Hip Bone Research Articles

Metastatic cancer in a medieval skeleton from the Principality of Liechtenstein.

We present a presumptive case of metastatic carcinoma in an individual from the 11th/12th century CE from Vaduz, Principality of Liechtenstein. The skeleton exhibits extensive new bone formation in the axial skeleton and the proximal humerus and femur. Radiological examinations revealed further sclerotic lesions in the clavicles, the manubrium, the sternum, the femoral diaphysis, and possibly the frontal. The pelvic bones and the sacrum, as well as the spine, are the most heavily affected skeletal regions. The newly formed bone in some lesions has a "sun-burst" appearance. The sex and age at death of the individual, the distribution and the osteoblastic nature of the lesions suggest that prostate carcinoma is the most likely primary tumor.

Characteristics of clinical manifestation of acute haematogenous osteomyelitis of the bones of the hip joint in children

Aim. To study the characteristics of the clinical manifestations of acute haematogenous osteomyelitis of the hip bones in children.Material and methods. The clinical features of acute osteomyelitis of the hip joint were studied in 90 children aged between 2 and 16 years during 2017-2023. In the early stages of the disease, 9 (10.0%) patients were admitted before 3 days after the onset of the disease, and 81 (90.0%) patients were admitted later than 3 days. The proximal femoral metaepiphysis was involved in 78 (86.7%) cases, the iliac bones in 10 (11.1%), the pubic bone in 1 (1.1%) and the sacroiliac joint in 1 (1.1%).Results and discussion. Examining the clinical picture of the disease, the main symptoms were: pain in the affected area - 87 (96.7%) patients, sometimes with pain radiating to nearby areas of the body, fever - 83 (92.2%), forced position of the affected limb with refusal to walk - 79 (88.8%), and limping in 11 (12.2%) patients. In addition, purulent leakage was observed in 2 cases, in the left pubic bone lesion purulent leakage was observed in the area of the inner surface of the left thigh and in the iliac bone lesion in the iliopsoas muscle.Conclusions. Acute haematogenous osteomyelitis of the bones of the hip joint in children usually begins acutely against the background of a healthy condition of the child with a triad of symptoms: pain, increase in body temperature, forced position of the limb. Local symptoms of the disease depend on the location of the primary focus, the degree of involvement of joints and soft tissues in the process.

Morphology and morphometry of the patella in a select Black South African sample

BackgroundFor many years, sex determination has been achieved through analysis of skeletal remains in forensic medicine. The patella can be utilized for sex determination in the absence (or damage) of the cranium, upper and lower limbs, and pelvic bones. Additionally, understanding the patella's morphology and morphometry is essential for diagnosing and treating injuries and disorders of the knee joint, as well as knee arthroplasty and patella ligament grafting (Medeiros et al., 2001). This study reviewed the morphology and morphometry of the patella in a Black African population of KwaZulu-Natal and determined if a correlation between the parameters of the patellae and sex exists. Materials and methods154 dry patellae belonging to a South African black population group were utilized to review their morphology and morphometry. The classifications of Wiberg (1941) and Borges et al. (2016) were adapted for the morphology. The seven morphometric measurements were adapted from Dayal and Bidmos (2005) and Borges et al. (2016). A p-value less than 0.05 was considered statistically significant. ResultsAccording to the Wiberg classification: Type 1 patellae were least prevalent (1.9 %), while Type 2 were most common with an incidence of 59.7 %. No statistical difference was recorded with sex (p-value = 0.517). According to Borges et al. (2016) classification: Type 1 (triangular-shaped) patellae were most prevalent in males and females (72.7 %) and Type 3 (irregular shape) patellae were least common in this study. A statistically significant difference between Borges et al. (2016) classification scheme (shape of the patella) and sexes was recorded (p-value = 0.003). A statistically significant relationship between morphometric parameters of the patella and sex was also recorded (p-value <0.001). Patella measurements were greater in males than in females. ConclusionIn this study, the patella displayed sexually dimorphic morphological and morphometric characteristics, which indicated that the patella may be used for sex determination in forensic cases with the KwaZulu-Natal population of South Africa, in addition to clinical applications such as knee arthroplasty, patellar ligament grafting, prosthesis synthesis, and patellar implants.

