Ends Of Bones Research Articles

Morphometric Study of Distal End of Humerus Bone in South Indian Population

Morphometric Study of Distal End of Humerus Bone in South Indian Population

Chondroblastoma of bone: case presentation, immunohistochemistry findings and literature review

Chondroblastoma is a rare benign cartilage-producing tu­mor, with an incidence of approximatively 1% of all pri­ma­ry bone tumors. It arises mostly in the second decade of life, affecting mainly the ends of the long tubular bones. We present two cases of chondroblastoma diagnosed and trea­ted in the “Foişor” Orthopedics, Traumatology and Oes­teo­articular TB Clinical Hospital, Bucharest, Romania. The purpose of this study is to contrast two different forms of presentation of the same histologic entity: one case of a 19-year-old male patient with a chondroblastoma lo­ca­ted in the proximal humerus, and the case of a 37-year-old male patient with a chondroblastoma of the cal­ca­neus. The mor­phological fea­tures, radiologic aspects and im­mu­no­his­tochemical stu­dies have been assessed. None of the cases presented with spe­ci­fic radiologic signs for chondroblastoma, both lesions being osteolytic and well-delineated, in favor of a benign en­ti­ty. The classic mor­pho­lo­gical aspects of chondroblastoma re­pre­sen­ted by tumor cells with round poly­gonal shape and nuclei with longitudinal grooves were as­so­cia­ted with variable amounts of chondroid matrix, pe­ri­cellular calcification and few randomly distributed osteo­clast-like giant cells. The im­mu­no­his­to­chemical studies showed the osteoblastic and chon­dro­blastic phenotype of the neoplastic cells, sustained by positivity for CD56 and S100. DOG1, cytokeratin 8/18 and smooth muscle actin (SMA) were also found focally po­si­tive. All cases were treated by curettage with bone graf­ting, without recurrence in the short-term follow-up. Given the nonspecific radiologic findings and the histologic he­te­ro­ge­nei­ty, chondroblastoma is sometimes misinterpreted as a ma­lig­nant tumor, while this neoplastic lesion has a benign be­havior and benefits from conservative surgical treatment only.

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.

Balloon Dilatation Technique for prevention and treatment of soft-tissue invagination in bone transport

Soft-tissue invagination is a common complication during the process of bone transport but lacks the effective methods for the treatment and prevention. The aim of this study is to analysis the effectiveness of a new type of method, Balloon Dilatation Technique (BDT), for the treatment and prevention of soft-tissue invagination. We retrospectively analyzed the clinical data of 17 patients (17 limbs), who underwent the BDT between July 2010 and February 2019. The BDT was used as a prevention role for 11 patients and for 6 patients as a treatment role. For all our patients, a balloon dilatator was surgically implanted in the bone gap. By injection of normal saline, the dilatator was immediately expanded during the surgery in the prevention group or was gradually expanded after surgery in the treatment group. When the saline-filled dilatator was squeezed by the bone ends, the injected saline was evacuated. The removal of the balloon dilatator was performed when the empty balloon impeded bone transport. Patient characteristics, perioperative complications, additional surgical procedures, rate of distraction, and clinical outcomes in the both of groups were recorded. The operation of dilatator implantation was performed alone without other procedures in 2 of the 6 patients in treatment group. Docking site revision was conducted at the time of dilatator removal in all patients. Soft-tissue invagination did not occur in prevention group and was successfully treated in treatment group. No major complications, such as dilatator breakage, neurovascular compromise, deep infection, flap necrosis, or invagination recurrence, were noted in the both of groups. The BDT could be considered to prevent or treat soft-tissue invagination during the process of bone transport. This study provides an effective method (BDT) to dynamically prevent or treat soft-tissue invagination during the process of bone transport. Proper patient selection and correct management of the dilatator are essential when applying this technique. Our clinical experience may contribute to better management of Ilizarov bone transport.

