Ends Of Long Bones Research Articles

DISTAL TIBIA INTEROSSEOUS OSTEOCHONDROMA WITH FIBULA DEFORMITY

Osteochondroma, one of the commonest bone tumors, is a cartilage capped exostosis. It occurs commonly in rapidly growing ends of long bones. It’s rare in slowly growing regions of long bones. Osteochondroma present in distal tibial interosseous border causing fibular deformity is very uncommon. Osteochondroma is usually managed conservatively till the age of skeletal maturity, but distal tibial osteochondromas are managed surgically to prevent deformity, impending fibula fracture, ankle pain, syndesmotic injury irrespective of skeletal maturity. It is a case report of an 18-year-old male with gradually increasing, painless mass at the distal leg for 6 years, increasing bowing deformity since 2 years with no functional limitations. Clinical and radiological findings were consistent with distal tibial osteochondroma with deformity of the adjoining fibula. Exostosis was excised successfully leaving a thin deformed distal fibula. The result was painless, stable, and non-progressive residual ankle deformity. Histopathology confirmed the diagnosis with no malignant transformation.

Wing and leg bone microstructure reflects migratory demands in resident and migrant populations of the Dark‐eyed Junco (Junco hyemalis)

Migration is the primary strategy that temperate birds use to avoid overwintering under harsh conditions. As a consequence, migratory birds have evolved specific morphological features in their wings and skeleton. However, in addition to varying in overall shape and size, bone can also change at the microstructural level by, for example, increasing its thickness. Such changes are critical to preventing fracture and damage under repeated loading (fatigue), yet it is not known whether migratory behaviour influences bone microstructure. To address this gap in the literature, we performed micro‐computed tomography on skeletons of resident and migrant subspecies of the Dark‐eyed JuncoJunco hyemalis. We investigated the differences in the major wing bone, the humerus, and the major leg bone, the femur. In each bone, we studied the microarchitecture of the two types of bone tissue: cortical bone, the thick outer layer of bone; and trabecular bone, which is the porous network of bone tissue at the ends of long bones. We used linear models to quantify morphological features with respect to body mass and migratory behaviour. Humeri from migratory birds were thinner, wider and had higher overall geometric stiffness, i.e. a higher polar moment of inertia, relative to humeri from resident birds. These features may help keep their bones stiff to maintain their increased body mass during migration. In contrast, migrant femora were shorter, thinner and had lower geometric stiffness than femora of residents, potentially to reduce total body mass. Tissue mineral density was lower in both the humerus and the femur of migratory birds. In addition, migratory subspecies had less trabecular bone (lower bone volume fraction) due primarily to a loss of trabecular thickness. Migratory behaviour may thus select for improved stiffness and fatigue resistance in the wing bones and reduced mass of leg bones. Our work demonstrates how important insights into morphological adaptation can be obtained by investigating bone microstructure.

Giant Cell Tumour of Hard Palate and its Surgical Management: Case Report.

The giant cell tumour is a benign but locally aggressive tumour accounting for 5% of all bone tumours typically seen at the metaphyseo-epiphyseal ends of long bones with 1% incidence in skull bones. We are presenting a case report of 40year old female with GCT of hard palate. An initial pre-operative plan was hard palate removal with complete tumour clearance trans-orally with iatrogenic oro-nasal fistula with rehabilitation to be done with obturator for closure of fistula and dentures to aid chewing. However, intra-operatively the surgical plan was revised and the tumour was removed with preservation of party wall mucosa. Thus, we present this case due to its clinical rarity and academic interest.

Composition and structure of human cartilage extracellular matrix: unravelling changes during osteoarthrosis at the nanoscale

Purpose: The articular cartilage is a 2-4 mm thick smooth tissue covering the ends of long bones in the joints. Its extracellular matrix (ECM) contains a significant amount of water (65-75 %wt.), type II collagen fibrils (ca. 20-30 %wt.) and negatively charged aggrecans (ca. 10 %wt.) organized in a peculiar three-dimensional network. Aggrecans only exist as an aggregate within the extracellular matrix (ECM): they are noncovalently attached to another long GAG chain, hyaluronic acid (HA) to form larger aggrecan aggregate.

The epiphyseal secondary ossification center: Evolution, development and function.