Intra-abdominal telangiectatic osteosarcoma: a case report

BackgroundTelangiectatic osteosarcoma is rare and it rarely affects flat bones, especially the bones of the pelvis. It is uncommon for telangiectatic osteosarcoma to be considered as a differential diagnosis when assessing a large intrabdominal mass.Case reportWe present our case of a 33-year-old African female who presented with a sizeable telangiectatic osteosarcoma of the left iliac bone. She reported a 3-year duration of a painless, slow-growing mass arising from the left flank. At examination, a large bony hard mass extending from the left ilium to the umbilicus was noted, almost mimicking an intra-abdominal pregnancy. All laboratory tests were within normal limits and an unconventional surgical approach was used for a one-stage excision of the tumor without complications. The definitive histopathological diagnosis postexcision was that of a telangiectatic osteosarcoma only on the second review of the histological specimen.ConclusionsPelvic telangiectatic osteosarcoma is rare, and the ilium is the commonly affected pelvic bone. These tumors can be sizeable at presentation with intra-abdominal or pelvic extension with a high chance of misdiagnosis. Fortunately surrounding soft tissue involvement seems to be a rare and late finding when present.

Vitamin D deficiency, pregnancy, and childbirth in early medieval Milan

This paper explores the burden of osteomalacia on pregnancy and childbirth through two cases from early medieval urban Milan. Two skeletons of female individuals with skeletal deformities and associated with 25–36 gestational weeks fetuses, excavated from the Ad Martyres and San Vittore al Corpo urban cemeteries and dated to the Early Middle Ages, were examined. Paleopathological and historical analyses were performed in a biocultural approach to investigate the impact of clinical complications and skeletal deformities on their daily life, the course of their pregnancy, and childbirth. The women showed severe skeletal deformities attributable to osteomalacia including scoliosis, reduced rib-neck angle, coxavara, severe bending of the pelvic bones, protrusio acetabuli, and narrowed pelvic outlet. The condition and its biomechanical complications impacted the health of both mothers and fetuses, the quality of life of the women (i.e., gait alteration, difficult and limited mobility, compression of internal organs), as well as pregnancy outcomes. It is possible that both the mothers and fetuses died due to childbirth complications. Bioarchaeological cases of osteomalacia, pregnancy, and death during childbirth are excessively rare. This paper also provides insight into how maternal experiences and biocultural environments in early medieval Milan impacted childbirth outcome. The study of the Ad Martyres and San Vittore al Corpo necropolises is still ongoing and could provide further insight. Isotopic and paleogenomic analyses may shed more light into the factors that led to vitamin D deficiency in these women.

Appropriateness of Imaging for Low-Risk Prostate Cancer-Real World Data from the Pennsylvania Urologic Regional Collaboration (PURC).

Imaging for prostate cancer defines the extent of disease. Guidelines recommend against imaging low-risk prostate cancer patients with a computed tomography (CT) scan or bone scan due to the low probability of metastasis. We reviewed imaging performed for men diagnosed with low-risk prostate cancer across the Pennsylvania Urologic Regional Collaborative (PURC), a physician-led data sharing and quality improvement collaborative. The data of 10 practices were queried regarding the imaging performed in men diagnosed with prostate cancer from 2015 to 2022. The cohort included 13,122 patients with 3502 (27%) low-risk, 2364 (18%) favorable intermediate-risk, 3585 (27%) unfavorable intermediate-risk, and 3671 (28%) high-risk prostate cancer, based on the AUA guidelines. Amongst the low-risk patients, imaging utilization included pelvic MRI (59.7%), bone scan (17.8%), CT (16.0%), and PET-based imaging (0.5%). Redundant imaging occurred in 1022 patients (29.2%). There was variability among the PURC sites for imaging used in the low-risk patients, and iterative education reduced the need for CT and bone scans. Approximately 15% of low-risk patients had staging imaging performed using either a CT or bone scan, and redundant imaging occurred in almost one-third of men. Such data underscore the need for continued guideline-based education to optimize the stewardship of resources and reduce unnecessary costs to the healthcare system.

