Diaphysis Of Long Bones Research Articles

Osteoid Osteoma in acromion of scapula: a case report

Background: Osteoid osteoma is a benign tumor, predominantly affects the younger age group with characteristic nocturnal symptoms, relieved by rest and anti-inflammatory drugs. It can affect any bone; the most common site is shaft of long bones of lower limb (90%). It is quite uncommon to find osteoid osteoma in acromion of scapula. Case Presentation: We describe a case of 46 year old male, presented with pain in left shoulder that simulated left shoulder joint arthritis. The diagnosis of osteoid osteoma involving acromion of scapula was made on bone scan. Tc99m MDP SPECT-CT images showed a distinct focus of increased uptake in the acromion of left scapula with characteristic central lucent nidus on CT images. Conclusion: Though Osteoid osteoma in acromion is very rare, shoulder pain in middle age group, when evaluated on nuclear medicine floor, should be evaluated with correlative SPECT-CT images to rule out such rare bony pathologies.

Damage Control Orthopedics in Multitrauma Patients: A Pediatric Case Presentation and Literature Review

Introduction: A multiple long-bone shaft fracture is associated with developing systemic complications and increased morbidity and mortality. Optimal timing for surgery of polytrauma patients according to damage control orthopedics principles is crucial. Case Presentation: We present a 5-year-old boy referred after a pedestrian car accident with right femoral shaft fractures, a left distal femur fracture, and a left tibial fracture. The patient was classified as a borderline state according to the orthopedic trauma team and was managed accordingly. Conclusions: An article review is presented that signifies the potential benefits of delays in operativemultitrauma fracture fixation, particularly for patients in a borderline state.

Bone infarcts: Unsuspected gray areas?

There is agreement to label as bone infarcts avascular necrosis (AVN) occurring in the metaphyses or diaphyses of long bones, the terms AVN or osteonecrosis being used at the epiphyses. One might expect bone infarction to hold no mysteries. Oddly enough, however, scientific evidence about bone infarcts is extraordinarily scant. The prevalence of bone infarcts is unknown. The main sites of involvement are the distal femur, proximal tibia, and distal tibia. In patients without sickle cell disease or Gaucher's disease, involvement of the upper limbs and lesions confined to the diaphysis are so rare as to warrant a reappraisal of the diagnosis. Although widely viewed as a generally silent event, bone infarcts causes symptoms in half the cases. Standard radiographs are normal initially then show typical high-density lesions in the center of the marrow cavity. A periosteal reaction is common and may be the first and only radiographic change. Magnetic resonance imaging consistently shows typical features and therefore, in principle, obviates the need for other investigations. Bone infarcts are multifocal in over half the cases and, when multifocal, are usually accompanied with multiple foci of epiphyseal avascular necrosis. Thus, bone infarcts, whose prognosis is good per se (with the exception of the very low risk of malignant transformation), are usually a marker for systemic avascular necrosis. Consequently, patients with bone infarcts must be investigated both for known risk factors and for other foci of avascular necrosis, which may, in contrast, have function-threatening effects.

516P Outcomes of surgical treatment of long bones' diaphysis tumors

Aim/Background: To study the direct results of surgical treatment of patients with diaphyseal tumors of long bones. Methods: Endoprosthetics for the replacement of post resectional defects of diaphysis of long bones was developed in surgical department of musculosceletal tumors of National Cancer Research Centre of the Health Ministry of the Republic of Uzbekistan (patent FAP 2012 0025 'Device for endoprosthetics of bone diaphysis'). Surgery using the prosthetics was performed in 16 patients with primary and metastatic tumors of long bones diaphysis. Men-8(50%), women-8 (50%), age of patients from 16 to 68. 12 patients were diagnosed primary tumors, in 4-metastatic affection (in one case- stomach and lungs cancer, in two case - breast cancer), all cases had solitary character. 12 patients had a diaphysis affection of thigh bone and in 4 cases humerus was affected as well. The length of affected bone was from 5 to 17 cm. Threat of pathological fracture was in 4 (25%) patients, fractures occurred in 12 (75%). All 16 patients segmental resection was performed with endoprosthetics. The length of resection was from 7 to 24 cm. Results: 90 % of patients had not pain syndrome in post operative period. Patients were activated on the 2-5 days, that gives the possibility of independent service and continuation of special treatment. In distant period two complications were observed (12,5%). One patient after 12 months of endoprosthetics of thigh bone diaphysis loosening the upper legs of endoprosthetics occurred, in another patient after 14 months endoprosthetics of humerus, the loosening of lower legs of endoprosthetics occurred. Reendoprosthetics was performed in both cases. The functional condition by scale MSTS: after endoprosthetics of humerus diaphysis- 90 %, thigh bone -85%, anatomical-functional results by scale Enneking in 4 (25%) patients were marked as excellent, in 8 (50%) as good, and in 4 (25%) as satisfactory. Conclusions: Thus, received results show efficacy of applying the developed device for endoprosthetics of bone diaphysis. Its usage for the replacement of formed post resectional defect of diaphysis allows to restore capability of functional condition of extremity and to get satisfactory anatomical-functional results. Disclosure: All authors have declared no conflicts of interest.

