Round Bone Research Articles

Management of a solitary bone cyst using a custom-made surgical guide for a minimally invasive approach: technical note and case report

BackgroundSolitary Bone Cyst (SBC), also known as a simple bone cyst, hemorrhagic cyst, or traumatic cyst is classified by the WHO among non-odontogenic benign lesions of the jaw. The article explores the use of a static 3D-printed surgical guide to treat mandibular SBC, emphasizing a minimally surgical approach for this lesion.Case PresentationA 20-year-old woman was referred for a persistent mandibular SBC lacuna, without specific complaints. Her medical history included a previous bone trepanation for a SBC in the same area, radiologically and surgically confirmed. X-ray assessment showed a well-defined unilocular radiolucency surrounding the root of the first left lower molar (tooth #36), measuring 10 × 10 mm. Pulp sensitivity was normal. CBCT data and STL files of dental cast were obtained preoperatively and registered. A 3D-printed surgical guide was used for minimally invasive trepanation of the buccal cortical. The simulation used a targeted endodontic microsurgery approach in order to determine axis and diameter of the trephine. Surgery was performed under local anesthesia. The guide was tooth supported integrating tubes and a fork for guiding precise trepanation. A 3.5 mm round bone window was created, leaving an empty cavity confirming SBC diagnosis and permitting bone curettage. A blood clot was obtained to promote bone healing. Complete reossification was observed after 6 months. The follow-up at 2 years confirmed a complete bone healing with normal pulp sensitivity.DiscussionThe 3D-printed windowed surgical guide with dental support offers big advantages, including improved visibility and reduced errors. Compared to traditional guides, it eliminates visual hindrance and allows easier and quick access to confined areas as well as an improved irrigation during drilling process. The article also highlights the importance of preoperative planning while acknowledging potential limitations and errors and surgical complications.ConclusionThe use of the 3D-printed surgical guide could be used in routine for minimally invasive intervention of SBC. This case also demonstrates the potential utility of this approach in various procedures in oral and maxillofacial surgery. The technique provides precise localization, reducing complications and enhances operative efficiency.

Modified Anatomical Anterior Cruciate Ligament Reconstruction with Flat Semitendinosus Graft and C-shaped Tibial Canal

Every year, approximately 400,000 patients undergo anterior cruciate ligament (ACL) reconstruction surgery in the United States, accounting for almost 50% of all knee surgeries in the country. Recent studies have demonstrated that the ACL is a ribbon-like structure with a C-shaped tibial insertion and a flat femoral origin. This article introduces a modification of an ACL reconstruction technique. The modification renders the procedure easily reproducible with standard surgical instruments. We will describe a surgical technique modification that goes beyond the standard round bone tunnels and adopts a more anatomical approach using a C-shaped tibial canal and a flat femoral canal using a flat semitendinosus (semi-T) graft. The use of a semi-T graft better reproduces the ribbon-like ACL anatomy. The semi-T graft, a flat femoral canal, and a C-shaped tibial canal provide increased bone-tendon contact surface area and decreased diffusion length, resulting in improved tendon-bone healing. The modification proposed by our team makes the anatomical ribbon-like ACL graft, C-shaped tibial canal, and the flat femoral canal technique feasible in every orthopaedic operating room and mitigates costly specialized instrument.

Quantitative and qualitative condylar changes following stabilization splint therapy in patients with temporomandibular joint disorders.