Evaluation of finite element modeling methods for predicting compression screw failure in a custom pelvic implant.

Introduction: Three-dimensional (3D)-printed custom pelvic implants have become a clinically viable option for patients undergoing pelvic cancer surgery with resection of the hip joint. However, increased clinical utilization has also necessitated improved implant durability, especially with regard to the compression screws used to secure the implant to remaining pelvic bone. This study evaluated six different finite element (FE) screw modeling methods for predicting compression screw pullout and fatigue failure in a custom pelvic implant secured to bone using nine compression screws. Methods: Three modeling methods (tied constraints (TIE), bolt load with constant force (BL-CF), and bolt load with constant length (BL-CL)) generated screw axial forces using functionality built into Abaqus FE software; while the remaining three modeling methods (isotropic pseudo-thermal field (ISO), orthotropic pseudo-thermal field (ORT), and equal-and-opposite force field (FOR)) generated screw axial forces using iterative physics-based relationships that can be implemented in any FE software. The ability of all six modeling methods to match specified screw pretension forces and predict screw pullout and fatigue failure was evaluated using an FE model of a custom pelvic implant with total hip replacement. The applied hip contact forces in the FE model were estimated at two locations in a gait cycle. For each of the nine screws in the custom implant FE model, likelihood of screw pullout failure was predicted using maximum screw axial force, while likelihood of screw fatigue failure was predicted using maximum von Mises stress. Results: The three iterative physics-based modeling methods and the non-iterative Abaqus BL-CL method produced nearly identical predictions for likelihood of screw pullout and fatigue failure, while the other two built-in Abaqus modeling methods yielded vastly different predictions. However, the Abaqus BL-CL method required the least computation time, largely because an iterative process was not needed to induce specified screw pretension forces. Of the three iterative methods, FOR required the fewest iterations and thus the least computation time. Discussion: These findings suggest that the BL-CL screw modeling method is the best option when Abaqus is used for predicting screw pullout and fatigue failure in custom pelvis prostheses, while the iterative physics-based FOR method is the best option if FE software other than Abaqus is used.

Prevalence and risk factors of osteosarcopenia in elderly patients with uncontrolled type 2 diabetes.

To assess the prevalence of osteosarcopenia (OS) in elderly patients with type 2 diabetes mellitus (T2DM) and explore the related risk factors for developing this condition. This cross-sectional study enrolled hospitalized T2DM patients aged 60 years and older. Patients underwent assessments of total hip bone mineral density (BMD), grip strength, the Short Physical Performance Battery (SPPB), and body composition. Based on the 2019 Asian Working Group for Sarcopenia (AWGS) criteria, appendicular skeletal muscle mass (ASM), grip strength, and SPPB were measured to diagnose sarcopenia. BMD and T values of the lumbar spine and hip were measured using dual-energy X-ray absorptiometry (DXA). Osteosarcopenia was defined when both sarcopenia and osteoporosis criteria were met. Statistical analysis included binary logistic regression to identify significant risk factors. A total of 254 hospitalized T2DM patients (80 males and 174 females) were included. They were divided into T2DM-OS (n = 58) and T2DM-NOS (n = 196) groups based on the presence of osteosarcopenia. The average ages were 72.724 ± 6.463 and 69.265 ± 6.035 years, respectively. The prevalence of osteosarcopenia in T2DM patients was 22.8%, with 20.7% (12 males) and 79.3% (46 females) in the T2DM-OS group. After adjusting for confounding factors, it was found that male gender (OR: 5.738, 95% CI: 1.602-20.551, P = 0.007), fasting plasma glucose (OR: 0.904, 95% CI: 0.821-0.995, P = 0.038), and ASMI (OR: 0.049, 95% CI: 0.013-0.184, P < 0.001) were major influencing factors for the development of osteosarcopenia in elderly T2DM patients. The prevalence of T2DM-OS is relatively high, with male gender, low fasting plasma glucose, and low ASMI identified as risk factors.

