Head Bone Research Articles

Massive accumulation of osteoclastic giant cells in rapid destructive hip disease

The term rapid destructive hip disease (RDHD) designates a rare coxarthropathy characterized by a rapid destruction of the femoral head within a few weeks to several months. The etiology and pathogenesis of RDHD are not understood. The goal of this study was to define the histological and histomorphometric hallmarks of RDHD to provide a basis for a deeper understanding of the underlying mechanisms. Fifteen consecutive RDHD patients (mean age 78.9 ± 6.4 years, 14 females) demonstrated the characteristic radiographic appearance of vanishing femoral head bone stock without signs of reactive anabolic changes. Histologic and histomorphometric analyses revealed severe bone resorption with significantly increased numbers of morphologically altered giant osteoclasts, the formation of giant cell granulomas both in bone marrow and the synovium and significantly increased osteoblast numbers and osteoid as compared to controls with primary osteoarthritis (OA). These results suggest that in RDHD, an unknown stimulus leads to a massive activation of osteoclasts and this in turn provokes a reactive increase in osteoblast activity that is too weak to counteract the rapid destruction of the hip, thus providing a rationale for a prospective systematic search for the stimuli upstream of the massively increased osteoclast activation in RDHD.

Diagnostic de l’engagement fœtal par l’échographie transpérinéale : étude préliminaire tunisienne

IntroductionThe assessment of fetal head engagement by digital examination is highly subjective even though this method remains the gold standard. Ultrasound could be a new way to specify the fetal head engagement with objective and reproductible measurements. ObjectiveTo compare the clinical data and the transperineal ultrasound results for the diagnosis of fetal head engagement. Patients and methodsWe conducted a prospective longitudinal study on a series of 70 patients and compared the clinical assessment of fetal engagement to the ultrasound measurements. Ultrasound examination was performed in the delivery room. The probe was placed on the ano-vulvar area. The measure used was: distance perineum–external table of fetal head bone. ResultsThe ultrasound measures of the distance [perineum–external table of fetal head bone] went from 13 to 75mm; and the measures of the distance [perineum–succedaneum bump] went from 22 to 68mm. We tried to retain a value threshold of the distance [perineum–external table of fetal head bone] above which the diagnosis of engagement would be countered. The threshold so proposed is of 55mm with a positive predictive value in 98%, a sensibility in 87% and specificity in 93%. Discussion and conclusionTransperineal ultrasound is a simple and easy method to define fetal head engagement by measuring the distance between perineum and fetal head. This new tool can be very useful in the delivery room when clinical examination is inconclusive hampered, for example, by the presence of a succedaneum bump.

Remplissage Versus Latarjet for Engaging Hill-Sachs Defects Without Substantial Glenoid Bone Loss: A Biomechanical Comparison

Recurrent shoulder instability is commonly associated with Hill-Sachs defects. These defects may engage the glenoid rim, contributing to glenohumeral dislocation. Two treatment options to manage engaging Hill-Sachs defects are the remplissage procedure, which fills the defect with soft tissue, and the Latarjet procedure, which increases glenoid arc length. Little evidence exists to support one over the other. We performed a biomechanical comparison of the remplissage procedure to the traditional Latarjet coracoid transfer for management of engaging Hill-Sachs defects in terms of joint stiffness (resistance to anterior translation), ROM, and frequency of dislocation. Eight cadaveric specimens were tested on a shoulder instability simulator. Testing was performed with a 25% Hill-Sachs defect with an intact glenoid and after remplissage and Latarjet procedures. Joint stiffness, internal-external rotation ROM, and frequency of dislocation were assessed. Additionally, horizontal extension ROM was measured in composite glenohumeral abduction. After remplissage, stiffness increased in adduction with neutral rotation (12.7 ± 3.7 N/mm) relative to the Hill-Sachs defect state (8.7 ± 3.3 N/mm; p = 0.016). The Latarjet procedure did not affect joint stiffness (p = 1.0). Internal-external rotation ROM was reduced in abduction after the Latarjet procedure (49° ± 14°) compared with the Hill-Sachs defect state (69° ± 17°) (p = 0.009). Horizontal extension was reduced after remplissage (16° ± 12°) relative to the Hill-Sachs defect state (34° ± 8°) (p = 0.038). With the numbers available, there was no difference between the procedures in terms of the frequency of dislocation after reconstruction: 84% of specimens (27 of 32 testing scenarios) stabilized after remplissage, while 94% of specimens (30 of 32 testing scenarios) stabilized after the Latarjet procedure. Both procedures proved effective in reducing the frequency of dislocation in a 25% Hill-Sachs defect model, while neither procedure consistently altered joint stiffness. In the treatment of shoulder instability with a humeral head bone defect and an intact glenoid rim, this study supports the use of both the remplissage and Latarjet procedures. Clinical studies and larger cadaveric studies powered to detect differences in instability rates are needed to evaluate these procedures in terms of their comparative efficacy at preventing dislocation, as any differences between them seem likely to be small.

