Osseous Fragments Research Articles

Collateral effects of targeting the nucleus pulposus via a transpedicular or transannular surgical route: a combined X-ray, MRI, and histological long-term descriptive study in sheep.

In the context of regenerative medicine strategies, based in particular on the injection of regenerative cells, biological factors, or biomaterials into the nucleus pulposus (NP), two main routes are used: the transpedicular approach (TPA) and the transannular approach (TAA). The purpose of our study was to compare the long-term consequences of the TPA and the TAA on intervertebral disc (IVD) health through a longitudinal follow-up in an ovine model. The TPA and the TAA were performed on 12 IVDs from 3 sheep. Six discs were left untreated and used as controls. The route and injection feasibility, as well as the IVD environment integrity, were assessed by MRI (T2-weighted signal intensity), micro-CT scan, and histological analyses (Boos' scoring). The sheep were assessed at 1, 3, and 7months. Both the TPA and the TAA allowed access to the NP. They both induced NP degeneration, as evidenced by a decrease in the T2wsi and an increase in the Boos' scores. The TPA led to persistent end-plate defects and herniation of NP tissue (Schmorl's node-like) after 7months as well as the presence of osseous fragments in the NP. The TPA induced more severe lesions in IVDs and vertebrae compared to the TAA. The lesions induced by the TPA are reason to consider whether or not this route is optimal for studying IVD regenerative medicine approaches.

Simulation Study on the Integration of Health Traits in Horse Breeding Programs.

Simple SummaryThe disease osteochondrosis dissecans (OCD) is an important health-related trait in horse breeding. This study aimed at finding a breeding strategy to reduce the occurrence of OCD without affecting the riding horse performance traits substantially. Therefore, a lifelike simulation of different possible ways to include this trait in a horse breeding program was performed. Effective strategies can be the exclusion of affected animals from breeding as well as the selection based on a breeding value estimation which considered OCD susceptibility together with riding horse performance traits in an index. A reduction in the frequency of occurrence of OCD was found to be linked with a slight decrease in the breeding values for the riding horse characteristics.Osteochondrosis dissecans (OCD) is a degenerative disease of the cartilage leading to osseous fragments in the joints. It is important in horse breeding both from an animal welfare and an economic perspective. To study adequate breeding strategies to reduce OCD prevalence, a lifelike simulation of the breeding program of German Warmblood horses was performed with the R package MoBPS. We simulated complex breeding schemes of riding horses with different selection steps and realistic age structure, mimicking the German situation. As an example, osseous fragments in fetlock and hock joints were considered. Different scenarios, either using threshold selection, index selection or genomic index selection, respectively, were compared regarding their impact on health and performance traits. A rigorous threshold selection as well as the integration of OCD in a selection index at the stage of stallion licensing and chosen frequency of use in breeding cases on a selection index that includes breeding values for OCD traits performed best on a comparable level. Simply integrating OCD in this breeding value was less effective in terms of OCD reduction. Scenarios with a higher reduction of OCD also showed a slightly reduced improvement in the riding horse performance traits.

Pyramidal and posterior osseous release for maxillary superior/posterior mobilization using an ultrasonic bone-cutting device after Le Fort I osteotomy

AimThe purpose of this study was to evaluate the efficiency of pyramidal and posterior osseous release (PPOR) for maxillary impaction using an ultrasonic bone-cutting device after Le Fort I (LFI) osteotomy. Materials and methodsIn total, 31 Japanese adults with jaw deformities, diagnosed as having maxillary excess with mandibular prognathism or deficiency, underwent LFI osteotomy and bilateral sagittal split osteotomy. The patients were divided into two groups: a trimming group (15 patients, four men and 11 women; mean age 24.8 years) and a PPOR group (16 patients, seven men and nine women; mean age 22.8 years). In the trimming group, osseous interference around the descending palatine artery (DPA) was removed using forceps, rounding bur, and reciprocating rasp. The PPOR technique was used to remove osseous fragments created by V-shaped osteotomy around the DPA following vertical osteotomy behind the DPA using an ultrasonic bone-cutting device (Variosurg 3; NSK, Tochigi, Japan). The operative times for maxillary osteotomy, total operative times (including bilateral sagittal split osteotomy), and total blood loss were assessed. ResultsThe mean planned amounts of maxillary impaction were 4.37 ± 1.27 mm in the trimming group and 4.38 ± 1.36 mm in the PPOR group (p = 0.98). The mean maxillary operative time for the PPOR group was significantly shorter, by 25.5% (p < 0.001). Total operative time for the PPOR group was also significantly shorter, by 24.3% (p < 0.001). Mean blood loss was significantly lower in the PPOR group than in the trimming group (p = 0.003). ConclusionThe PPOR technique for maxillary impaction after LFI osteotomy shortened the operative time and enabled secure reduction of the maxilla in patients who required the treatment of maxillary impaction with preservation of the DPA bundle.