A Comprehensive Narrative Review of the Impact of Pelvic Radiotherapy on Pelvic Bone Health: Pathophysiology, Early Diagnosis, and Prevention Strategies.

Radiotherapy is a commonly used modality in pelvic malignancies such as prostate, gastrointestinal, or gynecological, either as a primary treatment or an adjuvant post-surgery. Despite its positive impact on the prognosis of these patients, it was found in several studies that it contributes to insufficiency fractures in different sites of the pelvis, more commonly in the sacral ala. This is particularly true for elderly patients. There are several hypotheses on how radiotherapy affects bone health, as it destroys the bone matrix and causes obliterative vasculitis. Several imaging techniques, particularly magnetic resonance imaging (MRI), help detect the radiotherapy-induced fracture and distinguish it from metastases. Some modalities, such as intensity-modulated radiotherapy (IMRT) and brachytherapy, have decreased fracture risk by escaping the adjacent structures to the targeted organ. Pharmacological interventions such as amifostine and desferrioxamine are promising in terms of bone protection, which necessitates further studies to confirm their mechanism of action.

Ankylosing spondylitis and heterotopic calcification: a case from the Prehispanic population of Buenavista del Norte (Tenerife, Canary Islands).

Skeletal remains of an adult (estimated age at death ≈ 27-30 years) Prehispanic male with fusion in the sacroiliac joints showed a heterotopic ossification consisting of a flat, 10 × 5 cm bone formation covering the posterior aspect of the right sacroiliac joint. The bones were recovered from a burial cave containing remains of 4 individuals, located on the side of a ravine, in Buenavista del Norte (NW corner of Tenerife, Canary Islands), at ≈ 450 m altitude. This individual was probably affected by ankylosing spondylitis (AS) that led to bony fusion of the pelvic bones with the sacrum, but several unusual features prompted us to compare the pelvis with those belonging to two modern individuals affected by AS (20th century) housed at the Department of Anatomy of the school of medicine (University of La Laguna, Tenerife). The Prehispanic individual possibly suffered a pelvic fracture that caused a hematoma which underwent ossification. Some features (periosteal reaction, formation of new foramina) may also suggest a superimposed infection. The fracture altered the pelvic structure, severely narrowing the right sciatic notch, possibly causing neural and/or vascular compromise of the lower limbs. Living in a steep mountainous environment, this individual (possibly a goatherder) probably suffered a fall, that caused the fracture complicated by a severe bleeding and pelvic deformation.

Optimal Correction Strategy of Image Guided Radiation Therapy Including the Paraortic Lymph Node Region in Patients With Cervical Cancers

The clinically accepted planning target volume margin for radiation therapy to the paraortic nodal region in cervical cancer patients is 5 mm. However, the comprehensive alignment and variability from the pelvic bone to all lumbar vertebrae are undetermined. This study aims to quantify the residual setup errors between the pelvic bone and lumbar vertebrae and determine the optimal correction strategy for patients with cervical cancer. Fifteen patients underwent pretreatment mega-voltage computed tomography scans (375 total fractions). Residual setup errors and required margins for each lumbar vertebra were calculated based on registrations accounting for pelvic rotation and translation. The systematic residual errors (1 SD) at L1, L2, L3, L4, and L5 using pelvic bone registration were 6.5, 4.9, 3.1, 1.5, and 0.6 mm in the anterior-posterior (AP) direction, 3.1, 2.3, 1.4, 0.6, and 0.3 mm in the right-left direction, and 2.7, 2.2, 1.7, 1.0, and 0.5 mm in the superior-inferior direction, respectively. The residual setup errors were the largest in the AP direction. Registration based on the pelvic bone required margins in the AP direction of 16.0, 12.1, 7.7, 3.6, and 1.3 mm for L1, L2, L3, L4, and L5, respectively, whereas registration based on L3 required margins of 8.8, 4.8, 4.4, 7.1, and 7.7 mm for L1, L2, L4, L5, and pelvic bone, respectively. Considerable local setup variability was found in patients with cervical cancer. After reviewing the corrective strategies, we determined that L3-based registration effectively minimized the required margins.