This study aimed to explore the quantitative and qualitative condylar changes following stabilization splint (S.S) therapy, including condylar position, morphology, and bone mineral density (BMD) in subjects with temporomandibular disorders (TMD). In this retrospective clinical study, we enrolled 40 TMD subjects (80 joints) aged 18 to 35years, for whom a S.S was used to treat TMD. The 80 TMD consists of 32 masticatory muscle disorders (myalgia) and 48 TMJ disorders (arthralgia). Cone beam computed tomography (CBCT) was used to scan the TMJs of subjects pre- and post-treatment for three-dimensional analysis (3D). Using Mimics software v.21.0, quantitative (3D condylar and joint spaces dimensions parameters were measured using linear measurements in millimeters, according to the Kamelchuk method and Ikeda method, while the assessment of anteroposterior condyle position within the glenoid fossa was based on the method of Pullinger and Hollender), and qualitative (a round bone tissue with an area of 2 mm2 in three representative areas according to the Kamelchuk method to measure condylar BMD) pre- and post-treatment. Intra- and inter-group statistical comparisons were performed using the Wilcoxon signed ranks and the Kruskal-Wallis test, respectively. The course of treatment was 6-12months, with an average of 9.1months. For the pre- and post-treatment quantitative comparisons, there was a statistically significant difference in the anterior joint space (AJS) and coronal medial space, as well as the condyle length in the myalgia group and condylar width in the arthralgia group. For qualitative measurements, a significant difference was observed in the posterior slope of the myalgia group and the arthralgia group's anterior, superior, and posterior slopes. The inter-group comparisons revealed significant differences in AJS, condylar length, and anterior slope density. In short-term follow-up, the S.S influenced patients with TMD from different origins; it changes anterior and coronal medial joint space, condyle length in myalgia, and width in arthralgia. Furthermore, it improved the condyle bone density more evidently in arthralgia. This study highlights the influence of S.S on symptomatic populations with TMD of different origins from a qualitative and quantitative perspective.

Bilateral osteochondrosis of the distal tibial epiphysis: An extremely rare condition: Case report with literature review

Osteochondrosis is a developmental disease characterized by an abnormal endochondral ossification of the epiphyses or epiphyseal equivalents (round bones and apophyses). Distal tibial epiphysis is an uncommon location of this condition and bilateral involvement is extremely rare

History and Evolution of the Minimally Invasive Transforaminal Lumbar Interbody Fusion.

The minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is a popular surgical technique for lumbar arthrodesis, widely considered to hold great efficacy while conferring an impressive safety profile through the minimization of soft tissue damage. This elegant approach to lumbar stabilization is the byproduct of several innovations throughout the past century. In 1934, Mixter and Barr’s paper in the New England Journal of Medicine elucidated the role of disc herniation in spinal instability and radiculopathy, prompting surgeons to explore new approaches and instruments to access the disc space. In 1944, Briggs and Milligan published their novel technique, the posterior lumbar interbody fusion (PLIF), involving continuous removal of vertebral bone chips and replacement of the disc with a round bone peg. The following decades witnessed several PLIF modifications, including the addition of long pedicle screws. In 1982, Harms and Rolinger sought to redefine the posterior corridor by approaching the disc space through the intervertebral foramen, establishing the transforaminal lumbar interbody fusion (TLIF). In the 1990s, lumbar spine surgery experienced a paradigm shift, with surgeons placing increased emphasis on tissue-sparing minimally invasive techniques. Spurred by this revolution, Foley and Lefkowitz published the novel MIS-TLIF technique in 2002. The MIS-TLIF has demonstrated comparable surgical outcomes to the TLIF, with an improved safety profile. Here, we present a view into the history of the posterior-approach treatment of the discogenic radiculopathy, culminating in the MIS-TLIF. Additionally, we evaluate the hallmark characteristics, technical variability, and reported outcomes of the modern MIS-TLIF and take a brief look at technologies that may define the future MIS-TLIF.

Scaffold microarchitecture regulates angiogenesis and the regeneration of large bone defects

Emerging 3D printing technologies can provide exquisite control over the external shape and internal architecture of scaffolds and tissue engineering (TE) constructs, enabling systematic studies to explore how geometric design features influence the regenerative process. Here we used fused deposition modelling (FDM) and melt electrowriting (MEW) to investigate how scaffold microarchitecture influences the healing of large bone defects. FDM was used to fabricate scaffolds with relatively large fibre diameters and low porosities, while MEW was used to fabricate scaffolds with smaller fibre diameters and higher porosities, with both scaffolds being designed to have comparable surface areas. Scaffold microarchitecture significantly influenced the healing response following implantation into critically sized femoral defects in rats, with the FDM scaffolds supporting the formation of larger bone spicules through its pores, while the MEW scaffolds supported the formation of a more round bone front during healing. After 12 weeks in vivo, both MEW and FDM scaffolds supported significantly higher levels of defect vascularisation compared to empty controls, while the MEW scaffolds supported higher levels of new bone formation. Somewhat surprisingly, this superior healing in the MEW group did not correlate with higher levels of angiogenesis, with the FDM scaffold supporting greater total vessel formation and the formation of larger vessels, while the MEW scaffold promoted the formation of a dense microvasculature with minimal evidence of larger vessels infiltrating the defect region. To conclude, the small fibre diameter, high porosity and high specific surface area of the MEW scaffold proved beneficial for osteogenesis and bone regeneration, demonstrating that changes in scaffold architecture enabled by this additive manufacturing technique can dramatically modulate angiogenesis and tissue regeneration without the need for complex exogenous growth factors. These results provide a valuable insight into the importance of 3D printed scaffold architecture when developing new bone TE strategies.