Corrigendum: Ankle Salvage Procedure without Internal Fixation for Large Bone Defect after Failed Total Ankle Arthroplasty: A Case Report

In treatment of failure in ankle joint replacement therapy, talar avascular necrosis with massive bone defect, talus fracture with severe comminution and bone defect and ankle dislocation, treatment of large bone defects is considerably important for ankle joint stability and union, therefore, the choice of treatment for large bone defects is use of femoral head or iliac crest bone graft and rigid internal fixation. Because first generation total ankle arthroplasty performed for the first time using a cemented fixation technique requires a large amount of bone resection during re-surgery and there is some possibility of a larger bone defect after removal of implants, in cases where prosthesis for the defect is needed, performance of palliative femoral head or iliac crest bone graft and rigid internal fixation can be difficult. We report on a case of a 48-year-old woman who had experienced ankle pain for 25 years since undergoing total ankle arthroplasty. Because the patient had little ankle motion and rigid soft tissue despite a large bone defect caused by aseptic loosening, a good outcome was obtained only for the femoral cancellous bone graft using allo femoral head without internal fixation.

Pachydermoperisotosis.

Sir, We read with a great interest the article entitled “Enlarged hands and feet-Not always acromegaly” by Gnatnatti et al., published in IJEM 2012;16(Suppl 2):S318-20, and would like to add our experience about the fact that pachydermoperiostosis (PDP) can be easily mistaken for acromegaly. PDP also called primary hypertrophic osteoarthropathy (PHO), or idiopathic hypertrophic osteoarthropathy (IHO), or hereditary hypertrophic osteopathy (HHO), or Touraine-Solente-Gole syndrome is a rare genodermatosis[1] which is apparently inherited in a dominant pattern with variable penetrance. But, both autosomal recessive and X-linked inheritances have been suggested.[1] Recently, novel mutations have been reported in some Turkish,[2] and Chinese[3] families. Clinical modifications are thought to be related to excessive collagen formation and dysregulation of matrix proteins because of fibroblastic hyper activation.[4] PDP real incidence is unknown, but is prevailing in males with a sex ratio equal to 9:1. The disease mainly affects skin, but also bones. It is characterized by a thickening of the skin or pachydermia, excessive bone formation (or periostosis), and finger clubbing. Fingers modifications are represented by tissue swelling with loss of normal angle between nail and nail bed. Other manifestations are painful arthritis, cutis verticis gyrate (CVG) which is a condition of the scalp consisting of deep grooves and convolutions that resemble the surface of the brain. Other signs are hyperhydrosis, seborrhea, edema, and eyelid hypertrophy. There are two forms: The primary PDP in which no cause can be found, and the secondary form which is associated to several diseases and neoformations. The last one is considered as a paraneoplastic syndrome[5] which should be excluded before thinking to genetic form. For the management, as there is not any available specific treatment, genetic counseling should be offered to patients and their family to prevent new cases. Plastic surgery and botulinum toxin type A may help in complete forms. Joints pain can be treated by non steroidal anti-inflammatory agents or with corticoids. Biphosphonates are sometime used with success. Progressive skin and bones modifications raise differential diagnosis with acromegaly. But, contrary to acromegaly face and head bones are usually not involved in PDP and growth hormone (GH) is normal as in the following observation: A young man aged 26, with a family history of diabetes mellitus, high blood pressure, renal lithiasis, hyperhydrosis, and large hands (one brother), was sent to our unit for suspicion of acromegaly. His disease began when he was 10 marked by an enlargement of his hands and feet with hyperhydrosis. During the last 3 years, another phenomenon has appeared as he suffered from joint pains and exaggeration of hyperhydrosis. Medical history and clinical examination were against acromegaly and pleaded for PDP [Figure 1], because except for skin abnormalities the face was not concerned by bone hypertrophy. Research for other diseases and neoformations was negative. Biological assessment showed normal GH = 0.07 ng/ml contrary to acromegaly where GH is increased leading to acquired dysmorphic syndrome concerning hands and feet, but also the face as in the Figure 2.Figure 1: Pachydermoperiostosis (PDP) with hands and feet enlargement with finger clubbing. Remark the nondysmorphic face but with mild cutis verticis gyrate and hyperhydrosisFigure 2: Acquired modifications of the face in acromegaly. Remark the difference with PDP

