Metaphysis Of Long Bones Research Articles

Osteoporose em caprinos

Foi realizado um estudo de casos de osteoporose em caprinos provenientes de uma propriedade na área de abrangência do LPV-UFSM, determinando a epidemiologia, o quadro clínico-patológico e discutindo os prováveis mecanismos patogenéticos. Cinco cabras, fêmeas, SRD, de seis meses a seis anos de idade foram afetadas. As cabras eram mantidas em campo nativo, sem suplementação com ração e sob superlotação. Os principais sinais clínicos foram emagrecimento, dificuldade de locomoção e permanência em decúbito por longos períodos. As principais alterações macroscópicas nos ossos examinados foram vistas nas superfícies de corte e caracterizavam-se por depleção do osso esponjoso (porosidade) e redução acentuada da espessura do osso cortical. Havia também marcada atrofia serosa da gordura da medula óssea. Microscopicamente, nas regiões avaliadas (úmero proximal, rádio distal, fêmur distal, tíbia proximal e corpos das vértebras lombares) foi observada redução moderada a acentuada do número e da espessura das trabéculas ósseas nas epífises e metáfises dos ossos longos e nos corpos vertebrais. Os achados clínico-patológicos indicaram que a osteoporose observada provavelmente foi causada pela desnutrição. As alterações ósseas (diminuição no número e na espessura das trabéculas do osso esponjoso) sugerem que ambos os mecanismos, má formação óssea e reabsorção óssea aumentada, contribuíram para a ocorrência de osteoporose nos caprinos deste estudo.

Chronic non-bacterial osteomyelitis in childhood - a comprehensive review.

The clinical picture of childhood chronic recurrent multifocal osteomyelitis (CRMO) is characterized by an aseptic chronic osteomyelitis, most often affecting the metaphyses of the long bones. Skin inflammation (palmoplantar pustulosis, psoriatic lesions, acne) and inflammatory bowel disease may be associated with CRMO and therefore subsume this disease into the entity of SAPHO syndrome. Deregulated cytokine/chemokine expression in myeloid cells seems to drive chronic inflammation of the disease. NSAIDs may reduce pain, but additional second-line treatments (DMARDs, biologicals) are needed to treat persisting or progressing inflammation in a significant number of patients. The use of bisphosphonates may be a promising option in treating NSAID-refractory osteomyelitis in CRMO.

Desmoplastic Fibroma: A Case Report with Three Years of Clinical and Radiographic Observation and Review of the Literature

Background:Desmoplastic fibroma (DF) is an extremely rare locally aggressive bone tumor with an incidence of 0.11% of all primary bone tumors. The typical clinical presentation is pain and swelling above the affected area. The most common sites of involvement are the mandible and the metaphysis of long bones. Histologically and biologically, desmoplastic fibroma mimics extra-abdominal desmoid tumor of soft tissue.Case Presentation and Literature Review:A case of a 27-year old man with DF in the ilium, including the clinical, radiological and histological findings over a 4-year period is presented here. CT scans performed in 3-year intervals prior to surgical intervention were compared with respect to tumor extension and cortical breakthrough. The patient was treated with curettage and grafting based on anatomical considerations. Follow-up CT scans over 18-months are also documented here. Additionally, a review and analysis of 271 cases including the presented case with particular emphasis on imaging patterns in MRI and CT as well as treatment modalities and outcomes are presented.Conclusion:In patients with desmoplastic fibroma, CT is the preferred imaging technique for both the diagnosis of intraosseus tumor extension and assessment of cortical involvement, whereas MRI is favored for the assessment of extraosseus tumor growth and preoperative planning. While tumor resection remains the preferred treatment for DF, curettage and grafting prove to be an acceptable alternative treatment modality with close follow-up when resection is not possible. Curettage and grafting have been shown to provide good clinical results and are associated with long recurrence free intervals.