Верхнепалеолитические украшения из южной галереи Денисовой пещеры: коллекция 2021 года

This article presents a new collection of the Early Upper Paleolithic personal ornaments from layer 11 in the South Chamber of Denisova Cave. The collection contains items of several types: a flat round bone bead, pendants made of teeth of predators and ungulates with cutting and perforation, a pendant from a freshwater mollusk shell with a hole, a fragment of a bracelet, a ring and a pendant with cutting made of marble, a small flake from serpentine. As a result of the study, the technologies for ornament production were reconstructed, the main methods of their use were determined, and examples of ornaments reshaping for using according to a new function were recorded. The technology for the teeth pendants production included a short sequence of operations: obtaining blanks, processing by planing or scraping, applying circular cuts or perforating by drilling. The production of flat beads was carried out by cutting out elongated plates from the walls of the tubular bone of large mammals, preparing blanks by planing, cutting out preforms, biconical drilling and grinding. The finished pendants and beads were massively used to decorate clothes and as personal apparel. The technology for the production of ornaments from marble involved a short or longer sequence of actions. To create the most complex marble products, i.e. rings and bracelets, a similar technological sequence was used, including the selection and transportation of raw materials, perforation followed by boring of the resulting hole, grinding, and polishing. Rings and bracelets were used as apparel, and probably had a special status.

Fake gunshot wounds in the skull\u2014post-mortem artifact caused by steel probe during police search for a missing body

The paper presents a case of a forensic autopsy of a young woman who was murdered and her dismembered body was hidden in soil and water. In the skull of the deceased, in the temporal and occipital regions, the autopsy revealed 3 round, almost identical holes, which looked like small caliber gunshot wounds. Doubts about the cause of these injuries were raised by the fact that despite the decomposition of the body, the continuity of the dura at the site of these holes remained undamaged and the absence of any trace of a bullet’s wound track in the brain, the absence of a foreign body in the cranial cavity, as well as the absence of wounds on the opposite side of the skull that could be exit wounds. A thorough analysis of the investigation and the activities carried out during the search for the missing body allowed to adopt and finally confirm the hypothesis that the above mentioned skull damage occurred during the search for the cut-off head of the deceased in shallow water by means of special tapered conical steel probes used by the rescue/search teams. Due to the structure of such a spike, i.e., a sharp end and then a wide cone, only a superficial puncture of the steel probe tip three times into the skull had taken place, which caused regular, rounded bone damage without damaging the dura and brain. The presented case indicates that sometimes post-mortem artifacts may suggest a completely different origin of wounds, which emphasizes the need for a comprehensive analysis of all possible causes of their occurrence, particularly data concerning the handling of the corpse before it is delivered to the morgue, so as not to make a diagnostic error during autopsy.

Evaluation of Normal Morphology of Mandibular Condyle: A Radiographic Survey.

Objectives:The temporomandibular joint (TMJ) is a complex, highly specialized joint. Along with the teeth, these joints are considered to be a “tri-joint complex.” Mandibular condyle morphology is characterized by a rounded bone projection with an upper biconvex and oval surface in axial plane. Anatomical knowledge of the TMJ is one of the basic foundations of clinical practice, allowing the understanding of TMJ pathologies and fabrication of condylar prostheses. The cross-sectional descriptive study was undertaken to evaluate normal variation in the condylar morphology on radiographs in persons without TMJ symptomatology and its relation to age, gender, dentition status, chewing habits, parafunctional habits, history of orthodontic treatment, and denture wearing was assessed.Material and Methods:A total of 350 subjects without TMJ symptomatology included in the study were further grouped by age, gender, dentition status, chewing habits, parafunctional habits, history of orthodontic treatment, and denture wearing history. Panoramic radiograph was taken for the assessment of condylar morphology.Results:A significant association between dentition status and bilaterally similar condylar morphology was noticed. Bilaterally similar condyles were seen in 81.4% of subjects. Round-shaped condyles were seen in 176 (62%) persons. Loss of bilateral occlusion tends to alter the condylar morphology. Association between normal chewing habits and bilaterally similar condyle shapes was significant.Conclusion:The study describes the normal morphology of mandibular condyles in a population attending the tertiary dental care center, Kozhikode. The dentition status and chewing habits of individuals had a significant role in determining condylar morphology.

