Ends Of Bones Research Articles

Antibiotic Impregnated Cement Coated Intramedullary Nailing in the Management of Infected Fractures and Chronic Osteomyelitis of Long Bones

Background: In the era of modern transportation there is an increased incidence of compound fractures especially of long bones. As the skin barrier is broken, the bacteria from dirt, other contaminants can colonize at the wound site and thus can cause infection. Healing at the fracture site and that of soft tissues can be severely compromised by infection. So, treating the infection first followed by definitive fixation of fracture will nearly take 4-6 weeks. The antibiotic nailing technique can thus achieve both the targets in a short time. Local delivery of drug controls the infection and the fixation achieves stability. This even reduces the side effects due to over use of systemic and oral antibiotics. Osteomyelitis is also very common which can be hematogenous or post traumatic. This can weaken the bone and can cause fractures with trivial trauma. Discharging sinuses may also be accompanying. So even in this scenario long term use of antibiotics systemically may be required causing side effects. Antibiotic nailing can be very useful in this scenario. Methods: This is a prospective observational study. 20 patients above age of 20 years who were admitted or on follow up during the period of 2 years were considered for study. The patients with infected fractures with or without implant in situ and patients with chronic osteomyelitis with discharging sinuses were included. ASAMI Criteria: The final outcome is graded based on ASAMI criteria proposed by Paley et al. This was usually developed for determining the outcome after treatment of nonunion with Ilizarov ring fixator. It was applied in our study with some modification. Results: The average duration for achieving bony union was around 5 months (20 weeks). Minimum duration for bony union was around 4 months (16 weeks). Maximum duration for bony union was around 7 months (28 weeks) Average duration for control of infection in case of chronic osteomyelitis was around 4 months. Minimum duration for control of symptoms was 5 months. Maximum duration for control of symptoms was 7 months. Conclusion: Antibiotic impregnated cement coated intramedullary nailing is a very good and effective treatment for infected nonunion and chronic osteomyelitis long bones with bone defect less than 2 cm. In case of infected nonunion, as the bone ends will be sclerosed, freshening of ends and bone grafting is needed.

Inhibition of CX3CL1 by treadmill training prevents osteoclast-induced fibrocartilage complex resorption during TBI healing.

The healing of tendon-bone injuries is very difficult, often resulting in poor biomechanical performance and unsatisfactory functional recovery. The tendon-bone insertion has a complex four distinct layers structure, and previous studies have often focused on promoting the regeneration of the fibrocartilage layer, neglecting the role of its bone end repair in tendon-bone healing. This study focuses on the role of treadmill training in promoting bone regeneration at the tendon-bone insertion and its related mechanisms. After establishing the tendon-bone insertion injury model, the effect of treadmill training on tendon-bone healing was verified by Micro CT and HE staining; then the effect of CX3CL1 on osteoclast differentiation was verified by TRAP staining and cell culture; and finally the functional recovery of the mice was verified by biomechanical testing and behavioral test. Treadmill training suppresses the secretion of CX3CL1 and inhibits the differentiation of local osteoclasts after tendon-bone injury, ultimately reducing osteolysis and promoting tendon bone healing. Our research has found the interaction between treadmill training and the CX3CL1-C3CR1 axis, providing a certain theoretical basis for rehabilitation training.

CONTROLLING CELL ORGANIZATION IN WAVY ELECTROSPUN SCAFFOLDS FOR THE REGENERATION OF THE ANTERIOR CRUCIATE LIGAMENT

The anterior cruciate ligament (ACL) is the connective tissue located at the end of long bones providing stability to the knee joint. After tear or rupture clinical reconstruction of the tissue remains a challenge due to the particular mechanical properties required for proper functioning of the tissue. The outstanding mechanical properties of the ACL are characterized by a viscoelastic behavior responsible of the dissipation of the loads that are transmitted to the bone. These mechanical properties are the result of a very specialized graded extracellular matrix that transitions smoothly between the heterotypic cells, stiffness and composition of the ACL and the adjacent bone. Thus, mimicking the zonal biochemical composition, cellular phenotype and organization are key to reset the proper functioning of the ACL.We have previously shown how the biochemical composition presented to cells in electrospun scaffolds results in haptokinesis, reverting contact-guidance effects.[1] Here, we demonstrate that contact guidance can also be disrupted by structural parameters in aligned wavy scaffolds. The presentation of a wavy fiber arrangement affected the cell organization and the deposition of a specific ECM characteristic of fibrocartilage. Cells cultured in wavy scaffolds grew in aggregates, deposited an abundant ECM rich in fibronectin and collagen II, and expressed higher amounts of collagen II, X and tenomodulin as compared to aligned scaffolds. In-vivo implantation in rabbits of triphasic scaffolds accounting for aligned-wavy-aligned zones showed a high cellular infiltration and the formation of an oriented ECM, as compared to traditional aligned scaffolds.[2]