Ostéosarcome cutané primitif

Osteosarcoma is a malignant tumor of mesenchymatous origin that chiefly affects the metaphysis of long bones. The extraskeletal form of the disease is rare, and even rarer is a cutaneous site, whether metastatic or primary. Herein, we report a new case of primary cutaneous osteosarcoma. A 54-year-old woman presented a hard subcutaneous nodular tumor on her left arm noted 1 year earlier. The diagnosis of cutaneous osteosarcoma was made on the basis of histological analysis of the lesion, which showed a sarcomatous dermal-hypodermal proliferation secreting osteoid. Clinical and radiological staging ruled out any extra-cutaneous spread, particularly to bone, thus confirming the primary cutaneous nature of the osteosarcoma. Primary cutaneous osteosarcoma is a rare tumor, diagnosis of which is normally based on histopathological features.

Osteopoikilosis: A case report with review of literature

Osteopoikilosis is a rare hereditary condition present as an autosomal dominant trait in families, but can also present as sporadic cases. It is an asymptomatic condition; incidental radiological finding play an important role in its diagnosis. These are symmetrically distributed numerous small, well-defined, homogenous, circular or ovoid radio-densities clustered in epiphysis and metaphysis of long bones in periarticular regions. There is no age and sex affinity; age at the time of diagnosis range from 15 to 60 years. There are no specific clinical features; histological features are similar to the bone island and it may be associated with connective tissue disorders, synovial osteochondromatosis and a rare bone disease melorheostosis; genetically LEMD3 gene mutations are responsible for it. Osteopoikilosis must be differentiated from osteoblastic metastasis, synovial chondromatosis, tuberous sclerosis and mastocytosis. There are three rare complications, which have been reported like-spinal stenosis, dacrocrystitis and malignant transformation.

Chronic Recurrent Multifocal Osteomyelitis Causing an Acute Scoliosis

Study Design. A Case Report. Objective. We present a 15-year-old girl with an acute atypical scoliosis secondary to chronic recurrent multifocal osteomyelitis (CRMO). Summary of Background Data. CRMO is a rare nonpyogenic inflammatory bone condition with unclear aetiology. CRMO mainly affects the metaphyses of long bones, the pelvis, shoulder girdle, and less commonly the spine. Methods. Our case presented with a 6-month history of worsening thoracic back pain, asymmetry of her shoulders and abnormal posture. Whole spine radiographs revealed a right atypical thoracic scoliosis. Magnetic Resonance Imaging showed abnormal signal on the short TI inversion recovery (STIR) sequences in multiple vertebrae. A bone biopsy demonstrated evidence of fibrosis and chronic inflammatory changes. Interval MRI scans revealed new oedematous lesions and disappearance of old lesions. Symptoms improved. Results. It is important to consider CRMO as an acute cause of atypical scoliosis. Malignancy, pyogenic infections and atypical presentations of juvenile arthritis need excluding. Conclusion. This 24-month follow-up describes a rare cause of an atypical scoliosis and fortifies the small amount of the currently available literature. The case highlights the relapsing and remitting nature of CRMO with new lesions developing and older lesions burning out. We advise close radiological surveillance and symptomatic management.

A Review on Etiopathogenesis and Medicinal Management of Ante Brachial Deformities in Growing Dogs

The angular limb deformity of the forelimbs in dogs is a well-documented clinical entity and is defined as an axial deviation of limb in the frontal plane. Such ante-brachial deformities are frequently reported in growing dogs (Thorp, 1994). A high incidence of the condition has been reported in fast growing large breed dogs like Great Dane (Ramadan and Vaughan, 1978). Various workers have reported different causes for the ante brachial deformities. The most commonly reported cause being the premature closure of the growth plates (Guthrie and Pead, 1992). Trauma to the limb with or without radiographically visible fracture can induce such closures of the physis (Oi?½Brien, et al., 1971). The distal ulnar physis is the most frequently reported site for such physeal premature closures. This leads to reduced growth of the ulna predisposing to carpus valgus, cranial bowing of radius, carpal laxity, and carpal and elbow subluxation (Johnson et al., 1995).Angular deformities are also seen in association with metabolic bone diseases such as hyperptrophic osteodystrophy, retained cartilage core and nutritional secondary hyperparathyroidism (Riser and Shirer, 1965). Though the exact etiopathology of bone deformities are not clearly understood, in such conditions enlargement of metaphyses of long bones and thinning of cortices are seen, which in turn may lead to bending and bowing of the limbs. Further, retention of cartilage may also cause local disturbance in the bone growth and may produce limb shortening and angular deformities (Burk and Ackerman, 1986). These metabolic disturbances may also lead to variable degree of carpal laxity (Probst and Millis, 1994). Studies on the incidence of angular deformities are limited. Available literature shows only sporadic occurrences of such deformities. Singh et al (2008) reported 23.28 % incidence of angular deformities in the growing dogs of less than one year age.