Postoperative pain after posterior lumbar interbody fusion: is it worth it?

Introduction Posterior lumbar interbody fusion (PLIF) is a widely accepted procedure for many lumbar degenerative disorders. However, it has been suspected for causing significant postoperative pain in the first few months. Patients and methods This prospective study included 36 consecutive patients who underwent a single-level PLIF procedure and were followed up for at least 1 year. At one-year follow-up, there were 20 females and 16 males, with an average age of 60.7 y (range: 39–81 y). All patients were operated in a standardized fashion, with bone graft taken from the iliac crest. Postoperatively, all patients received a standardized analgesic regimen. The modified Oswestry disability index (ODI) and visual analog score (VAS) were assessed preoperatively, at 3 months, at 6 months, and at 1 year postoperatively. Patients who had an obvious surgical reason for postoperative pain such as pedicular screw misplacement, postoperative hematoma, infection, wound problems, loose osseous fragment impingement on neural structures and postoperative pedicle, vertebral body, endplate fracture, or sacroiliac joint violation were excluded from the study. Results The most common indication for PLIF was lumbar stenosis with instability (n=18) and at 1-year follow-up, all 36 patients achieved bony intervertebral body fusion. The average preoperative ODI was 67.33% (range: 56–82%), and the mean preoperative VAS was 7 (range: 5–9). At 3 months, there was a significant improvement in relation to the preoperative ODI and VAS (P less than 0.0001 for both). Yet, at 6 months and at one year, there was a significant improvement when compared with the preoperative ODI and VAS (P Conclusion For many patients, PLIF is a painful experience, and strict adherence to the details of the operation are necessary to optimize the overall outcome. Still, the iliac crest graft is a major source of postoperative pain, although there is a significant overall improvement of the ODI and VAS at 1 year, and most patients report that they benefited from this operation. This series is based only on a single-center experience, and hence larger multicentric studies are needed to produce reliable data. Confounding this small series is individual pain perception and the inherent subjectivity of the ODI and the VAS.

Intranasal Bolsters: A Novel Technique for Nasal Bone Stabilization.

Nasal bone stabilization, in the setting of comminuted nasal fracture or surgical osteotomy, represents a challenging surgical experience. Postoperative shifting of osseous fragments may result in compromised outcomes in an otherwise well-performed procedure. Although prior studies have reported nasal bone fixation with implementation of wires, plates, or halos, these techniques are often difficult to employ routinely. Herein, the authors describe a novel and facile technique for the maintenance of unstable nasal bones using customized intranasal bolsters.

Osteochondral lesions of the lateral trochlear ridge: a rare, subtle but important finding on advanced imaging in patients with elbow pain.

To characterize the radiographic, CT, and MRI appearance of clinically and/or surgically proven osteochondral lesions of the lateral trochlear ridge. Ten years of medical charts with elbow radiographic, CT, and MRI studies were retrospectively reviewed. Patients with pathology isolated to the lateral trochlear ridge were included. Studies were reviewed by two radiologists. Identifiable pathology on each type of study was noted and characterized. Ten elbow studies were included, all from males aged 15 to 58 years (mean 29 years). Five elbow radiographs were normal, one showed mixed lucency and sclerosis of the lateral trochlear ridge, and four demonstrated small osseous fragments adjacent to the ridge. In all cases, CT demonstrated focal lucency at the cortical surface of the lateral trochlear ridge; 8 contained small osseous fragments, axial plane maximum width ranged from 5 to11 mm, depth from 1 to 2 mm. Focal bone marrow edema in the subchondral lateral trochlear ridge was found in the 6 cases with MR images. Two demonstrated linear high signal underlying the in situ osseous fragment, faintly visible on MRI. In 9 cases, arthroscopy was performed within 3 months of imaging. The remaining patient was treated conservatively with casting. Osteochondral lesions of the lateral trochlear ridge are rare but important, as these patients go on to arthroscopy at a high rate. If an abnormality of the lateral trochlear ridge is seen or suspected, we recommend CT as the best imaging study to define these lesions.