Bone age is used widely by pediatricians to assess the skeletal maturity of a child and predict growth potential. This entails measuring the size of secondary ossification centers (SOCs), which develop with age in the ends of long bones, which are initially cartilaginous. However, little is presently known about the developmental biology, evolution and functional role of these skeletal elements. Here, we summarize the knowledge currently available in this area and discuss potential primary functions of the SOC.

Adipose-derived stromal vascular fraction prevent bone bridge formation on growth plate injury in rat (in vivo studies) an experimental research

The growth plate is cartilage tissue found at the end of long bones in children, responsible for longitudinal bone growth. Injuries to the growth plate cartilage often lead to unwanted bony repair, resulting in growth disturbances such as limb length discrepancy and angulation deformity in children. There is currently no clinical treatment that can fully repair an injured growth plate. Tissue engineering is promising for regeneration of growth plate. Adipose-derived stromal vascular fraction highlight the promising potential as tissue engineering therapy for inducing regeneration of injured growth plate and able to reduce the formation of bony repair that can lead to deformity and limb length discrepancy. Using an animal model of growth plate injury, bone bridge formation is evaluated after 28 days using Enzyme-linked Immunoassay, radiology, histopathology and Immunofloresence examination. Radiological analyses performed by evaluation of grey value using ImageJ software and diameter bone bridge measured from the end to end distance between uninjured growth plate evaluated by histopatology examination. Enzyme-linked Immunoassay and immunofloresence are used to evaluate chondrocyte and chondrogenic marker within the defect. The result shows in group with Adipose-derived stromal vascular fraction have a significant lower bone bridge formation compare to positive control group. This current study represents the first work that has utilized this animal model to investigate whether Adipose-derived stromal vascular fraction can be used to initiate regeneration at the injured growth plate.

What Factors Are Associated with Treatment Outcomes of Japanese Patients with Clear Cell Chondrosarcoma?

What Factors Are Associated with Treatment Outcomes of Japanese Patients with Clear Cell Chondrosarcoma?

Giant-cell Tumor of the Metacarpal in a Young Female: A Rare Case Report

Giant-cell tumors (GCTs) or osteoclastomas of the bone are locally aggressive tumors with tendency for local recurrence. The tumors show predilection for women with majority of patients in the third or fourth decades of life. Usually, GCT involves the ends of long bones. The most common sites involved are the distal femur, proximal tibia, distal radius, and the sacrum. Unusual locations such as scapula, skull, and small bones of the hand and feet are involved in approximately 2% of cases. Involvement of metacarpal has been reported in few cases so far. We report a case of GCT in the first metacarpal in a 16-year-old girl. We discuss the clinical, pathological, and radiological features. Awareness of this location is important, and GCT should be included in the differential diagnosis of expansile lesions of the small bones of the hand.

Deep Learning Based High-Resolution Reconstruction of Trabecular Bone Microstructures from Low-Resolution CT Scans using GAN-CIRCLE.

Osteoporosis is a common age-related disease characterized by reduced bone density and increased fracture-risk. Microstructural quality of trabecular bone (Tb), commonly found at axial skeletal sites and at the end of long bones, is an important determinant of bone-strength and fracture-risk. High-resolution emerging CT scanners enable in vivo measurement of Tb microstructures at peripheral sites. However, resolution-dependence of microstructural measures and wide resolution-discrepancies among various CT scanners together with rapid upgrades in technology warrant data harmonization in CT-based cross-sectional and longitudinal bone studies. This paper presents a deep learning-based method for high-resolution reconstruction of Tb microstructures from low-resolution CT scans using GAN-CIRCLE. A network was developed and evaluated using post-registered ankle CT scans of nineteen volunteers on both low- and high-resolution CT scanners. 9,000 matching pairs of low- and high-resolution patches of size 64×64 were randomly harvested from ten volunteers for training and validation. Another 5,000 matching pairs of patches from nine other volunteers were used for evaluation. Quantitative comparison shows that predicted high-resolution scans have significantly improved structural similarity index (p < 0.01) with true high-resolution scans as compared to the same metric for low-resolution data. Different Tb microstructural measures such as thickness, spacing, and network area density are also computed from low- and predicted high-resolution images, and compared with the values derived from true high-resolution scans. Thickness and network area measures from predicted images showed higher agreement with true high-resolution CT (CCC = [0.95, 0.91]) derived values than the same measures from low-resolution images (CCC = [0.72, 0.88]).

