resolution peripheral quantitative computed tomography in 214 healthy Chinese boys and 219 Chinese girls aged between 7 and 17 years living in Hong Kong. Measurements of 110 slices (9.02 mm) were acquired 5 mm proximal to the growth plate of the nondominant distal radius. Porosity was measured using StrAx1.0 (Straxcorp, Melbourne, VIC, Australia) and trabecular plate and rod structure were measured using individual trabecula segmentation (ITS). Mechanical properties were estimated using finite element analysis (FEA). Results were adjusted for age, total bone cross-sectional area (CSA), dietary calcium intake, and physical activity. In boys, total bone CSA was 17.2% to 22.9% larger throughout puberty, cortical/total bone CSA was 5.1% smaller in Tanner stage 2 only, cortical porosity was 9.4% to 17.5% higher, and matrix mineral density was 1.0% to 2.5% lower in Tanner stage 2 to 5, than girls. Boys had higher trabecular rod BV/TV in Tanner stage 3 and 4, but higher trabecular plate BV/TV and plate to rod ratio in Tanner stage 5, than girls. Boys had 17.0% lower apparent modulus than girls in Tanner stage 2. A transient phase of higher porosity due to dissociation between bone mineral accrual and linear growth may contribute to higher distal radial bone fragility in Chinese boys compared to girls. © 2018 American Society for Bone and Mineral Research.

Comparing the effectiveness of mobilization techniques with movement and myofascial techniques in patients following distal radius fractures treated conservatively

Introduction: Fractures of the distal radius are one of the most common types in the upper limb area. They lead to significant reduction in range of mobility, muscle weakness and the occurrence of serious pain. Material and methods: The research involved 20 patients from the Specialist Hand Rehabilitation Centre in Krakow, who were rehabilitated after fractures to the distal radial bone. They were randomly divided into two groups. In group A (n = 10), there were patients who underwent mobilization techniques with movement according to the Mulligan concept as part of their manual work. Group B (n = 10) consisted of patients subjected to myofascial techniques. Functional examination of the hand was carried out twice before and after beginning rehabilitation. The range of active mobility, muscle strength and superficial feeling were examined. Based on the obtained results, functional loss was calculated according to Swanson’s method, Total Active Motion and the sensory index. The obtained results were subjected to statistical analysis using the Excel 10 programme. Results: Significant improvement in hand and muscle strength was noted in both groups. In the group of patients treated with myofascial techniques, better rates of improvement for the tested parameters were obtained than in the group treated with the use of joint mobilization techniques. Conclusions: 1. The applied programme of rehabilitating patients following fracture of the distal radial bone is characterized by statistically significant improvement in hand function. 2. The use of soft-tissue techniques is a more effective method of hand function restitution than the method of mobilization with movement. myofascial techniques, forearm fractures, physiotherapy

Premenopausal women with early breast cancer treated with estradiol suppression have severely deteriorated bone microstructure

BackgroundIn premenopausal women with early estrogen-receptor-positive breast cancer, combined ovarian suppression and aromatase inhibition reduce estradiol production precipitously. The resulting unbalanced and rapid bone remodelling replaces older bone with less bone that is less fully mineralized. We hypothesized that these changes result in severe microstructural deterioration and reduced matrix mineralization density. MethodsImages of the distal radius and distal tibia were acquired using high-resolution peripheral quantitative computed tomography in a cross-sectional study of 27 premenopausal women, mean age 43.3years (range 30.4 to 53.7) with early breast cancer made estradiol deficient for 17months (range 6–120) using ovarian suppression and aromatase inhibition, 42 healthy age-matched premenopausal and 35 postmenopausal controls, mean age 62.6years (range 60.2 to 65.5). Cortical and trabecular microstructure were quantified using Strax software. ResultsCompared with premenopausal controls, the women with breast cancer had 0.75 SD (95% CI 0.21 to 1.29) lower distal radial trabecular bone volume due to 1.29 SD (0.71 to 1.87) fewer trabeculae. Cortical porosity was 1.25 SD (0.59 to 1.91) higher but cortical thickness was not reduced. Compared with postmenopausal controls 20years older, cases had comparable or lower trabecular bone volume and comparable cortical porosity and thickness. Matrix mineral density was 1.56 SD (0.90 to 2.22) lower than in premenopausal controls and 2.17 SD (1.50 to 2.84) lower than in postmenopausal controls. Results at the tibia were similar. ConclusionThe severe cortical porosity and trabecular deterioration associated with estradiol depletion and the longevity of premenopausal women with early breast cancer treated with endocrine therapy provide a compelling rationale to investigate the efficacy of antiresorptive therapy initiated at the time of breast cancer treatment.

Lower leg arterial calcification assessed by high-resolution peripheral quantitative computed tomography is associated with bone microstructure abnormalities in women.