Cephalic Morphology of Ariosoma gilberti (Bathymyrinae: Congridae)

The head bones and relevant muscles are important elements composing the feeding and respiration apparatus and can be considered as highly important structures for giving rise to evolutionary specializations. The eels of the Anguilloidei is a diverse group and structural diversity in their cranial musculoskeletal system is thus to be expected. Ariosoma gilberti is a member of Bathymyrinae (Congridae) with a hydraulic based prey transport and closely related to muraenid family with mechanical prey transport system. Since there is no information about the cephalic morphology of A. gilbert, hence this study was conducted to provide detailed description of its cranial osteology and myology. The immobile maxillary with large pointed teeth, an anterior moderate mouth gape, large jaw closing muscles and large lateral and ventral bony elements, providing more room for the orobranchial cavity of A. gilberti suggesting the presence of a hydraulic and suction-based mechanism.

Correlation between femoral head bone iron content, serum ferritin and bone mineral density of postmenopausal women with femoral neck fragility fracture

Objective To explore the correlation between femoral head bone iron content,serum ferritin (SF) and bone mineral density of postmenopausal women with femoral neck fragility fracture.Methods From June 2010 to March 2013,156 postmenopausal women with femoral neck fragility fractures aged from 56 to 92 years old,with an average age of 72.40±8.97 years,were divided into 5 groups based upon the stratification of 10-year age intervals (≤60,61-70,71-80,81-90 and ≥91).Blood samples were collected to determine iron metabolism and bone metabolic markers after overnight fasting.Bone specimens were obtained for detecting bone iron contents and performing iron stain respectively after hip arthroplasty surgery.BMD was measured by dual energy X-ray absorptiometry(DXA)at hip and lumbar spine from L1 to L4 ten days after surgery.Results There were significant differences in the values of bone iron content,SF,transferrin,total iron binding capacity,serum procollagen type Ⅰ N-terminal propeptide,β-carboxy terminal telopeptide of collagen type Ⅰ and BMD at hip and L1 to L4 in all groups.BMD at hip and L1 to L4 decreased while bone iron content and SF increased with age; the peaks of bone iron content and SF were both in 81-90 years group; the average of bone iron content and SF was 96.81 μg/g and 235.66 μg/L respectively.There were 100 patients (100/156,64.1％) whose SF was over 200 μg/L.Bone iron content combined with SF,age and BMI could be put into the regression models of BMD at various proximal femur sites (femoral neck R2=0.443,Wards triangle R2=0.397,greater trochanter R2=0.322 and total femur R2=0.379).After adjustment of age,weight,BMI and other factors,we found that bone iron content and SF were negatively correlated with BMD at proximal femur,but had no significant correlation with BMD at lumbar spine.Conclusion Iron accumulation is prevalent in postmenopausal women with hip fragility fractures.High bone iron content and SF are independent risk factors for low BMD at proximal femur.These results provide clinical evidences that iron accumulation is associated with postmenopausal osteoporosis. Key words: Osteoporosis, postmenopausal; Femur head; Ferritins; Bone density

Management of humeral and glenoid bone loss in recurrent glenohumeral instability.