Chondromyxoid fibroma: unusual location

Chondromyxoid fibroma is a rare bone tumor with cartilaginous differentiation which presents less than 1% of bone tumors. It is a benign lesion and occurs in the fibula in less than 10% of the cases. A 25-year-old with no medical history, right-hander, and long-distance running athlete who consulted in our orthopedic department for right ankle pain. This symptom dates back to 6 weeks and considerably hampered his professional sports activities. This mechanical ankle pain is next to the external malleolus without irradiation and subsides with usual analgesics. The clinical examination was poor. There was no swelling. Bony landmarks were painless. Motion range was normal. The neurovascular exam did not find any abnormalities. X-rays showed a rounded and well-defined lytic bone lesion located in the external malleolus and classified Lodwick Ia (A,B). Due to the benign aspect, we decided to perform an excisional biopsy with a cancellous autograft. The gesture was performed by a lateral approach under loco-regional anesthesia. The graft was taken from the proximal tibial epiphysis through a small internal incision. The patient resumed his training after 2 months, and returned to his professional sports level after 3 months. At the last follow-up of 6 months, the patient had not reported any symptoms and the radiological control was satisfying (C,D).

PO 18072 - Peroneus longus tendon injury associated with the presence of peroneum

Introduction: The os peroneum is a round or oval sesamoid bone located distally within the substance of the peroneus longus tendon near the cuboid bone. Peacock et al. suggested that the presence of the os peroneum might be associated with tendon rupture due to friction at the junction with the bone; in turn, Brigido et al. developed radiographic criteria that associate sesamoid fracture with mechanical failure of the peroneus longus tendon. Objective: To report an unusual case of peroneus longus tendon injury associated with the presence of os peroneum in a patient with hindfoot varus. Methods: A 55-year-old male patient who engaged in physical activity 3 times a week developed pain on the lateral side of the ankle resulting in decreased physical functioning and sports performance. Radiography showed the presence of os peroneum associated with a proximal injury of the peroneus longus tendon detected by magnetic resonance imaging. Results: The patient was treated conservatively with an analgesic physical therapy program followed by functional rehabilitation. The patient progressed from a score of 9 on the visual analog scale for pain in the first month to a score of 0 at 6 months, with grade 5 final eversion force and a return to sports performance at the preinjury level. Conclusion: Treatment options for this injury range from tendon debridement, fixation or excision of the os peroneum to tenodesis or tendon anchorage to the cuboid or calcaneus. Nonsurgical treatment, including immobilization and the use of anti-inflammatory medication, followed by physical therapy is the initial treatment of choice and, as in the reported case, may provide an excellent outcome.

Imaging of osteochondrosis.

Osteochondrosis is an abnormality of the epiphyses or epiphyseal equivalents (round bones and apophyses) during later stages of endochondral ossification. This process of abnormal endochondral ossification can occur at various locations throughout the body. The pathogenesis of osteochondrosis is under active investigation. In humans, the process of abnormal endochondral ossification has been attributed to a combination of vascular insult and trauma. Although the proposed etiology of osteochondrosis varies based on body part affected, the overall process is defined by necrosis, revascularization and repair. As such, common radiologic findings include those of osseous destruction and associated inflammation. The purpose of this review is to discuss the current understanding of osteochondroses as a disease entity and explore imaging features of osteochondroses throughout the body.

