Radial Diaphysis Research Articles

ANALYSIS OF OSSIFICATION CENTRES OF THE RADIAL DIAPHYSIS IN FETUSES OF 20-32 WEEKS OF GESTATION

The aim of the study – to investigate the characteristics of ossification of the right andleft radial diaphysis in fetuses of 20-32 weeks’ gestation.Materials and methods. Computed tomography scans of 52 human fetuses at 20-32 weeksof gestation were analyzed to study the characteristics of ossification of the radial bones inhuman fetuses. The results of the study were statistically analyzed in Excel. Student’s t-testfor independent variables and univariate analysis of variance were used to compare means.Results. In human fetuses of 20-32 weeks of gestation, the mean length of ossificationof the right radius increases from 19.63±0.19 mm to 40.87±0.09 mm, and the left radiusincreases from 20.43±0.18 mm to 41.62±0.28 mm, according to the quadratic equation: y= 1.7152 x age – 13.152 (R2 = 0.9825). When analyzing the proximal transverse diameterof the diaphysis of the radius, its increase occurs according to the following quadraticequation: y = 0.2354 x age-1.6858 (R² = 0.9797). In the analysis, the transverse diameterof the middle part of the radius diaphysis increases according to the following quadraticequation: y = 0.1388 x age – 1.0613 (R² = 0.9832). When analyzed, the transversediameter of the distal part of the radial diaphysis increases according to the followingquadratic equation: y = 0.1491 x age – 1.1459 (R² = 0.9847).Conclusion. The obtained morphometric data on ossification of the radial diaphysis can beconsidered normal for the studied 20-32 weeks of gestation and can be used for assessmentof fetal age and for ultrasound diagnosis of congenital pathologies of the upper extremity.

Stress Changes in the Canine Radius after Locking Plate Fixation Using Finite Element Analysis.

The aim of this study was to evaluate the stress changes in the radii beneath the locking plates (LP) of dogs implanted with LP using finite element analysis (FEA). The study included radii harvested from eight dogs. After computed tomography (CT) scans of the forelimb, the articular surface of the radius was fixed using resin. Material tests were conducted to identify the yield and fracture points and for verification with FEA. The CT data of the radius were imported into FEA software. The radii were classified into three groups based on the placement of the LP (nonplate placement, intact group; 1 mm above the radial surface, LP + 1 mm group; 3 mm above the radial surface, LP + 3 mm group). Equivalent, maximum, and minimum principal stresses and minimum principal strain were measured after FEA at the radial diaphysis beneath the plate. In shell elements, the LP + 1 mm and LP + 3 mm groups showed a significantly lower maximum principal stress compared with the intact group. In solid elements, the LP + 1 mm and LP + 3 mm groups showed a significantly higher equivalent stress and a significantly lower maximum principal stress compared with the intact group. When an axial load is applied to the radius, LP placement reduces the tension stress on the cortical bone of the radius beneath the plate, possibly related to implant-induced osteoporosis and bone formation in the cortical bone beneath the plate.

Effects of simulated radioulnar synostosis on supination and pronation in cats. A cadaveric study.

To evaluate the effect of an induced synostosis with a screw on pronation and supination in cats. Ex vivo biomechanical study. A total of 58 feline forelimbs. A total of 58 cadaveric feline thoracic limbs were mounted on a custom-built jig with the elbow and carpus flexed at a 90° angle. To exclude any orthopedic disease, radiographs of the forelimbs were performed prior to the mechanical tests. Radioulnar synostosis was imitated with a 2 mm cortical screw through the radius into the ulna in the proximal (Group P; n = 54), middle (Group M; n = 52), and distal (Group D; n = 53) radial diaphysis. The angles of pronation and supination were recorded after manually applying a two-finger tight rotational force to the metacarpus. Rotational tests were performed without a screw (Group N) and with a screw in each of the aforementioned positions. Pairwise comparisons between the groups were performed based on their angles of rotation with a paired t-test with the Benjamini-Hochberg procedure and a mixed model ANOVA. Mean angles of rotation decreased between Group N (129.5 ± 15.9°) and all groups with imitated radioulnar synostosis to a mean angle of 37.5 ± 14.5° (p < .0001). Mean angles of rotation did not differ between the groups with imitated radioulnar synostosis. Induced radioulnar synostosis decreases antebrachial rotation by more than two-thirds, regardless of location. Implants fixating the radius to the ulna should be avoided in cats, regardless where they are located along the radial diaphysis.