Biomechanical evaluation of the screw preload values used in the plate placement for bone fractures

The purpose of this study is to examine the effects of screw preload values on the bone-plate system. The preload value was taken differently in the literature range from 50 N to 3000 N. These preload value were examined in this study. The finite element method was used to calculate the strain and stress on the models. The long bone, plate and screws were modeled as 3D using CAD software. The finite element models were created using Ansys Workbench software. The convergence and validation study were made for the correct results. The 400 N axial load was applied to the proximal end of bone. The distal end of the bone fixed for boundary condition. The preload values were applied to the screws differently. The results of the finite element analysis were compared and evaluated. The results showed that when the preload values increased, the von Mises stresses and strains on the bone and plate system increased. The critical preload value of the screw is the 500 N. The upper values of this critical value can be damaged bone and plate system. The critical region of the bone is the holes where the screw inserted. In conclusion, the preload values of the screw should not exceed the 500 N for the successful fixation.

GEODE OR SUBCHONDRAL BONE CYST.

Geode or subchondral bone cyst is a lytic lesion in the peri-articular area and this condition is seen as a cyst or cyst erosion in a bone end. Basically, a cyst is lined by epithelium but subchondral bone cyst is not lined by epithelium. Subchondral bone cyst are common in various articular diseases.

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.

Comparison of three different correction trajectories for foot and ankle deformity treated by supramalleolar osteotomy using a novel external fixator.

Based on the principle of distraction osteogenesis, external fixators are widely used in deformity correction of the foot and ankle. In this study, a novel ankle external fixator is proposed to correct complex multiplane deformities, especially for supramalleolar osteotomy to correct distal tibia deformities. The relatively simple structure and fewer struts in the proposed fixator reduce the complexity of adjusting the external fixator. Based on two existing adjustment strategies, a new strategy taking into account the orientation and shortest path of the ankle joint center is proposed, which is named joint adjustment for equal bone distraction. By proposing the inverse kinematic solutions of the novel external fixator, mathematical derivations of the bone trajectory and modelling of the bone shape for the three distraction strategies are performed. The results obtained by comparative analysis indicate that a uniformly spaced path of the ankle joint center can be acquired, and a smooth and uniform correction trajectory of the distal tibia end can be obtained using the new adjustment strategy. It can avoid bone end interference and only generates a maximum deviation 0.66% greater than the currently optimal 1 mm/day. The new strategy can perform multiplane corrections simultaneously, which shortens the correction time and reduces the patient's pain.

Functional and Radiological outcome of Limb Reconstruction system (LRS) in infected nonunion of Tibia

Introduction: Infected non-union of tibial diaphysis has been a challenging problem. Tibia being subcutaneous bone, fracture healing especially following compound fracture with any pre or postoperative infection leads to notorious non union. Though there have been various treatment modalities to deal with the condition, Limb reconstruction system (LRS) provides simple effective and versatile treatment modality where liberal resection of long segment of infected bone, can be reproduced by combining the masquelet technique with the distraction osteogenesis. It’s light weight and allows better wound management, makes it more patients compliant. Materials and Methods: In this retrospective study, 20 patients of infected non-union of tibial diaphysis were treated by using the Limb reconstruction system during April 2017 to may 2019 at our institute. The final assessment was done upon only those patients who were followed for at least one year post-operatively, using Association for the Study and Application of Methods of Ilizarov (ASAMI) score. Results: According to ASAMI score, bony results were excellent in 75%, good in10%, fair in 5% and poor in 10% and functional results were excellent in 60%, good in 20%, fair in 10% and poor in 10% of patients. The mean bone resection was 7.3 cm, the mean duration of bone transport was 10.4 weeks, the mean bony union time was 11.1 weeks and the mean duration of consolidation of regenerate was 37.8 weeks. Conclusion: The LRS is simple effective and versatile treatment modality in infected non-union of tibia. Itnot only provides bone transport, fusion of the bone ends and finally consolidation of the regenerate on itself but also facilitates in dealing with limb length discrepancies along with early mobilization and better wound management. Keywords: LRS, Infected non-union, Bone regenerate, Resected bone, ASAMI score.

