Proximal Part Of Tibia Research Articles

New specimens of the early Permian apex predator Varanops brevirostris at Richards Spur, Oklahoma, with histological information about its growth pattern.

An articulated pelvic region and additional isolated material of Varanops brevirostris, which are indistinguishable from those of the generotype from the Cacops bonebed, demonstrate the presence of this large varanopid at the Richards Spur locality. The articulated specimen includes lumbar, sacral, and anterior caudal vertebrae, partial pelvis, femur, and proximal part of tibia, confirming the autapomorphies previously suggested for this species. These include the presence of distinct blade-like shapes of the neural spines in the sacral region, the presence of deeply excavated pubis, and the presence of a distinct transverse ridge on the ventral surface of the femur distal to the intertrochanteric fossa. It has also been found that the transverse ridges and grooves become larger during ontogeny since the juvenile specimen did not exhibit a well-developed ridge. Histological analysis of isolated limb bones and neutron computed tomography (nCT) of the articulated specimen indicate that the latter likely belonged to an adult individual. This is in contrast to the other varanopid at Richards Spur, the significantly smaller, more gracile predator Mesenosaurus efremovi, which also shows the presence of growth lines and the external fundamental system with an estimated minimum age of fourteen.

Is Proximal Tibia Sufficient for Accurate Measurement of Tibial Slope Angles on Three-dimensional Tomography-based Anatomical Models?

Tibial slope measurements performed using only the proximal part of tibia ignore the native tibial anatomical axis. Our first aim is to measure the native medial, lateral and total tibial slope angles of gender groups using the whole tibial anatomical axis on computerized tomography-based three-dimensional anatomical models. The second aim is to determine the correlation between proximal and whole tibial anatomical axis for measurement of medial, lateral, and total tibial slope angles. We randomly selected 100 females and 100 males between 18-60 years of age. Three-dimensional anatomical models of right and left tibia were created. The gender-specific differences of medial, lateral, and total tibial slope angles according to proximal and whole tibial anatomical axis were measured. Correlation coefficients (r) of medial, lateral, and total tibial slope angles measured with proximal and whole tibial anatomical axis were calculated. The mean age was 47.1 years. A statistically significant difference was observed between female (7.1 ± 3) and male (8.2 ± 2.5) groups in terms of mean lateral tibial slope angles according to the whole tibial anatomical axis (p=0.008). A strong correlation between proximal and whole tibial anatomical axis for all tibial slope angle measurements was detected. The method we determined for 3D measurement of medial, lateral and total tibial slope angles using proximal tibial anatomical axis has a strong correlation with slope angles measured in accordance with the whole tibial anatomical axis. Our 3D tibial slope angle measurement method on the proximal tibia has high reliability and could be used in the daily practice.

Diachronic changes in size and shape of human proximal tibia in Central Europe during the latest 1200 years

During the past twelve centuries, the stature of Central European inhabitants has increased significantly with corresponding changes in the size of lower limb bones. The aim of our study was to determine whether these changes have occurred strictly in relation to size or if the shape of skeletal structures has been altered simultaneously. Diachronic size and shape changes in the proximal part of tibia in a Central European population (Czech Republic) were studied using geometric morphometrics (principal components analysis, Hotelling's test, linear discriminant analysis). The study sample consisted of 183 three-dimensional (3D) models of adult tibiae dating to the early Middle Ages (N=65), early 20th century (N=60), and from a modern Czech population (N=57). A positive secular trend in size manifested only between the two modern Czech populations (the 20th century vs. the 21st century), a time range shorter than one century. By contrast, landmark-based shape analyses revealed significant differences in tibial morphology over the three periods covered in the study. In particular, progressive changes were observed in the position of tibial tuberosity (shifted medially), the inclination of the line connecting tuberosity with anterior edge of the tibial plateau (sloped down), the reshaping of the lower back condyle boundary (shifted posteriorly), and reshaping of the medial contour of the medial condyle (shifted anteriorly). Changes in the shape of the proximal tibial extremity across the chronologically distinct groups indicated the existence of discreet but convincing microevolutionary trends involving this anatomical structure.

Chondroblastoma of proximal humerus: Case report and review of literature

Introduction: Chondroblastoma is a benign, epiphyseal bone tumor. It makes for approximately 1% of all bone tumors. In 1931, it was suggested to be a chondromatous variant of giant cell tumor by Codman. He reported these lesions in the region of proximal part of humerus. It is more common in second decade of life with male-to-female ratio of 2:1. It preferentially affectes the proximal part of tibia, distal part of femur, proximal humerus, and flat bones like the iliac bones. Case report: We report case of a 15 year-old male who presented with pain over the right shoulder. Preoperative radiograph showed a large lytic tumor arising from proximal humerus interspersed with areas of calcification which was indicative of chondroblastoma on MRI and biopsy done later. Conclusions: This patient had chondroblastoma with minimal symptoms of pain with no other abnormality. Chondroblastomas are typically benign, but progress locally or metastatise rarely. Early diagnosis and apt primary management prevents further surgeries and recurrences.