Sphenoclival Intraosseous Lipoma in Skull Base

Intraosseous lipoma is a rare benign tumor, mostly occurring in lower limb especially in os calcis and the metaphyses of long bones. Intraosseous lipoma of the skull is even rarer, with 12 cases having been reported to involve the sphenoid bone in the literature. We present the third reported case of sphenoclival intraosseous lipoma in a 43-year-old man with headache, hyperprolactinemia and visual disturbance. Performed Magnetic Resonance Imaging (MRI) revealed pituitary macroadenoma as well as a mildly expansile lesion with high signal intensity on both T1- and T2-weighted sequences within the left greater wing of the sphenoid and the clivus. The patient refused to undergo surgical removal of pituitary macroadenoma and medical treatment was initiated instead; thereafter, follow up Computed Tomography (CT) and MRI scans revealed regression of the pituitary macroadenoma whereas the sphenoclival lesion was depicted as a welldefined fat-containing intraosseous lesion which showed no perceptible growth, 17 months later.

1030 A Case of Rhizomelic Chondrodysplasia Punctata in Newborn

Rhizomelic chondrodysplasia punctata is an rare autosomal recessive peroxisomal disease. The main features of the disease are shortening of the proximal long bones, punctate calcifications in the metaphysis and epiphysis...

Nonossifying fibroma developed in metaphysis and epiphysis—a case report

Nonossifying fibroma is developed in childhood and adolescence and is usually asymptomatic. It is typically arises in the metaphysis of long bone and migrates toward the diaphysis with growth. We present a very rare case of nonossifying fibroma involving metaphysis and epiphysis of the distal femur in a 20-year-old man. Nonossifying fibroma is a benign fibroblastic lesion, which is also termed benign cortical defect and fibroxanthoma. A nonossifying fibroma rarely causes problems and does not interfere with healing or growth. The lesions are usually asymptomatic. With growth and remodeling of the bone, the lesion typically disappears and is replaced with normal bone. However, the lesion may weaken the involved bone, causing fracture. The lesion typically arises in the metaphysis of long bones and may migrate toward the diaphysis with growth. There have never been reports of nonossifying fibroma involving epiphysis that we know of. We report a very rare case of nonossifying fibroma involving metaphysis and epiphysis in a young adult. Written, informed consent was obtained from the patient to publish this case report, including the images.

Chondromyxoid Fibroma with Secondary Aneurysmal Bone Cyst of the Rib

Chondromyxoid fibroma (CMF) is a rare, benign cartilaginous tumor, comprising less than 1% of primary bone tumors, and usually occurs in the metaphysis of a long tubular bone around the knee. We report a rare case of CMF of the rib. The patient was a 25-year-old man who visited the hospital for left upper back pain. Roentgenography revealed an 8-cm mass in the left upper lung field; computed tomography revealed a large multicystic tumor with aneurysmal bone cyst (ABC)-like features in the posterior mediastinum. ABCs are also a rare benign tumor representing 2.5% of primary bone tumors, and most of ABCs are located in the metaphysis of long bones and vertebrae. To the best of my knowledge, there is no report of CMF with secondary ABC of the rib. We performed total resection of the tumor. Complete tumor resection may be the best treatment option for a cure.