Recurrent shoulder instability and resultant glenoid and humeral head bone loss are not infrequently encountered in the population today, specifically in young, athletic patients. This review on the management of bone loss in recurrent glenohumeral instability discusses the relevant shoulder anatomy that provides stability to the shoulder joint, relevant history and physical examination findings pertinent to recurrent shoulder instability, and the proper radiological imaging choices in its workup. Operative treatments that can be used to treat both glenoid and humeral head bone loss are outlined. These include coracoid transfer procedures and allograft/autograft reconstruction at the glenoid, as well as humeral head disimpaction/humeroplasty, remplissage, humeral osseous allograft reconstruction, rotational osteotomy, partial humeral head arthroplasty, and hemiarthroplasty on the humeral side. Clinical outcomes studies reporting general results of these techniques are highlighted.

Mosaic in Nine Lives

Mosaic in Nine Lives Ife-Chudeni A. Oputa (bio) I The pearl-sized hole in my sister’s arm is all that remains of our messy ritualafter she cuts and drains the perpetual blackhead that swelled in abscessto the size of a golf ball. The muck that oozes out reeks, has been buildingup beneath her skin for years, only a hint of it sputtering onto my thumbseach time I tried to push the puss out like a sigh, my fingers not nimble enoughto coax the body of its secrets. II When we are still young enough to find the same things wondrous, she teaches me to play dead. This is a drill we run: one of us going limp midsentence while the other runs for help or screamsuntil the dead one says Stop. III the neck bone’s connected to the head bonethe head bone’s connected to the jaw bonethe jaw bone knows to lock downwhen too much truth starts scratching. [End Page 320] IV I am 23 and it is spring, so I break open a new silence and pull queer out like hair from the throat— She is not surprised, says:as a girl, I had a dream where wewere lovers; what else could that mean? V A cocktail or twoand my sister is loose-lippedand earnest, pouts out storiesshe’s forgotten not to tell, will forgetshe’s told in the morning. VI We are women. We land in New York for New Year’s Eve.We walk down the airplane aisle andmy sister goes limp. VII My sister does not want to goto the emergency room,although she cannot zip her own shoes,she cannot walk, she cannot stand. We have not trained for this,so I recite the blackout backto her slumps in seat / eyes roll back / bottom lip slack / hrrrr [End Page 321] then to a flight attendant, two EMTs, our motherslumps in seat / eyes roll back / bottom lip slack / hrrrr a nurse, another nurse, a doctor, our fatherslumps in seat / eyes roll back / bottom lip slack / hrrrr hrrrr hrrrr The specialist shows us the blood clotseffloresced across her lungs like so manydandelion seeds, so many unspoken things. VIII The funny bone, though connected to the arm bone, is not a bone at all. It isthe nerve that after days sleeping upright beside my sister’s bed—head heavyatop my right fist, elbow compressed onto the corner of the armrest—radiates awarning down my forearm to my pinky and ring fingers to go numb, so that Icannot hold a pen or bend my arm or write at all. IX The body wants to be a private thing, this I understand:there are things I still won’t tell, even when she asks. [End Page 322] Click for larger view View full resolution Ife-Chudeni A. Oputa A. H. Jerriod Avant © 2013 [End Page 323] Ife-Chudeni A. Oputa Ife-Chudeni A. Oputa is currently pursuing an MFA in poetry and an MA in African American and African Diaspora Studies at Indiana University, Bloomington. She is a Cave Canem Fellow who has also attended the Callaloo Creative Writing Workshop. Her work has appeared or is forthcoming in [PANK] online, Muzzle, and Kinfolks Quarterly. She is a native of Fresno, CA. Copyright © 2014 The Johns Hopkins University Press

Seleção de características morfofuncionais de cavalos da raça Mangalarga Marchador por meio da análise de componentes principais

Dados de 14.288 animais da raça Mangalarga Marchador, nascidos de 1990 a 2005, foram utilizados para avaliar a redução da dimensionalidade do espaço multivariado para características morfofuncionais, por meio da análise de componentes principais. Foram consideradas as características: altura na cernelha, altura na garupa, comprimento da cabeça, comprimento do pescoço, comprimento do dorso, comprimento da garupa, comprimento da espádua, comprimento do corpo, largura da cabeça, largura das ancas, perímetro do tórax, perímetro da canela e a pontuação da marcha. Para tais características, obtiveram-se sete componentes principais, a partir da matriz de correlação, que apresentaram variância inferior a 0,7 (autovalor inferior a 0,7). Isso sugere sete variáveis para descarte, por apresentarem maiores coeficientes de ponderação, em valor absoluto, a partir do último componente principal. A razão para isso é que variáveis altamente correlacionadas com os componentes de menor variância representam variação praticamente insignificante. Com base nesses resultados, recomendam-se as seguintes características para serem mantidas em trabalhos futuros com esta base de dados: pontuação da marcha, altura na garupa, comprimento do dorso, comprimento da garupa, largura da cabeça e perímetro da canela.

