Tibia Research Articles

Revision arthrodesis in a failed knee arthrodesis for a giant cell tumor excision of distal femur: a case report

Giant cell tumor is a benign tumor with locally aggressive behaviour. It is common in 20–40 years of age group. Common location of the tumor includes distal end of femur, proximal end of tibia. It is slightly more common in females than males. We present a case of forty-four years-old lady with a persistent swelling over her left knee and was diagnosed with a distal femur giant cell tumor. After a wide excision, dual free fibula grafting and arthrodesis of the knee with a long nail was performed. However, she experienced pain and progressive deformity three years after surgery. X-rays revealed the failure of union of the free fibula graft to the residual femur and the breakage of the nail at that site. A revision arthrodesis was performed with removal of implant and stabilizing the non-united ends with dual plating with bone grafting from lateral tibial condyle and bone graft substitutes. She was discharged with left side non weight bearing mobilization with walker support and was started on full weight-bearing mobilization after one year with satisfactory union on X-rays.

Comparative biochemical analysis of platelet-rich plasma-chitosan and platelet-rich fibrin-chitosan for treating tibial bone defects in rabbits.

Fracture healing can cause serious complications, both preoperatively and postoperatively, including malunion or non-union. Biomaterials can enhance the fracture healing process. This study aimed to compare platelet-rich plasma (PRP)-chitosan and platelet-rich fibrin (PRF)-chitosan on the basis of biochemical parameters for fracture treatment in rabbits. This study involved 12 clinically healthy rabbits. After preparing PRP and PRF, a 3-mm bone defect was created in the tibia of each rabbit. The animals were divided randomly into two groups (A and B). Group A received PRP-Chitosan, and Group B received PRF-Chitosan. Bone healing was assessed using biochemical parameters (calcium [Ca], phosphorus [P], serum alkaline phosphatase [ALP], and osteocalcin [Ocn]) at 2-, 4-, 6-, and 8-week postoperatively. The data were compared using repeated-measures analysis of variance (p < 0.05) with Statistical Package for the Social Sciences statistical software. Group-wise comparison showed no significant differences (p > 0.05) between the groups, except for ALP levels, which were significantly higher in Group B than in Group A (p < 0.05). In the week-wise comparison, there was a significant difference between both groups, as Ca and ALP levels showed significant differences at all weeks postoperatively, whereas Ocn showed a significant difference at 2- and 4-week postoperatively (p < 0.05). However, there was no difference in P levels between the groups at any post-operative week (p > 0.05). Both combinations enhanced bone regeneration. However, PRF-Chitosan is a better combination for bone repair than PRP-Chitosan. There were some limitations of this study, such as a small sample size, only male rabbits were used, and a lack of mechanical testing; these limitations should be addressed in future studies. The insights gained from the present study may open a new approach to the use of a combination of biomaterials for bone healing, which should be further investigated clinically and in other animal models as a future scope.

Evaluating Docking Site Local Hematoma Formation and Blood Flow on its Healing Using the Accordion Technique at the End of Tibial Bone Transport

Evaluating Docking Site Local Hematoma Formation and Blood Flow on its Healing Using the Accordion Technique at the End of Tibial Bone Transport

The Impact of Blood Flow Restriction Training on Tibial Bone Stress Injury Rehabilitation: An Exploratory Case Series.

Lower extremity bone stress injuries (BSI) are common injuries among athletes and military members. Typical management involves a period of restricted weightbearing which can have rapid detrimental effects upon both muscle and bone physiology. Few studies have investigated the effect of blood flow restriction (BFR) training on bone in the rehabilitative setting. The purpose of this study was to investigate the effects of lower extremity exercise with the addition of BFR upon bone mineral density, bone mineral content, and lean body mass in military members with tibial BSIs. Case series. Twenty military members with MRI-confirmed tibial BSI were recruited to complete lower extremity exercise with the addition of BFR twice per week for four weeks. The BFR cuff was applied proximally to the participant's involved limb while they performed gluteal, thigh, and leg resistance exercises. Outcomes were assessed at baseline and four weeks. The primary outcomes were whole leg bone mineral density (BMD), bone mineral content (BMC), and lean body mass (LM) as measured by dual-energy x-ray absorptiometry. Secondary outcomes included thigh and leg circumference measures and patient-reported outcomes, including the Lower Extremity Functional Scale (LEFS), Patient-Reported Outcomes Measurement Information System 57 (PROMIS-57), and Global Rating of Change (GROC). No significant differences were found in BMD (p=0.720) or BMC (p=0.749) between limbs or within limbs over time. LM was generally less in the involved limb (p=0.019), however there were no significant differences between or within limbs over time (p=0.404). For thigh circumference, significant main effects were found for time (p=0.012) and limb (p=0.015), however there was no significant interaction effect (p=0.510). No significant differences were found for leg circumference (p=0.738). Participants showed significant mean changes in LEFS (15.15 points), PROMIS physical function (8.98 points), PROMIS social participation (7.60 points), PROMIS anxiety (3.26 points), and PROMIS pain interference (8.39 points) at four weeks. The utilization of BFR in the early rehabilitative management of tibial BSI may help mitigate decrements in both bone and muscle tissue during periods of decreased physical loading. 4.