Morphological and Morphometrical Analysis of Proximal and Distal Ends of Radius Bone and Its Clinical Implications

Morphological and Morphometrical Analysis of Proximal and Distal Ends of Radius Bone and Its Clinical Implications

Bland-Altman Analysis of Different Radiographic Measurements of the Hallux Valgus Angle and the Intermetatarsal Angle After Distal Osteotomy.

ObjectiveThe aim of the present study was to evaluate commonly used approaches for detection of radiographic angles in hallux valgus deformity patients.MethodsThis retrospective study was conducted in patients with hallux valgus deformity at Wangjing Hospital of China Academy of Chinese Medical Sciences from January 2016 to January 2019. The inclusion criteria were: (i) postoperative dorsoplantar weight‐bearing radiographs for the feet of patients with the hallux valgus; (ii) patients had been managed with a distal osteotomy of the first metatarsal and the osteotomized bone ends recovered. The exclusion criteria applied were as follows: (i) age > 65 years or < 18 years old; (ii) blurry image; (iii) previous history of severe foot trauma and surgery. Postoperative radiographs for hallux valgus were analyzed using six methods: by a line drawn through the long axis of the first metatarsal bone (method 1); an extended line drawn to bisect the shaft of the metatarsal at two levels with joined points of bisection (method 2); a line drawn to connect the center of the articular surface of the metatarsal head and the center of the proximal articulation (method 3); a line drawn from the center of the head of the first metatarsal head through the center of the base of the first metatarsal bone (method 4); a line drawn through the center of the head and the center of the proximal shaft (method 5); and a line drawn from the center of the head of the first metatarsal head through the center of the proximal articulation (method 6). The measurement results obtained were subjected to Bland–Altman analysis and consistency evaluation.ResultsA total number of 20 radiographs were collected for measurement. No statistically significant differences were found in the measurement values among the six methods (P > 0.05). The lowest values of the average measurement, standard deviation, and confidence interval were established in method 3, followed by those in methods 1 and 4. The standard deviation of the measurement value and the confidence interval in method 2 were the largest. Methods 1 and 4 had similar confidence intervals and were with a high consistency. Due to the nature of the retrospective study, no follow‐up and complications were applicable in the present study.ConclusionLine drawn through the long axis of the first metatarsal bone (method 1) and line drawn from the center of the head of the first metatarsal head through the center of the base of the first metatarsal bone (method 4) were reliable and well repeatable, and may be used for postoperative radiographs.

Effectiveness of Progressive Resistance Drills and Dynamic Balance Training on Functional Performance among the Patients with Osteoarthritis of Knee

Osteoarthritis, degenerative joint disease in which the wearing down of the protective tissue at the ends of bones (cartilage) occurs gradually and worsens over time. The majority of people aged 40 years have radiographic evidence of knee osteoarthritis, is more common in women than in men.(1) Exercise has a wide range of health benefits in every individual. Mostly for middle aged population there is a clear evidence to support exercise in improving health and functional performance with well evidenced exercise programs.(2, 3) These programs have shown to improve the mobility of joints and strength of muscles around the joints by performing specific exercises for the specific muscles. This population people are often unable to undertake high intensity exercise programs. Therefore progressive resistance exercises are been used as an alternative. Many research studies have reported the benefits of resistance exercises as a physical activity for middle aged adults and individuals with limited movement. Method: The subjects in the KIMSDU campus were screened and 41 subjects fulfilling the criteria were involved. Prior consent was taken. Treatment protocol consists of progressive resistance exercises for 4 days per week for 6 weeks The interpretation of the study was done on the basis of comparing pre-test and post test assessment of Western Ontario and McMaster Universities Osteoarthritis Index(WOMAC) and BERG BALANCE TEST. Result: Intra group comparison results showed that progressive resistance exercises are effective and WOMAC and Berg Balance Test were statistically extremely significant (p<0.0001) and (p<0.0001) respectively. Conclusion: Progressive resistance exercises were significantly effective in improving the mobility and function and reducing the pain among the patients with osteoarthritis of knee.

