Long Bones Research Articles

Craniofacial osteosarcomas – The challenges in the diagnosis of a biologically distinct entity

Osteosarcoma is the second most common primary neoplasm arising from bone next to Multiple myeloma and is common in metaphysis of long bones. Osteosarcoma of the jaw bones is a biologically distinct entity in contrast with Osteosarcoma of the long bones. This review highlights the challenges in the diagnosis of craniofacial osteosarcoma and emphasizes the need for appropriate diagnosis of this entity for proper management.

Acoustic Emission Signatures During Failure of Vertebra and Long Bone.

Clinical classification of an injury has traditionally involved medical imaging, patient history, and physical examination. The pathogenesis or process of injury has been viewed as a crucial component to estimating fracture stability and direct treatment. However, injury classification systems generally exclude pathogenesis and injury mechanisms because these components are often difficult to elucidate. Furthermore, the development of bone damage relative to the mechanical response is difficult to quantify, which limits the ability to define injury and develop injury criteria. Past advents of new knowledge about the mechanisms and progression of fracture have refined safety standards and engineering design for limiting injury. Post-hoc methodologies for identifying and classifying injuries for post-mortem human surrogate (PMHS) research are well established. Though bone fractures can be classified post hoc, questions remain. Surface acoustic sensing (SAS) is an effective approach to augment PMHS experimentation. The objective was to develop and validate an acoustic-emission-based method to characterize bone fractures during injurious loading conditions using acoustic emissions (AEs) in two bone types: vertebral body (VB) and long bone (LB). The newly developed method incorporated the Stockwell transform to estimate the relative energy release rate (RERR) from bone fracture using acoustic signal processing. Fractures were characterized through AE burst durations and frequency content. Results indicated that VB fractures from compression are prolonged processes compared to LB fracture, which was staccato in nature. Significant (p<0.01) differences between burst duration and frequency content were identified between the two bone types.

En bloc resection combined with induced membrane technique for treatment of Cierny-Mader type IV posttraumatic long bone infection

Objective To investigate the results of Cierny-Mader type Ⅳ posttraumatic long bone infection treated by en bloc resection combined with induced membrane technique. Methods A retrospective case series analysis was made on 36 patients with posttraumatic long bone infection treated by en bloc resection combined with induced membrane technique from January 2013 to January 2015. There were 30 male and 6 female patients between 21 and 68 years (mean, 41 years). Infection control, bone union, function activity and complications were detected after operation. Results After debridement in the first stage, a segmental bone defect of 5.5 cm in length (range, 2-10.9 cm) was seen in all patients. Seven patients needed a local flap transfer to cover the wound and five patients had a second debridement. Mean duration of systemic antibiotic use was 2 weeks (range, 1-6 weeks) and mean time interval of second-stage bone grafting was 12 weeks after debridement (range, 6-36 weeks). Mean follow-up was 29.5 months (range, 24-45 months). One patient had recurrence and was cured with radical debridement and a permanent acrylic spacers insertion, with the cure rate of bone infection of 97% (35/36). All patients achieved bone union with a mean duration of 5.9 months (range, 4-8 months), and were able to walk independently. Thirty patients returned to work or pre-operative physical labor. No pain and re-fracture occurred. Six patients had adjacent joint stiffness. Conclusion En bloc resection combined with induced membrane technique is associated with radical debridement, decreased recurrence rate and limb salvage, indicating a simple and effective method for Cierny-Mader type IV posttraumatic long bone infection. Key words: Osteomyelitis; Fractures, bone; Induced membrane technique

Masquelet technique to treat post-traumatic osteomyelitis of long bones

Long bone osteomyelitis often results from serious open fractures or some closed fractures. Its treatment is a clinical difficulty in orthopaedics. Masquelet is a new strategy for bone reconstruction, validated by surgeons in their treatment of acute bone loss, bone tumor and bone infection. It is carried out in 2 stages. At the first stage, infection was eliminated by radical debridement and placement of antibiotic bone cement into the defect, which induces a pseudomembrane to facilitate the growth of bone graft. At the second stage, reconstruction of the bone defect is performed by bone grafting in the membrance after removal of the bone cement. The unique characteristics of this technique arouse more and more attention recently. Therefore, we would like to present a review about this Masquelet technique dealing with post-traumatic osteomyelitis of long bones. Key words: Osteomyelitis; Wounds and injuries; Bone defect; Masquelet technique