Recurrent giant cell tumour of the thoracic spine managed by total en bloc spondylectomy and denosumab therapy: a case report

BackgroundGiant cell tumour (GCT) of the bone is a rare, invasive benign bone tumour, which typically originates in the metaphyseal ends of long bones and rarely in the spine. Here, we report a rare case of recurrent GCT of the thoracic vertebra, which was managed by three-level total en bloc spondylectomy (TES) after denosumab therapy.Case presentationA 50-year-old woman presented with a 2-month history of progressive lower back pain. Magnetic resonance imaging revealed destruction of the T11 vertebra and a soft tissue mass. The patient underwent tumour resection. Computed tomography at the 2-year follow-up revealed relapse of the resected tumour, which had spread to the T12 vertebral body. Subsequently, denosumab therapy was administered to the patient for 1 year. The growth of the tumour was controlled, and its boundary line was clear. Thereafter, TES for the T10-T12 vertebrae was performed, and spinal reconstruction was completed through a one-stage single posterior approach. The patient’s condition improved postoperatively, and no evidence of recurrence of GCT of the bone or spinal deformity was observed at the 32-month follow-up.ConclusionsDenosumab therapy contributed to tumour regression. Three-level TES may be an effective and feasible strategy for managing large recurrent GCTs of the spine after denosumab therapy.

A rare case of hereditary multiple osteochondromas

Five (5) years old male patient came to outpatient department with complain of multiple swelling over chest region with upper extremities. The clinical examination revealed that there is chest multiple mass growth of about 3-4 cm bilaterally each over chest, upper extremities and forehead. The development of multiple benign osteocartilaginous masses (exostoses) begins with the relation with the ends of long bones of the lower limbs such as the femurs and tibias and of the upper limbs such as the humerus and forearm bones with chest region. The patient also had complains of difficulty in eating, finger grips, as well as loss of functional independence. On clinical examination the patient was diagnosed with a rare case of hereditary multiple osteochondromas (HMO).

An Unsual Site about Small Cells Osteosarcoma Parietal Region and Classique Osteosarcoma Occipital Region Mimicking Meningioma with Literature Review Management and Outcome

Introduction: Primary osteosarcoma (OS) is the second most common primary bone malignancy, the first being multiple myeloma. OS occurs in the second decade, with a predilection for ends of long bones. Head and neck involvement is seen in 2-9% with extragnathic craniofacial bones in 1–2% of cases. Small Cell OS (SCO) constitutes 1.3-4% of all OS, skeletal distribution and age range being similar. Materials and Methods: We report two rare osteosarcoma and we done the review of the literature about the management and the outcome about intracranial osteosarcoma in our department of neurosurgery. Results: It is two osteosarcoma cases about a 72-year-old man and one 49-year-old man who both mimiking first meningioma. The first case is an unusual site parietal and the second case is occipital. The both benefited surgery with excision and exam of histology confirm diagnosis. But the first case died 15 days after surgery in intensive unit care and the second cases died after one year, he benefited surgery and chemotherapy. Conclusion: Small cell osteosarcoma (SCO) is an extremely uncommon entity that mainly involves the metaphysics of long bones and, rarely, the skull. Histopathology is the key to establishing the correct diagnosis, including sub typing for appropriate management and prognostication, as radiological features are not specific

Physeal bridges: causes, diagnosis, characterization and post-treatment imaging.

The cartilaginous primary physis, or growth plate, at the end of long bones in children allows for longitudinal bone growth. A variety of insults to the physis can lead to physeal bridge formation, which in turn can lead to limb-shortening and angular deformities. This paper begins with a description of the causes, risk factors and mechanisms by which bridges form. Then it reviews the use of imaging in the diagnosis and characterization of bridges and in the evaluation of treatment and post-treatment complications. It is important for radiologists taking care of children to be aware of the indirect and direct imaging findings of physeal bridges to aid in their diagnosis, to be able to characterize bridges as part of preoperative planning, and to know the imaging finding of post-resection complications.