Computer-Aided Assessment of Three-Dimensional Standard Bone Morphology of the Distal Radius.

The present study attempted to define the three-dimensional (3D) locations of reference points and standard measures of the distal radius of a normal wrist joint. One hundred wrists from 50 males and 50 females who matched the age distribution (19-95 years old, mean: 56.0 years old) were evaluated. Computed tomography (CT) images of normal wrist joints acquired for comparison with the affected side were used. The absence of a previous history and complaints in the unaffected wrist was confirmed in an interview and with medical records. Three-dimensional images of the distal radius were reconstructed using the data obtained from CT scans. The site at which the major axis of the radial diaphysis contacted the distal radius joint surface was defined as the origin. The 3D coordinates of reference points for the radial styloid process (1), sigmoid notch volar edge (2), and sigmoid notch dorsal edge (3) as well as the barycenter for the joint surface and joint surface area were evaluated. A slope of the line connecting coordinates 1-2 in the coronal plane was evaluated as the 3D radial inclination (3DRI) and that connecting coordinates 2-3 in the sagittal plane as the 3D palmar tilt (3DPT). Each measurement value was compared between males and females. The positions of each reference point from the origin were as follows: (1) 14.2 ± 1.3/12.6 ± 1.1 mm for the distal-palmar-radial position; (2) 19.3 ± 1.3/16.9 ± 1.3 mm for the proximal-palmar-ulnar position; (3) 15.6 ± 1.4/14.1 ± 0.9 mm for the proximal-dorsal-ulnar position; and (barycenter) 4.1 ± 0.7/3.7 ± 0.7 mm for the proximal-volar-ulnar position for males and females, respectively. The areas of the radius articular surface were 429.0 ± 67.9/347.6 ± 44.6 mm2 for males and females, respectively. The 3DRI and 3DPT were 24.2 ± 4.0/25.7 ± 3.1° and 10.9 ± 5.1/13.2 ± 4.4° for males and females, respectively. Significant differences were observed in all measurement values between males and females (p &lt; 0.01). The reference points and measured values obtained in the present study will serve as criteria for identifying the dislocation direction and reduction conditions of distal radius fractures in 3D images.

Atypical Fracture of Radial Diaphysis After Sauvé-Kapandji Procedure: A Retrospective Radiographic Evaluation of Fracture Progression.

The Sauvé-Kapandji procedure (SK), which combines distal radioulnar joint arthrodesis with creation of an ulnar pseudarthrosis, achieves good outcomes with few complications for patients with distal radioulnar joint instability or arthritis. The authors describe a case of atypical fracture of the radial diaphysis that occurred in a 79-year-old woman with rheumatoid arthritis who had undergone SK 18 years earlier. The patient had taken alendronate for osteoporosis for 13 years but had discontinued treatment 2 years before onset of symptoms. Retrospective review of serial radiographs revealed focal cortical thickening at the fracture site beginning 18 months before the onset of prodromal pain and becoming more evident over time. The patient underwent surgical repair of the fracture, which had occurred at the attachment of the pronator teres. Histopathological examination of bone excised from the fracture site and from the iliac graft used for fracture repair revealed markedly fewer trabecular osteoblasts than normal and no osteoclasts, indicating severe suppression of bone turnover. It is important to evaluate the radial diaphysis on radiographs taken after SK for early signs of atypical fracture, especially in patients with rheumatoid arthritis and a history of bisphosphonate use. Given the patient's history of bisphosphonate use and the similar radiographic appearance to atypical femoral fractures, the authors applied the term atypical radial fracture to this case. [Orthopedics. 2023;46(5):e317-e320.].