An Unusual Giant Osteochondroma of Distal Tibia: A Case Report with Literature Review

Introduction: Benign bone tumors like osteochondroma are common during skeletal maturity occurring usually at the ends of long bones, such as the distal femur, proximal humerus, and proximal tibia. The tumor can occur in sessile or pedunculated forms. Mass lesions occurring around the ankle can lead to chronic pain, pathological fractures, progressive erosion, and scalloping of adjacent bone. This report highlights a case of a progressively enlarging bony swelling around the distal tibia with uncommon radiological and histological presentation managed with en bloc excision. Case Report: A 30-year-old male with 3 years of progressive bony enlargement without any history of significant trauma presented to our tertiary care hospital. The radiological and histological investigations were performed and many varied differentials were proposed. The lesion was provisionally diagnosed to be a case of an uncommon form of osteochondroma and en bloc excision was done. The patient followed up for a period of 6 months and the patient had uneventful recovery with no recurrence. Conclusion: Osteochondromas in the distal tibia are infrequent occurrences among common skeletal tumors. Timely surgical intervention is recommended for symptomatic lesions or those causing compression or mass effects. Keywords: Osteochondroma, distal tibia, benign, tumor, fibular deformation, bizarre parosteal osteochondramatous proliferation.

Dilemma of Antemortem and Post-mortem Fracture: A Brief Research

The major duties of a medicolegal system in handling deaths falling under its jurisdiction are to determine the cause and manner of death, identify the deceased if unknown, determining the time of death and injury, collecting evidence from the body that can be used to prove or disprove an individual's guilt or innocence and to confirm or deny the account of how the death occurred, documenting injuries. However, the most important query that is to be solved during autopsy is to designate an injury as either post-mortem or antemortem. Five cases are discussed here to differentiate antemortem and post-mortem injury. There are various permutations and combinations that makes it difficult to designate an injury antemortem. Even when an injury is antemortem, one couldn't find the properties of it due to the dynamic process of sustaining an injury. Infiltration of blood in the fractured ends of bones is a process that needs time to appear and depends on the severity of injuries sustained over the body. If the process of sustaining the injuries is sudden and there is rupture of greater blood vessels, one cannot find any infiltration of blood in the bony trabeculae on autopsy.

Treatment of Infected Nonunion of Fracture of the Proximal Third of Tibia Using Ilizarov Ring Fixator: A Case Series

Abstract Introduction: Nonunions (NUs) of the fractured proximal third of the tibia are challenging to manage owing to a capacious canal and scarce anterior soft-tissue cover. Infection further complicates the use of internal fixators in such patients. We present a study of 25 cases of infected NU of the proximal third of the tibia that we treated using the Ilizarov ring fixator over 10 years. Materials and Methods: Twenty-three men and two women with infected NU of the proximal tibial meta-diaphyseal junction were studied. The mean age of the patients was 39.2 years. Treatment involved thorough debridement of the NU site with freshening of the bone ends followed by the application of a 3-ring hybrid Ilizarov construct. The patients were followed at regular intervals to assess the infection control, union, limb function, and complications. Results: Successful union and eradication of infection were achieved in 21 patients. Union was not satisfactory in four cases. The average fixator time was 7.12 months. Average knee flexion of 99.2° was observed. The Association for the Study and Application of the Methods of Ilizarov score was excellent in 56% of cases and good in 28%. Six patients required soft-tissue reconstruction. One patient suffered a fracture at the distal pin site while one had a refracture 4 months after treatment completion. Three patients developed a discharging sinus which required debridement and oral antibiotics. Conclusion: The Ilizarov construct provides multilevel, multidirectional, and multiplanar stability, aiding early mobility. Appropriate case selection, sound soft-tissue reconstruction, robust infection control, and good patient compliance are important for the success of the treatment.