Lower Paleolithic bone tools from the ‘Spear Horizon’ at Schöningen (Germany)

The Lower Paleolithic locality of Schöningen 13 II-4 is famous for the discovery of wooden spears found amongst the butchered remains of numerous horses and other large herbivores. Although the spears have attracted the most interest, other aspects of the associated artifact assemblage have received less attention. Here we describe an extraordinary assemblage of 88 bone tools from the ‘Spear Horizon.’ This sample includes numerous long-bone shaft fragments (mostly of horse), three ribs used as ‘retouchers’ to resharpen flint tools, and a complete horse innominate that was used as an anvil in bipolar knapping. Most of the retouchers were prepared by scraping the diaphysis of fresh and dry long-bones. Technological analysis of the associated lithic assemblage demonstrates exhaustive resharpening to maintain functional cutting edges. Whereas the flint tools were brought to the site, curated, and maintained, the retouchers had a shorter use-history and were either discarded after a limited period or broken to extract marrow.Horse and bison metapodials with flaked and rounded epiphyses are interpreted as hammers used to break marrow bones. Several of the ‘metapodial hammers’ were additionally used as knapping percussors. These constitute the earliest evidence of multi-purpose bone tools in the archeological record. Our results highlight the advanced knowledge in the use of bones as tools during the Lower Paleolithic, with major implications for understanding aspects of non-lithic technology and planning depth in early hominins.

Skeletal Pathology of Eastern Grey Kangaroos (Macropus giganteus) Exposed to High Environmental Fluoride Levels in South-Eastern Australia

Significantly elevated bone fluoride concentrations have been reported in a population of eastern grey kangaroos (Macropus giganteus) resident near a fluoride-emitting aluminum smelter in southeastern Australia. This paper describes the skeletal and synovial joint lesions observed post mortem in the same sample of kangaroos (n=76). The prevalence and severity of skeletal lesions, specifically the formation of multiple, large, smooth exostoses over the diaphysis of long bones (especially, but not exclusively, on the tibia, fibula and metatarsi), were positively associated with bone fluoride concentration. So too were lesions of degenerative joint disease, including periarticular osteophytosis, articular cartilage erosion/ulceration, synovial hyperplasia and joint capsular fibrosis. Joint lesions were most commonly seen in the knee, hock and metatarsophalangeal joints. This is the first study to describe in detail the full range of lesions induced by chronic fluorosis in a marsupial species.

Hypertrophic osteopathy in a cat with a concurrent injection-site sarcoma

Case summary An 11-year old neutered female domestic shorthair cat presented for investigation of a large, partially ulcerated skin mass in the area of the left scapula. The cat had been vaccinated 6 weeks previously in the same area. Haematology showed a marked neutrophilia and monocytosis. Tru-cut biopsies were taken and histopathology was consistent with a high-grade soft tissue sarcoma. Thoracic radiographs and abdominal ultrasound revealed no abnormalities. Moderate mixed (palisading, brush border and smooth) periosteal reaction was seen on the diaphysis of long bones at the time of the radiographic examination. Magnetic resonance imaging of the mass showed infiltration within deeper tissues and the owners elected euthanasia. Post-mortem examination confirmed the presence of hypertrophic osteopathy with a concurrent injection-site sarcoma. No evidence of intra-thoracic or intra-abdominal disease was found.Relevance and novel information To our knowledge, this is the first report where hypertrophic osteopathy has been described in a cat with a soft tissue sarcoma, most likely an injection-site sarcoma.