Barrier effect of improved porcine small intestinal submucosa absorbable membrane on early healing of mandibular defects in rabbits

Objective To evaluate the barrier effect of an absorbable barrier membrane made by small intestinal submucosa (SIS) compared with Bio-Gide collagen membrane. Methods 12 healthy New Zealand male white rabbits were randomly assigned. A or B round bone defects with a depth of 2 mm and a diameter of 5 mm or 8 mm was made in each rabbit's mandibular. The following treatments were given respectively: covered with SIS membrane (S), covered with Bio-Gide membrane (G) and blank control (O). Then we got six groups: AS, AG, AO, BS, BG, and BO (n=4). After 4 weeks, the rabbits were sacrificed. The specimens were examined by naked-eye observation, new bone percentage (BV/TV) and bone mineralized density (BMD), which were measured and analyzed by Micro-CT. The data were analyzed with one-way ANOVA. Results After 4 weeks, Bio-Gide membranes were fused with the surrounding tissue while SIS membranes held the form with no significant degradation. In the AS, BS and AG groups, the absorbable membranes smoothly covered on the new bone. While in the BG group, Bio-Gide membranes collapsed to the center of the bone defects. The 3D reconstruction of Micro-CT showed that a large number of newly formed trabeculae were found in the four groups of AS, BS, AG, and BG. In the central subsidence area of the BG group, the newly formed trabeculae were sparse. However only a small amount of new bone trabecula appeared at the bottom of the defects in groups AO and BO. Micro-CT quantitative results showed that BV/TV (39.10%±0.79%) and BMD [(517.73±11.22) mg/cm3] of AS group were significantly higher than those of AO group [26.67%±1.12%, (319.81±8.00) mg/cm3] (P 0.05). BV/TV (34.90%±1.35%) and BMD [(409.09±8.14) mg/cm3] of BS group were significantly higher than those of BO group [23.63%±2.07%, (171.00±16.24) mg/cm3] (P 0.05). HE staining analysis revealed that significant bone formation was achieved in the AS, AG, BS and BG groups, and trabecular bone of AS and AG groups were thicker and denser. In AO and BO group, there were scattered new bone tissues in edges of host bone, and no coarse trabecular bone formed. Conclusion In the early healing of two sizes bone defects in rabbit mandibular, SIS membrane and Bio-Gide membrane have a similar barrier effect in guided bone regeneration. And SIS membrane's ability to maintain space for bone regeneration seems to be better.

Evaluation of outcome and prognostic factors in paediatric extraskeletal ewings sarcoma: A single institution experience.

e21507 Background: Ewing's sarcoma (ES) represent the most frequent small and round cell bone tumors of childhood and adolescence. Data on extraskeletal ewings sarcoma (EES) with uniform chemotherapy protocol are very minimal. We aimed to assess this aspect in our patients and identify prognostic factors in patients with extraskeletal ewings sarcoma. Methods: A retrospective analysis of data was done between January 2005 and January 2016. These paediatric EES patients who received chemotherapy with VAC-IE regimen were evaluated for their response, overall survival (OS) and Event free survival (EFS). The prognostic factors which influenced their overall survival were also analysed. Results: Fourty one paediatric EES patients were diagnosed at our institute out of which 31 patients received treatment at our hospital. 25.8% (8) were metastatic at presentation. The mean age was 12.37 years (1-18 years) with a predominant female preponderance 54.8%. The commonest site at presentation was presacral mass (7) and mass in the brain parenchyma (8). Rare sites of presentation as a nasal mass and parotid mass was seen in one patients each. 78% received chemotherapy with VAC-IE regimen. The ORR was 71% (8 CR + 9 PR). Toxicity was grade III neutropenia in 5 (20.8%). 8 patients received local RT. The 3 year OS and EFS in the localized EES were 55% and 39% and in metastatic EES were 35% and 24% respectively. Low hemoglobin (P = 0.05) and high LDH (P = 0.01) predicted inferior OS for the entire EES cohort on multivariate analysis. Conclusions: High LDH and low hemoglobin is associated with poor OS for patients with EES ewings sarcoma. VAC-IE is a very effective and a safe chemotherapy regimen and should be considered in patients with extraskeletal ewings sarcoma.

Evaluating Ossifications of the Nuchal Ligament with Cervical Computed Tomography.