Functional outcome of limb salvage surgery in gaint cell tumour around knee with mega-endoprosthetic reconstruction

Introduction: Giant cell tumors (GCTs) represent 3-4% of all primary tumors of bone [1]. These tumour are locally aggressive and predominantly affect the ends of long bones (usually the distal femur and proximal tibia) in young adults. The ideal aim in the management of GCT is to eradicate the tumor without sacrificing the joint. Wide resection should be the treatment of choice, especially for situations such as recurrences, pathological fractures and tumors which are frankly malignant tumorAim: To determine the functional outcome and complications of mega endoprosthesis in treatment of gaint cell tumour around knee joinMaterials and Methods: Retrospective study conducted from 2010 to 2016 with age ranging from 16 to 30 years with follow up period- 48 months. All patient with primary GCTs around knee who had met with inclusion criteria underwent surgery. All patient underwent definitive wide local resection and Mega-endoprosthetic reconstruction, Functional outcome was scored by musculoskeletal tumour society scoring (MSTS). Complications related to surgery such as Infection, Aseptic loosening, Dislocation, Skin necrosis and Fractures were evaluated. The diagnosis was based on histopathological features noted on a core biopsy. Patients with a high-grade GCT were subjected to computed tomography of the chest and bone scan for metastatic evaluation.Results: The average MSTS functional score was 75% (Range- 60% to 100%), 4-year survival rate was 100% in our study. Average range of movements at 4 years was 80 (70-90). Among the 8 patients, 2 had complications related to surgery. One had infection which required intravenous antibiotics treatment but infections did not subsided so patient underwent allograft bone transplant with arthrodesis. One had foot drop secondary to common peroneal palsy, Six months post-surgery, he was able to walk with a single crutch and coped well with his foot drop. Conclusions: Wide resection and endoprosthetic replacement should be considered as a preferred treatment option in treatment of aggressive gaint cell tumour around knee joint. Mega-endoprosthetic reconstruction provides good functional outcome in patients with these kind of tumour and can be considered as treatment of choice if and when the limb can be salvageable.

An Unsual Site about Small Cells Osteosarcoma Parietal Region and Classique Osteosarcoma Occipital Region Mimicking Meningioma with Literature Review Management and Outcome

Introduction: Primary osteosarcoma (OS) is the second most common primary bone malignancy, the first being multiple myeloma. OS occurs in the second decade, with a predilection for ends of long bones. Head and neck involvement is seen in 2-9% with extragnathic craniofacial bones in 1–2% of cases. Small Cell OS (SCO) constitutes 1.3-4% of all OS, skeletal distribution and age range being similar. Materials and Methods: We report two rare osteosarcoma and we done the review of the literature about the management and the outcome about intracranial osteosarcoma in our department of neurosurgery. Results: It is two osteosarcoma cases about a 72-year-old man and one 49-year-old man who both mimiking first meningioma. The first case is an unusual site parietal and the second case is occipital. The both benefited surgery with excision and exam of histology confirm diagnosis. But the first case died 15 days after surgery in intensive unit care and the second cases died after one year, he benefited surgery and chemotherapy. Conclusion: Small cell osteosarcoma (SCO) is an extremely uncommon entity that mainly involves the metaphysics of long bones and, rarely, the skull. Histopathology is the key to establishing the correct diagnosis, including sub typing for appropriate management and prognostication, as radiological features are not specific.

Osteopoikilosis

A 39-year-old man presented to the orthopaedic clinic with a 1-month history of sacrococcygeal pain. The patient denied experiencing any other constitutional symptoms and any other disorders, and no history...

A LOW GRADE TUMOR, EXTRA SKELETAL MYXOID CHONDROSARCOMA, WITH METASTATIC POTENTIAL: A CASE REPORT

Extraskeletal Myxoid Chondrosarcoma (EMC) is a rare soft tissue sarcoma of uncertain differentiation characterized by abundant myxoid matrix located in the soft tissues. It affects mainly the soft tissues of the proximal end of long bones. EMC has a male preference, and this occurs in soft tissue area in patients who are more than 40 years old. The present case was 63 year old female diagnosed as EMC on histopathological examination with immuno–histochemical confirmation and after eight months presented with pulmonary and inguinal metastasis. EMC is a rare tumor should be considered in the differential diagnosis of myxoid soft tissue neoplasm. Therefore, a multi-modal approach, having distinct clinical, cytological, histo-pathological, immunohistochemical features and cytogenetics analysis, must be necessary in establishing a more definitive diagnosis, which may finally lead to a more targeted and specific treatment for patients. &#x0D; Keywords: Extraskeletal myxoid chondrosarcoma, Inguinal metastasis, low grade tumor, IHC