Osteosclerotic Bone Dysplasia of the Craniofacial Bones

Melorheostosis is a rare sclerosing bone dysplasia which is characterized by a localized, diffuse thickening of the cortical bone mainly affecting diaphysis of long bones, and bones of hand and feet unilaterally. Involvement of the maxillofacial region is rare and the diagnosis is mainly based on radiographic features. We report a rare case of a 5 year old girl with Osteosclerotic Bone Dysplasia (Melorheotosis) of multiple craniofacial bones.

The Management of Bone Loss of Diaphyseal Tibial Long Bones

The management of segmental defects within the diaphysis of long bones is one of the most challenging problems that the surgeon confronts in his practice. The procedures traditionally used to bridge bone gaps include autogenous bone grafting (1), posterolateral bone grafting (2), transplantation of allograft bone & tibialization of fibula procedures (3,4). All the above traditional methods of management of bone defects sometimes require multiple surgical interventions. The treatment period is long & weight bearing may not be possible while the functional results are often less than satisfactory. Recent studies showed that the G.A. llizarov Technique is a more popular than vascularised bone grafts especially for big bone defects (5).

Ewing's sarcoma of proximal phalanx of the hand with skip metastases to metacarpals.

Ewing's sarcoma is the second most common malignant primary bone tumor of childhood and adolescence affecting mainly the diaphysis of long bones and flat bones. This tumor is extraordinarily rare in small bones of the hand and presents as a swelling with atypical radiological features of cystic and lytic lesion with scant periosteal reaction. The common differential diagnosis include osteomyelitis, tuberculosis, enchondroma and benign tumors. Moreover, skip metastasis to adjacent bones is even rarer. The prognosis of this condition is greatly influenced by the presence of metastasis at presentation, further emphasizing the importance of early diagnosis. Multimodality treatment using surgery, radiotherapy and chemotherapy is currently recommended though no consensus exists. We report a case of Ewing's sarcoma of the little finger proximal phalanx which was initially missed and developed skip metastasis to several metacarpals within 4 months.

Reconstruction of bone loss of diaphyseal tibial bones using G.A. Ilizarov technique

The management of segmental defects within the diaphysis of long bones is one of the most challenging problems that the surgeon confronts in his practice. The procedures traditionally used to bridge bone gaps include autogenous bone grafting [1], posterolateral bone grafting [2], transplantation of allograft bone [3] and fibular protibia procedures [4]. All the above traditional methods of management of bone defects sometimes require multiple surgical interventions. The treatment period is long and weight bearing may not be possible while the functional results are often less than satisfactory. Recent studies showed that the G.A. Ilizarov Technique is a more popular than vascularised bone grafts especially for big bone defects [5, 14].

Establishing biomechanical mechanisms in mouse models: practical guidelines for systematically evaluating phenotypic changes in the diaphyses of long bones.

Mice are widely used in studies of skeletal biology, and assessment of their bones by mechanical testing is a critical step when evaluating the functional effects of an experimental perturbation. For example, a gene knockout may target a pathway important in bone formation and result in a "low bone mass" phenotype. But how well does the skeleton bear functional loads; eg, how much do bones deform during loading and how resistant are bones to fracture? By systematic evaluation of bone morphological, densitometric, and mechanical properties, investigators can establish the "biomechanical mechanisms" whereby an experimental perturbation alters whole-bone mechanical function. The goal of this review is to clarify these biomechanical mechanisms and to make recommendations for systematically evaluating phenotypic changes in mouse bones, with a focus on long-bone diaphyses and cortical bone. Further, minimum reportable standards for testing conditions and outcome variables are suggested that will improve the comparison of data across studies. Basic biomechanical principles are reviewed, followed by a description of the cross-sectional morphological properties that best inform the net cellular effects of a given experimental perturbation and are most relevant to biomechanical function. Although morphology is critical, whole-bone mechanical properties can only be determined accurately by a mechanical test. The functional importance of stiffness, maximum load, postyield displacement, and work-to-fracture are reviewed. Because bone and body size are often strongly related, strategies to adjust whole-bone properties for body mass are detailed. Finally, a comprehensive framework is presented using real data, and several examples from the literature are reviewed to illustrate how to synthesize morphological, tissue-level, and whole-bone mechanical properties of mouse long bones.