Advances in the treatment of Orthopaedic diseases with Bone Marrow Mesenchymal Stem Cells

Bone Marrow Mesenchymal Stem Cells (BMSCs) are ideal seed cells for cell therapy, which have been through many long-term studies of in vitro and animal disease model treatment and have been widely used in preventing and treating a variety of clinical diseases caused by aging and other damage, including bone injury and regeneration, neural degenerative and injury, myocardial injury, liver cirrhosis, diabetes, lung disease and so on. BMSCs application in the treatment of orthopaedic disease is the most common and effective. By retrospective literature review, we summarize the BMSCs transplantation application in Orthopaedic disease treatment. As an ideal cell source, BMSCs was first applied in bone tissue engineering, mainly used in the treatment of long bone defect and bone nonunion; Recently, the research trends of clinical BMSCs application turned to treat degenerative diseases and genetic disorders because of its great potential, including osteoarthrits, femoral head necrosis, disc degeneration, spinal cord injury, knee varus, osteogenesis hypoplasia, hypophosphatasia and so on. The safety and efficacy of BMSCs treatment are the key issues in clinical cell therapy. There is no side effects and complications after BMSCs treatment, prove its clinical application is safe. But due to type and degree of disease and individual differences, therapeutic methods including injection method, effective concentrations, treatment window selection, cycle and therapeatic effects have a bigger difference. There is still no uniform of recognized operation standards for the treatment of the same type of disease. So BMSCs transplantation requires effective control during whole medical process and its application in orthopedic diseases is still lack of large-scale multicenter clinical study. Therefore, this review focuses on induction, summary and analysis in the research status of BMSCs in bone disease treatment, and provide new ideas and methods for BMSCs transplantation in orthopaedic disease prevention and treatment.

Influence of β-calcium phosphate on repair of large bone defects using nested composite bone graft of allogeneic bone and vascular autograft bone

Objective To study the influence of β-calcium phosphate on the repair of large bone defects using nested composite bone graft of allogeneic bone and vascular autograft bone. Methods Sixteen New Zealand rabbits of 6 months old were randomly divided into 2 equal groups (n=8). Models of 15 mm large bone defect were created on the middle and upper shaft of the right tibia in all the rabbits. The defects were repaired using nested composite bone graft of allogeneic bone and vascular autograft bone. The gap between the allogeneic bone and the autograft bone in the composite bone graft was filled with β-calcium phos-phate in the experimental group but not filled in the control group. X-ray examination was conducted to observe fracture healing on the right postoperative day and 8 and 12 weeks after operation; examination of bone mineral density in the bone defect area was conducted at 1, 8 and 12 weeks after operation; histological observation of samples was made at 8 and 12 weeks after operation. The 2 groups were compared regarding the effect of β-calcium phosphate on the repair of bone defects. Results All the animals survived till the observation time and their wounds healed well without any infection. X-ray showed better bone union in the experimental group than in the control group at 8 and 12 months after operation. In the experimental group, the bone mineral density at one week(0.171±0.016 g/cm2) increased significantly at 8 weeks(0.293±0.014 g/cm2) but decreased significantly at 12 weeks (0.274±0.014 g/cm2) (P< 0.05); in the control group, the bone mineral density at one week (0.154±0.011 g/cm2) increased significantly at 8 weeks(0.211±0.008 g/cm2) and increased significantly still higher at 12 weeks (0.235±0.010 g/cm2) (P< 0.05). At 8 and 12 weeks, the bone mineral density in the control group was significantly lower than in the experimental group(P< 0.05). Histological detection showed that massive new bone formed in the composite bone graft in the experimental group at 8 and 12 weeks after operation while little new bone formed in the bone defect area and there was a distinct gap between the allogeneic bone and the autograft bone in the control group. Conclusion As filling of β-calcium phosphate particles can accelerate formation of new bone callus to promote healing of long bone defects, it makes up for the shortcoming of conventional nested composite bone graft of allogeneic bone and vascular autograft bone. Key words: Transplantation, autologous; Reconstructive surgical procedures; Animal experimentation; β-calcium phosphate; Large bone defects

Flexible intramedullary nail is still a cost-effective, minimally invasive treatment for stable tibial diaphyseal fracture - A large scale study