Reduction cranioplasty with the aid of simulated computer imaging for the treatment of hydrocephalic macrocephaly

The occurrence of hydrocephalic macrocephaly is uncommon. When the condition does occur, it is usually seen in infants and young children. Patients with this disorder have an excessively enlarged head and weak physical conditions. Various surgical techniques of reduction cranioplasty for the treatment of these patients have been reported. In this study, a revised surgical procedure with the aid of simulated computer imaging for the treatment of hydrocephalic macrocephaly is presented. Five cases of hydrocephalic macrocephaly in children ranging in age from 16 to 97 months were reviewed. These patients underwent surgical treatment at The First Affiliated Hospital of Xiamen University over a period of 4 years from January 2007 to January 2011. After physical examination, a 3D computer imaging system to simulate the patient's postoperative head appearance and bone reconstruction was established. Afterward, for each case an appropriate surgical plan was designed to select the best remodeling method and cranial shape. Then, prior to performing reduction remodeling surgery in the patient according to the computer-simulated procedures, the surgeon practiced the bone reconstruction technique on a plaster head model made in proportion to the patient's head. In addition, a sagittal bandeau was used to achieve stability and bilateral symmetry of the remodeled cranial vault. Each patient underwent follow-up for 6-32 months. Medium-pressure ventriculoperitoneal shunt surgery or shunt revision procedures were performed in each patient for treating hydrocephalus, and all patients underwent total cranial vault remodeling to reduce the cranial cavity space. Three of the 5 patients underwent a single-stage surgery, while the other 2 patients underwent total cranial vault remodeling in the first stage and the ventriculoperitoneal shunt operation 2 weeks later because of unrecovered hydrocephalus. All patients had good outcome with regard to hydrocephalus and macrocephaly. There are still no standard surgical strategies for the treatment of hydrocephalic macrocephaly. Based on their experience, the authors suggest using a computer imaging system to simulate a patient's postoperative head appearance and bone reconstruction together with total cranial vault remodeling with shunt surgery in a single-stage or 2-stage procedure for the successful treatment of hydrocephalic macrocephaly.

Changes in the frequencies of human hematopoietic stem and progenitor cells with age and site

This study enumerated CD45(hi)/CD34(+) and CD45(hi)/CD133(+) human hematopoietic stem cells (HSCs) and progenitor granulocyte-macrophage colony forming cells (GM-CFCs) in blood and trochanteric and femoral bone marrow in 233 individuals. Stem cell frequencies were determined with multiparameter flow cytometry and using an internal control to determine the intrinsic variance of the assays. Progenitor cell frequency was determined using a standard colony assay technique. The frequency of outliers from undetermined methodological causes was highest for blood, but less than 5% for all values. The frequency of CD45(hi)/CD133(+) cells correlated highly with the frequency of CD45(hi)/CD34(+) cells in trochanteric and femoral bone marrow. The frequency of these HSC populations in trochanteric and femoral bone marrow rose significantly with age. In contrast, there was no significant trend of either of these cell populations with age in the blood. Trochanteric marrow progenitor GM-CFCs showed no significant trends with age, but femoral marrow GM-CFCs trended downward with age, potentially because of the reported conversion of red marrow at this site to fat with age. Hematopoietic stem and progenitor cells exhibited changes in frequencies with age that differed between blood and bone marrow. We previously reported that side population (SP) multipotential HSC, which includes the precursors of CD45(hi)/CD133(+) and CD45(hi)/CD34(+), decline with age. Potentially the increases in stem cell frequencies in the intermediate compartment between SP and GM progenitor cells observed in this study represent a compensatory increase for the loss of more potent members of the HSC hierarchy.