The nuchal ligament (NL) extends from the external occipital protuberance and median nuchal line to the spinous process of the 7th cervical vertebrae. In this study, we evaluated the incidence, location level, and size of ossifications of the NL (ONL) in patients who underwent cervical computed tomography (CT) for various reasons. The present study included 481 patients (187 females and 294 males) who underwent cervical CT from February 2011 to November 2016 due to reasons such as trauma, cervical spondylosis, neck pain, and screening for metastasis. CT was performed using 2- or 8-slice scanners. Archive images of patients on picture archiving and communication system were retrospectively evaluated by two radiologists. The structures in bone density and form detected in NL were evaluated as nuchal ossification. ONL location levels, numbers, and dimensions were determined. The relationship between both sexes and age and the incidence of ONL was investigated. ONL was detected in 44 patients (9.14%). The mean ages of patients with ONL and without ONL were 62.27±13.92 (23-86) and 41.78±20.76 (4-101) years, respectively. There was a statistically significant relationship between ONL and age (p<0.001). Thirty-six patients had one ONL, seven patients had two, and one patient had three. The most common ONL location was the C5 spinous process level (n=12) followed by the C6 spinous process level (n=8). The longest ONL in craniocaudal direction was 20.9 mm, and the shortest one was 3.1 mm. ONL is a smooth-contoured ovoid or round bone structure extending parallel to the longitudinal axis that can frequently be observed as one or multiple occurrences with different sizes on cervical CT images.

Anterior Cervical Discectomy With Fusion Using a Local Source for Cancellous Autograft: A Biomechanical Analysis of Vertebral Body Stability in an Osteopenic Bone Model.

Background:Anterior cervical discectomy with fusion is an effective treatment for patients having cervical radiculopathy and myelopathy. To reduce morbidity associated with autograft taken from the iliac crest without sacrificing high fusion rates, a novel technique that harvests bone from the vertebral body adjacent to the operative disc space has been proposed. The effects of square and round bone graft harvest techniques on the mechanical stability of the osteopenic donor vertebrae are unknown. We analyzed the biomechanical implications of the technique by subjecting osteopenic models to uniaxial compression to compare yield strengths of surgically altered and unaltered specimens.Methods:Biomechanical grade polyurethane foam was cut into 60 different 12 mm × 17 mm × 20 mm blocks. The foam had a density of 10 pounds per cubic foot, simulating osteoporotic bone. Rectangular prism (4 mm × 4 mm × 6 mm) and cylindrical cores (r = 2 mm, h = 8 mm) were removed from 20 blocks per group. Twenty samples were left intact as a control group. Anterior plate screws were applied to the models and a Polyether ether ketone (PEEK) interbody spacer was placed on top. Samples underwent uniaxial compression at 0.1 mm/s until mechanical failure. Points of structural failure were determined using a 0.1% offset on a force–displacement curve and compared to determine the reductions in compressive strength.Results:The mean force eliciting structural failure for intact samples was 450.6 N. Average failure forces for rectangular prisms and cylindrical cores removed were 383.2 and 395.4 N, respectively. Removal of a rectangular prismatic core of the necessary volume resulted in a 15.0% reduction in compressive strength, while removal of a cylindrical core of comparable volume facilitated a reduction of 12.2%.Conclusion:Local autograft harvested from adjacent vertebrae reduces morbidity associated with a second surgical site while minimally reducing the compressive strength of the donor vertebra in an osteopenic model, lending credence to the efficacy of this technique in elderly patient populations.

SMD Kozlowski type caused by p.Arg594His substitution in TRPV4 reveals abnormal ossification and notochordal remnants in discs and vertebrae

Spondylometaphyseal dysplasia Kozlowski type (SMDK) is a monogenic disorder within the TRPV4 dysplasia spectrum and has characteristic spinal and metaphyseal changes. We report skeletal MR imaging in a two-year-old patient who manifested typical clinical and radiographic features of SMDK. The diagnosis was confirmed by molecular analysis which revealed a mutation NM_021625.4:c.1781G > A - p.(Arg594His) in exon 11 of the TRPV4 gene. We have documented abnormalities in endochondral formation of the long and short tubular bones as well as round bones of the wrists and feet. The vertebral bodies had increased thickness of hyaline cartilage which enveloped ossification centers. The vertebrae and discs also had abnormalities in size, shape and structure. These anomalies were most likely the consequence of notochordal remnants presence within the intervertebral discs and in the vertebral bodies. The advantages of MR imaging in bone dysplasias caused by TRPV4 mutations are emphasized in this article.

Reuse of a Reversed "Bone Pad" to Perforate Incompletely Penetrated Burr Holes Created by Automatic-Releasing Cranial Perforators.