Lovastatin Combination Therapy Increases the Survival and Proliferation of Rat Bone Marrow-Derived Mesenchymal Stem Cells Against the Inflammatory Activity of Lipopolysaccharide.

Oxidative stress hurts the survival of transplanted mesenchymal stem cells (MSCs). Lipopolysaccharide (LPS) preconditioning inhibits apoptotic death in MSCs. Also, Lovastatin's protective effect was reported on MSCs. Here, we investigated the potential of LPS and Lovastatin combination therapy on the survival and proliferation of MSCs. MSCs harvested from adult rats (240-260 g) femur and tibia bone marrow. Third passage MSCs were divided into 6 groups control group, LPS, LPS + Lovastatin (10 and 15 µM), and Lovastatin (10 and 15 µM). Cell survival and proliferation were assessed using an MTT assay 24 h after LPS, Lovastatin, or LPS + Lovastatin treatment. Also, Malondialdehyde (MDA) as a lipid peroxidation marker and antioxidant enzymes such as Glutathione peroxidase (GPX) and Superoxide dismutase (SOD) activity levels evaluated. Finally, the expression level of tumor protein P53 (P53) and octamer-binding transcription factor 4 (OCT4) genes were measured by qRT-PCR test. Lovastatin 10 μM potentiated proliferation and survival of MSCs. It can increase the activity of GPX and SOD. 10 µM Lovastatin could not affect MDA amounts but decreased the expression levels of P53 and Oct4 significantly. Nevertheless, treatment with LPS reduced the survival and proliferation of MSCs, along with a significant reduction in GPX activity. LPS + Lovastatin could increase SOD activity, however, GPX enzyme activity and MSCs proliferation did not change so, and it was not effective. We propose Lovastatin at the dose of 10 µM as a suitable combination agent to increase the survival and proliferation of MSCs in oxidative stress conditions.

Effects of phytase and 25-hydroxycholecalciferol supplementation in broilers fed calcium-phosphorous deficient diets, with or without Eimeria challenge, on growth performance, body composition, bone development, and gut health

The study evaluated the effects of nutritional strategies on broilers challenged with Eimeria from days 14 to 26. A total of 840 Cobb male broilers were fed five diets in a 2 × 5 factorial arrangement: 1) nutrient adequate diet (PC; 0.84% calcium [Ca], 0.42% available phosphorus [avP]); 2) Ca-P deficient diet (NC; 0.64% Ca, 0.22% avP); 3) NC + 1500 FTU/kg phytase of diet (NC+PHY); 4) NC + 5000 IU/kg 25-hydroxycholecalciferol of diet (NC+25OHD); and 5) NC with both supplements (NC+PHY+25OHD), with and without Eimeria challenge. All treatments had six replicate cages with 14 birds per cage. At 5 days post inoculation (DPI), the challenged birds exhibited higher serum fluorescein isothiocyanate-d (FITC-d) levels than the unchallenged birds (P < 0.001). The NC+PHY and NC+PHY+25OHD groups exhibited lower FITC-d levels compared to the NC+25OHD group (P = 0.012). Significant interaction effects between Eimeria challenge and dietary treatments were observed on various parameters. During 0-6 and 0-12 DPI, Eimeria challenge resulted in decreased the body weight gain (BWG) (P < 0.05) but had a negative effect on the feed conversion ratio (FCR) in birds compared to the unchallenged group (P < 0.05). Reducing Ca and avP levels in the diet (NC) did not adversely affect BWG, but negatively impacted FCR, bone ash weight, ash concentration, and femur bone microstructure parameters (P < 0.05). On 12 DPI, Eimeria challenge led to decreased tibia bone weight, bone volume, fat free bone weight (FFBW), and ash weight of birds (P < 0.05). Supplementation with phytase alone or in combination with 25OHD improved growth performance, gut permeability, bone ash and bone microstructure parameters in birds (P < 0.05). However, the group fed 25OHD alone showed enhancements on growth performance, mineral apposition rate (MAR), bone ash concentration and ash percentage of the birds (P < 0.05). In conclusion, lowering Ca and avP levels in the diet negatively affected FCR and bone development but did not affect intestinal integrity in broilers. Dietary supplementation of phytase, 25OHD, or phytase in combination of 25OHD could enhance the growth performance and bone quality of broilers infected with Eimeria. Notably, the benefits of phytase supplementation were generally more pronounced than those associated with 25OHD supplementation; however, the combination of phytase and 25OHD could induce optimum effects.