Dysbaric Osteonecrosis

To perform a general literature review of dysbaric osteonecrosis (DON) to describe its pathophysiology, prevalence in scuba divers, prognosis, and treatment options. A literature search on PubMed was performed using the term "dysbaric osteonecrosis" yielding 67 results. There was no exclusion based on dates. Articles that mainly dealt with decompression sickness secondary to tunnel work, mining, or airplane travel were not selected. An additional search on PubMed using the terms "(osteonecrosis diving) NOT dysbaric" was performed to identify other publications not picked up in the initial search. Dysbaric osteonecrosis is associated with prolonged hyperbaric exposure and rapid decompression that cause nitrogen bubbles to enter the fatty marrow-containing shafts of long bones leading to reduction in blood flow and subsequent osteonecrosis. Patients may present asymptomatically, and typical radiographic findings of DON include: decalcification of bone, cystic lesions, osteosclerotic patterns, nontraumatic fractures, bone islands, and a subchondral crescent sign. Surgical treatment options are comprised of core decompression and free vascularized fibular graft, whereas nonsurgical treatment options consist of monitoring, physical therapy, and bisphosphonate therapy. Although the incidence of DON has decreased significantly over the past 2 decades, the lack of timely diagnosis and optimal management keeps DON relevant in the orthopedic and sport medicine community.

440. The new way of surgical treatment in tumour of diaphysis of long bones

Background: To study the direct results of surgical treatment of patients with diaphyseal tumors of long bones.

Cranio-osteoarthropathy associated with inflammatory arthritis

Cranio-Osteoarthropathy (COA) is a very rare form of primary hypertrophic osteoarthropathy (HOA). HOA is characterised by digital clubbing, arthropathy, pachyderma and sub-periosteal new bone formation along shafts of long bones. In COA, decreased neurocranium ossification is seen without the pachyderma feature.

The three-front model: a developmental explanation of long bone diaphyseal histology of Sauropoda

The bone histology of non-avian dinosaurs is enlightening for understanding many aspects of the growth and development of these long-extinct animals. The rate of bone apposition and remodelling in the shaft of long bones appears to be accelerated in some groups and decelerated in others. We propose a developmental model to illustrate these fundamental aspects of long bone diaphyseal histology at different growth stages. We developed the model based on an ontogenetic series of long bones of the sauropod dinosaur Apatosaurus. The model describes the histology and microanatomy based on three fronts that move radially: the apposition front, the Haversian substitution front, and the resorption front. When applied to additional sauropod dinosaurs, differences and similarities observed in the microstructure of the different taxa could be explained with the model. The benefit of this model is that it is not limited to Sauropoda but appears to be applicable to a broad range of terrestrial amniote long bones and thus could provide unique insights into life history and evolutionary patterns of bone development. © 2014 The Linnean Society of London, Biological Journal of the Linnean Society, 2014, 112, 765–781.

X-ray computed tomography of two mammoth calf mummies

Two female woolly mammoth neonates from permafrost in the Siberian Arctic are the most complete mammoth specimens known. Lyuba, found on the Yamal Peninsula, and Khroma, from northernmost Yakutia, died at ages of approximately one and two months, respectively. Both specimens were CT-scanned, yielding detailed information on the stage of development of their dentition and skeleton and insight into conditions associated with death. Both mammoths died after aspirating mud. Khroma's body was frozen soon after death, leaving her tissues in excellent condition, whereas Lyuba's body underwent postmortem changes that resulted in authigenic formation of nodules of the mineral vivianite associated with her cranium and within diaphyses of long bones. CT data provide the only comprehensive approach to mapping vivianite distribution. Three-dimensional modeling and measurement of segmented long bones permits comparison between these individuals and with previously recovered specimens. CT scans of long bones and foot bones show developmental features such as density gradients that reveal ossification centers. The braincase of Khroma was segmented to show the approximate morphology of the brain; its volume is slightly less (∼2,300 cm3) than that of neonate elephants (∼2,500 cm3). Lyuba's premaxillae are more gracile than those of Khroma, possibly a result of temporal and/or geographic variation but probably also reflective of their age difference. Segmentation of CT data and 3-D modeling software were used to produce models of teeth that were too complex for traditional molding and casting techniques.