A biomechanical test model for evaluating osseous and osteochondral tissue adhesives

BackgroundCurrently there are no standard models with which to evaluate the biomechanical performance of calcified tissue adhesives, in vivo. We present, herein, a pre-clinical murine distal femoral bone model for evaluating tissue adhesives intended for use in both osseous and osteochondral tissue reconstruction.ResultsCylindrical cores (diameter (Ø) 2 mm (mm) × 2 mm depth), containing both cancellous and cortical bone, were fractured out from the distal femur and then reattached using one of two tissue adhesives. The adhesiveness of fibrin glue (Tisseeltm), and a novel, biocompatible, calcium phosphate-based tissue adhesive (OsStictm) were evaluated by pullout testing, in which glued cores were extracted and the peak force at failure recorded. The results show that Tisseel weakly bonded the metaphyseal bone cores, while OsStic produced > 30-fold higher mean peak forces at failure (7.64 Newtons (N) vs. 0.21 N). The failure modes were consistently disparate, with Tisseel failing gradually, while OsStic failed abruptly, as would be expected with a calcium-based material. Imaging of the bone/adhesive interface with microcomputed tomography revealed that, for OsStic, failure occurred more often within cancellous bone (75% of tested samples) rather than at the adhesive interface.ConclusionsDespite the challenges associated with biomechanical testing in small rodent models the preclinical ex-vivo test model presented herein is both sensitive and accurate. It enabled differences in tissue adhesive strength to be quantified even for very small osseous fragments (<Ø4mm). Importantly, this model can easily be scaled to larger animals and adapted to fracture fragment fixation in human bone. The present model is also compatible with other long-term in vivo evaluation methods (i.e. in vivo imaging, histological analysis, etc.).

Chronic Symptomatic Ankle Avulsion Fracture

Category: Ankle Introduction/Purpose: Persistent pain and instability following inversion or eversion injuries of the ankle is not rare. Besides injury of lateral or medial ligaments, avulsion fracture of lateral or medial malleolus could be found in some cases. The avulsion fracture may result in nonunion and/or ligamentous laxity which could lead to chronic ankle pain. The purpose of this study was to evaluate the intraoperative findings and long-term outcomes of patients of symptomatic ankle avulsion fracture. Methods: 23 patients of ankle avulsion fracture along with chronic ankle pain and instability were studied. Tenderness and swollen at lateral and/or medial gutter were found and radiographic images were taken for the diagnosis. After at least 6 months of unsuccessful non-operative treatment, all patients underwent surgery of osseous fragments excision and anatomic ankle ligaments reconstruction. AOFAS-AH and VAS Score were given to assess the outcomes of surgery. Results: There were 21 males and 9 females among the patients. The average age of the patients was 24.6 years (range, 18-45 years) at the time of injury and 27.3 years (range, 18-46) at the time of surgery, indicating a mean delay in diagnosis and/or treatment of 2.7 years. At a mean follow-up of 2.6 years (range, 1 to 5.2 years), the average AOFAS-AH Score increased from 72.5 to 93.2 out of 100 (P&lt;0.05), the average VAS score decreased from 6.2 to 1.2 (P&lt;0.05). Conclusion: For those patients of ankle avulsion fracture presenting with chronic ankle pain and instability, surgical excision of the bony fragment combined with reconstruction of ankle ligaments were effective in eliminating pain, restoring ankle stability, and helping return to the pre-injury functional level.

Teen With Acute Shoulder Pain Four Years After A Car Accident.