Impact of Hydroxyapatite Nanoparticles, Demineralized and Decellularized Bone Matrix on Tibia Fracture Healing: A Biochemical and Histological Study in Goats

At present, using bone grafts is the most successful surgical approach for repairing deficits in the bone structure. This study investigated into how goat tibial defect fracture healing was impacted by using hydroxyapatite (HA) or demineralized and decellularized bone matrix (dDBM) xenograft. Methodology: In this study, fifteen young goats were employed. Three groups (n=5) consisting of the control group, nano-group, and xeno-group were created from the animals. Bone drill was used to remove 2 mm from the tibia of the right hind limp in all animals. The hydroxyapatite nanoparticles (HA) in the Nano-group and the xenograft demineralized and decellularized bone matrix (dDBM) (obtained from sheep tibia) in the Xeno-group were used to fill the bone defect respectively, while the bone defect in the control group remained without treatment, and the surgical site was regularly closed. Blood serum was collected at the following intervals: postoperative, 14, 42, and 64 days for detection of alkaline phosphatase (ALP) and osteocalcin (OC) levels. At 64 days after surgery, all goats were euthanized and the healing was evaluated by specimen histological observation. Results: Biochemical examination in treated groups (Nano and Xeno groups) showed a statistically significant (P &lt; 0.05) increase in the level of ALP and OC. histopathological examination at 64 day post-operation, treated groups shows Completely grown woven bone and the fracture callus composed of mature fibro-osteoid mixture. In conclusion, We demonstrate that the healing process accelerated and the bone defect can be filled by using hydroxyapatite (HA), or dDBM, as a scaffold for the damaged tibia bone.

Biomechanical Evaluation of the Osseointegration Levels of Implants Placed Simultaneously With Tibia, Femur, and Jaw Allogeneic Bone Grafts.

In implant-supported prosthetic treatments, the jaw bones may not always have enough bone to accommodate implants. Allogeneic grafts can also be preferred as an alternative to autogenous grafts in cases of vertical and horizontal bone deficiencies. The aim of this study is to evaluate the osseointegration levels of lathe-faced titanium implants placed together with allogeneic bone tissue transplants obtained from tibia, femur, and mandible bones using a biomechanical method. Twenty-eight female Sprague Dawley rats were included in the study. The subjects were divided into groups where bone transplantations were performed together with implant placement from the tibia (n=7), femur (n=7), and lower jaw (n=7) regions. Four rats (left and right) were used as donors. Grafts, along with implants, were surgically placed in the corticocancellous part of the metaphyseal parts of the tibia bones of rats. At the end of the 2-week experimental setup, all rats were killed, and the implants and surrounding bone tissues were subjected to biomechanical reverse torque analysis (N/cm), no statistical difference was detected in terms of bone-implant fusion between the groups in which the femur and tibia bones were transplanted (P>0.05), while the bone-implant fusion value in the group in which the lower jaw bone was transplanted was found to be statistically higher than the femur and tibia bones (P<0.05). Based on the limited results of this study, it can be thought that the lower jaw allogeneic jawbone has a higher osseointegration potential than allogeneic grafts obtained from the femur and tibia.

Timely tibiotalar fusion after utilization of Masquelet technique guided by in-hospital 3D printing

The following report describes a case of a 24-year-old female who presented with a traumatic open trimalleolar ankle fracture withsevere distal tibial bone loss. She was submitted to a staged acute Masquelet technique, where the in-hospital 3D printing was utilizedto guide the shaping and sizing of the antibiotic cement spacer and, subsequently, the bone allograft utilized two months later duringtibiotalar fusion. Adequate bony consolidation was achieved at the 7-week follow-up, and the patient was able to bear weight at 12weeks fully. Level of Evidence V; Therapeutic studies; Case Report.