The Association Between the Volar Aspect of the Distal Radial Diaphysis and the Lunate Rotation Center on Lateral View X-ray of the Wrist

For the treatment of severe distal radius fracture dislocations or malunions, especially those accompanied by intra-articular fractures, radiographic indexes based on the relationship between the carpus and radius are occasionally needed to achieve the ideal radiocarpal reconstruction. This study defined a reference point on the lunate and examined whether this point was located on a line extending along the volar aspect of the distal radial diaphysis on lateral radiographs of the wrist. Two hundred one lateral wrist radiographs of adults were obtained, and the center of a circle passing through 3 selected points on the proximal articular surface of the lunate was defined as the lunate rotation center. Thereafter, the distance between the rotation center and a line extending along the volar aspect of the distal radial diaphysis was measured. Additionally, the distance between the rotation center and the midpoint of the distal articular surface of the lunate was measured. The mean distance between the lunate rotation center and the line extending along the volar aspect of the distal radial diaphysis was-0.01 ± 0.09 mm. The difference in this distance between both wrists in the same patient was 0.3 ± 0.12 mm. The distance between the rotation center and the midpoint of the distal articular surface of the lunate was 0.3 ± 0.05 mm. This study demonstrated that the lunate rotation center was located on a line extending along the volar aspect of the distal radial diaphysis and at the midpoint of the distal articular surface of the lunate. This study demonstrates that this association could become an important index for preoperative planning of corrective osteotomy for complicated intra-articular distal radial fracture malunions. Additionally, it may aid in confirming the reduced position during or after surgery for wrist fracture dislocations.

HR-pQCT parameters of the distal radius correlate with the bending strength of the radial diaphysis.

High resolution, peripheral quantitative computed tomography (HR-pQCT) scanners can now characterize an individual's trabecular architecture, cortical structure, and volumetric bone mineral density at a nominal resolution of 61μm. While predictions of failure load of the distal radius and tibial diaphysis in compression by finite element analysis (FEA) of HR-pQCT scans have been validated against mechanical tests of cadaveric bones in compression, namely for images with nominal resolutions of 82μm and 165μm, the HR-pQCT parameters that best predict bending strength of cortical bone remain unknown. Therefore, we scanned cadaveric forearms from 31 elderly donors (Female: 72.8±8.8years and Male: 72.1±6.3years), and then loaded the radial diaphysis to failure in three-point bending after denuding each bone (38 in total). The cortical parameters had stronger correlations with ultimate moment than the trabecular parameters such that cortical area and estimated failure load of the distal radius had the highest Spearman correlation coefficients (r=0.89 and r=0.81, respectively, p<0.0001). Despite being a known determinant of bone strength, cortical porosity of the distal radius did not correlate with ultimate moment (p=0.8537). In multivariate linear regressions with section modulus (SM) of the radial diaphysis as one of two predictors of bending strength, cortical area and cortical thickness were each significant contributors to the prediction of ultimate moment. Their contribution was one-half and one-third, respectively, of the contribution from SM. None of the HR-pQCT parameters were strongly correlated with post-yield displacement, an indicator of bone brittleness. In support of HR-pQCT imaging of the distal radius to identify individuals with osteoporosis, the present study found that parameters of the cortex and failure load predictions by linear FEA are strongly related to the bending strength of cortical bone.

Sex and External Size Specific Limitations in Assessing Bone Health From Adult Hand Radiographs.