HISTORY: 18yo male with sudden onset, severe right shoulder pain occurring while sitting in class 11 days prior to presentation. He had a history of a posterior shoulder dislocation at age 14 in a car accident, requiring relocation under sedation without known complication. He completed PT at that time, however was unable to return to football or overhead throwing activities. At the start of his new onset pain, he suspected re-dislocation of his shoulder and went to the ED. X-rays were abnormal but with unclear diagnosis. He was referred to sports medicine clinic for further evaluation and treatment. PHYSICAL EXAMINATION: Inspection: Significant atrophy of the supraspinatus and infraspinatus. Right shoulder was held elevated. Intertrigo noted in right axilla. Range of motion of the shoulder: 20 degrees forward flexion, 20 degrees forward flexion, 0 degrees external rotation, and internal rotation to T12. Strength: 4/5 empty can, 4/5 internal rotation, 3+/5 external rotation. Neurovascular: Brisk pulses, 2 second capillary refill, intact motor exam, and sensation intact in all dermatomes. Special tests: Neer’s positive pain with no increased ROM, Speed’s test positive, O’Brien’s test positive, cross over test negative, and Hawkin’s positive. DIFFERENTIAL DIAGNOSIS: Recurrent shoulder dislocationMalignant or benign bony lesionPathologic fracture of proximal humerusRotator cuff tearDisruption of suprascapular nerve TEST AND RESULTS: X-rays of the right shoulder:- Patchy sclerosis and irregular shape of the humeral head. - Decreased joint space of the glenohumeral joint and elevation of the humeral head.- Hill-Sachs deformity with small adjacent osseous fragment. - Curvilinear osseous density superior to the humeral head - likely calcification of the rotator cuff or loose body. MRI with and without contrastiv> FINAL WORKING DIAGNOSIS: Osteonecrosis of the humeral head TREATMENT AND OUTCOMES: Referred to orthopedic shoulder specialist who plans to do a hemiarthroplasty without a stem. Surgery is planned for December 1, 2017. Follow-up will be available by May 2018.

Le site de Alp 2 (St Bernard-du-Touvet, Chartreuse, Isère) : un campement de chasse d’altitude du Premier Mésolithique

The Mesolithic “ station” of Alp 2 is a block-shelter of glacial origin located at 1 720 masl in the “ Haut de Chartreuse” national reserve. Threatened to be destroyed by marmot’s burrows, the site has been subject to archaeological attention and excavated between 1998 and 2000 under the direction of P. Bintz. The short stratigraphic sequence revealed several well-conserved Mesolithic levels which delivered plenty of faunal remains as well as lithic artefacts. Some 17,584 lithic artefacts have been identified, including 182 cores, 255 arrowheads and 653 blades and bladelets. Raw material identification indicates an equal share, in terms of quantity, of local and exogenous flint. Based on typotechnological analysis, most of these artefacts can be attributed to the First Mesolithic with a débitage of bladelets obtained by direct percussion with a soft stone precursor. Although more discreet, the remaining items belong to the Second Mesolithic, while few of them share some affinities with the Early Neolithic. Faunal remains are rich and generally well-preserved with a total of 1583 osseous fragments, among which 752 have been well identified. Among the twelve distinctive taxa identified, the chamois and the ibex are the most represented. Forest species, such as deer and wild boar are much rarer. This wildlife association is in complete adequacy with the geographical and the topographic situation of the site. With few bones showing anthropic traces, such as butchery marks and breaks on fresh bone, there is no doubt for the anthropological origin of this bone’s accumulation.

Modified Elmslie-Trillat Procedure for Distal Realignment of Patella Tendon

Patellofemoral dysfunction, due to either a patellofemoral malalignment or patellar instability, is a complex and debilitating condition that significantly decreases the knee function. Conservative management may yield significant clinical outcomes; however, when morphologic anomalies are identified, the surgical approach should be employed. Hence, several surgical procedures have been described in the scientific literature aiming the correction of underlying extensor mechanism malalignments. Still, the rate of complications is higher than desirable. The described technique is based on the principles of transferring the tibial tubercle medially as described in the Elmslie-Trillat technique. However, a curvilinear horizontal cut is made prior to the vertical cut, which raises a thick osseous fragment and allows the formation of a gutter when the osseous fragment is moved medially. Whereas the horizontal gutter provides stability to the bone fragment, the thicker dimension of the osseous fragment and retention of the distal attachment significantly enhances the osteotomy union. Hence, adequate pain relief and stability with very low postoperative morbidity could be achieved. The purpose of this surgical note is to describe a modification to the Elmslie-Trillat technique to treat patellofemoral dysfunctions, achieving a higher osseous stability and decreased postoperative morbidity.