Technical and Biological Reliability of pQCT Measured Bone and Muscle Tissue Quality Across the Age-Span

Introduction: Reliable peripheral quantitative computed tomography (pQCT) assessment is essential to the accurate longitudinal reporting of bone and muscle quality. However, the between-day reliability of pQCT and the influence of age on outcome reliability is currently unknown.Objective: To quantify the same- and between-day reliability of morphological pQCT at proximal and distal segments of the forearm, shank, and thigh, and explore the influence of participant body size, age, and sex on outcome reliability.Methods: Men and women (49 % female, 18-85 years, n=72-86) completed two consecutive-day pQCT testing sessions, where repeat measurements were conducted on day-one for technical error, and between-day for biological error quantification. Testing was undertaken following best practice body composition testing guidance, including standardized presentation and consistent time-of-day.Results: All measurements of bone were classified as having ‘good’ to ‘excellent’ reliability [intraclass correlation coefficient (r=0.786- 0.999], as were measurements of muscle area (ICC r=0.991-0.999) and total fat (r=0.996-0.999). However, between- and same-day muscle density measurements at the thigh and forearm were classified as ‘poor’ (r=0.476) and ‘moderate’ (r=0.622), respectively. Likewise, intramuscular fat area at the thigh was classified as ‘moderate’ (r=0.737) for between-day measurement. Biological error was inflated compared to technical error by an average of 0.4 % for most measurements. Error values tended to increase proportionally with the amount of tissue quantified and males had significantly greater biological error for measurement of distal tibial bone (p<0.002) and trabecular area (p<0.002). Biological error was inflated among older adults for measurement of forearm muscle density (p<0.002).Conclusions: Most pQCT outcomes can be implemented with confidence, especially outcomes that assess bone area and density at any of the radial, tibial, and femoral sites investigated herein. However, it is important to account for the influence of biological measurement error in further studies, especially for muscle and intramuscular fat outcomes derived by pQCT.

Association between changes in serum bone metabolism markers and bone microarchitecture changes during basic combat training – The ARMI study

ImportanceU.S. Army Basic Combat Training (BCT) improves tibial volumetric bone mineral density (BMD) and structure in most, but not all soldiers. Few studies have investigated whether changes in serum bone biomarkers during BCT are associated with changes in tibial BMD and bone structure following BCT. ObjectiveTo characterize bone biomarker changes during BCT and to investigate the relationship between changes in bone biomarkers and changes in tibial BMD and bone structure. MethodsWe enrolled 235 trainees entering BCT in this ten-week prospective observational study. Trainees provided fasted blood samples and questionnaires weekly throughout BCT. Procollagen type 1 N-terminal propeptide (PINP) and C-terminal telopeptide of type 1 collagen (CTX) were measured by enzyme-linked immunoabsorbent assays every two weeks during BCT. We evaluated body composition and mass via dual-energy X-ray absorptiometry and bone structure, microarchitecture, and mineral density at the distal tibia via high-resolution peripheral quantitative computed tomography at baseline and post-BCT. ResultsBoth male (n = 110) and female trainees (n = 125) were young (20.9 ± 3.7 and 20.7 ± 4.3 years, respectively), with normal to overweight BMIs (25.2 ± 4.1 and 24.2 ± 3.6 kg/m2, respectively). In female trainees, PINP increased during and post-BCT compared to baseline, with the greatest increase in PINP at week four (45.4 % ± 49.6, p < 0.0001), whereas there were no changes in CTX. PINP also increased in male trainees, but only at weeks two and four (21.9 % ± 24.5, p = 0.0027 and 35.9 % ± 35.8, p < 0.0001, respectively). Unlike female trainees, in males, CTX was lower than baseline at weeks four, eight, and post-BCT. The change in PINP from baseline to week four of BCT was positively associated with changes in tibial BMD, Tb.BMD, Tb.Th, Tb.BV/TV, Ct.Th, Ct.Ar, and Ct.Po from the baseline to post-BCT. ConclusionThe bone formation marker PINP increases during U.S. Army BCT, especially during the first four weeks. Increases in PINP, but not CTX, were correlated with improved BMD and bone structure in the distal tibia.