Strength and Aerobic Exercise for the Treatment of Osteoarthritis Symptoms

Background: Arthritis is a prevalent joint disease characterized by joint inflammation. Osteoarthritis is the most common form of arthritis which causes progressive cartilage breakdown at the ends of bones and may affect surrounding ligaments, menisci and muscles. Osteoarthritis puts individuals at an increased risk of developing comorbid conditions. The use of exercise is growing as a low-risk treatment for symptoms of osteoarthritis. Purpose: The purpose of this narrative review is to examine how strength and aerobic exercise interventions can be used for the management of osteoarthritis symptoms. Methodology: A literature search was conducted utilizing PubMed, Medline, Google Scholar, and UBC Library. Selected literature included quasi-experimental studies, randomized-controlled trials, systematic reviews, narrative reviews, and exercise guidelines. Results: The literature indicates that strength exercise is beneficial to symptom management and physical function among individuals with osteoarthritis. Research specific to quadriceps strengthening showed significant improvements in physical performance, walking self-efficacy, and pain. While aerobic exercise plays a vital role in overall well-being, it also is shown to be as effective as strength exercise for symptom management and physical function. Conclusion: Evidence suggests that strength and aerobic exercise can enhance the quality of life among individuals with osteoarthritis. Greater dissemination of evidence is needed to increase awareness of strength and aerobic exercise as a valuable treatment option for osteoarthritis. Further research is required to determine optimal exercise parameters prescribed for individuals with osteoarthritis. Health & Fitness Journal of Canada 2019;XXX(X):X-XX. https://doi.org/10.14288/hfjc.XXX.XXX Keywords: Physical Activity, Quadricep Strengthening, Exercise Prescription, Randomized-Controlled Trial, Systematic Review, Medications

Investigation of Correction Trajectory Considering Bone End-Plane Orientation and the Shortest Growth Path.

External fixators are widely used in orthopedics for the purposes of fracture reduction and bone deformity correction. Since there is nonlinear mapping between the joint and operation spaces of the external fixator, bone correction trajectories achieved by equally adjusting the length of the struts in the joint space are usually not the trajectories that clinicians expect. Based on two different adjustment strategies, a new strategy considering bone end-plane orientation and the shortest growth path is proposed to plan the position and orientation of the distal bone end, which is named joint adjustment for equal bone distraction. By proposing the inverse and forward kinematic solutions of an Ortho-SUV external fixator, correction trajectories with three different adjustment strategies are generated and compared, and the bone shapes for each strategy are modeled. The results obtained by comparative analysis indicate that a smooth and uniformly spaced linear trajectory can be acquired using the new adjustment strategy, which can avoid bone end interference and maintain an optimal distraction rate of 1.03 mm/day, with only a 3% error compared with 1 mm/day. The new strategy can perform multiplane corrections simultaneously and is beneficial for stimulating the growth of new bone tissue.

Anatomy of Trabeculae Lumbar Vertebrae On a Bats (Megachiroptera)

Bats are the only mammals that can fly. Because of their ability to fly, making the tension received by the bat's spine comes from the front and back.Spongy bone, also known as cancellous bone or trabecular bone, is a very porous type of bone found in animals. It is highly vascularized and contains red bone marrow. Spongy bone is usually located at the ends of the long bones (the epiphyses), with the harder compact bone surrounding it. It is also found inside the vertebrae, in the ribs, in the skull and in the bones of the joints. Spongy bone is softer and weaker than compact bone, but is also more flexible. It is characterized by a lattice-like matrix network called trabeculae (Latin for little beam) that gives it its spongy appearance. Observation of trabeculae can be done by removing the flesh, muscles, and all the tissues attached to the lumbar vertebrae bone. Then the lumbar vertebrae was sanded and to know the anatomy of the trabeculae, it was done by observing the lumbraris vertebrae using a binocular microscope and taking pictures using a camera. Then the structure is analyzed. The observations showed that the anatomical structure of the lumbar vertebrae trabeculae in bats are stressed by tension must be withstood, a ligament being as strong for its weight.