Here, we report the relationships of bone geometry, volumetric bone mineral density (BMD) and bone microarchitecture with lower leg arterial calcification (LLAC) as assessed by high-resolution peripheral quantitative computed tomography (HR-pQCT). We utilized the Hertfordshire Cohort Study (HCS), where we were able to study associations between measures obtained from HR-pQCT of the distal radius and distal tibia in 341 participants with or without LLAC. Statistical analyses were performed separately for women and men. We used linear regression models to investigate the cross-sectional relationships between LLAC and bone parameters. The mean (SD) age of participants was 76.4 (2.6) and 76.1 (2.5) years in women and men, respectively. One hundred and eleven of 341 participants (32.6%) had LLAC that were visible and quantifiable by HR-pQCT. The prevalence of LLAC was higher in men than in women (46.4% (n = 83) vs. 17.3% (n = 28), p < 0.001). After adjustment for confounding factors, we found that women with LLAC had substantially lower Ct.area (β = -0.33, p = 0.016), lower Tb.N (β = -0.54, p = 0.013) and higher Tb.Sp (β = 0.54, p = 0.012) at the distal tibia and lower Tb.Th (β = -0.49, p = 0.027) at the distal radius compared with participants without LLAC. Distal radial or tibial bone parameter analyses in men according to their LLAC status revealed no significant differences with the exception of Tb.N (β = 0.27, p = 0.035) at the distal tibia. In the HCS, the presence of LLAC assessed by HR-pQCT was associated with relevant bone microstructure abnormalities in women. These findings need to be replicated and further research should study possible pathophysiological links between vascular calcification and osteoporosis.

Bone Microarchitecture in Men and Women with Diabetes: The Importance of Cortical Porosity.

High-resolution peripheral quantitative computed tomography (HR-pQCT) captures novel aspects of bone geometry, volumetric bone mineral density and offers the ability to measure bone microarchitecture, but data relating measures obtained from this technique to diabetic status are inconsistent in women and lacking in men. Here, we report an analysis from the Hertfordshire Cohort Study, where we were able to study associations between bone microarchitecture from HR-pQCT of distal radius and distal tibia in 332 participants (177 men and 155 women) aged 72.1-81.4years with or without diabetes mellitus (DM); n=29 (18 men and 11 women) and n=303, respectively. Statistical analyses were performed separately for women and men. The mean (SD) age of participants was 76.4 (2.6) and 76.1 (2.5) years in women and men, respectively. Participants with DM differed significantly in terms of weight in both women (70.4±12.3 vs. 80.3±18.3kg; p=0.015) and men (81.7±11.4 vs. 92.8±16.3kg; p<0.001) but no differences were found in height, smoking status, alcohol intake, social class and physical activity among women or men. Analyses in women revealed that cortical pore volume (Ct.Po.V) was higher in participants with DM and close to statistical significance for cortical porosity (Ct.Po) (β=0.76 [0.12, 1.41] z-score, p=0.020 and β=0.62 [-0.02, 1.27] z-score, p=0.059, respectively) at the distal radius. Adjustment for weight did not materially affect the relationship described for Ct.Po.V (β=0.74 [0.09, 1.39], p=0.027) and Ct.Po (β=0.65 [-0.01, 1.30], p=0.053) at the distal radius. After adjustment for weight, analyses in men revealed that Ct.Po and Ct.Po.V were higher in participants with DM (β=0.57 [0.09, 1.06] z-score, p=0.021 and β=0.48 [0.01, 0.95] z-score, p=0.044, respectively) at the distal tibia. Analyses of distal radial and tibial trabecular bone parameters according to diabetic status revealed no significant differences among men or women after adjustment for weight. We found higher cortical porosity and cortical pore volume at the distal tibia in men with DM and higher cortical pore volume at the distal radius in women with a non-significant tendency for higher cortical porosity. The results of our study suggest that deficits in cortical bone exist both in older men and women with DM.

Correlation Between Distal Radial Cortical Thickness and Bone Mineral Density

To determine interobserver reliability in measuring the cortical thickness of distal radiuses on posteroanterior radiographs obtained at the time of injury and to determine whether there is a correlation between distal radius cortical thickness and hip and lumbar spine scores on dual-energy x-ray absorptiometry (DXA). Four orthopedic surgeons at 2 academic institutions who were blinded to the study protocol reviewed standard posteroanterior wrist radiographs of 80 women over age 50 years with distal radius fractures with DXA data obtained within the past 2 years. Radial bicortical widths were measured at 50 and 70 mm proximal to the distal ulnar articular surface, and mean bicortical thickness was calculated from radiographs of the injured wrist. Average bicortical width was compared with each patient's femoral and lumbar spine bone density measures. Data were analyzed using Pearson correlation coefficients and simple linear regression. Inter-rater reliability was evaluated using intra-class correlation coefficients. The inter-rater reliability for average bicortical thickness had a high intra-class correlation coefficient value of 0.91. Average bicortical thickness showed a statistically significant positive relationship with femoral bone density. Average bicortical thickness was statistically correlated with femoral bone density values, with a 1-mm increase in average bicortical thickness associated with a 0.05 g/cm(2)-increase in femoral density. Average bicortical thickness was not associated with lumbar bone density. Bicortical thickness of the distal radius was positively correlated with femoral bone density but not with lumbar spine density. This may reflect similarity in quality and loading properties of the femur and radius as appendicular bones, compared with the axial spine. Identification of thinned distal radial cortices in association with distal radius fracture is a simple qualitative observation that should prompt further evaluation with DXA and medical management of bone insufficiency. Diagnostic II.