Design of functionally graded porous lattice structure tibial implant for TAR

Use of porous lattice structures and functionally graded (FG) implants in orthopaedic applications has emerged as a promising solution to reduce stress shielding. However, there is a notable research gap in examining the effects of post-operative scenarios within the lattice pores and different porosity distribution laws in functionally graded porous lattice structure (FGPLS) implants on the biomechanical performance of tibial implant for total ankle replacement (TAR). The objective of the study is to investigates the effects of both post-operative tissues and various porosity distribution laws on the biomechanical performance of tibial implant for TAR and proposes a new design strategy. CAD models for lattice structures at various porosities were developed to incorporate the effects of post-operative tissues such as fibrous tissue, cartilage, immature bone, and mature bone. The pore spaces of these lattice structures were assumed to be filled with the post-operative ingrowth tissues. The lattice structure and these tissues together form the Representative volume element (RVE), whose effective properties were calculated using Asymptotic homogenization (AH) technique. Equations linking mechanical properties and porosity were established and used to assign mechanical properties to macro-FE models of FGPLS tibial implants based on three different power laws i.e. n = 0.1,1 and 5. Macro-FE models for intact and implanted tibia bones were developed using homogeneous properties of cortical bone and heterogeneous cancellous bone properties. The proximal part of the tibia was fixed, and a compressive load was applied through the anterior nodes of the meniscal bearing to represent dorsiflexion loading during normal walking. The Finite Element Analysis (FEA) was utilized to investigate the biomechanical performance of these implanted models in terms of stress distribution in the tibia bone and implant-bone micromotion. A comparison was made between models with solid metallic implants and those with FGPLS implants. Additionally, models with varying post-operative tissues in the pore space were compared, as well as models with different porosity variation laws were also compared. Results demonstrated that models implanted with FGPLS implants having porosity variation based on power law n = 0.1 showed increased bone stress and micromotion compared to those with solid metallic implants. Specifically, in models with FGPLS implants with porosity variation based on a power law of n = 0.1, the bone area with stress ranging from 2–5 MPa increased significantly in the periprosthetic region compared to models with solid metallic implants. The bone stress value for the majority of the region above the medial and lateral peg increased from 1–2 MPa to 2–5 MPa. Although there was a slight increase in micromotion values, they remained below the acceptable threshold of 50 µm. Models with porosity variations based on power laws n = 1 and n = 5 exhibited similar bone stress and micromotion results as solid metallic implants. Additionally, no significant difference in bone stresses was observed for different stages of bone ingrowth at pore space. These findings indicate that both the porous structure and porosity distribution within the implant significantly influence the biomechanical performance of tibial implants for TAR. So, it can be concluded that FGPLS implants with power law n = 0.1 are effective in reducing stress shielding and supporting the long-term survival of TAR by increasing bone stress and reducing the chances of aseptic loosening due to implant induced adaptive bone remodelling.

Modeling and Validation of Rabbit Tibia Bone by Reverse Engineering

In the medical field, 3D modeling and prototyping of hard or soft tissues of living organisms provides great convenience for surgeons before the operation and during the simulation phase of the operation. In this study, 3D regular mesh and prototype models were created from normal CT data of the right tibia bone of a New Zealand albino rabbit and the errors occurring during this creation were compared. According to the results obtained, the lowest errors occurred in the TL dimension, while the largest errors occurred in the ITDD dimension. The measured error amounts vary between 0.8% and 7.2%. Considering these error margins compared to similar studies, it is seen that the modeling is quite normal and a satisfactory way to simulate surgeons has been created. Key Words: Rabbit Tibia, 3D Bone Modeling, Additive Manufacturing

A novel robotic surgical assistant for total knee arthroplasty has a learning curve ranging from 6 to 14 cases and exhibits high accuracy in tibial bone cuts