The effects of vitamin K-rich green leafy vegetables on bone metabolism: A 4-week randomised controlled trial in middle-aged and older individuals

BackgroundHigh vegetable intake is associated with beneficial effects on bone. However, the mechanisms remain uncertain. Green leafy vegetables are a rich source of vitamin K1, which is known to have large effects on osteoblasts and osteocalcin (OC) metabolism. ObjectiveTo examine the effects of consumption of two to three extra serves of green leafy vegetables daily on bone metabolism. MethodsThirty individuals (mean age 61.8 ± 9.9 years, 67% male) completed three experimental phases in a randomised controlled crossover design, each lasting four weeks, with a washout period of four weeks between phases (clinical trial registration: ACTRN12615000194561). The three experimental phases were: (i) increased dietary vitamin K1 by consuming green leafy vegetables (H-K; ~200 g/d containing 164.3 [99.5–384.7] μg/d of vitamin K1); (ii) low vitamin K1 by consuming vitamin K1-poor vegetables (L-K; ~200 g/d containing 9.4 [7.7–11.6] μg/d of vitamin K1); and (iii) control (CON) where participants consumed an energy-matched non-vegetable control. OC forms, total OC (tOC), carboxylated OC (cOC) and undercarboxylated OC (ucOC), were measured in serum pre- and post-intervention for each experimental phase using a sandwich-electrochemiluminescence immunoassay. ResultsPre-intervention tOC, ucOC and ucOC:tOC levels were similar between phases (P > .05). Following H-K, but not L-K, tOC, ucOC and ucOC:tOC levels were significantly lower compared to pre-intervention levels (P ≤ .001) and compared to CON (~14%, 31% and 19%, respectively, all P < .05), while cOC remained unchanged. ConclusionsIn middle-aged healthy men and women, an easily achieved increase in dietary intake of vitamin K1-rich green leafy vegetables substantially reduces serum tOC and ucOC suggesting increased entry of OC into bone matrix, where it may improve the material property of bone. In conjunction with previous epidemiological and randomised controlled trial data, these findings suggest that interventions to increase vegetable intake over extended periods should include bone end points including fracture risk.

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?

Evaluation of global gene expression in regenerate tissues during Masquelet treatment.

The Masquelet induced-membrane (IM) technique is indicated for large segmental bone defects. Attributes of the IM and local milieu that contribute to graft-to-bone union are unknown. Using a rat model, we compared global gene expression profiles in critically sized femoral osteotomies managed using a cement spacer as per Masquelet to those left empty. At the end of the experiment, IM and bone adjacent to the spacer were collected from the Masquelet side. Nonunion tissue in the defect and bone next to the empty defect were collected from the contralateral side. Tissues were subjected to RNA isolation, sequencing, and differential expression analysis. Cell type enrichment analysis suggested the IM and the bone next to the polymethylmethacrylate (PMMA) spacer were comparatively enriched for osteoblastic genes. The nonunion environment was comparatively enriched for innate and adaptive immune cell markers, but only macrophages were evident in the Masquelet context. iPathwayGuide was utilized to identify cell signaling pathways and protein interaction networks enriched in the Masquelet environment. For IM vs nonunion false-discovery rate correction of P values rendered overall pathway differences nonsignificant, and so only protein interaction networks are presented. For the bone comparison, substantial enrichment of pathways and networks known to contribute to osteogenic mechanisms was revealed. Our results suggest that the PMMA spacer affects the cut bone ends that are in contact with it and at the same time induces the foreign body reaction and formation of the IM. B cells in the empty defect suggest a chronic inflammatory response to a large segmental osteotomy.