Equine Articular Cartilage Stiffness Determination Using Indentation

In order to determine that the stiffness varies between different joint types, an indentation test was performed on fresh equine articular cartilage surfaces from the fetlock, carpal, and stifle joints. The results demonstrated that the stiffness varies on different joints showing different mechanical behaviors. A flat-ended cylindrical indenter is lowered at a constant rate for 20 s until the indentation depth reaches 0.2 mm (velocity of 10 μm/s). It was shown that the articular cartilage of the fetlock is stiffer than the carpal and stifle joints. The average stiffness of the fetlock, carpal, and stifle joints are 46.1 N/mm, 20.5 N/mm, and 2.73 N/mm, respectively. The coefficients of a fit for the joints were statistically compared as well using the student t-test. The differences of some coefficients between the fetlock, carpus, and stifle were “very highly significant” (p &lt; 0.001). Four different surfaces in the fetlock and four in carpal joint were compared as well. The front lateral, front medial, rear lateral, and rear medial cartilage surfaces in the fetlock were not significantly different in stiffness. In the carpus, the distal radius and proximal radial carpal bone articular cartilage surfaces showed significantly different stiffness from the others, while the distal radial carpal bone and proximal third carpal bone articular cartilage surfaces possessed similar stiffness values. The cartilage surfaces from the radiocarpal joint were stiffer than the midcarpal joint. Clear trends in the correlations between stiffness and weight as well as stiffness and age of the horse were not observed.

Comparison of equine articular cartilage thickness in various joints

Purpose: Thicknesses of fresh equine articular cartilage surfaces from the fetlock, carpal and stifle joints were measured employing a needle probe test.Materials and methods: Eighty-seven samples used in measurement were cultivated from fetlock, carpal and stifle joints of 12 deceased within 4 h of death. After approximately three minutes of exposure to air during dissection, all cartilage samples were preserved in a saline solution to keep the articular cartilage hydrated for testing. The thickness was measured on five different spots on the same sample. The thicknesses of the fetlock, carpus and stifle were compared.Results: The articular cartilage of the stifle was thicker than the fetlock and carpus, while the fetlock and the carpus had similar thickness values. The average thickness of the fetlock, carpal and stifle joint are 0.86, 0.87 and 2.1 mm, respectively. They were statistically compared using the Student t-test. The differences on the articular cartilage thicknesses between the fetlock and stifle, and carpus and stifle were “very highly significant” (p < 0.001). This indicates that the articular cartilage thickness of the stifle is significantly different from that of the fetlock and carpus. Four different surfaces in the fetlock and four in the carpal joint were also compared. Significant differences between each set of the four surfaces were not observed. In the carpus, the difference in thickness between the distal radius and proximal third carpal bone articular cartilage surfaces as well as the proximal radial carpal bone and distal radial carpal bone articular cartilage surfaces were statistically significant.

Jaccoud's Arthropathy with Radial Shaft Deformity in a Patient with a History of Mild Carditis and Sydenham's Chorea

Background: Jaccoud’s arthropathy was first described in 1869 in a patient with recurrent attacks of acute rheumatic fever and recurrent migratory polyarthritis. The typical features include characteristic joint deviation with metacarpophalangeal subluxation, ulnar deviation, swan neck deformity of the fingers, and Z deformity of both thumbs and hook formation and alignment disorders without noticeable erosions on radiographs. In this report, Jaccoud’s arthropathy presenting with deformity of shaft of the radius is described. Case presentation: A 12-year-old-girl was diagnosed to have chorea at the age of 8 years after she presented with irregular, jerky, rapid and involuntary movements that involved the face, the trunk and the distal extremities. She was treated with haloperidol. The chorea resolved after 3 months of treatment. Echocardiogram showed thickening of the mitral valve leaflets and mild mitral regurgitation. Three years later, the child presented with progressive symmetric deformity of the wrist joints. She reported no pain or limitation of movement. On physical examination, there was no cardiac murmur. There was varus deformity of both wrist joints. There was no tenderness or limitation of movement. Anti-streptolysin O was negative at the first presentation and on this visit. Rheumatoid factor was negative but antinuclear antibody test was positive. Echocardiogram showed complete resolution of the mitral regurgitation. X-ray of the wrists showed marked symmetric curving of the distal radius and varus deformity of the wrists. There was joint deviation with metacarpophalangeal subluxation and ulnar deviation of the hand. There was no Z deformity of the thumbs. Conclusion: The common presentation of Jaccould’s arthropathy is involvement of the wrist, metacarpophalangeal joints and joints of the feet. The metacarpal and metatarsal bones are the ones, which are commonly affected. Our patient has an unusual presentation of deformity of the distal radial bone. This has not been described, at least to our knowledge.