Background: Many times, we come across patients who ask for conservative line of treatment either because of lower socioeconomic status or many people are unable to stay in the hospital for various reasons. Being orthopedicians, mere treatment of fracture should not be our only aim. Our aim also should be to treat patient as a whole. In country like India, especially in rural set-up, economy plays a major role. Hence, we conducted a study to evaluate the cost-effectiveness of flexible unreamed nailing, using Ender nails for the most common long bone fracture, i.e., tibia. Materials and Methods: Nearly 590 patients with diaphyseal fractures were fixed with Ender nails from September 2002 to September 2016. The mean age of the patients was 39 years (range 18–65 years). Inclusion criteria were closed fractures and type 1 compound fractures with relative stable configuration. Exclusion criteria were long oblique and spiral fractures; type 2 and type 3 open fractures. Two Ender nails of 4.5 mm each were passed across the fracture site into the distal fragment. The mean follow-up was 16 months. Results: Average time to fracture union was 11 weeks (range 8–14 weeks). Average peri-operative blood loss was 120°. Conclusions: Ender nailing in cases of tibial diaphyseal fractures could achieve reliable fracture stability, better union with least complications. Advantage of low-cost intramedullary device, its easy removal, and less hospital stay makes this even more attractive for the poor patients.

Intraosseous lipoma of ilium: A rare case report with review of literature

Intraosseous lipoma (IL) is a rare benign bone lesion, and it constitutes about 0.1% of all bone tumors. The majority of cases are located in the metaphyseal region of the long bones in the lower limbs. We report a rare case of lipoma of the ilium in a 12-year-old male child presenting with mass over the right gluteal region. Meticulous marginal dissection was done, and a pedunculated mass originating from the lower right sacroiliac region was excised in toto. The case was an atypical example of an IL with a large outgrowth involving sacroiliac region with inconclusive magnetic resonance imaging and needle biopsy findings.

Heterogeneous modelling and finite element analysis of the femur

As the largest and longest bone in the human body, the femur has important research value and application prospects. This paper introduces a fast reconstruction method with Mimics and ANSYS software to realize the heterogeneous modelling of the femur according to Hu distribution of the CT series, and simulates it in various situations by finite element analysis to study the mechanical characteristics of the femur. The femoral heterogeneous model shows the distribution of bone mineral density and material properties, which can be used to assess the diagnosis and treatment of bone diseases. The stress concentration position of the femur under different conditions can be calculated by the simulation, which can provide reference for the design and material selection of prosthesis.

Contribución al estudio de los peces Cheirodontinae (Familia Characidae) de Costa Rica y Panamá. Géneros Compsura y Pseudocheirodon

The present paper defines the taxonomic position of Compsura gorgonae. The genus Pseudocheirodon is maintained tentatively distinct from Cheirodon. Compsura gorgonae is distinguished from Pseudocheirodon affinis by the presence of spines on the anal fin of males, fewer maxillary teeth and longer maxillary bone. A key is pravided to distinguish the genera Compsura, Cheirodon, Odontostilbe and Pseudocheirodon. Over 2,800 specimens from 54 Panamanian and Costa Rican collections were utilized. The number of lateral line pores of C. gorgonae increases in a westward direction and this may be related to the shorter rivers of steeper gradient and more turbid waters in the rainy season in western Panama. The number of lateral line pares of P. affinis , also quite variable (7-3 3), showed a random rather than clinal variation. Both the above species, when sympatric, exhibit nearly the same average number of lateral line pares, which suggests an adaptation to the same enviranmental factors. The length of the maxillary bone of C. gorgondo decreased from east to west, whereas in P. affinis the situation was reversed. No hypothesis could be offered for this latter relationship.

Puerarin and zinc additively prevent mandibular bone loss through inhibiting osteoclastogenesis in ovariectomized rats.