ABSTRACTMorphological parameters measured for the second metacarpal from hand radiographs are used clinically for assessing bone health during growth and aging. Understanding how these morphological parameters relate to metacarpal strength and strength at other anatomical sites is critical for providing informed decision‐making regarding treatment strategies and effectiveness. The goals of this study were to evaluate the extent to which 11 morphological parameters, nine of which were measured from hand radiographs, relate to experimentally measured whole‐bone strength assessed at multiple anatomical sites and to test whether these associations differed between men and women. Bone morphology and strength were assessed for the second and third metacarpals, radial diaphysis, femoral diaphysis, and proximal femur for 28 white male donors (18–89 years old) and 35 white female donors (36–89+ years old). The only morphological parameter to show a significant correlation with strength without a sex‐specific effect was cortical area. Dimensionless morphological parameters derived from hand radiographs correlated significantly with strength for females, but few did for males. Males and females showed a significant association between the circularity of the metacarpal cross‐section and the outer width measured in the mediolateral direction. This cross‐sectional shape variation contributed to systematic bias in estimating strength using cortical area and assuming a circular cross‐section. This was confirmed by the observation that use of elliptical formulas reduced the systematic bias associated with using circular approximations for morphology. Thus, cortical area was the best predictor of strength without a sex‐specific difference in the correlation but was not without limitations owing to out‐of‐plane shape variations. The dependence of cross‐sectional shape on the outer bone width measured from a hand radiograph may provide a way to further improve bone health assessments and informed decision making for optimizing strength‐building and fracture‐prevention treatment strategies. © 2022 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

Anatomical and Clinical Concepts in Distal Radius Volar Ulnar Corner fractures.

Background Volar ulnar corner fractures are a subset of distal radius fractures that can have disastrous complications if not appreciated, recognized, and appropriately managed. The volar ulnar corner of the distal radius is the "critical corner" between the radial calcar, distal ulna, and carpus and is responsible for maintaining stability while transferring force from the carpus. Description Force transmitted from the carpus to the radial diaphysis is via the radial calcar. A breach in this area of thickened cortex may result in the collapse of the critical corner. The watershed ridge (line) is clinically important in these injuries and must be appreciated during planning and fixation. Fractures distal to the watershed ridge create an added level of complexity and associated injuries must be managed. An osteoligamentous unit comprises bone-ligament-bone construct. Volar ulnar corner fractures represent a spectrum of osteoligamentous injuries each with their own associated injuries and management techniques. The force from the initial volar ulnar corner fracture can propagate along the volar rim resulting in an occult volar ligament injury, which is a larger zone of injury than appreciated on radiographs and computerized tomography scan. These lesions are often underestimated at the time of fixation, and for this reason, we refer to them as sleeper lesions. Unfortunately, they may become unmasked once the wrist is mobilized or loaded. Conclusions Management requires careful planning due to a relatively high rate of complications after fixation. A systematic approach to plate positioning, utilizing several fixation techniques beyond the standard volar rim plate, and utilizing fluoroscopy and/or arthroscopy is the key strategy to assist with management. In this article, we take a different view of the volar ulnar corner anatomy, applied anatomy of the region, associated injuries, and management options.

Spatial Recombinant Human Bone Morphogenetic Protein 2 Delivery from Hydroxyapatite Scaffolds Sustains Bone Regeneration in Rabbit Radius.

Regenerating large bone defects requires a multifaceted approach combining optimal scaffold designs with appropriate growth factor delivery. Supraphysiological doses of recombinant human bone morphogenetic protein 2 (rhBMP2), typically used for the regeneration of large bone defects clinically in conjunction with an acellular collagen sponge (ACS), have resulted in many complications. In this study, we develop a hydroxyapatite/collagen I (HA/Col) scaffold to improve the mechanical properties of the HA scaffolds, while maintaining open connected porosity. Varying rhBMP2 dosages were then delivered from a collagenous periosteal membrane and paired with HA or HA/Col scaffolds to treat critical-sized (15 mm) diaphyseal radial defect in New Zealand white rabbits. The groups examined were ACS +76 μg rhBMP2 (clinically used INFUSE dosage), HA +76 μg rhBMP2, HA +15 μg rhBMP2, HA/Col +15 μg rhBMP2, and HA/Col +15 μg rhBMP2 + bone marrow-derived stromal cells (bMSCs). After 8 weeks of implantation, all regenerated bones were evaluated using microcomputed tomography, histology, histomorphometry, and torsional testing. It was observed that the bone volume regenerated in the HA/Col +15 μg rhBMP2 group was significantly higher than that in the groups with 76 μg rhBMP2. The same scaffold and growth factor combination resulted in the highest bone mineral density of the regenerated bone, and the most bone apposition on the scaffold surface. Both the HA and HA/Col scaffolds paired with 15 μg rhBMP2 had sustained ingrowth of the mineralization front after 2 weeks compared to the groups with 76 μg rhBMP2, which had far greater mineralization in the first 2 weeks after implantation. Complete bridging of the defect site and no significant difference in torsional strength, stiffness, or angle at failure were observed across all groups. No benefit of additional bMSC seeding was observed on any of the quantified metrics, while bone-implant apposition was reduced in the cell-seeded group. This study demonstrated that the controlled spatial delivery of rhBMP2 at the periosteum at significantly lower doses can be used as a strategy to improve bone regeneration around space maintaining scaffolds. Tweet Inside-out or outside-in: growth factors delivered from the outside of porous mineral-collagen scaffolds, maintain strength and regrow bone better in a rabbit study. Twitter handle for senior author (@Guda_Lab) and sponsoring institution (@UTSA) Impact Statement This study provides insights on bone regeneration in the presence of spatially controlled delivery of recombinant human bone morphogenetic protein 2 (rhBMP2) from porous hydroxyapatite scaffolds coated with collagen I films. Using critical-sized defects created in the radial diaphysis of skeletally mature New Zealand White rabbits, microcomputed tomography and histomorphometry indicated significantly higher bone regeneration, bone mineral density, and bone-implant contact, as well as sustained regeneration over longer durations with lower dosage of rhBMP2 delivered periosteally.