Features of treatment of posterior urethral injuries in the acute period of traumatic disease

BACKGROUND: Combined pelvic trauma in men in 10%–24% of cases is accompanied by damage to the posterior urethra, and no consensus on the treatment tactics has been established for such patients. AIM: This study aimed to evaluate the results of treatment of patients with closed injury of the posterior urethra and traumatic shock. MATERIALS AND METHODS: A retrospective analysis of the results of treatment of 46 patients with closed injury of the posterior urethra caused by a fracture of the pelvic bones and traumatic shock was performed. The average age of patients was 42.1 ± 9.9 years. The severity of urethral injuries was assessed according to the American Association for the Surgery of Trauma (AAST) classification. RESULTS: The choice of treatment techniques depended on the degree of damage to the urethra and severity of traumatic shock. Upon hospital admission, 15 (32.6%) patients were diagnosed with grade I, 21 (45.6%) with grade II, and 10 (21.7%) with grade III traumatic shock. In grade I–II traumatic shock patients with incomplete urethral rupture, a urethral catheter was inserted, followed by conservative therapy. If a catheter insertion was possible, a retropubic revision of the urethra was performed. Patients with grade III–V urethral injury according to AAST and grade I–II traumatic shock underwent primary or delayed urethroplasty, such as urethral suturing and urethra-urethral anastomosis. Patients with grade III traumatic shock had a urethral catheter or cystostomy. In the long-term, 6 of 17 (36.9%) patients who underwent primary or delayed urethroplasty had short-term (up to 5 mm) urethral strictures, for which optical urethrotomy was performed. All patients with complete urethral avulsion who did not undergo early urethroplasty developed 10–20 mm strictures, requiring reconstructive surgery. CONCLUSIONS: The choice of treatment techniques for patients with concomitant damage to the posterior urethra depends on the degree of damage to the urethra and severity of traumatic shock. The scope of treatment in the acute period may include urethral or suprapubic drainage of the bladder or reconstructive surgery.

Does adding sacroiliac (type IV) resection to periacetabular (type II) resection increase complications or provide worse clinical outcomes? An institutional experience and systematic review