Impact of implant size on cement filling in hip resurfacing arthroplasty

Larger proportions of cement within femoral resurfacing implants might result in thermal bone necrosis. We postulate that smaller components are filled with proportionally more cement, causing an elevated failure rate. A total of 19 femoral heads were fitted with polymeric replicas of ReCap (Biomet) resurfacing components fixed with low-viscosity cement. Two specimens were used for each even size between 40 and 56 mm and one for size 58 mm. All specimens were imaged with computed tomography, and the cement thickness and bone density were analyzed. The average cement mantle thickness was 2.63 mm and was not correlated with the implant size. However, specimen with low bone density had thicker cement mantles regardless of size. The average filling index was 36.65% and was correlated to both implant size and bone density. Smaller implants and specimens with lower bone density contained proportionally more cement than larger implants. According to a linear regression model, bone density but not implant size influenced cement thickness. However, both implant size and bone density had a significant impact on the filling index. Large proportions of cement within the resurfacing head have the potential to generate thermal bone necrosis and implant failure. When considering hip resurfacing in patients with a small femoral head and/or osteoporotic bone, extra care should be taken to avoid thermal bone necrosis, and alternative cementing techniques or even cementless implants should be considered. This study should help delimiting the indications for hip resurfacing and to choose an optimal cementing technique taking implant size into account.

Measurement Properties of Radial and Tibial Speed of Sound for Screening Bone Fragility in 10- to 12-Year-Old Boys and Girls

The objective of this study was to analyze measurement properties of the radial and tibial speed of sound (SoS) evaluated by quantitative ultrasound (QUS) for screening bone fragility. Bone fragility was defined as low whole body less head bone mineral density (WBLH BMD) measured by DXA (first tertile, 95% CI −1.1 to −0.9) and as past fractures evaluated by questionnaire. The sample included 319 nonobese boys and girls, ages 10–12 yr. All bone variables were standardized. The results revealed concordance coefficient correlations between WBLH BMD and radial and tibial SoS of 0.129 and 0.038, respectively. The regression lines between DXA and QUS variables were different from the identity lines. Cross-classification analysis by Kappa statistic showed that only 34% and 36% of the 113 participants categorized in the first tertile of WBLH BMD were also categorized in the first tertile of tibial and radial SoS, correspondingly. Logistic regression with gender and maturity adjustments demonstrates that radial SoS was the single significant variable in predicting OR for identifying participants with past fractures. In conclusion, the radial QUS revealed itself to be a valuable tool for screening bone fragility in youth of 10–12 yr, despite the absence of agreement with DXA WBLH BMD.

Studies about Movement Biofidelity of a Dummy Neck Used in an Impact Testing Device

The paper presents the studies made on a similar biomechanical system composed by neck, head and thorax bones. The main movements analyzed were: axial rotation (left-right), lateral bending (left-right) and flexion-extension movement. After simulation was obtained the entire mechanical behavior based on data tables or diagrams. The models were defined in a CAD environment which includes Adams algorithm for dynamic simulations. The virtual models were obtained starting with CT images made on a living human subject. That virtual model composed by neck and head can be included in complex system (as a car system) and supposed to impact simulations (virtual crash tests). Also was developed a mathematical model based on Lagrange equations for a frontal impact testing cervical system. Our research team built main components of a testing device for dummy car crash neck-head system using anatomical data.

Clinical Application of the "Glenoid Track" Concept for Defining Humeral Head Engagement in Anterior Shoulder Instability: A Preliminary Report.