Evaluation of Radiographic Parameters Following Dorsal Wrist-Spanning Plate Fixation of Distal Radius Fractures to the Second Versus Third Metacarpal

Dorsal wrist-spanning plate fixation for comminuted, intra-articular distal radius fractures involves the indirect reduction of intra-articular fractures via ligamentotaxis. The reduction is maintained by application of a bridge plate from the radial diaphysis to either the second or third metacarpal. The objective of this study was to retrospectively compare radiographic outcomes between distal radius fractures managed with bridge plate fixation to the second versus third metacarpal. A single-institution retrospective review identified 50 cases of distal radius fractures that underwent dorsal wrist-spanning plate fixation, with 9 and 41 fractures undergoing fixation to the second and third metacarpals, respectively. Radiographic parameters, such as radial height, radial inclination, volar tilt, and ulnar variance, were measured at 3 time points: immediately after surgery, immediately prior to elective plate removal, and at the final follow-up. Radiographic measurements of the 2 cohorts were compared at the 3 time points. Final radiographs showed an average radial height of 8.9 mm versus 9.4 mm for the second versus third metacarpal cohorts, respectively; average radial inclination of 17.4° for both the second and third metacarpal cohorts; average volar tilt of 1.9° versus 1.7° for the second versus third metacarpal cohorts, respectively; and an average ulnar variance of+0.6 mm versus+0.1 mm for the second versus third metacarpal cohorts, respectively. Radiographic parameters of the second and third metacarpal cohorts were similar across all the time points. Additionally, evaluation of the radiographic parameters across the 3 time points (immediately after surgery, immediately prior to elective plate removal, and at the final follow-up) demonstrated little to no loss of radiographic alignment. Radiographic outcomes for distal radius fractures managed with bridge plate fixation to the second versus third metacarpal appear similar. The distal plate fixation site can likely be determined on the basis of fracture anatomy and patient-specific features. Therapeutic IV.

Pathological Fracture due to the Aneurysmal Bone Cyst Involving a Large Segment of Radius Diaphysis in an Adolescent

A cystic lesion of the long bones occasionally presents with a pathological fracture. Various etiologies are described, and the aneurysmal bone cyst (ABC) is an uncommon lesion in the forearm bones. Usually, ABC involves the metaphyseal region as an eccentric expansile lesion and its presence in diaphysis is rare. Involvement of a large segment of a long bone is a very uncommon presentation for any cystic lesion including ABC. Fracture resulting in the settings of ABC with an extensive diaphyseal involvement is a rare and challenging presentation. We describe relevant details pertaining to a case of a 13-year-old female involving a large segment of the radial diaphysis that was managed operatively and finally diagnosed as ABC. She had good outcome in the follow-up of 5 years, and no postoperative complication or recurrence was noted.