Background and objectivesInternal hemipelvectomy is a limb sparing procedure most commonly indicated for malignant bone and soft tissue tumors of the pelvis. Partial resection and pelvic reconstruction may be challenging for orthopedic oncologists due to late presentation, high tumor burden, and complex anatomy. Specifically, wide resection of tumors involving the periacetabular and sacroiliac (SI) regions may compromise adjacent vital neurovascular structures, impair wound healing, or limit functional recovery. We aimed to present a series of patients treated at our institution who underwent periacetabular internal hemipelvectomy (Type II) with or without sacral extension (Type IV) in combination with a systematic review to investigate postoperative complications, functional outcomes, and implant and patient survival following pelvic tumor resection via Type II hemipelvectomy with or without Type IV resection. Materials and methodsA surgical registry of consecutive patients treated with internal hemipelvectomy for primary or secondary pelvic bone tumors at our institution since 1994 was retrospectively reviewed. All type II resection patients were stratified into two separate cohorts, based on whether or not periacetabular resection was extended beyond the SI joint to include the sacrum (Type IV), as per the Enneking and Dunham classification. Patient demographics, operative parameters, complications, and oncological outcomes were collected. Categorical and continuous variables were compared with Pearson's chi square or Fisher's exact test and the Mann-Whitney U test, respectively. Literature review according to PRISMA guidelines queried studies pertaining to patient outcomes following periacetabular internal hemipelvectomy. The search strategy included combinations of the key words “internal hemipelvectomy”, “pelvic reconstruction”, “pelvic tumor”, and “limb salvage”. Pooled data was compared using Pearson's chi square. Statistical significance was established as p < 0.05. ResultsA total of 76 patients were treated at our institution with internal hemipelvectomy for pelvic tumor resection, of whom 21 had periacetabular resection. Fifteen patients underwent Type II resection without Type IV involvement, whereas six patients had combined Type II/IV resection. There were no significant differences between groups in operative time, blood loss, complications, local recurrence, postoperative metastasis, or disease mortality. Systematic review yielded 69 studies comprising 929 patients who underwent internal hemipelvectomy with acetabular resection. Of these, 906 (97.5 %) had only Type II resection while 23 (2.5 %) had concomitant Type II/IV resection. While overall complication rates were comparable, Type II resection alone produced significantly fewer neurological complications when compared to Type II resection with sacral extension (3.9 % vs. 17.4 %, p = 0.001). No significant differences were found between rates of wound complications, infections, or construct failures. Local recurrence, postoperative metastasis, and survival outcomes were similar. Type II internal hemipelvectomy without Type IV resection on average produced higher postoperative MSTS functional scores than with Type IV resection. ConclusionIn our series, the two groups exhibited no differences. From the systematic review, operative parameters, local recurrence or systemic metastasis, implant survival, and disease mortality were comparable in patients undergoing Type II internal hemipelvectomy alone compared to patients undergoing some combination of Type II/IV resection. However, compound resections increased the risk of neurological complications and experienced poorer MSTS functional scores.

Finite element modeling of stress distribution and safety factors in a Ti-27Nb alloy hip implant under real-world physiological loading scenarios.

Total hip arthroplasty (THA) is one of the most successful orthopaedic interventions globally, with over 450,000 procedures annually in the U.S. alone. However, issues like aseptic loosening, dislocation, infection and stress shielding persist, necessitating complex, costly revision surgeries. This highlights the need for continued biomaterials innovation to enhance primary implant integrity and longevity. Implant materials play a pivotal role in determining long-term outcomes, with titanium alloys being the prominent choice. However, emerging evidence indicates scope for optimized materials. The nickel-free β titanium alloy Ti-27Nb shows promise with excellent biocompatibility and mechanical properties. Using finite element analysis (FEA), this study investigated the biomechanical performance and safety factors of a hip bone implant made of nickel-free titanium alloy (Ti-27Nb) under actual loading during routine day life activities for different body weights. The FEA modelled physiological loads during walking, jogging, stair ascent/descent, knee bend, standing up, sitting down and cycling for 75 kg and 100 kg body weights. Comparative analyses were conducted between untreated versus 816-hour simulated body fluid (SBF) treated implant conditions to determine in vivo degradation effects. The FEA predicted elevated von Mises stresses in the implant neck for all activities, especially stair climbing, due to its smaller cross-section. Stresses increased substantially with a higher 100 kg body weight compared to 75 kg, implying risks for heavier patients. Safety factors were reduced by up to 58% between body weights, although remaining above the desired minimum value of 1. Negligible variations were observed between untreated and SBF-treated responses, attributed to Ti-27Nb's excellent biocorrosion resistance. This comprehensive FEA provided clinically relevant insights into the biomechanical behaviour and integrity of the Ti-27Nb hip implant under complex loading scenarios. The results can guide shape and material optimization to improve robustness against repetitive stresses over long-term use. Identifying damage accumulation and failure risks is crucial for hip implants encountering real-world variable conditions. The negligible SBF effects validate Ti-27Nb's resistance to physiological degradation. Overall, the study significantly advances understanding of Ti-27Nb's suitability for reliable, durable hip arthroplasties with low revision rates.

Automatic variable extraction from 3D coxal bone models for sex estimation using the DSP2 method.