Craniomaxillofacial Features in Hereditary Multiple Exostosis

Hereditary multiple exostosis is the most common form of bone dysplasia. This entity is also known as diaphyseal aclasis, hereditary deforming chondrodysplasia, multiple hereditary exostoses, multiple osteochondromatosis, multiple cartilaginous exostosis, dyschondroplasia, and Ehrenfried disease. It is an inherited autosomal dominant disease with predominance in males and a benign condition characterized by the presence of multiple exostosis or osteochondromas arising from long and flat bones.Osteochondroma is the most common benign tumor in persons between 10 and 30 years of age. It accounts for 20% to 50% of all benign tumors and 10% to 15% of all bone tumors. It is more commonly located at the level of the metaphysis of long bones. However, osteochondroma is rare at the level of the facial bones and skull base. It has been reported in the maxillary sinus and in different parts of the mandible, such as the condyle, ramus, body, and symphyseal region. It is very uncommon in the coronoid process and occipital bone.Jacob disease, or osteochondroma of the mandibular coronoid process, is a benign skeletal tumor that is rare in the oral and maxillofacial skeleton. A review of the literature revealed only 41 histologically proven cases of 52 reported cases. To the best of the authors' knowledge this is the first clinical report of bilateral coronoid osteochondroma and associated occipital exostosis in a patient with hereditary multiple exostosis.

Percutaneous drainage as a novel approach for the treatment of Brodie's abscess

Brodie’s abscess is an insidious, localized, subacute osteomyelitis, typically caused by Staphylococcus aureus. Typically seen in the metaphyses of long bones in a young male patient, the diagnosis is frequently challenging. There are often mild clinical symptoms and radiographic features are frequently similar to primary bone tumours such as osteoid osteoma.1,2 Although the imaging features of Brodie’s abscess are well established, histopathological diagnosis is indicated to establish a diagnosis and guide treatment. Conventional treatment is curettage, biopsy, and culture followed by immobilization and a prolonged period of antimicrobial therapy.3e6 We describe a case of percutaneous computed tomography (CT) drainage as a novel adjunct in the treatment of Brodie’s abscess with diagnostic and therapeutic value.

Experience of managing acute osteomyelitis in a district general hospital

Introduction A cute Osteomyelitis (AO) is a suppurative bone infection caused by haematogenous spread within the metaphysis of long bones. Unlike septic arthritis, children with AO are usually systemically well and the classic text book description of fever, swelling and limp is often absent. Prompt diagnosis and treatment is important to avoid complications such as growth arrest, septic arthritis and chronic infection. Objective 1) To review the clinical presentation and value of laboratory and radiological investigations in diagnosing Acute Osteomyelitis; 2) To review current treatment of Acute Osteomyelitis and follow up of patients for complications. Method We retrospectively reviewed case notes of 12 children who were diagnosed with acute osteomyelitis over a two year period. Results Temperature of 38 degrees and above was present only in one third of patients whereas loss of function and pain were present in all the patients. Recent infection or trauma was present in most of the cases. An elevated ESR (>35 in 10 patients) and high platelet count (>400 in 11 patients) were the most consistent laboratory results. CRP was less than 15 in 3 patients. Blood cultures were negative in all but one case where group B streptococcus was isolated in a neonate from blood and aspiration of joint. MRI was helpful in confirming equivocal diagnosis. Bone scan when done in 4 cases helped in diagnosing AO. Flucloxacillin was an effective antibiotic in the majority except for neonatal osteomyelitis. 6 children received antibiotics for 42 days, 1 child for 5 days and 1 for 70 days, the rest received antibiotics for 14 days. Intravenous antibiotic treatment duration was very variable and was guided by resolution of inflammatory markers to normal levels. Antibiotics was started on the 12th day of presentation for a baby and 3 en had complications where one child required a sequestrectomy, one developed a Brodie9s abscess and one developed chronic recurrent multifocal osteomyelitis. Conclusions Acute osteomyelitis still remains a difficult diagnosis. A high index of suspicion together with a combination of clinical signs, laboratory and radiological tests are essential to facilitate prompt diagnosis and treatment to avoid long term complications. Good team working, information sharing and communication with our orthopaedic colleagues is essential to reduce morbidity and improve quality of care.