BackgroundThe adoption of robot-assisted total knee arthroplasty (TKA) aims to enhance the precision of implant positioning and limb alignment. Despite its benefits, the adoption of such technology is often accompanied by an initial learning curve, which may result in increased operative times. This study sought to determine the learning curve for the ROSA (Robotic Surgical Assistant) Knee System (Zimmer Biomet) in performing TKA and to evaluate the accuracy of the system in executing bone cuts and angles as planned. The hypothesis of this study was that cumulative experience with this robotic system would lead to reduced operative times. Additionally, the ROSA system demonstrated reliability in terms of the accuracy and reproducibility of bone cuts.MethodsIn this retrospective observational study, we examined 110 medical records from 95 patients who underwent ROSA-assisted TKA performed by three surgeons. We employed the cumulative summation methodology to assess the learning curves related to operative time. Furthermore, we evaluated the accuracy of the ROSA Knee System in performing TKA by comparing planned versus validated values for femoral and tibial bone cuts and angles.ResultsThe learning curve for the ROSA Knee System spanned 14, 14, and 6 cases for the respective surgeons, with operative times decreasing by 22 min upon reaching proficiency (70.8 vs. 48.9 min; p < 0.001). Significant discrepancies were observed between the average planned and validated cuts and angles for femoral bone cuts (0.4 degree ± 2.4 for femoral flexion, 0.1 degree ± 0.6 for femoral coronal alignment, 0.3 mm ± 1.2 for distal medial femoral resection, 1.4 mm ± 8.8 for distal lateral femoral resection) and hip–knee–ankle axis alignment (0.3 degree ± 1.9 )(p < 0.05) but not for tibial bone cuts. Differences between planned and validated measurements during the learning and proficiency phases were nonsignificant across all parameters, except for the femoral flexion angle (0.42 degree ± 0.8 vs. 0.44 degree ± 2.7) (p = 0.49).ConclusionThe ROSA Knee System can be integrated into surgical workflows after a modest learning curve of 6 to 14 cases. The system demonstrated high accuracy and reproducibility, particularly for tibial bone cuts. Acknowledging the learning curve associated with new robot-assisted TKA technologies is vital for their effective implementation.

Accuracy of an image matching technique for assessing knee alignment during the stance phase of gait using single-plane anteroposterior radiography.

Accurate measurement of bone alignment of the knee during walking provides ideal clinical information for diagnosis and treatment of knee joint disorders. To bring this ideal closer to clinical reality, we developed an image matching technique to measure the three-dimensional (3D) position of bones using anteroposterior radiography during the stance phase of treadmill walking. To develop and validate an image matching method for evaluation of 3D knee alignment using anteroposterior radiography of artificial femoral and tibial bones. The 3D position of each bone was recovered by minimizing the difference between the projected outline and the contour of the bone in the anteroposterior radiograph. The true value of the position was measured using a 3D coordinate measuring machine. The mean values ± standard deviation and root mean squares (RMS) of translation errors were within -1.6 ± 2.1 mm and 2.6 mm, respectively, for femur, and 2.1 ± 1.9 mm and 2.8 mm for tibia. The mean values ± standard deviation and RMS of errors in rotation were within 0.3 ± 0.7° and 0.7°, respectively, for femur, and -0.3 ± 0.9° and 0.9°, respectively, for tibia. Our method is suitable for evaluating 3D knee alignment on anteroposterior radiography.

Mining Candidate Genes and Identifying Risk Factors for Leg Disease in Broilers: A Mendelian Randomization Study.

Clinical investigations have highlighted disruptions in bone metabolic processes and abnormal fluctuations in serum indicator levels during the onset of leg disease (LD) in broilers. However, the presence of a genetic causal relationship for this association remains undetermined. Therefore, the aim of this study is to discern the risk factors underlying LD development using 1235 sequenced white-feathered broilers. We employed Mendelian randomization (MR) analysis to assess the associations of bone strength (BS), bone mineral density (BMD), tibial bone weight (TBW), tibial bone length (TBL), tibial bone diameter (TBD), bone ash (BA), ash calcium (Ash Ca), ash phosphorus (Ash P), serum calcium (Ca), serum phosphorus (P), serum alkaline phosphatase (ALP), and serum osteoprotegerin (OPG) with the incidence of LD. Compelling evidence underscores a causal link between the risk of developing LD and decreased BMD (odds ratio (OR) = 0.998; 95% CI: 0.983, 0.993; P < 0.001) and narrower TBD (OR = 0.985, 95% CI: 0.975, 0.994, P = 0.002). Additionally, serum OPG concentrations (OR: 0.995, 95% CI: 0.992, 0.999, P = 0.008) were associated with BMD (OR = 0.0078, 95% CI = 0.0043 to 0.0140, P < 0.001), indicating a robust genetic relationship between ALP concentrations (OR: 0.988, 95% CI: 0.984, 0.993, P < 0.001) and TBD (OR = 0.0046, 95% CI = 0.0026, 0.0083, P < 0.001). Moreover, elevated serum Ca (OR: 0.564, 95% CI: 0.487, 0.655, P < 0.001) and P (OR: 0.614, 95% CI: 0.539, 0.699, P < 0.001) levels were associated with a narrower TBD. Elevated serum levels of Ca, P, ALP, and OPG contribute to disturbances in bone metabolism, while decreased BMD and narrower TBD are associated with a greater risk of developing LD in broilers. This discovery elucidates the metabolic risk factors for LD in broilers and could provide information on LDs, such as osteoporosis, in humans.