Thanks to technical progress and the availability of virtual data, sex estimation methods as part of a biological profile are undergoing an inevitable evolution. Further reductions in subjectivity, but potentially also in measurement errors, can be brought by approaches that automate the extraction of variables. Such automatization also significantly accelerates and facilitates the specialist's work. The aim of this study is (1) to apply a previously proposed algorithm (Kuchař et al. 2021) to automatically extract 10 variables used for the DSP2 sex estimation method, and (2) to test the robustness of the new automatic approach in a current heterogeneous population. For the first aim, we used a sample of 240 3D scans of pelvic bones from the same individuals, which were measured manually for the DSP database. For the second aim a sample of 108 pelvic bones from the New Mexico Decedent Image Database was used. The results showed high agreement between automatic and manual measurements with rTEM below 5% for all dimensions except two. The accuracy of final sex estimates based on all 10 variables was excellent (error rate 0.3%). However, we observed a higher number of undetermined individuals in the Portuguese sample (25% of males) and the New Mexican sample (36.5% of females). In conclusion, the procedure for automatic dimension extraction was successfully applied both to a different type of data and to a heterogeneous population.

Synchronous multifocal osteosarcoma: Report of 4 cases and literature review

BackgroundMultifocal osteosarcoma (MFOS) is rare, accounting for approximately 1.5 % of osteosarcomas, and can be synchronous (lesions within six months) or metachronous (lesions after six months). The etiology and optimal treatment for MFOS remain controversial. This report presents four patients with synchronous MFOS and reviews the literature. Case presentationCase 1: A 24-year-old female with low back pain was found to have multiple lytic bone lesions with increased FDG uptake in the vertebral column and pelvic bones. Biopsy confirmed osteoblastoma-like osteosarcoma. After chemotherapy, she is alive after 5 months.Case 2: A 6-year-old girl with right knee pain had a distal femur mass and a calcified inguinal lesion. Biopsies revealed osteoblastic osteosarcoma with metastatic lymph node involvement. Following chemotherapy and surgeries, she experienced recurrence and required further surgery. She is alive after 21 months.Case 3: A 4-year-old boy with a walking disability had a sclerotic bone lesion in the distal femur and additional lesions in the pelvis and acetabulum. Biopsy confirmed osteoblastic osteosarcoma. Despite treatment, he developed metastases and died 7 months after diagnosis.Case 4: A 9-year-old girl with right knee swelling had a sclerotic lytic lesion in the distal femur and an acetabular lesion. Biopsies confirmed chondroblastic osteosarcoma. After chemotherapy and surgery, she experienced recurrence and underwent pelvic resection. She died 24 months after diagnosis. ConclusionSynchronous MFOS is a highly aggressive osteosarcoma variant with a poor prognosis. Aggressive, individualized treatment may improve outcomes, particularly in metachronous cases. Further research is needed to enhance understanding and management of this rare condition.

Biomechanical assessment and comparison of fixation methods for bilateral sacroiliac joint luxation in 3D-printed feline pelvic bone models.

Bilateral sacroiliac joint luxation, a condition primarily observed in cats, can significantly impact their quality of life. This study aimed to compare a control with three distinct fixation methods to identify the most robust fixation method capable of withstanding significant tensile stress. Twenty pelvic bone models of cats were made using a 3D printer with polylactic acid plastic. Each model was assembled by cutting the sacroiliac joints and pelvic girdle symphysis with a handsaw, then bonded with cyanoacrylate glue. 3D feline pelvic bone models were categorized into four significant groups, each consisting of five models. The study discovered that the three groups used distinct fixation methods: Two lag screws (DS), K-wires at the ilium wing and sacroiliac joints (TK), and K-wires at the sacroiliac joints (DK). The final group, not fixed, was the control. The results were characterized further through a mechanical compression force test using a universal testing machine. The most robust method at the sacroiliac joints, the DK technique, sustained a maximum force of up to 183.86 N while maintaining the correct bone alignment. The fixation method is more accessible and faster to implement in comparison to the DS method. The DK group exhibited the greatest maximum load capacity among all groups. Sacroiliac joint luxation treatment can effectively be addressed using the K-wires fixation method. However, the DK need space of sacral body same as DS for fixation. Further clinical study should be performed.