High-Grade Chondrosarcoma of Nasal Septum-A Rare Case Report and Review of Literature

Chondrosarcoma of the nasal septum is a rare malignancy. Since 1927 to date, 69 cases of chondrosarcoma of nasal septum have been reported. In addition to the 70th case, we reported here. Mostly chondrosarcoma is present on the ends of long bones and 5-10% in the head-neck region. In our case, 50 years old female presented a bilateral nasal obstruction, and a biopsy was sent for nasal mass. Histomorphology suggested high-grade chondrosarcoma, which is positive for S-100 immunohistochemistry. Early intervention through radiology and biopsy will manage the patient with chondrosarcoma.

Failure in articular cartilage: Finite element predictions of stress, strain, and pressure under micro-indentation induced fracture

Articular cartilage is found at the distal end of long bones and is responsible for assisting in joint articulation. While articular cartilage has remarkable resistance to failure, once initially damaged, degeneration is nearly irreversible. Thus, understanding damage initiation is important. There are a few proposed mechanisms for articular cartilage failure initiation: (A) a single collagen fibril stress-based regime; (B) a rate-dependent regime captured by brittle failure at slow displacement rates (SDR) and ductile failure at fast displacement rates (FDR); and (C) a rate-dependent regime where failure is governed by pressurization fragmentation at SDR and governed by strain at FDR. The objective of this study was to use finite element (FE) models to provide evidence to support or refute these proposed failure mechanisms. Models were developed of microfracture experiments that investigated osmolarity (hypo-osmolar, normal osmolarity, and hyper-osmolar) and displacement rate (FDR and SDR) effects. Cartilage was modeled with a neo-Hookean ground matrix, strain-dependent permeability, nonlinear fibril reinforcement with viscoelastic fibril terms, and Donnan equilibrium swelling. Total stress, solid matrix stress, Lagrange strain, and fluid pressure were determined under the indenter tip at the moment of microfracture. Results indicated significant rate dependence across multiple outputs, which does not support (A) a single failure regime. Larger solid and fluid pressures at FDR than SDR did not support (C) a rate-dependent regime split by pressurization at SDR and strain at FDR. Consistent solid shear stresses at SDR and consistent third principal solid stresses at FDR support (B) the ductile-brittle failure regime. These findings help to shed light on the underlying mechanisms of articular cartilage failure, which have implications for the development of osteoarthritis.

Homeostatic Regulation of Pro-Angiogenic and Anti-Angiogenic Proteins via Hedgehog, Notch Grid, and Ephrin Signaling in Tibial Dyschondroplasia.

Precise coupling of two fundamental mechanisms, chondrogenesis and osteogenesis via angiogenesis, plays a crucial role during rapid proliferation of growth plates, and alteration in their balance might lead to pathogenic conditions. Tibial dyschondroplasia (TD) is characterized by an avascular, non-mineralized, jade-white "cartilaginous wedge" with impaired endochondral ossification and chondrocyte proliferation at the proximal end of a tibial bone in rapidly growing poultry birds. Developing vascular structures are dynamic with cartilage growth and are regulated through homeostatic balance among pro and anti-angiogenic proteins and cytokines. Pro-angiogenic factors involves a wide spectrum of multifactorial mitogens, such as vascular endothelial growth factors (VEGF), platelet-derived growth factors (PDGF), basic fibroblast growth factor (bFGF), placental growth factors, transforming growth factor-β (TGF-β), and TNF-α. Considering their regulatory role via the sonic hedgehog, notch-gridlock, and ephrin-B2/EphB4 pathways and inhibition through anti-angiogenic proteins like angiostatin, endostatin, decoy receptors, vasoinhibin, thrombospondin, PEX, and troponin, their possible role in persisting inflammatory conditions like TD was studied in the current literature review. Balanced apoptosis and angiogenesis are vital for physiological bone growth. Any homeostatic imbalance among apoptotic, angiogenetic, pro-angiogenic, or anti-angiogenic proteins ultimately leads to pathological bone conditions like TD and osteoarthritis. The current review might substantiate solid grounds for developing innovative therapeutics for diseases governed by the disproportion of angiogenesis and anti-angiogenesis proteins.