ІМІТАЦІЙНО-КОМП’ЮТЕРНЕ МОДЕЛЮВАННЯ БІОМЕХАНІЧНИХ СИСТЕМ ДЛЯ ДОСЛІДЖЕННЯ ФУНКЦІОНАЛЬНИХ МОЖЛИВОСТЕЙ АПАРАТІВ ЗОВНІШНЬОЇ ФІКСАЦІЇ

Представлений алгоритм дій при створенні тривимірних комп‘ютерних динамічних моделей для дослідження репозиційних можливостей апаратів зовнішньої фіксації (АЗФ). З використанням запропонованого алгоритму в програмі Autodesk Inventor 11 створені три моделі біомеханічних систем: I – «кістка – компонування апарата Ілізарова для корекції кутових зміщень»; IІ – «кістка – компонування апарата Ілізарова для корекції багатокомпонентних зміщень»; ІII – «кістка – апарат для корекції деформації кісток і суглобів».&#x0D; Встановлено, що тривимірні комп’ютерні моделі систем для черезкісткового остеосинтезу (ЧО) найбільш доцільно будувати з застосуванням способу шаблонів, що дозволяє здійснювати корекцію геометричних параметрів деталей в зборці моделі та забезпечує можливість швидкої зміни компонування АЗФ.&#x0D; Застосування розроблених тривимірних динамічних моделей забезпечує можливість моделювання репозиції кісткових фрагментів за різних типів переломів та будь-якої площини зламу; моделювання корекції деформації кісток; визначення оптимальної траєкторії переміщення фрагментів; вибору оптимального типу репозиційних елементів та компонування АЗФ.

Progressive neurological deficits after general anaesthesia in a horse

An otherwise healthy eight-year-old Irish Sports Horse mare weighing 590 kg underwent general anaesthesia for bilateral tarsal arthroscopy and arthrotomy with subsequent removal of two osseous intra-articular fragments. The horse...

Posterior Malleolar Open Reduction and Internal Fixation Through a Posterolateral Approach for Trimalleolar Fractures.

The patient is prone for the operation. A longitudinal incision is made between the lateral border of the Achilles tendon and the posteromedial border of the fibula. The posterior aspect of the fibula is easily reached through the interval just lateral to the peroneal muscle. After debridement of the fracture, it can be reduced and is fixed with either (1) a buttress plate or (2) lag screw(s) with a neutralizing plate. The belly of the flexor hallucis longus is bluntly dissected off of the interosseous membrane and the lateral side of the tibia through the interval medial to the peroneal muscle. Retracting the muscle belly medially allows the posterior aspect of the tibia to be seen. The periosteum is incised to expose the posterior malleolar fracture. Loose fragments can be removed by levering the posterior fragment distally. Reduction is performed and is held temporarily by Kirschner wires. Fixation is undertaken using either lag screws or a slightly prebent 3-hole buttress plate. Placement of a lag screw through the most distal hole of the plate can help to close any possible gaps. Slight internal rotation of the lower leg allows the medial malleolus to be approached and fixed. Percutaneous anterior-to-posterior screw fixation is an alternative, but it frequently leads to a nonanatomical reduction of the fragment. This technique provides an adequate view of the fracture, an anatomical reduction in most cases, and sound fixation of the posterior malleolar fragment. Other advantages are that small fragments are easier to fix and small intra-articular fragments can be removed from the site of the fracture.

18F‐sodium fluoride positron emission tomography of the equine distal limb: Exploratory study in three horses