Impact of Adolescent Pregnancy on Bone Density in Underprivileged Pre-Menopausal Indian Women

High prevalence (31.5%) of adolescent pregnancies (AP) have been reported in India. Reports suggest that pregnancy during adolescence may have deleterious effects on peak bone mass. Very few studies have described the long-term effects of a history of AP on bone mass. The objective of this study was to compare bone mineral density (BMD) and bone geometry of premenopausal women with first childbirth during adolescence (i.e., before age of 19 years) or after 20 years. A cross-sectional study was conducted in 242 women (age 28.0-54.5 years) from Pune, India (November, 2015 to November, 2017). Women were divided into 2-groups: Group-1: women-who had 1st-pregnancy and childbirth before 19 years of age (AP n = 131) and Group-2: women-who had 1st pregnancy after 20 years of age (non-AP n = 111). Demographic data, anthropometric measurements, and biochemical tests were performed using standard protocols. Physical activity and nutrient intakes were recorded using validated questionnaires. Areal BMD and bone geometry were measured using Dual-Energy-Absorptiometry-DXA (Lunar-iDXA, GE Healthcare) and peripheral-quantitative-computed-tomography-pQCT (XCT2000, Stratec Inc.). Mean age of the study group was 37 ± 4.6 years; in women from group-1 mean age at first delivery was 16.9 ± 1.6 years as against 22.6 ± 3.1 years in group-2. Both groups were similar in body mass index and socioeconomic status. pQCT measured radial diaphyseal cortical thickness (1.97 ± 0.3 mm vs 1.88 ± 0.3 mm resp., p = 0.016, periosteal circumference (38.0 ± 3.6 mm vs 36.7 ± 2.5 mm, resp. p = 0.016), total bone area (114.3 ± 24.8 mm2 vs 108.7 ± 14.7 mm2 resp. p = 0.026) and stress-strain index (SSI = 217 ± 75 vs 201 ± 40 mm3 resp. p = 0.042) were significantly higher in group-1 than group-2. After adjusting for anthropometric and lifestyle parameters, pQCT measured cortical thickness (1.98 ± 0.03 mm in group-1, 1.87 ± 0.03 mm group-2, p = 0.01, mean ± SE) and iDXA derived aBMD at forearm were still significantly higher (0.599 ± 0.006 g/cm3 vs 0.580 ± 0.006 g/cm3, p = 0.023) in Group-1. Our data suggest that women with a history of adolescent pregnancy had better bone geometry and higher aBMD at radius in later years. We speculate that early exposure to pregnancy resulted in higher aBMD at the radius and induced changes at radial diaphysis with bones becoming thicker and wider among these women.

Functional state of the brain bioelectric activity in treatment of diaphyseal lesions of the radius using the transosseous osteosynthesis of the wire and rod arrangement

Radial fracture is the most common trauma to the musculoskeletal system and accounts for 50 % of traumatic injuries to the bones of the upper limb. Disability in patients with fractures of the forearm bones ranges from 6 to 8 months, so the choice of the most effective method of treatment is very relevant. Currently, an important point is the tendency of optimizing the transosseous method by eliminating the disadvantages and looking for new advantages of external fixation. Bone fracture and associated surgical intervention are always accompanied by varying degrees of changes in the links of the central nervous system, hemodynamics and metabolism. In order to study the bioelectrical activity of the brain in 47 patients with a fracture of the radial diaphysis treated in the Traumatology Department of the Irkutsk Scientific Centre of Surgery and Traumatology, in the pre- and postoperative period we compared EEG indicators of two variants of the layout of the external fixation apparatus (EF): wire and rod. Analysis of the rhythms of bioelectrical activity of the brain in both groups in the preoperative period revealed a normal zonal distribution with the dominance of the alpha rhythm on the EEG, which generally reflects a rather high degree of organization of neuroactivity and indicates the stability of cerebral homeostasis. At the same time, in the group of patients with a wire-mounted EF device in the postoperative period, EEG indices significantly differed from the values of the norm and ndicators in the group with a rod-shaped arrangement. A decrease in the amplitude of alpha and beta rhythms was noted, as well as a shift in the frequency of bioelectric activity towards slow waves, which is a sign characteristic of discirculatory encephalopathy. An EEG study using the method of transosseous osteosynthesis with EF devise of a rod assembly showed its greater efficiency compared to the use of an EF device of a wire assembly during treatment and rehabilitation. Thus, the study of the bioelectric activity of the brain is a reliable method for assessing its functional state after an injury, as well as the effectiveness of the treatment.