Masquelet Technique: Visualization of Cement Spacer Utilizing Methylene Blue

Masquelet Technique: Visualization of Cement Spacer Utilizing Methylene Blue

Comparison of Osteometric Dimensions of Lower end of Femoral Bone by Side of Femur among Bangladeshi Population

Background: Osteometric dimensions of the femoral bone have significant clinical and anthropological implications. However, there is a lack of comprehensive data on these dimensions specific to the Bangladeshi population. This study aims to fill this research gap by analyzing the osteometric dimensions of the lower end of the femoral bone among a sample set in Bangladesh. Methods: This cross-sectional observational study was conducted in three medical colleges in Dhaka, Bangladesh. A total of 50 dried femurs were collected based on specific inclusion and exclusion criteria. Osteometric measurements, including bicondylar width, medial and lateral condylar depths, intercondylar notch width, and intercondylar notch depth, were obtained using digital sliding calipers. Result: The study revealed notable differences in osteometric measurements between right and left femurs. For instance, 39.29% of right femurs had below-average Femoral Bicondylar Width (<65 mm) compared to 13.64% of left femurs. The mean Femur Medial Condylar Width was 31.05 mm with a standard deviation of 1.74 mm. Conclusion: The study provides valuable, region-specific osteometric data that has both clinical and anthropological implications. The findings are particularly important for the preparation of prosthetics and other supporting structures, which can be highly beneficial for both patients and medical practitioners.

Osteometric Dimension of Lower End of Femoral Bone among Bangladeshi Population

Introduction: The osteometric dimensions of the lower end of the femur have significant clinical implications, particularly in the context of total knee arthroplasty (TKA). Accurate measurements are crucial for the design of femoral components in TKA, which can influence surgical outcomes. This study aims to determine the measurements of different variables of the lower end of the femur, including femoral condylar width, intercondylar width and depth, and the depth of the medial and lateral condyles, in a Bangladeshi population. Methods: This cross-sectional study was conducted on 50 dried femurs collected from three medical colleges in Dhaka, Bangladesh. Measurements were obtained using digital sliding calipers and were rounded to two decimal places. Data analysis was performed using SPSS. Result: Statistical analysis revealed that 56% of the femurs were right-sided and 44% were left-sided. The mean femoral bicondylar width was 69.78 ± 5.38 mm, falling mostly in the "Above Average" range (30%). The mean intercondylar width was 23.77 ± 1.55 mm, with 50% falling in the "Medium" range. Other variables like femur medial condylar width had a mean of 31.05 ± 1.74 mm. Conclusion: Observationally, the study successfully delineates the osteometric dimensions of the lower end of the femur in a Bangladeshi cohort. The statistical results not only fulfill the study's initial aim but also provide a nuanced understanding of the osteometric variations. These findings are instrumental for clinicians in the design and customization of femoral components in TKA, thereby potentially enhancing surgical outcomes and patient satisfaction. The data also lay the groundwork for future research in this area.

Prediction of Osteoarthritis in the Knee by KOA Diagnosis Using Artificial Intelligence Based Techniques

Knee Osteoarthritis is the most common form of knee arthritis. A healthy knee's articular cartilage, a smooth, slick tissue, allows for simple bending and straightening. The ends of the leg bones that make up your knee are covered, safeguarded, and cushioned by this material. Two c-shaped segments of meniscal cartilage between your bones serve as "shock absorbers" to cushion your knee joint. Osteoarthritis develops gradually. The cartilage becomes rough and ragged as it ages. It hurts to move the bones along this exposed area. The most prevalent signs and symptoms of knee osteoarthritis are pain and stiffness. After being inactive for a while or in the morning, symptoms typically worsen. The earlier you begin treatment, the better, as osteoarthritis gets worse with time. Your doctor may prescribe additional tests after reviewing your symptoms and medical history, such as X-rays, which can reveal bone and cartilage damage as well as the existence of bone spurs, and magnetic resonance imaging (MRI) scans. So, the KOA diagnosis will be based on two modalities: X-rays and MRIs. Depending upon the patient’s opinion about their knee problems, the doctor will decide whether to take X-rays or MRIs for KOA diagnosis. 
 To avoid such severe knee issues, researchers used many various techniques for KOA diagnosis in the existing system in order to treat it at an early stage of knee problems. In order to do that, we conducted a survey of research articles based on the KOA diagnosis published in the years 2021 and 2022 for this work. From the conducted survey, the methodologies which are AI-based techniques used for KOA diagnosis are discussed and their performance metrics are compared. The current review paper's goal is to do research on the various KOA diagnosis approaches employed in the years 2021 and 2022. As a result of this study, the methodologies which are AI-based techniques used for KOA diagnosis achieves good efficiency in predicting the osteoarthritis in the knee.