Positron emission tomography (PET) is a cross-sectional, functional imaging modality that has recently become available to the horse. The use of 18 F-sodium fluoride (18 F-NaF), a PET bone tracer, has not previously been reported in this species. To assess the feasibility of 18 F-NaF PET in the equine distal limb and explore possible applications in the horse in comparison with other imaging modalities. Exploratory descriptive study involving three research horses. Horses were placed under general anaesthesia prior to intravenous (i.v.) administration of 1.5 MBq/kg of 18 F-NaF. Positron emission tomography imaging of both front feet and fetlocks was performed using a portable scanner. Computed tomography (CT) of the distal limb was performed under a separate anaesthetic episode. Bone scintigraphy and magnetic resonance imaging (MRI) were subsequently performed under standing sedation. Images obtained from PET and other imaging modalities were independently assessed and the results correlated. Positron emission tomography images were obtained without complication. The radiation exposure rate was similar to equine bone scintigraphy. Positron emission tomography detected focal 18 F-NaF uptake in areas where other imaging modalities did not identify any abnormalities. This included sites of ligamentous attachment, subchondral compact bone plate and the flexor cortex of the navicular bone. 18 F-NaF uptake was identified in some, but not all, osseous fragments and areas of osseous formation, suggesting a distinction between active and inactive lesions. A small number of horses were included and histopathology was not available. 18 F-NaF PET imaging of the equine distal limb provides useful additional information when compared with CT, MRI and scintigraphy and has the potential for both research and clinical applications in the horse. The Summary is available in Chinese - see Supporting information.

The transpedicular surgical approach for the development of intervertebral disc targeting regenerative strategies in an ovine model.

To investigate the suitability of the transpedicular approach (TPA) in a sheep model of IVD regenerative strategies METHODS: 24 IVD from four sheep were used. TPA and biopsies of the Nucleus pulposus (NP) were performed in 18 IVD (6 IVD control). Seven discographies were performed to assess the feasibility of injecting contrast agent. MRI, micro-CT scan, and histological analyses were performed and the accuracy of the TPA was evaluated. The effects on the vertebra and endplates were analyzed. 83% of our biopsies or injections were located in the NP. Osseous fragments in IVD were observed in 50%. We observed two cases (11%) of rostral endplate fracture and five cases (27%) of breaching of the cortical pedicle and encroachment into the spinal canal. Two cases of perivertebral venous embolism and two of backflow through the canal of the TPA inside the vertebra were noted. Significant damage occurred to the bone structure of the vertebra and to the rostral endplate on which the IVD had been inserted. TPA induces damage to the endplates, and it may lead to neurological impairment and leakage of injected materials into the systemic circulation. These adverse effects must be fully considered before proceeding with TPA for IVD regenerative strategies.

Prospective study of management of close or compound segmental fracture tibia by close reduction and internal fixation with interlocking nail

Background: Fractures of tibia are rated as one among the list of common and major skeletal injuries as one third of its surface is subcutaneous. Segmental tibial fractures feature a unique fracture type characterized by a completely isolated intercalary osseous fragment separated by at least two different fracture lines. Since tibia is a large bone and one of the principal load bearing bones in the lower extremity, fractures can cause prolonged morbidity, extensive disability unless treatment is appropriate. Treatment of such fractures in adults is a challenge to orthopaedic surgeons due to its poor soft tissue coverage and poor blood supply. Moreover, compartment syndrome, neurovascular injuries and infection might add to the burden. Later non union, delayed union and Mal-union may occur. The acceptable treatment goal for the segmental fracture tibia is union maintaining normal length, normal alignment without rotational deformity, normal joint movements and reduced hospital stay. Interlocking nailing has proven to be the method of choice for fixation of these fractures. The intramedullary nailing under image intensifier fulfills the objective of stable fixation with minimal tissue damage resulting in better and quicker fracture unions. Materials and methods: This study included 51 patients admitted in the Department of Orthopaedics with either open (37) or close segmental tibia fractures with compromised soft tissue (14) and treated with interlocking nail. Anterioposterior and lateral radiograph were done to diagnose fracture type. Routine preoperative investigation was followed. Patients were operated within 48 hours of hospital admission. Patients were followed up periodically on an outpatient basis on 2nd, 4th, 6th, 10th, 14th, 18th week and 6th month. Clinical and radiological assessment was done for pain, deformity, shortening, range of motion of knee, ankle, subtalar joints and radiological union.The final outcome was assessed using Johner and Wruh’s criteria Results and Discussion: In our series, out of 51 cases, 47 (92.15%) had acceptable Johner and wruth's criteria for functional results (sum of excellent and good results). Excellent in 36 (70.59%), good in 11 (21.57%), fair in 3 (5.87%) and poor in 1 (1.97). These results were comparable with results btained by Ekeland and Alho who reported results excellent in 29, good in 13 and fair in 2 and poor in one out of 45 cases.Conclusion: From this study, it was concluded that the preferred method of initial fracture stabilisation is the use of unreamed interlocking inramedullary tibial nail with immediate soft tissue cover whenever possible, this procedure require less surgical time, hospital stay, is cost effective and have minimum complications with good functional outcome.