Bone pearl: An enigmatic supernumerary ossicle of the thumb

AbstractA 73‐year‐old Polynesian male exhibits a small, round, supernumerary bone along the radial diaphysis of the proximal phalanx of the right thumb. This accessory bone resembles a pearl in shape and color and is firmly attached via soft tissue, a ligament. A search of the literature failed to reveal any supernumerary bones attached to the radial surface of the first proximal phalanx. The presence of this supernumerary bone, although quite small and different from other small ossicles in the human skeleton, is potentially important to clinicians, anatomists, and anthropologists. This bone, or others like it, could be symptomatic and represents a rare trait that contributes to our knowledge of anatomical variation in hand bones.

Unusual Combination of Postero-Lateral Elbow Dislocation and Ipsilateral Diaphyseal Radial Fracture: A Case Report and Review of Literature

The combination of a radial diaphysis fracture and ipsilateral elbow dislocation is a rare lesion. Only a few similar cases have been reported in the literature. Such injuries need a concentric reduction of the dislocation and an anatomical fixation of the radius for optimal functional outcomes. The radial fracture and ipsilateral dislocation of the elbow were probably caused by forearm hypersupination with extension of the elbow. Closed reduction of the elbow and operative stabilization of radial fracture were done with good clinical, radiological and functional outcomes in 8 months follow-up period. We discuss through a clinical case of a radial shaft fracture unusually associated with postero-lateral elbow dislocation and through a review of the literature the clinical aspects, the mechanism, treatment and the evolving profile of this particular lesion.

Development of a novel atrophic non-union model in rabbits: A preliminary study

Background and aimThe currently available atrophic non-union models rely on wide segmental excision of bone diaphysis to impede the process of healing but lack resemblance to the clinical scenario. The present study focused on developing an in vivo model of atrophic non-union fracture in rabbit radius that can replicate the clinical scenario. Materials and methodsThe atrophic non-union fracture model was developed by creating a 10 mm segmental bone defect in the radial diaphysis of five adult New Zealand White rabbits. The periosteum (2 mm) of the cut bone ends was cauterized using electrocautery to induce atrophy. Atrophic non-union was confirmed using radiographic and histologic evaluations on 30th postoperative day. ResultsThe radiographic signs of healing were completely absent in all the rabbits on 30th postoperative day, indicating inert bone ends. Histological findings further confirmed the presence of inert bone ends, indicating the development of atrophic non-union. ConclusionThe combination of the segmental bone defect, electrocautery induced thermal damage of bone end periosteum, and delayed treatment can induce the development of atrophic non-union fracture model in rabbits that can replicate the clinical scenario.

Vascularized ulnar periosteal pedicled flap for forearm nonunion in children

We report our experience with the use of a vascularized ulnar periosteal pedicled flap to treat forearm nonunion in children. Seven children underwent surgical treatment of radial diaphysis nonunion with this technique. The mean duration of nonunion prior to the flap was 9 months. Significant postoperative improvements were observed in pain severity (mean visual analogue scale score of 0.6), Quick Disabilities of the Arm, Shoulder, and Hand (mean score of 7.1) and grip strength (89% higher than preoperative status). Union was achieved in all patients, with a mean time to union of 3 months. One patient developed distal radioulnar synostosis as a postoperative complication. A vascularized ulnar periosteal pedicled flap is a reliable and versatile technique for treating forearm nonunion in children, associated with both good outcomes and low donor morbidity.Level of evidence: IV.