A Review of Cyclic Phosphatidic Acid and Other Potential Therapeutic Targets for Treating Osteoarthritis.

Osteoarthritis (OA), a chronic degenerative joint disease, is the most common form of arthritis. OA occurs when the protective cartilage that cushions the ends of bones gradually breaks down. This leads to the rubbing of bones against each other, resulting in pain and stiffness. Cyclic phosphatidic acid (cPA) shows promise as a treatment for OA. In this article, we review the most recent findings regarding the biological functions of cPA signaling in mammalian systems, specifically in relation to OA. cPA is a naturally occurring phospholipid mediator with unique cyclic phosphate rings at the sn-2 and sn-3 positions in the glycerol backbone. cPA promotes various responses, including cell proliferation, migration, and survival. cPA possesses physiological activities that are distinct from those elicited by lysophosphatidic acid; however, its biochemical origin has rarely been studied. Although there is currently no cure for OA, advances in medical research may lead to new therapies or strategies in the future, and cPA has potential therapeutic applications.

Location of Polyelectrolytes in Swollen Lipid Oligobilayers.

Osteoarthritis is caused by degeneration of the cartilage, which covers the bone ends of the joints and is decorated with an oligolamellar phospholipid (PL) bilayer. The gap between the bone ends is filled with synovial fluid mainly containing hyaluronic acid (HA). HA and PLs are supposed to reduce friction and protect the cartilage from wear in joint movement. However, a detailed understanding of the molecular mechanisms of joint lubrication is still missing. Previously, we found that aqueous solutions of HA and poly(allylamine hydrochloride) (PAH), the latter serving as a polymeric analogue to HA, adsorb onto the headgroups of surface-bound 1,2-dimyristoyl-sn-glycero-3-phosphocholine (DMPC) oligobilayers and significantly enhance their stability with respect to shear forces, typically occurring in joint movement. We now investigated the precise location of PAH chains across the lipid films in neutron reflectivity measurements, as bridging of the oligobilayers by polyelectrolytes (PEs) might be the cause for their improved mechanical stability. In a first set of experiments, we used hydrogenated PAH and chain-deuterated DMPC (DMPC-d54) to improve the contrast between the lipids and potentially intruding PAH. However, due to difficulties in distinguishing between incorporation of water and PAH, penetration into the lipid chain region could hardly be proven quantitatively. Therefore, we designed a more elaborate experiment based on mixed films of DMPC-d54 and hydrogenated DMPC, which is insensitive to water penetration into the films. Beside facilitating a detailed structural characterization of the oligolamellar system, this elaborate approach showed that PAH adsorbs to the DMPC heads and penetrates the lipid tail strata. No PAH was found in the lipid head strata, which excludes bridging of several lipid bilayers by the PE chains. The data are consistent with the assumption that PAH bridges are formed between the headgroups of two adjacent bilayers and contribute to the enhanced mechanical stability.

Robust hyperparameter tuned deep Elman neural network for the diagnosis of osteosarcoma on histology images