Application of the Modified RUST Score in Tibial Bone Transport and Factors Associated with Docking Site Complications.

Reconstruction of segmental bone defects with bone transport is a well-established treatment. Mechanical complications at the docking site after frame removal are common. These complications include malunion, non-union, axial deviation and refracture. A simple tool to assess the healing of the docking site is currently lacking. The aim of this study is to evaluate the use of the modified RUST (mRUST) score in the setting of bone transport and to identify factors associated with an increased risk of docking site complications. This retrospective study was conducted at a single tertiary centre in South Africa, included 24 patients with a tibial bone defect treated with bone transport and a circular frame between 2014 and 2023. Demographic data, clinical and bone transport characteristics were recorded. Mechanical complications, such as fracture, non-union, any angulation >5°, shortening >5 mm, or any other complication requiring reoperation, were recorded. The mRUST was adapted as a ratio for the purpose of this study to overcome the common occurrence of cortices being obscured by the frame. The mRUST ratio was applied before and after frame removal for each patient by three appraisers. Comparison between the groups with and without complications was performed regarding bone transport characteristics, docking site configuration and mRUST ratio. The correlation of the score between radiographs before and after frame removal was assessed. The inter-rater reliability of the mRUST was analysed using Fleiss Kappa statistics for each cortex individually and the intraclass correlation coefficient (ICC) for the mRUST ratio. In this study, 20 men and 4 women with a median age of 26 years were included. The overall rate of mechanical complications after frame removal was 21.7%. Complications were all related to the docking site, with two angulations, two fractures and one non-union. Demographics, bone transport characteristics and mRUST ratio before and after frame removal were similar between the two groups. Regarding the configuration of the docking site, an angle of 45° or more between the bone surfaces was associated with the occurrence of mechanical complications (p < 0.001). The correlation of the mean mRUST ratio before and after frame removal showed a moderate relationship, with a Spearman correlation coefficient of 0.50 (p-value 0.13). The inter-rater reliability of the mRUST was "fair" (kappa 0.21-0.40) for the scoring of individual cortices, except for one score which was "slight" (kappa 0.00-0.20). The ICC of the mRUST ratio was 0.662 on radiographs with the frame, and 0.759 after frame removal. This study did not find the mRUST or mRUST ratio useful in assessing the healing of the docking site to decide on the best time to remove the frame. However, a notable finding was that the shape and orientation of the bone ends meeting at the docking site might well be relevant to decrease complication rates. If the angle between the bony surfaces is 45° or more, it may be associated with an increased risk of complications. It may be worthwhile considering reshaping these bone ends at the time of debridement or formal docking procedure to be more collinear, in order to reduce the potential for mechanical complications such as non-union, axial deviation or refracture at the docking site. Kummer A, Nieuwoudt L, Marais LC. Application of the Modified RUST Score in Tibial Bone Transport and Factors Associated with Docking Site Complications. Strategies Trauma Limb Reconstr 2024;19(2):73-81.

Gradual Transverse Transport of Naturally Tibialized Fibula Using Hexapod Frames to Treat Neglected Type V Tibial Segmental Defects.