Multidisciplinary Reconstructive Approach to Traumatic Extensor Mechanism Disruption: A Case Report.

Extensor mechanism disruptions are relatively uncommon injuries involving injury to either the quadriceps tendon, the patella, or the patellar tendon. To the best of our knowledge, little has been written to date about reconstructive options following injuries to the patellar tendon insertion at the tibial tubercle in adult native knees. This case report highlights a unique case of extensor mechanism disruption due to traumatic tissue loss, and discusses the novel treatment of such a case. The patient was informed that data concerning the case would be submitted for publication, and he provided consent. A twenty-year-old-man presented to our level-I trauma center after being struck by a motor vehicle and pulled several blocks. He had a 7 × 7-cm open wound over the anterior aspect of the proximal part of the right tibia, with exposed cancellous bone, no visible cortical bone, and a traumatic arthrotomy of the knee (Fig. 1). He was unable to actively perform a straight leg raise against gravity. Radiographs and computed tomography (CT) revealed a complete loss of the anterior cortex of the tibia at the level of the tibial tubercle with an intact patella (Figs. 2 and 3). Fig. 1 Zone of injury. Note the cancellous bone over the proximal aspect of the tibia and the clearly visible articular surface of the knee. Fig. 2 Lateral view of the right knee with a cortical defect over the anterior aspect of the proximal part of the tibia following the first irrigation and debridement and placement of the vacuum-assisted closure device. Fig. 3 CT scan showing loss of the anterior aspect of the proximal part of the right tibia with air around the site of bone loss. The patient was taken urgently to the operating room for irrigation and debridement of the right traumatic knee arthrotomy; a repeat irrigation and debridement was performed …

A Late Fracture of the Femur Through an External Fixator Pin Site: A Case Report.

We present a late complication associated with an external fixator. A healthy man sustained an open floating knee injury that was initially treated with a spanning external fixator prior to definitive fixation. The femoral and tibial fractures ultimately healed after several procedures. He presented four years later after sustaining a low-energy subtrochanteric fracture of the femur through the pin site of the external fixator that had been previously placed in the proximal part of the femur. A fracture through a pin site is a rare and concerning late complication. The patient was informed that data concerning the case would be submitted for publication, and he provided consent. A healthy thirty-eight-year-old man presented with a 32-B1 subtrochanteric fracture of the left femur. Four years previously, the patient had been involved in a motorcycle accident and had sustained grade-3A open fractures of the distal part of the left femur and the proximal part of the left tibia (Fig. 1). He had originally been treated with irrigation and debridement followed by the placement of a spanning external fixator. The pins had been placed in the proximal part of the femoral shaft and in the distal part of the tibial shaft (Figs. 2-A and 2-B). It is unclear on the operative note as to whether the 5-mm pins had been inserted with or without predrilling. It is also unclear as to whether the pins had been inserted by hand or with power. Fig. 1 Anteroposterior radiograph of the left knee demonstrating the original injuries. Anteroposterior radiographs after external fixator placement in the femoral shaft (Fig. 2-A) and in the tibial shaft (Fig. 2-B). Fig. 2-A Fig. 2-B One week after the initial injuries, the patient had undergone removal of the external fixator, repeat irrigation/debridement, and open reduction and internal fixation of the fractures of the distal part of the femur and the proximal part of the tibia. There had been no immediate complications reported from this procedure. The patient …

Construction of clinical score system of giant cell tumors and clinical verification

Objective To establish a clinical score system of giant cell tumors （GCT） according to its morphological features presented on three-dimensional （3D） computed tomographic imaging. Methods Sixteen patients with GCT around knee were included from January 2006 to March 2009. Of the tumors, 9 were located in the distal part of femur, and 7 were in proximal part of tibia. Each patient was exposed to spiral CT preoperatively. Then these primitive CT dates were inputted into digital Orthopedics clinical research platform. With 3D surfaces reconstruction and volume rendering, we reconstructed 3D morphology of GCT. The measurement index included pathological fracture, the degree of involvement of cortical bone, the volume of tumor, the distance between tumor and joint surface and the percentage of involvement areas of articular surface. On account of previous literature and above data, clinical score system of GCT was established. Its feasibility was testified by clinical data. Results A new clinical score system of GCT was established. It was named Hu-Chen Giant Cell Tumor Scale. Full score of the system was 12. In the 16 patients, 5patients whose points was more than 9 elevated by Hu-Chen Giant Cell Tumor Scale preoperatively were treated by wide excision and prosthetic replacement. The postoperative average MSTS score of 5 patients was 27, and there were no recurrence. The 5 patients whose points was 6-8 elevated by Hu-Chen Scale were treated by intralesional excision and structured allograft. The postoperative average MSTS score of the patients was 29, and 1 case underwent recurrence whose points was 8. The 6 patients whose points were less than 6 elevated by Hu-Chen Scale were treated by intralesional excision and morsellized allograft. The postoperative average MSTS score of the patients was 27, and there were no recurrence. Conclusion Hu-Chen Giant Cell Tumor Scale established based on digital techniques includes lots of factors which determined surgical strategy. The grating system is an effectively, reliable method in treatment of GCT. Key words: Giant cell tumer of bone; Imaging, three-dimensional; Analog-digital conversion