Osteosarcomas are a type of bone tumour that can develop anywhere in the bone but most typically do so around the metaphyseal growth plates at the ends of long bones. Death rates can be lowered by early detection. Manual osteosarcoma identification can be difficult and requires specialised knowledge. With the aid of contemporary technology, medical photographs may now be automatically analysed and categorised, enabling quicker and more effective data processing. This paper proposes a novel hyperparameter-tuned deep learning (DL) approach for predicting osteosarcoma on histology images with effective feature selection mechanism which aims to improve the prediction accuracy of the classification system for bone tumor detection. The proposed system mainly consists of ‘6’ phases: data collection, preprocessing, segmentation, feature extraction, feature selection, and classification. Firstly, the dataset of histology images is gathered from openly available sources. Then Median Filtering (MEF) is utilized as the preprocessing step that enhances the quality of the input images for accurate prediction by eliminating unwanted information from them. Afterwards, the pre-processed image was segmented using Harmonic Mean-based Otsu Thresholding (HMOTH) approach to obtain the tumor-affected regions from the pre-processed data. Then the features from the segmented tumor portions are extracted using the Self-Attention Mechanism-based MobileNet (SAMMNet) model. A Van der Corput sequence and Adaptive Inertia Weight included Reptile Search Optimization Algorithm (VARSOA) is used to select the more relevant features from the extracted features. Finally, a Hyperparameter-Tuned Deep Elman Neural Network (HTDENN) is utilized to diagnose and classify osteosarcoma, in which the hyperparameters of the neural network are obtained optimally using the VARSOA. The proposed HTDENN attains the higher accuracy of 0.9531 for the maximum of 200 epochs, whereas the existing DENN, MLP, RF, and SVM attains the accuracies of 0.9492, 0.9427, 0.9413, and 0.9387. Likewise, the proposed model attains the better results for precision (0.9511), f-measure (0.9423), sensitivity (0.9345) and specificity (0.9711) than the existing approaches for the maximum of 200 epochs. Simulation outcomes proved that the proposed model outperforms existing research frameworks for osteosarcoma prediction and classification.

Wedgeless V-Shaped Osteotomy of the Distal Medial Femur with Locking Plate Fixation for Correction of Genu Valgum in Adolescents and Young Adults.

Genu valgum is a common disorder affecting adolescents and young adults. Treatment of this disorder requires restoration of normal mechanical axis alignment and joint orientation, for which it is important to assess whether the deformity arises from the distal femur, knee joint, or proximal tibia. Most commonly, the deformity originates from the distal femur, and various osteotomies of the distal femur have been described1-6. The presently described wedgeless V-shaped osteotomy7,8 is a good option among the various alternative procedures listed below. The anesthetized patient is placed in the supine position on a radiolucent operating table. A bolster is placed beneath the knee to relax the posterior structures. A medial longitudinal skin incision is made that extends from the level of the medial joint line to 5 cm proximal to the adductor tubercle. The vastus medialis is identified and elevated anteriorly by detaching it from its distal and posterior aspects. The leash of vessels underneath the vastus medialis is identified, and the apex of the V-shaped osteotomy is kept just proximal to it. The anterior arm of the V is kept longer than the posterior one, both of them are kept perpendicular to each other, and the apex of the V is made to point distally. The osteotomy is performed on the medial cortex with use of an oscillating saw or multiple drill holes that are then connected using a thin osteotome. Care is taken not to utilize a saw or drill on the lateral cortex. A gentle valgus thrust is applied to break the lateral cortex without periosteal disruption. The apex of the V osteotomy on the proximal fragment is trimmed, and the deformity is corrected with varus force. The osteotomy site is stabilized with use of an anatomically contoured distal medial femoral locking plate or a medial proximal tibial L-shaped buttress plate (of the contralateral side). The implant position is verified under a C-arm image intensifier. The wound is closed in layers over a suction drain in a standard manner. Various types of corrective osteotomies of the distal femur have been described in the literature, including the lateral opening wedge, medial closing wedge, dome, and spike osteotomies1-6. All of these procedures have certain limitations and shortcomings. The wedgeless V-shaped osteotomy is another described procedure that is inherently stable7,8. It is a safe procedure and yields good clinical outcomes8,9. The posterior arm of the V-shaped osteotomy is kept smaller than the anterior arm. The proximal cortical bone is allowed to dig into the cancellous bone of the wider distal metaphysis during deformity correction. Trimming the apex of proximal bone end after making the osteotomy facilitates the process. In a study of 46 patients with a mean age of 16.9 years (range, 15 years to 23 years), Gupta et al.8 reported that the mean radiographic tibiofemoral angle improved from 22.2° (range, 16° to 29°) preoperatively to 5.1° (range, 0° to 10°) postoperatively (p < 0.001). Similarly, the mean lateral distal femoral angle improved from 79.2° preoperatively to 89.1° postoperatively (p < 0.001) and the mean mechanical axis deviation improved from 19.6 mm preoperatively to 3.7 mm postoperatively (p < 0.001). A total of 44 of 46 cases had an excellent functional outcome, with the other 2 having good outcomes. None of the patients in the study had an unsatisfactory outcome. It is important to keep the whole lower limb accessible to the image intensifier intraoperatively.Identification of the leash of vessels underneath the vastus medialis is important to decide the level of the osteotomy.It is important to preserve the periosteal sleeve on the lateral aspect of the femur. CORA = center of rotation of angulationECG = electrocardiogramLDFA = lateral distal femoral angleMAD = mechanical axis deviationMPTA = medial proximal tibial angle.