Background:The optimal treatment of Hill-Sachs injuries is difficult to determine and is potentiated by the finding that a Hill-Sachs injury becomes more important in the setting of glenoid bone loss, making engagement of the humeral head on the glenoid inherently easier. The “glenoid track” concept was developed to biomechanically quantify the effects of a combined glenoid and humeral head bony defects on instability.Purpose:To clinically evaluate humeral head engagement on the glenoid by utilizing glenoid track measurements of both humeral head and glenoid bone loss.Study Design:Retrospective cohort.Methods:A total of 205 patients with recurrent anterior shoulder instability were evaluated, and of these, 140 patients (68%; 9 females [6%] and 131 males [94%]) with a Hill-Sachs lesion and a mean age of 27.6 years (range, 15-47 years; standard error of mean [SEM], 0.59) were included in the final magnetic resonance angiogram [MRA]) analysis. Bipolar bone loss measures of glenoid bone loss (sagittal oblique MRA) and multiple size measures of the Hill-Sachs injury (coronal, axial, and sagittal MRA) were recorded. Based on the extent of the bipolar lesion, patients were classified with glenoid track as either outside and engaging of the glenoid on the humeral head (OUT-E) or inside and nonengaging (IN-NE). The 2 groups were then compared with clinical evidence of engagement on examination under anesthesia (EUA) using video arthroscopy, number of dislocations, length of instability, and patient age.Results:The mean glenoid bone loss was 7.6% (range, 0%-29%; SEM, 1.20%), and 31 of 140 (22%) patients demonstrated clinical engagement on EUA. Radiographically, 19 (13.4%) patients were determined to be OUT-E, while 121 (86.6%) were IN-NE and not expected to engage. Of those 19 patients with suggested radiographic engagement (OUT-E), 16 (84.5%) had clinical evidence of engagement versus only 12.4% that clinically engaged (15/121) without radiographic evidence of engagement (IN-NE) (P < .001). Younger age and a greater number of recurrence events were jointly predictive of a patient being classified as OUT-E (11.8 vs 6.4 dislocations; P = .015).Conclusion:This study demonstrates that glenohumeral engagement was well predicted based on preoperative glenoid and humeral head bone loss measurements using the glenoid track method. In addition, younger age and a greater number of recurrences were predictive of engagement. The glenoid track concept may be important to fully assess the overall risk for engagement prior to surgery and may help guide surgical decision making such as bony augmentation procedures.

THU0503 Hip Bone Marrow Lesions in Asymptomatic and Osteoarthritic Adults: Prevalence, Risk Factors and Significance

BackgroundBone marrow lesions (BMLs) at the knee have an important role in the pathogenesis of osteoarthritis (OA), being associated with increased pain, accelerated cartilage loss, and increased risk of total...

THU0443 Differential diagnosis between rheumatoid arthritis and peripheral spondylarthropathies: Usefulness of shoulders ultrasonography

BackgroundThe differential diagnosis between rheumatoid arthritis (RA) and peripheral spondylarthropathies (pSpA) could be difficult. A recent ultrasound study showed that ultrasonography (US) of hands might help the physician to differentiate...

AB1292 Patological changes of shoulder joint in early phase of rheumatoid arthritis detected by ultrasound, magnetic resonance imaging and power doppler

ObjectivesThe primary objective of the study was to establish the status of rotator cuff in the early rheumatoid arthritis (RA) using shoulders ultrasonography (US), Power Doppler (PD) and MRI. The...

Haemophilus influenzae Type b in an Immunocompetent, Fully Vaccinated ALL Survivor

A 7-year-old boy with a history of recurrent acute lymphoblastic leukemia (ALL), in remission, presented to primary care clinic after 2 days of progressive right hip pain with weight-bearing activities. He was otherwise asymptomatic at the time of presentation. Blood cultures revealed Gram-negative diplococci, which prompted an MRI that was significant for a hip joint effusion and femoral head bone marrow edema. The patient had no sick contacts and no significant past medical history other than ALL. The patient had been given all recommended childhood vaccinations. Arthrocentesis and needle biopsy of the femoral neck were not diagnostic for malignancy and revealed only mild hip joint inflammation, leading to a diagnosis of osteomyelitis. The organism in the original blood culture was identified as Haemophilus influenzae type b, β-lactamase negative. Review of the patient's medical records showed a history of complete immunization to Haemophilus influenzae type b. An immunologic evaluation was made to determine if the patient retained immunity from his other vaccinations. Pathogen-specific antibody testing revealed detectable antibodies to polio but not measles, mumps, rubella, varicella-zoster virus, tetanus, diphtheria, pertussis, or hepatitis B. This loss of immunologic memory appears to be a rarely described side effect of ALL chemotherapy. There is currently no protocol to evaluate the immunologic memory of patients who underwent chemotherapy for ALL or to revaccinate them after their treatment. It is unclear whether the loss of immunologic memory is genuinely rare or is underdiagnosed because affected patients are protected by herd immunity.