Adult intramedullary ewing sarcoma of the proximal hip.

Ewing sarcoma of bone is classically a permeative lesion in the diaphysis of long bones in children. While they occur primarily in children and adolescents, they can be seen in young adults in their 20s, but these are typically seen in flat bones. The permeative nature of the lesion can elicit new bone formation creating a partially sclerotic appearance, cortical expansion presenting as a “Codman triangle,” or have an “onion-skin” type of aggressive periosteal reaction/periostitis. Ewing sarcoma is rarely seen without an associated soft-tissue mass and is even rarer to just have benign-appearing periostitis (e.g., thick, uniform, or wavy cortex). We present such a case of Ewing sarcoma in a young adult confined to just the medullary metadiaphysis without cortical erosion or soft-tissue mass. To the best of our knowledge, this is the first case to be reported in the radiology literature.

The Validity of CMFDA and Ethd-1 in the Determination of Osteocyte Viability in the Diaphysis of Long Bones in a Sheep Model

The determination of osteocyte viability is essential in bone research and clinical practice; however its determination at the time of sampling, without disruption of the bone matrix is difficult. The current clinical histological diagnosis of osteonecrosis requires the identification of empty osteocyte lacunae, which may take up to 4 weeks to completely develop. The aim of this study was to assess the efficacy of 5-chloromethylfluorescein diacetate (CMFDA) and ethidium homodimer-1 (EthD-1) to stain osteocyte viability at the time of sampling without disrupting the bony architecture in a sheep model. The methods involved harvesting adult sheep femoral and tibial mid-diaphyseal bone and staining 1 cm thick samples with different concentrations of CMFDA and EthD-1 for varying durations at different temperatures. Osteocyte viability and the effect on background staining were assessed. The results show that CMFDA and EthD-1 can successfully stain for osteocyte viability in situ at the time of sampling without destruction of the bone matrix. Optimal staining is achieved with a concentration of 2.5 μl CMFDA (25 μmol) and 5 μl EthD-1 (10 μmol) to 1ml DMEM (Dulbecco's modified Eagle's medium) for a duration of 4 hours at 4oC. These intermediate stain concentrations, low temperatures and short incubation periods limit background staining. We conclude that in contrast to analysing for empty osteocyte lacunae, CMFDA and EthD-1 can stain osteocytes for their viability from the time of injury and thus may aid in an earlier and more precise diagnosis of the percentage of osteocyte necrosis.

The Diaphyseal nutrient foramina architecture - a study on the human upper and lower limb long bones

The nutrient foramina are cavities that conduct the nutrient arteries and the peripheral nerves on the shaft of long bones. Long bones receive most of the interosseous blood supply from the nutrient arteries, and sometimes through the periosteal vessels. Nutrient arteries play an important role in nutrition and growth of the bones particularly during its growth period in the embryo and fetus as well as during early phases of ossification. The present study was conducted in the department of Anatomy, MNR Medical college, Sangareddy, Medak, Andhra Pradesh and Govt. Medical College, Aurangabad, Maharashtra. A study group comprised of 1320 (840male, 480 female) long bones of upper and lower limbs of known age and sex from the bone library. The number, location, direction, position and also whether the nutrient foramina obey the general rule that is directed away from the growing end of long bone is determined in this study. Distance of nutrient foramina from either ends of long bones are more in males than females. Single nutrient foramen is common in females whereas multiple nutrient foramena in males. Femur showed highest number of nutrient foramena in 2 nd segment in males and females only 1% shows multiple nutrient foramens in second segment. Two nutrient foramens were found in 68% of femur, 14% of tibia, 20% of fibula and only 10% of Humerus while it is less in females.