Predictive accuracy of ultrasonography on upper ends of radius and ulna in age estimation in a sample of Egyptian population

Background Forensic age estimation is considered a prime focus of forensic anthropological analysis of living and human skeletal remains. Aim This study aimed to assess the accuracy of ultrasonography (US) in bone age estimation and to compare the predictability of age detection using ultrasound on the upper ends of the radius and ulna in a sample of Egyptian population. Patients and methods This cross-sectional study was conducted on 111 Egyptian volunteers of both sexes aged from 10 to 25 years old and subjected to the sonographic examination of the elbow joint. The volunteers were grouped into three age groups: group 1 (from 10 up to &lt;12 years), group 2 (from 12 up to 16 years), and group 3 (&gt; 16 up to 25 years). Results There was no statistically significant difference between both sexes concerning the age groups suggested by the stage of the epiphyseal union of the upper ends of the radius and ulna detected by US examination. The Kappa agreement test showed that there was a good agreement between the age estimated by the US examination based on the stage of the epiphyseal union of proximal ends of radius and ulna and the official age (Kappa=0.756, and 0.630, respectively). Conclusion US can be used as a suitable alternative modality for age estimation. The studied bone ends showed good agreement between the official age and the US estimated age. The proximal radius was with the highest agreement.

C2 Odontoid Fracture Associated with C1-C2 Rotatory Dislocation: A Retrospective Analysis of 2 Surgical Techniques

Odontoid fractures in association with a C1-C2 rotatory luxation reports are seldom found in the literature. The fusion between the lateral mass of C1 and C2 could be of interest to ensure adequate treatment in these particular cases. We report 23 cases where there was coexistence of an odontoid fracture and rotatory subluxation, which were treated surgically using cages between C1 and C2 or just traditionalGoel-Harmstechnique. Weevaluated the radiologic fusion rate, reoperation rate, and complications. This was a single-center, retrospective, cohort study of patients with C2 fractures (mixed type and C1-C2 rotatory luxation according to the Fielding classification) who were treated surgically. Radiologic computed tomography scans were used to assess fusion (presence of bridging trabecular bone end plate or pseudoarthrosis) between 6months and 1.5years after the surgery. Twenty-three patients were diagnosed with C2 fractures and C1-C2 rotatory luxation that were treated surgically and were suitable for the analysis; 11 patients underwent C1-C2 fusion with intra-articular cages, and 12 underwent a classical Goel-Harms technique. The fusion rate at the C1-C2 joint was higher in the cages group. Only 12 patients exhibited fusion at the level of the odontoid fracture. C2 fractures associated with C1-C2 rotatory dislocation are rare. The fusion rate at the level of the odontoid in these patients appears to be lower than that reported in patients without rotatory dislocation. It may be of special interest to obtain a clear fusion at the C1-C2 joint, where this type of implant seems to offer an advantage.

Pengaruh Edukasi Manajemen Patah Tulang Terhadap Pengetahuan Pasien Di Ruang Bedah Rumah Sakit Umum Cendrawasih Dobo

Fractures can occur with broken bones where the bone can remain in a closed fracture or outside the skin in open fractures. Fractures of the sharp ends of bones can cause harm to the soft tissues, usually the muscles surrounding the bones are more or less damaged. The nerves and blood vessels that run near the bones can also be injured (Sudiharto, 2020). The purpose of this activity is to provide health education to inpatients who experience fractures at the Cendrawasih Dobo General Hospital so that patients and their families understand fracture management quickly and accurately. The method of implementing this activity is health counseling to patients and their families who experience fractures at the Cendrawasih General Hospital in Dobo. Participants who were seen in this activity were fracture patients and their families at Cendrawasih Dobo General Hospital, totaling 10 people. Based on this community service activity, it can be seen that this activity can increase patient and family knowledge in health counseling related to fracture management.