It can be difficult to make complete burr holes using a perforator with automatic releasing systems in cases of a soft diploe or thick calvarial bone. To demonstrate the utility of a flipped "bone pad" (BP) in recovery of penetration failure when using an automatic releasing perforator. For craniotomy or ventricular drainage, the first step is to make 1 or more burr holes using a craniotome. Neurosurgeons sometimes incompletely penetrate the skull using the latest tools. As a countermeasure for such cases, we have developed a simple and practical method. When making a perforation using a high-speed perforator, a round bone piece we call the BP is formed just above the dura. We pulled the BP from a completed burr hole, and placed the reversed BP in position at the bottom of the incompletely perforated burr hole. The BP acted as a new hard surface, preventing the automatic releasing system from activating, and allowed the burr hole to be completed by the craniotome without the need for additional tools. With this technique, we have successfully completed 6 out of 7 imperfectly perforated burr holes using a perforator with an automatic releasing system. There were no technique-related complications, such as plunging or dural laceration. The method has the advantage that the BP can be obtained without drilling an additional burr hole, and can be completed without the need for increasing cost, time, or instrument usage.

Lectinhistochemistry Evaluation of Rabbits Tibia Implanted with Macroporous Biphasic Ceramic Implants

Many techniques are used to assess biomaterials implants, always intending to measure osseointegration success and tissue response facing the implanted material. Calcium phosphates are widely used as biomaterial and a major component of bone. Many processing methods have been used to achieve porous materials to allow bone ingrowth with an osteoconductive scaffold for bone. To obtain the macroporous BCP implant it was processed by direct consolidation using the protein-action technique, a globular protein based consolidation with ovalbumin. The samples were sintered at 1250°C for 30 minutes, after sintering samples were cut in 4mm diameter cylinders, with 73% volume of porosity and mean pore size ranging about 100 µm. In the present work the macroporous BCP of HAp:β-TCP is assessed after bone implantation in rabbits tibia by lectinhistochemistry (LHC) technique. Lectins are proteins from non-imune origin which binds with strong specificity carbohydrates, LHC is a technique which mark histologically carbohydrates present in glycoproteins of cells. The macroporous BCP cylindrical samples were implanted in male rabbits tibia to the evaluation of biocompatibility and osseointegration in a period of 2 weeks to 4 weeks. After euthanasia of rabbits, tibia samples from the surgery site were taken and fixed with formalin, decalcified, dehydrated and embedded with paraffin to perform histological slides for both morphological and molecular evaluation. The morphological evaluation were performed on histological slides stained with Haematoxilin and Eosin (HE), while for molecular evaluation LHC was performed on histological slides using the lectins PNA, UEA-1, WGA, sWGA and RCA-1 (Vector Labs). All samples osseointegrated well with the bone and the neoformed bone surrounding the implant took the shape of its surface. The implants also allowed bone ingrowth inside the pores towards the center of implant, characterized by islets of round bone present in the HE stained slides.

The Accessory Ossicles of the Foot and Ankle; a Diagnostic Pitfall in Emergency Department in Context of Foot and Ankle Trauma

Trauma of the foot and ankle is commonly seen in patients presenting to accident and emergency departments (1). Although, the use of Ottawa Ankle Rules has reduced unnecessary radiographs, radiography still remains the most appropriate initial imaging modality in patients with suspected fractures (2). The decision to engage in further imaging, indications for conservative treatment versus surgery and consultation with an orthopedic surgeon or radiologist, often rests on the emergency physician’s interpretation of the radiographical findings. Therefore, it is important for the emergency physician to be aware of abnormal and normal variants of bony lesions of the foot and ankle and the various radiological pitfalls that may cause confusion. Many skeletal variations of the foot and ankle are found, including different accessory ossicles and sesamoid bones. Sesamoid bone is a small rounded bone embedded within a tendon or joint capsule. Sesamoid bones are typically found in locations where a tendon passes over a joint. They prevent the friction between the tendon and the joint, protect the tendon and increase its biomechanical effect by changing the direction of pull of the tendon. On the other hand, accessory ossicles are usually derived from the failure of union of secondary ossification centers to the main bony mass. They usually remain asymptomatic and are recognized as an incidental radiographic finding (3). However, in the context of trauma, these ossicles can be misdiagnosed as avulsion fractures, or a reverse situation in which an avulsion fracture can be evaluated as an accessory ossicle is possible. This pictorial review summarizes the most common accessory ossicles found around the foot and ankle and the fractures that may cause confusion with the accessory ossicles and sesamoid bones Abstract