Extra axial bone ablation with augmentation

Pelvic bone metastases frequently result in severe pain and disability. Open surgical reconstruction is associated with a high complication and mortality rate. Percutaneous screw fixation is a minimally invasive treatment that is safe and effective for the management of periacetabular metastases. This article details our technique for pelvic screw fixation, including (1) perioperative care, (2) navigation and needle guidance, (3) access, (4) biopsy and ablation, (5) screw placement, and (6) cement augmentation.

A Gender-based Study on the Morphometry of Cotyloid Cavity of the Coxal Bone in South Indian Population

Abstract Background and Aim: The cotyloid cavity (acetabulum) is a cup-shaped hollow on the lateral aspect of the coxal bone. The head of the femur articulates with cotyloid cavity to form the hip joint. The cotyloid cavity varies in size, shape, and depth among individuals. Any deviation from the normal range of parameters of the acetabulum may result in arthrosis-related pathologies. Materials and Methods: The present study was conducted on 200 dry human hip bones. The bones were collected from the department of anatomy of a medical college in Mangalore. The following morphometrical parameters of the cotyloid cavity were measured: (a) transverse diameter of acetabulum, (b) acetabular height, (c) acetabular depth, (d) acetabular volume, (e) distance from the pubic tubercle to the anterior rim of the acetabulum, and (f) ratio between distance from the pubic tubercle to the anterior rim of the acetabulum and acetabular height. Range, mean, standard deviation, and standard error of mean were determined for each parameter. P value was also calculated. Gender-wise comparison of the results was done. Results: The independent t-test was done, and the P value was calculated for each parameter. All the parameters showed significant differences between the male and female hip bones. Conclusion: In this modern era, total and partial hip replacement surgeries are very commonly performed. Therefore, knowledge regarding the various morphometrical parameters of the cotyloid cavity may be of great help in the preoperative planning period. It would also be of great help in the fields of forensic anthropology, osteology, and anatomy.

Changes of bone and articular cartilage in broilers with femoral head necrosis

Femoral head necrosis (FHN) in broilers is a common leg disorder in intensive poultry farming, giving rise to poor animal health and welfare. Abnormal mechanical stress in the hip joint is a risk factor for FHN, and articular cartilage is attracting increasing attention as a cushion and lubrication structure for the joint. In the present study, broilers aged 3 to 4 wk with FHN were divided into femoral head separation (FHS) and femoral head separation with growth plate lacerations (FHSL) groups, with normal broilers as control. The features of the hip joint, bone, and cartilage were assessed in FHN progression using devices including computed tomography (CT), atomic force microscope (AFM), and transmission electron microscopy (TEM). Broilers with FHN demonstrated decreased bone mechanical properties, narrow joint space, and thickened femoral head stellate structures. Notably, abnormal cartilage morphology was observed in FHN-affected broilers, characterized by increased cartilage thickness and rough cartilage surfaces. In addition, as FHN developed, cartilage surface friction and friction coefficient dramatically increased, while cartilage modulus and stiffness decreased. The ultramicro-damage occurred in chondrocytes and the extracellular matrix (ECM) of cartilage. Cell disintegration, abnormal mitochondrial accumulation, and oxidative stress damage were observed in chondrocytes. A notable decline in cartilage collagen content was observed in ECM during the initial stages of FHN, accompanied by a pronounced reduction in collagen fiber diameter and proteoglycan content as FHN progressed. Furthermore, the noticeable loosening of the collagen fiber structure and the appearance of type I collagen were noted in cartilage. In conclusion, there was a progressive decrease in bone quality and multifaceted damage of cartilage in the femoral head, which was closely linked to the severity of FHN in broilers.