Les restes humains de la grotte ornée paléolithique des Deux-Ouvertures (Ardèche, France)

The opening of the Deux-Ouvertures cave is on the left bank of the Ardèche River, just before the canyon exit on the land of the village of Saint-Martin d’Ardèche in the Southwest of France. Although it has been known since 1896, the deep part of one of the galleries was not discovered until 1985. The surface of this gallery was covered by animal bones, 90% of which belonged to Ursus spelaeus. In 2007, two osseous human fragments were discovered: the distal part of an adult humerus and the diaphysis of a radius belonging to a young individual. These two specimens are the topic of the present paper. Although the date of the humerus (34,440–33,730cal BP) corresponds to the period when bears frequented the caves, the dates of the diaphysis of the radius (4410–4570 cal BP), found at the heart of the “decorated Paleolithic sector”, lead us to assume that it was transported there, perhaps deliberately. The study of the two human bones originating in the Deux-Ouvertures cave illustrates that the diaphysis of the radius, belonging to a young individual of the Neolithic period, does not exhibit any differences in comparison to modern radii. By contrast, the distal part of the adult humerus, although it is incomplete and altered, is the first example that has been dated in the Ardèche of adult human remains associated with a decorated Paleolithic cave. This specimen, aside perhaps from the width of its median column, is rather slender and does not present any significant difference in relation to other upper Paleolithic humeri.

Within Normal Limits

os peroneum, sesamoid bone fracture: The arrows demarcate significant distraction between the ossicles of the os peroneum.FigureFigureFigureA 74-year-old man presented with a complaint of pain along the lateral aspect of his left foot. Radiographs demonstrated two osseous densities at the lateral plantar aspect, with an 8 mm distraction between them, consistent with an acute fracture of the os peroneum. An MRI of the left foot showed a full thickness tear and complete disruption of the peroneus longus tendon, causing the distraction between the fracture fragments. The os peroneum is a sesamoid bone located adjacent to the lateral margin of the cuboid within the distal peroneus longus tendon, and is present in approximately 26 percent of the population. (AJR Am J Roentgenol 2001;177[1]:257.) This accessory ossicle can be bipartite or multipartite. It is important to make the distinction between a bipartite os peroneum and an acute fracture. It has been shown that an os peroneum fracture fragment separation of 6 mm or more, like the one in our case, is associated with a full-thickness tear of the peroneus longus tendon. (Radiology 2005;237[1]:235.) Delayed diagnosis can result in unnecessary prolonged pain, ankle instability, and peroneal compartment syndrome. Acute fractures of the os peroneum occur with sudden inversion of the ankle due to contraction of the peroneus longus tendon, leading the os peroneum to come into forced contact with the cuboid, resulting in fracture and possible disruption of the tendon. Accurate documentation of clinical history and mechanism of the trauma may assist in raising suspicion for the injury.Figure: The arrow shows a multipartite os peroneum without significant distraction of the ossicles.Figure: A schematic diagram of the os peroneum sesamoid bones embedded within the peroneus longus tendon.Sesamoid bone fractures should be considered when interpreting radiographs in the setting of trauma; they are commonly overlooked due to their subtlety. Distraction of the osseous fragments by more than 6 mm in particular should prompt further workup.

Suture-on-Screw Technique for Os Acetabuli Fixation and Labral Repair

The os acetabuli is thought to arise from unfused secondary ossification centers or as rim fractures in the setting of dysplastic hips or hips with femoroacetabular impingement. Resection of a large os acetabuli can lead to structural instability of the joint, and in these cases, osteoplasty of the impingement, reduction and internal fixation of the osseous fragment, and labral repair have been described in the literature. Anchor fixation for labral repair in the surrounding zone of the osteosynthesis might bring some technical problems. We aim to describe a technical modification improving labral lesion treatment while addressing the rim fracture. The addition of a suture to the screw addresses both lesions because it simultaneously has the function of a screw and an anchor. A suture-on-screw technique for os acetabuli fixation helps surgeons to gain versatility and is more cost-effective for the patients and health services.