ANALYSIS OF GIANT CELL TUMOUR OF BONES: ITS PATTERN, VARIOUS TREATMENT MODALITIES AND THEIR RESULTS

Background: Giant cell tumour is a benign aggressive tumour of bone accounting for 5% of all primary bone tumours with feature of local recurrence, potential for metastasis and malignant transformation and usually seen at the end of long bones after skeletal maturity. The incidence of lung metastases from a histologically-proven GCT ranges from 1% to 9%. The recurrence rate after intralesional curettage without adjuvant therapy is reported to be up to 50%. Extended curettage with use of adjuvents is the treatment of choice for treating the most GCT of bones.&#x0D; Material and method: 25 patients presented with GCTBs included.In all patients standard plain anteroposterior and lateral radiographs of the involved extremity were done.MRI of involved extremity was done in 19 cases. Diagnosis confirmed by biopsy and histopathological examination. The treatment of GCT is directed towards local control without scarifying joint function. This has been traditionally achieved by intralesional curettage with autograft reconstruction by packing the cavity of excised tumour with iliac cortico-cancellous bone. Results: We have treated 25 patients of GCTBs. Females (15) were more commonly affected than male (10). Most common site for GCT was around the knee joint mostly in proximal tibia (6 out of 25). Average range of motion of knee joint was 60 to 112 degree and in wrist joint it was 0 to 45 degree of palmar flexion and 0 to 30 degree of dorsi flexion. Conclusion: We believe that removal of most of tumour mass by extended curettage is very essential step in preventing recurrence and achieving good functional outcome in future.&#x0D; Key words: giant cell tumour of bones, autograft, extended curettage

Relationship between Elastic Module and Porous Structure of Cancellous Bone

Trabecular bone, widely presented in the ends of long bones and chine, is a typically porous structure which provides a multifunction such as light weight, undertaking load, impact energy buffer and hosting marrow cells. The structure of trabecular is a dominant factor for the strength of cancellous bone. The prediction of the trabecular bone’s mechanical properties depending on the trabecular structure is very useful for the diagnosis and treatment of osteoporosis. The object of this study is to establish a relationship between the mechanical properties and topological, morphological parameters of trabecular bone. The 50 3-D data of cancellous bone are selected from the CT images of three caput femurs and disposed in BoneJ, through which the BV/TV, SMI and genus parameters of each samples are obtained. The deformation behaviors of trabecular bone are simulated in ABAQUS through uniaxial compression on the 3-D model derived from stack images. Then linear-regression analyses are conducted on the BV/TV, genus, SMI and apparent Young’s modulus, resulting a high correlation (R^2=0.84) between the Young’s modulus and the hybrid parameter derived from SMI and normalized genus, corresponding to morphological and topological parameter of the samples respectively. The result indicates that it’s promising to establish the relationship between mechanical properties of trabecular bone and their topological and morphological parameters.

Growth Plate Injuries of the Lower Extremity: Case Examples and Lessons Learned.

Background:The presence of growth plates at the ends of long bones makes fracture management in children unique in terms of the potential risk of developing angular deformities and growth arrest.Materials and Methods:We discuss three distinct cases depicting various aspects of physeal injury of the lower extremity in children.Results:The case illustrations chosen represent distinct body regions and different physeal injuries: Salter–Harris II fracture of the distal femur, Salter–Harris VI perichondrial injury of the medial aspect of the knee region, and Salter–Harris III fracture of the distal tibia. The clinical presentation, pertinent history and physical findings, imaging studies, management, and subsequent course are presented.Conclusions:Growth plate injuries of the lower extremity require a high index of suspicion and close monitoring during skeletal growth. Early recognition and proper management of these injuries can minimize long term morbidity. The treatment plan should be individualized after a comprehensive analysis of the injury pattern in each patient. Establishing a long term treatment plan and discussing the prognosis of these injuries with the child's caretakers is imperative.