Puerarin and zinc play a key role in preventing osteoporotic-related bone loss. Previous research on puerarin or zinc mainly focused on the anti-osteoporotic effects of long bone. However, it is obscure for puerarin or zinc to prevent mandibular osteoporosis. Here, we explore the effects on additive coadministration of puerarin and zinc on preventing mandibular bone loss in ovariectomized rats, and evaluate the underlying mechanisms ex vivo. Rats were ovariectomized and administrated puerarin, zinc or both. After 12 weeks, bone mineral density (BMD) and histomorphometry of mandibles were measured by micro-CT. The mechanical properties were determined using a three-point bending test. Then, osteogenic differentiation of primary bone marrow stromal cells (BMSCs) and osteoclastogenesis of bone marrow mononuclear were performed ex vivo. The culture supernatant and serum level of bone biochemical markers including osteoprotegerin (OPG), osteopontin (OPN), receptor activator of nuclear factor (NF)-κB ligand (RANKL), and tartrate-resistant acid phosphatase (TRAP) were detected by ELISA. Culture supernatant and serum levels of calcium were measured using a Plasma Emission Spectrometer. One-way ANOVA was used for statistical analyses. The results showed that administration of puerarin plus zinc prevented the decrease in mandibular BMD and bone morphometrical parameters more effectively than single use of puerarin or zinc (p<0.05), which was similar to the biomechanical tests (p<0.05). Furthermore, puerarin and zinc additively up-regulated OPG, OPN protein levels, Ca ion level and down-regulated RANKL, TRAP protein levels. In conclusion, puerarin and zinc additively prevent mandibular bone loss through inhibiting osteoclastogenesis in ovariectomized rats, which will shed more light on the potential use of puerarin and zinc in the prevention/treatment of oral bone loss clinically.

PET/CT findings of Langerhans cell histiocytosis in children

Objective To summarize the 18F-FDG PET/CT findings of LCH in children, and explore its value in the diagnosis of LCH. Methods PET/CT imaging and clinical data of 13 patients(6 males, 7 females; average age (3.0±2.3) years) with LCH confirmed by histology before treatment from August 2011 to December 2015 in Xin Hua Hospital were retrospectively analyzed. Results All 13 patients have different degrees of bone destruction with increased metabolism, the common lesion sites were craniofacial bone, spine, limb long bones, ribs/chest/shoulder blade and pelvic bone. Lymph node lesions which manifested lymph node enlargement with increased metabolism were found in 10 cases, and the SUVmax was 4.0±1.3. Diffuse FDG uptake in spleen was found in 10 cases. There were 4 cases with liver lesions, 3 with lung lesions, 1 with high metabolic nodules in muscle, 1 with orbital lesions and 1 with intraspinal high metabolic nodules. Conclusion 18F-FDG PET/CT could display the distribution and activity of LCH, and plays an important role in the diagnosis and systemic evaluation of LCH. Key words: Histiocytosis, Langerhans-cell; Tomography, emission-computed; Tomography, X-ray computed; Deoxyglucose

Estrogen-mediated dental tissue regeneration.

As the key regulator of hard tissue metabolism in both men and women, estrogen regulates the processes necessary for cell growth, proliferation, and differentiation through estrogen receptor (ER). Estrogen deficiency usually causes systemic osteoporosis not only in long bones but also in jaw bones, and exogenous estrogen can enhance the osteogenic potential of mesenchymal stem cells. Dental mesenchymal stem cells (DMSCs) represent a group of stem cells isolated from different parts of the tooth, including dental pulps, apical papillae and periodontal ligaments. A number of studies have proved that estrogen plays an important role in the proliferation, differentiation and tissue regeneration of human DMSCs. Thus, this review will focus on the effects of estrogen on proliferation, apoptosis, and differentiation of dental stem cells, discuss evidence from studies in rodents that estrogen plays an important role in dental morphogenesis as well as periodontal remodeling, and suggest directions for future studies in estrogen-related tooth regeneration.

Acute traumatic coagulopathy is associated with deep vein thrombosis in severely traumatic patients