Diagnosis and treatment of chondroblastoma: Our experience

The paper presented the results of diagnostics and treatment of patients with diagnosis of chondroblastoma, treated at the Institute of Orthopedic Surgery "Banjica", Belgrade. A total of 30 patients were analyzed, involving the period from 1975-2004. All important data were obtained using the complete medical documentation, physical examination, radiographic findings and available additional diagnostic procedures. The proximal part of tibia, the proximal part of humerus and the distal part of femur were the most common sites of tumor, accounting for 63% of cases. Higher incidence of chondroblastoma was found in male patients, especially in the second decade of life. Pathohistological tumor verification was done in all patients. The patients were then treated by different surgical procedures, both on account of primary lesion and recurrence. Curettage and osteoplasty using the auto- and homograft were carried out in 21 patients, wide resection in nine cases, and amputation was performed in three cases. One patient had radiotherapy due to recurrence of lesion, nevertheless malignant transformation of chondroblastoma occurred in time. Seven patients manifested local recurrence, and one of them even had relapse on two occasions and malignant transformation of chondroblastoma. Malignant lesions were found in three cases (10% of patients); one lesion was diagnosed as primary while other two malignancies were detected only after recurrence, and the treatment was completed by lower leg amputation.

The Incidence of Infection in Interlocking Intramedullary Nailing after Skeletal Traction of Distal Femur

Purpose: The insertion site of K-wire for skeletal traction is proximal part of tibia or distal part of femur. However, people prefer proximal tibia over distal femur due to lower risk of infection rate when change to interlocking IM nailing is needed. We evaluated the infection rate of interlocking IM nailing. Materials and Methods: Fourty-seven patients were included in this study who underwent interlocking IM nailing due to femur shaft fracture. Traction was applied at the distal femur in 19 cases and proximal tibia in 10 cases before interlocking IM nailing. No skeletal traction was applied to the remaining 18 cases. Thirty-eight patients were male and 9 were female. The average age at the time of surgery was 36.7 years old (range, 15~17 years). The average traction period was 9.5 days (range, 3~33 days) and the average followed-up period was 17.2 months. Results: In the distal femoral traction group, 8 cases of superficial pin tract infection developed, but no case of deep infection such as osteomyelitis occurred. In the proximal tibia traction group, 2 cases of superficial pin tract infection developed, but no case of deep infection occurred. In the group that received no skeletal traction before interlocking IM nailing, no case of infection developed. Conclusion: In femur shaft fracture, the distal femoral skeletal traction followed by interlocking IM nailing of femur, compared to proximal tibia skeletal traction, did not increase the risk of deep infection such as osteomyelitis.

Implant selection in revision total knee arthroplasty.

Revision total knee arthroplasty implants have evolved from fully constrained (fixed-hinge) to semiconstrained to contemporary constrained designs. The latter category includes nonlinked constrained (total condylar-III) designs ( Fig. 1) and rotating-hinge designs ( Figs. 2-A and 2-B). Fig. 1: Postoperative anteroposterior radiograph illustrating a nonlinked constrained knee design that was used to revise a failed primary total knee arthroplasty in a patient with rheumatoid arthritis. Figs. 2-A and 2-B: Preoperative (Fig. 2-A) and postoperative (Fig. 2-B) radiographs of the knee of a low-demand seventy-nine-year-old woman who was managed with a rotating-hinge knee prosthesis because of a comminuted periprosthetic supracondylar fracture of the femur. Additionally, the advent of limb-salvage procedures following tumor resection and other instances in which there is massive segmental bone loss, such as that seen after multiple failed arthroplasties (particularly following failed reimplantation for infection), has stimulated the development of modular or custom segmental replacement and the use of allograft-prosthesis composites. Segmental modular megaprostheses are rotating-hinge components with modular stems of varying lengths that are used to replace segmental femoral or tibial diaphyseal bone loss ( Fig. 3). Fig. 3: Lateral radiograph illustrating reconstruction of segmental bone defects of the distal part of the femur and proximal part of the tibia. On the femoral side a custom segmental distal femoral rotating-hinge prosthesis was used, and on the tibial side an allograft-prosthesis composite was used. Use of the proximal tibial allograft facilitated reattachment of the extensor mechanism. An allograft-prosthesis composite consists of a structural allograft, usually the distal part of a donor femur or the proximal part of a donor tibia, into which a stemmed prosthesis is cemented. The composite structure is attached to the remaining host bone with use of matching step-cuts at the junction of the allograft and the host bone. The construct is stabilized with an intramedullary stem ( Figs. 4-A …