Dynamics of hematological parameters in rabbits for osteosubstitution by hydroxyapatite ceramics doped with germanium and in complex with blood coagulation activator

Bone tissue has powerful regenerative properties, thanks to which, with stable fixation, quite large amounts of skeletal bone damage can be successfully repaired. However, in the case of fragmentary fractures, the use of osteosynthesis methods alone does not always ensure the optimal course of reparative regeneration, as its regenerative potential is lost. Therefore, there is a need to replace post-traumatic bone defects and stimulate reparative osteogenesis. For this purpose, doped or doped with various elements (Ge, Si, Zn, Ag, Cu) composite materials. The aim of the study was to investigate the dynamics of hematological parameters in rabbits for osteosubstitution by hydroxyapatite ceramics doped with germanium and in combination with a blood clotting activator. Model defects were formed in the radial diaphysis and femur metaphysis in rabbits with a 3 mm and 4.2 mm diameter drill bit, respectively. Anesthesia included acepromazine, thiopenate, and lidocaine infiltration anesthesia. Animals of the first experimental group (n = 12) were replaced by defects with granules of hydroxyapatite ceramics doped with germanium (HTGe), the second (n = 12) – hydroxyapatite ceramics doped with germanium with blood coagulation activator (HTGe + a), the third – (n = 12). hydroxyapatite α + β with active (α + β + a), and control – granules of undoped ceramics (HT). On day 7, animals of all groups had minor post-traumatic erythrocytopenia and oligochromemia. There was also a gradual increase in the content of leukocytes in the blood with a peak on the 14th day, which in the group HTGe + a lasted until the 30th day. The increase in the number of leukocytes and their peak values occurred within the physiological norm and only approached its upper limit. In most groups there was a pronounced thrombocytosis during the first 14 days with normalization to the 30th day, but in the 2nd experimental group the number of platelets returned to normal only on the 60th day. Changes in most integral hematological indices, which reflect the relationship between blood cell populations, are characteristic of the inflammatory-resorptive phase of reparative osteogenesis. The dynamics of hematological parameters indicates the absence of a pronounced reaction of the body to the implantation of hydroxyapatite composite doped with germanium. The combination of hydroxyapatite ceramics doped with germanium with coagulation activator eliminates post-traumatic oligochromemia and erythrocytopenia and significantly increases the level of hematological integral indices, which indicates a more intensive course of inflammatory-resorptive clinical resorptive aparation phase.

Peak vertical jump power predicts radial bone strength better than hand grip strength in healthy individuals.

Osteoporosis is considered a pediatric disease with geriatric consequences. However, measuring bone strength in children is complex and creates a practical problem for health professionals, teachers and parents. A non-invasive measure of muscle fitness that correlates to bone strength may provide a means to monitor bone strength throughout the lifespan. Therefore, the purpose of this study was to investigate the relationship between common muscle function tests (relative grip strength (RGS), peak vertical jump power (PP)) and bone strength in the radial diaphysis and epiphysis of a healthy population. Healthy participants (n=147 (81 female)) performed a bilateral grip strength test using a hand dynamometer, and a maximal vertical jump test. Peak vertical jump power was calculated from maximal jump height using the Sayer’s equation. Moment of inertia (MoI), cortical area (CoA), cortical bone mineral density (cBMD), and polar strength-strain index (SSIp) were measured using peripheral Quantitative Computed Tomography (pQCT) to determine bone strength parameters at the 66% radial site (predominantly cortical bone). At the 4% site (trabecular bone site), bone mineral content (vBMC.tb), bone mineral density (vBMD.tb), total area (ToA.tb) and bone strength index (BSIc) were measured. Hierarchical multiple regression analyses determined the relationship of each muscle function test for each bone envelope (cortical and trabecular). For the cortical bone measurements: RGS, and PP were both significantly correlated with CoA, MoI, and SSIp. Peak vertical jump power predicted bone strength parameters to a greater extent compared to RGS. For the trabecular bone envelope, RGS was not a predictor of bone strength however peak power was a significant predictor of bone strength parameters. Peak vertical jump power was a significant predictor of bone strength at both trabecular and cortical radial sites. Interestingly PP, a lower limb measurement explained the most variance in the bone strength of the upper limb.