Objective To investigate the risk factors of deep vein thrombosis (DVT) as well as the association between acute traumatic coagulopathy (ATC) and DVT. Methods A retrospective observational study was carried out during the 12 month period in 2014 in emergency intensive care unit (EICU) of acute trauma center of Shanghai Jiao Tong University Affiliated Sixth People's Hospital. Data including age, gender, body mass index, injury severity score (ISS), mechanism of injury, injury sites, international normalized ratio (INR) and DVT of each patient were recorded. Patients were divided into ATC group and non-ATC group according to INR to compare the incidence of DVT. Results A total of 200 trauma patients were enrolled in this cohort. Sixty(30%) patients suffered from ATC. And eighty-seven patients (43.5%) were subjected to DVT. Patients with ATC had a significant higher incidence of DVT (71.7% vs. 31.4%, P<0.01). Multiple logistic regression revealed that patients in ATC group were highly associated with DVT in the magnitude of more than five fold (OR=5.74, 95%CI: 2.80-11.74, P<0.01) compared with non-ATC group. It was more significant (OR=9.80, 95%CI: 2.09-45.90, P=0.004) in patients with lesser severe trauma (9≤ISS<16). Meanwhile, spinal cord injury and long-bone fracture of lower extremities were independent risk factors for the development of DVT. Conclusions Severe trauma patients admitted to EICU within 24 hours post-injury have a high incidence of ATC. And those patients with ATC have a significantly higher incidence of DVT, especially in lesser severe trauma (9≤ISS<16). Spinal cord injury and long-bone fracture of lower extremities were independent risk factors for developing DVT. Key words: Trauma; Coagulopathy; Deep vein thrombosis; Injury site; Injury severity; Age; Body mass index; Risk factors

Clinical and genetic study on a family with metatropic dysplasia due to transient receptor potential vanilloid 4 gene mutation

Objective To summarize the clinical, radiographic and genetic features of a family with metatropic dysplasia, in order to improve the level of understanding and diagnosis of this disease. Methods The proband, a one-year old boy, was diagnosed as metatropic dysplasia.His mother was 26 years old with mildly phenotype.Their clinical features and bone X-ray findings were analyzed.The DNA samples of the proband and his parents were collected.The coding exons and flanking introns regions of transient receptor potential vanilloid 4 (TRPV4) gene were amplified by polymerase chain reaction(PCR) and analyzed by DNA automatic detector.The pathology, diagnosis, treatment and prognosis were expounded. Results The symptoms of the boy were characterized by short extremities, a short trunk with progressive kyphoscoliosis, and craniofacial abnormalities that include a prominent forehead, midface hypoplasia, and a squared-off jaw.His motor development was slightly delayed.Mental development was normal.Bone X ray of the boy showed platyspondyly and severe metaphyseal enlargement with shortening of long bones and irregularities and delayed ossification of epiphysis.The patient and his mother were heterozygous for the nucleotide substitutions c. 2396>T (p.P799L) in TRPV4 gene. Conclusions The patient and his mother with metatropic dysplasia were diagnosed with TRPV4 gene analysis.The patient showed typical clinical features.His mother was mild.Metatropic dysplasia had signi-ficantly clinical heterogeneity.Gene analysis is helpful for the diagnosis. Key words: Spondyloepiphyseal dysplasia; Metatropic dysplasia; Transient receptor potential vanilloid 4 channel protein; Transient receptor potential vanilloid 4 gene mutation

Treatment of unstable pelvic fractures with an external fixator and combined screwing at iliac crests and pubic symphysis

Objective To study the clinical efficacy of external fixator and combined screwing at iliac crests and pubic symphysis for the treatment of unstable pelvic fractures. Methods From January 2013 to February 2014, 12 cases of unstable pelvic fracture were treated at our department. They were 8 men and 4 women, from 32 to 57 years of age (average, 42.5 years) . Seven cases were caused by a traffic accident, and 5 by falling from a height. By Tile classification, 8 cases were type B (including type B1 in 3 cases, type B2 in 3 and type B3 in 2) , and 4 cases type C1. Associated injury included shock in 7 cases, bladder injury in one, limb long bone fracture in 6, joint injury in 3, and thoracic and lumbar injury in 4. The interval from injury to operation averaged 4 days, ranging from 12 hours to 7 days. The type B fractures were treated with an external fixator and combined screwing at iliac crests and pubic symphysis while the type C1 fractures with internal fixation with percutaneous S1 sacroiliac screws in addition to what was used for the type B fractures. Results The 12 patients were followed up for 5 to 12 months (average, 9 months) . No one died in this group. The fractures healed after 8 to 13 weeks (average, 11.3 weeks) . All the patients recovered normal walking. Superficial infection at the pin hole occurred in 7 cases, but there was no deep infection. Screw loosening was observed in only one case, and no reduction loss, injury to nerves or urinary canal was observed. According to the Majeed criteria, the efficacy was evaluated as excellent in 10 cases, good in one, and moderate in one. Conclusion External fixator and combined screwing at iliac crests and pubic symphysis can restore the stability of anterior pelvic ring, leading to good clinical outcomes. Key words: Pelvis; Fractures, bone; Fracture fixation; External fixator