Telangiectatic Osteosarcoma

Osteosarcoma is one of the most common primary malignant bone tumors in children and adolescents. Telangiectatic osteosarcoma is an unusual variant of osteosarcoma, forming 3% to 10% of all osteosarcomas. Radiographically, these tumors appear as purely lytic destructive lesions located in the metaphyses of long bones. The location and x-ray appearance of telangiectatic osteosarcomas are reminiscent of an aneurysmal bone cyst and can test the acumen of a diagnostic radiologist. Distinguishing between the two entities microscopically can also be quite challenging. Telangiectatic osteosarcoma shows dilated blood-filled spaces lined or traversed by septa containing atypical stromal cells, with or without production of a lacelike osteoid matrix. This review highlights the diagnostic features of telangiectatic osteosarcoma and discusses differential diagnostic considerations, treatment options, and prognostic implications.

Intra-articular osteoid osteoma in the proximal ulna combined with radial head subluxation: a case report

Osteoid osteoma is a relatively common benign bone tumor that was first described by Jaffe in 1935. Its typical clinical feature is pain, which is worse at night and relieved by nonsteroidal anti-inflammatory drugs (NSAIDs). Typical radiologic findings are a nidus with a small radiolucent area within an extensive reactive cortical thickening. This tumor has a predilection for the diaphysis or metaphysis of long bones, with 50-60% occurring in the femur or tibia. However, localization in the elbow is a very rare presentation, and shows an atypical picture that causes both diagnostic delay and therapeutic problems. We herein report a case of a 19-year-old man who had pain and limited motion of the left elbow as a result of osteoid osteoma at the sigmoid notch of the proximal ulna. Anterior subluxation of the radial head was also observed by simple radiographs. En bloc resection and synovectomy resulted in pain relief, motion recovery, and reduction of the subluxated radial head. The patient consented when asked if data concerning his case could be submitted for publication.

Fibrochondrogenesis, an Antenatal and Postnatal Correlation

Fibrochondrogenesis is a rare, neonatally lethal osteochondrodysplasia, with autosomal recessive inheritance. It differs from other lethal dwarfisms in that it leads to broad, long-bone metaphyses (dumb-bell shaped) and pear-shaped vertebral bodies. We report a case of fibrochondrogenesis with severe pear-shaped platyspondyly, suspected antenatally, and give a comprehensive pictorial review of the antenatal ultrasound and postnatal radiographic findings. Only few cases of fibrochondrogenesis are diagnosed before the termination of pregnancy.

Chondromyxoid fibroma of mandible: A case report and review

Chondromyxoid fibroma is a rare benign tumor of chondral origin. It usually involves the proximal metaphysis of long bones, while involvement of craniofacial skeleton is extremely unusual. This article reports on a chondromyxoid fibroma of mandible in a 19 year old female, along with suggested aspects of origin, clinical and radiographic appearances, and suggested treatment modalities of this tumor.

Unusual Presentation Of An Aneurismal Bone Cyst In The Patella With Fracture – A Case Report

We report about a 25-year old man having an aneurysmal bone cyst in the patella presenting with fracture after falling from a height of 3 feet. He was asymptomatic before the fall. He was treated with curettage, bone grafting and internal fixation using tension band wire technique. Bone cysts are very unusual in the patella. Around 1% of primary bone tumours are aneurysmal bone cysts.(1) They are common in metaphyses of long bones of the lower extremity. Less than 1% of aneurysmal bone cysts occur in the patella.

Unusual localization of an aneurysmal bone cyst in ulnar coronoid process

Aneurysmal bone cysts are non-neoplastic, expansile, osteolytic tumor-like conditions. All bones may be involved, but the most commonly affected is the metaphysis of the long bones, especially the tibia, humerus and femur. We present a 13-year-old female patient with a cystic lesion with cortical continuity and a large bone cyst in the coronoid process of the ulna. The bone cyst was treated with curettage, phenol application and cement implantation following cyst debulking. Aneurysmal bone tumors are rare tumor-like conditions and localization at the coronoid process of the ulna with mechanical block of the elbow motion has yet to be reported. Debulking and curettage of the lesion and bone cement implantation are useful methods for local control of aneurysmal bone cysts.