Molecular Pathogenesis of Bone Degenerative Disease and Associated Inflammatory Processes

IntroductionOsteoarthritis is one of the most common forms of arthritis, which is a result of the degeneration of protective cartilage at the end of bones, resulting in friction in the joints. This is due to a complex pathophysiologic process where inflammation and physical alterations of the bone contribute to the overall pathology. During this process, several mediators of inflammation and matrix degradation are formed. Profiling of some of these mediators and related biomarkers provides a molecular approach to understand the processes involved in the progression of this disease. The aim of this study is to profile various biomarkers of inflammation and hemostatic activation in osteoarthritis patients undergoing total joint replacement.Materials and MethodSeventy‐four EDTA plasma samples were collected from osteoarthritis patients prior to their surgery. The control comprised of a pool prepared from normal male and female EDTA plasma. Such coagulation markers as D‐Dimer, vWF, MP‐TF, PAI‐1, TAFI, and fibronectin were performed using ELISA techniques. Matrix metallopeptidase 9 (MMP‐9) and C‐reactive protein were also measured using ELISA methods. All results were compiled as group means and compared with EDTA controls. Appropriate statistical methods were used to analyze the data.ResultsThe circulating level of D‐Dimer was much higher on average in the patient samples (9178 ± 3.56 ng/ml) in comparison to the control samples (115 ± 85 ng/ml) p&lt;0.05. The concentration of vWF was higher (125 ± 28 %) than in the control sample (104 ± 7.4%) p&lt;0.05. There was not a significant difference between the MP‐TF or TAFI concentrations in the total joint samples vs the controls p&lt;0.05. There was no correlation among any of the tested biomarkers.ConclusionThis data shows that osteoarthritis patients exhibit marked elevation of inflammatory and hemostatic activation biomarkers. Wide variations are noted in the circulating level of these biomarkers in patients. This data suggests that multifactorial processes are involved in the pathogenesis of osteoarthritis. Profiling of inflammatory and thrombotic biomarkers may be helpful in the risk stratification and risk management in these patients.

Prediction of Conservative Treatment Failure for Isolated Unilateral Mandibular Condylar Fractures Using Quantitative Measures: Suggestion of Indications for Intervention.

Interest in the treatment of mandibular condyle fracture in cases of maxillofacial trauma has been a huge concern for decades because of a diversity of opinions on the topic and the relatively few studies conducted on individuals treated by physiotherapy or rehabilitation with or without intermaxillary fixation (IMF). We measured fracture gaps between bone ends over an 8-year period from 2012 to 2019. The study cohort was composed of only conservatively treated patients. This retrospective study was conducted to identify factors that influence treatment failure by comparing a functional treatment (physiotherapy) group with an IMF group in terms of fracture gaps and other variables. In addition, an algorithm was devised to enable clinicians to determine promptly whether IMF is needed for mandibular condylar fractures. Significant correlations were observed between several parameters and malocclusion. Multiple regression analysis resulted in the following coefficients: 0.072 for fracture gap (P = 0.006) and 0.006 for age (P < 0.05) in functional treatment group. However, in the IMF group, correlations with malocclusion were 0.063 for fracture gap (P = 0.000) and 0.003 for age (P = 0.083). We proposed a diagnostic algorithm for isolated unilateral mandibular condyle fractures that provides guidance regarding surgical correction. If indications for surgical correction, as regards anatomical location, fracture level, fracture gap between bone ends, and patient cooperability, are not satisfied, clinicians should select IMF or functional treatment (rehabilitation). If the fracture gap is less than 6 mm and the patient is cooperative, functional rehabilitation would be more suitable than IMF.