A new adult specimen of the basalmost ornithuromorph bird Archaeorhynchus spathula (Aves: Ornithuromorpha) and its implications for early avian ontogeny

Most living birds characteristically grow rapidly and reach adult size within a year. Nevertheless, little is known about how such an advanced developmental strategy evolved despite many discoveries of early fossil birds. Here we assess the long-bone histology from a new adult specimen of Archaeorhynchus spathula, the basalmost taxon of Ornithuromorpha. Ornithuromorpha is the most inclusive clade containing extant birds but not the Mesozoic Enantiornithes. Histological analysis reveals that the cortex is composed of parallel-fibred bone with three lines of arrested growth, indicative of slow and annually interrupted growth for this taxon. Such bone histology is significantly different from that of other known basal ornithuromorphs, but resembles that of enantiornithines, which leads us to suggest protracted slow growth in the common ancestor of Ornithuromorpha and Enantiornithes. The fusion sequence of the tarsometatarsus between Enantiornithes and Ornithuromorpha has long been hypothesized to be differen...

Computer-assisted orthopedic surgery

Computer-assisted surgery (CAS) has been used in orthopaedic surgery for over 20 years. Through real-time and quantitative feedback, it provides the surgeons the visibility of surgical anatomy, improves accuracy, reduces the outlier of the surgical results and maximizes the outcomes. CAS has been popularly applied in joint arthroplasty, bone osteotomy, implantation of screws in spine surgery, reconstruction of ligaments in sports medicine, open reduction and internal fixation of long-bone fracture and tumor surgery. The article is to overview the current CAS clinical application status and related outcomes. Whether the better postoperative images can translate into improved clinical functional outcomes deserves long term follow up.

Clinical features and gene mutation analysis of cartilage oligomeric matrix protein in a family with pseudoachondroplasia

Objective To investigate cartilage oligomeric matrix protein(COMP)gene mutation in a three-generation pedigree with two cases of pseudoachondroplasia, and to definitize genotype-phenotype correlation. Methods The clinical data and peripheral blood were collected from the patients with pseudoachondroplasia and their family members. All the 19 exons and their flanking sequences of COMP gene in two patients and three unaffected family numbers and 50 unrelated individuals were analyzed by PCR amplification and direct sequencing. Results The proband, a 6-year-old girl presented with typical clinical features of pseudoachondroplasia, including disproportionate short limb dwarfism, staggering gait, double genu varus deformity, and wider clinical and imaging long bone metaphysis. The 33-year-old father showed a similar manifestation including disproportionate short limb dwarfism and double genu varus deformity, and was performed correcting operation on lower limbs for double genu varus at the age of 10 years. DNA sequencing analysis of the COMP gene revealed a del mutation(c.1417_1419delGAC)in exon 13 in two patients with pseudoachondroplasia, but not in the other unaffected members from the pedrgree and 50 control subjects. Conclusion A del mutation c. 1417_1419delGAC of COMP gene may contribute to the disease in the pedigree. Key words: Pseudoachondroplasia; Cartilage oligomeric matrix protein; Gene mutation

Cave sediments and fossils as karst archives: the Urșilor and Muierilor caves, Romania

During the last eight years an ongoing interdisciplinary research is being carried out at the Ursilor and Muierilor caves, Romania. This sedimentological, geomorphological and geochronological study aims at better understanding of the taphonomy of the MIS 3 fossil accumulations and their palaeoclimate context. The two sites contain complex types of fossil thanatocoenosis - in situ, secondary or mixt. Numerous methods of investigation, typical for this type of multidisciplinary research were applied: AMS 14C direct dating on fossil bone (N = 42), U/Th dating of the relevant speleothems (N = 4), termoluminiscence for dating sediments (OSL; N=7), analysis of physical and chemical properties of cave sediments, rock magnetism, stable isotope analyses on the cave bear’s bone collagen (δ15N and δ13C; N=125), taphonomic methods for assessing the bone assemblage’s properties (MNI, NISP, ISD, long bone orientation etc.), high resolution osteometry, laser scanning of the cave bear’ bioglyphs etc.