Although several reconstructive methods have been developed to manage large segmental tibial bone defects including bone transport (distraction osteogenesis), contralateral fibular graft, allograft, tibiofibular synostosis, Masquelet technique, and 3D printed scaffold, neglected large tibial defects in adults remain challenging problems. This study describes gradual transverse transport of naturally tibialized fibula using hexapod frames in management of adult patients with neglected large tibial defects. We retrospectively reviewed four cases of transverse transport of naturally tibialized fibula from November 2018 to February 2022. We measured the length of the tibial defect and the transported fibular segment, the mid-diaphyseal diameter and cortical thickness of the affected fibula, contralateral fibula, and tibia. The parameters measured both preoperatively and postoperatively were leg length discrepancy, hip-knee-ankle angle, medial proximal tibial angle, posterior proximal tibial angle, lateral distal tibial angle, range of motion of the knee and ankle joints, and Lower Extremity Functional Scores (LEFS). Patients' satisfaction rates using Likert scale were also recorded. Among four female patients, three suffered from tibial osteomyelitis, and one was due to congenital pseudarthrosis of the tibia. The average follow-up time was 2.7 ± 1.4 years. The average length of tibial defect was 14.0 ± 0.8 cm. The average preoperative shortening of the affected leg was 9.0 ± 2.5 cm, which changed to 0.6 ± 0.8 cm postoperatively. The median length of the transported fibular segment was 15.2 cm. Two patients had varus deformity, two had recurvatum, and one had procurvatum preoperatively. Postoperative radiological measurement showed all deformities corrected and no ankle valgus deformity developed during follow-up. All patients achieved union and can fully weight bear on the affected extremity. The average fixator time was 12.9 ± 2.9 months. The average preoperative and postoperative LEFS, respectively, were 53.5 ± 5.0, 70.5 ± 1.3, with a significant difference (p = 0.003). Three patients reported very satisfied with the outcome, and one patient reported satisfied. Three patients had pin tract infections, and one patient had skin necrosis which healed after additional surgery. One patient had surgical release of the hamstring tendons due to flexion contracture of the knee. Two patients had 15° of reduction in ankle range of motion. One patient had transient common peroneal nerve palsy which spontaneously recovered within 6 weeks. The transverse transport of naturally tibialized fibula was both a safe and effective method to treat the long-standing type V tibial segmental defect.

The Efficacy of Body-Weight Supported Treadmill Training and Neurotrophin-Releasing Scaffold in Minimizing Bone Loss Following Spinal Cord Injury.

Spinal cord injury (SCI) can lead to significant bone loss below the level of the lesion increasing the risk of fracture and increased morbidity. Body-weight-supported treadmill training (BWSTT) and transplantation strategies using neurotrophins have been shown to improve motor function after SCI. While rehabilitation training including BWSTT has also been effective in reducing bone loss post-SCI, the effects of transplantation therapies in bone restoration are not fully understood. Furthermore, the effects of a combinational treatment strategy on bone post-SCI also remain unknown. The aim of this study was to determine the effect of a combination therapy including transplantation of scaffold-releasing neurotrophins and BWSTT on the forelimb and hindlimb bones of a T9-T10 contused SCI animals. Humerus and tibia bones were harvested for Micro-CT scanning and a three-point bending test from four animal groups, namely injury, BWSTT (injury with BWSTT), scaffold (injury with scaffold-releasing neurotrophins), and combinational (injury treated with scaffold-releasing neurotrophins and BWSTT). BWSTT and combinational groups reported higher biomechanical properties in the tibial bone (below injury level) and lower biomechanical properties in the humerus bone (above injury level) when compared to the injury and scaffold groups. Studied structural parameters, including the cortical thickness and bone volume/tissue volume (BV/TV) were also higher in the tibia and lower in the humerus bones of BWSTT and combinational groups when compared to the injury and scaffold groups. While no significant differences were observed, this study is the first to report the effects of a combinational treatment strategy on bone loss in contused SCI animals and can help guide future interventions.

The embryotoxic and teratogenic effects of metamizole sodium.

Drug use during pregnancy is an important issue that must be investigated due to its adverse effects on maternal and foetal health. This study aimed to determine the embryotoxic and teratogenic effects of in-ovo administered metamizole (dipyrone), which can be used when needed during pregnancy and has potent analgesic, antipyretic, anti-inflammatory, and long bone (tibia and femur) effects. This study used 240 fertile eggs from Atak S breed chickens, divided into eight equal groups: control, vehicle control, and 15.62, 31.25, 62.5, 125, 250 and 500 mg/kg metamizole. The eggs were hatched on the 21st day of incubation, and the chicks' body weights and mortality rates were determined. The right and left femur and tibia bones were resected from the chicks. Anatomical reference points were determined after removing the soft tissues of the bones, and necessary morphometric measures were taken from these points with a 0.01 mm precision using digital callipers. The 100% lethal dose (LD100) was identified in the highest examined dose (500 mg/kg) in the Chicken Embryotoxicity Screening Test (CHEST)-I stage. The CHEST-II stage determined the 50% lethal dose (LD50). High-dose metamizole affected skeletal development, significantly decreasing tibia and femur lengths and corpus thicknesses and increasing mortality.