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Resumen: La epifisiólisis femoral proximal o deslizamiento capital femoral es un trastorno de la cadera que se caracteriza por un desplazamiento de la epífisis sobre la metáfisis a través de la fisis (cartílago de crecimiento), quedando la epífisis posterior e inferior. Es una entidad relativamente frecuente en atención primaria y prehospitalaria que genera dolor y limitación de cadera; sin embargo, por su sintomatología vaga es usualmente infradiagnosticada o es diagnosticada tardíamente generando consecuencias a largo plazo. Si se tienen en cuenta los factores de riesgo asociados a una adecuada exploración física y el uso imágenes diagnósticas se lograría hacer un diagnóstico oportuno y una disminución de la tasa de complicaciones.
Abstract: Proximal femoral epiphysiolysis or slipped capital femoral is a hip disorder characterized by a displacement of the epiphysis over the metaphysis through the physis (growth plate), leaving the epiphysis in a posterior and inferior position. It is a relatively frequent entity in primary and prehospital care that generates hip pain and limitation. However, due to its vague symptoms, it is usually underdiagnosed or diagnosed late, generating long-term consequences. If the risk factors associated to an adequate physical examination and the use of diagnostic images are taken into account, a timely diagnosis and a reduction in the rate of complications would be achieved.
Resumo: A epifisiólise proximal do fêmur ou escorregamento epifisário proximal do fêmur é um transtorno do quadril que é caracterizado por um deslocamento da epífise sobre a metáfise por meio da fise (placa de crescimento), ficando a epífise posterior e inferior. É uma entidade relativamente frequente em atenção primária e pré-hospitalar que gera dor e limitação do quadril; contudo, por sua sintomatologia vaga, é usualmente subdiagnosticada ou é diagnosticada tardiamente, o que leva a consequências em longo prazo. Se os fatores de risco associados com uma adequada exploração física e com o uso de imagens diagnósticas forem considerados, é possível realizar um diagnóstico oportuno e diminuir a taxa de complicações.
Subject(s)
Humans , Slipped Capital Femoral Epiphyses , Primary Health Care , Epiphyses , Delayed DiagnosisABSTRACT
@#Introduction:Redisplacement following fracture reduction is a known sequela during the casting period in children treated for distal radius fracture. Kirschner wire pinning can be alternatively used to maintain the reduction during fracture healing. This study was conducted to compare the outcomes at skeletal maturity of distal radius fractures in children treated with a cast alone or together with a Kirschner wire transfixation. Materials and Methods: This was a retrospective study involving 57 children with metaphyseal and physeal fractures of the distal radius. There were 30 patients with metaphyseal fractures, 19 were casted, and 11 were wire transfixed. There were 27 patients with physeal fractures, 19 were treated with a cast alone, and the remaining eight underwent pinning with Kirschner wires. All were evaluated clinically, and radiologically, and their overall outcome assessed according to the scoring system, at or after skeletal maturity, at the mean follow up of 6.5 years (3.0 to 9.0 years). Results: In the metaphysis group, patients treated with wire fixation had a restriction in wrist palmar flexion (p=0.04) compared with patients treated with a cast. There was no radiological difference between cast and wire fixation in the metaphysis group. In the physis group, restriction of motion was found in both dorsiflexion (p=0.04) and palmar flexion (p=0.01) in patients treated with wire fixation. There was a statistically significant difference in radial inclination (p=0.01) and dorsal tilt (p=0.03) between cast and wire fixation in physis group with a more increased radial inclination in wire fixation and a more dorsal tilt in patients treated with a cast. All patients were pain-free except one (5.3%) in the physis group who had only mild pain. Overall outcomes at skeletal maturity were excellent and good in all patients. Grip strength showed no statistical difference in all groups. Complications of wire fixation included radial physeal arrests, pin site infection and numbness. Conclusion: Cast and wire fixation showed excellent and good outcomes at skeletal maturity in children with previous distal radius fracture involving both metaphysis and physis. We would recommend that children who are still having at least two years of growth remaining be treated with a cast alone following a reduction unless there is a persistent unacceptable reduction warranting a wire fixation. The site of the fracture and the type of treatment have no influence on the grip strength at skeletal maturity.
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Objective To study the effect of dynamic pressure on the expression of parathyroid hormone-related protein (PTHrP)mRNA in metaphyseal cartilage stem cells of rats so as to further explore whether fiber actin (F-actin)is involved in the mechanical signal transduction process.Methods We isolated and cultured metaphyseal cartilage stem cells of rats by immunomagnetic beads.The third-generation rat metaphyseal cartilage stem cells were randomly divided into four groups:0%,3%,6%,and 12% deformed groups according to the size of dynamic pressure strength.We used a self-prepared dynamic tonic culture device to exert different intensity of pressure on each group of cells for 24 hours.Flow cytometry was used to detect the cell cycle distribution and apoptosis rate.The expression of PTHrP mRNA in each group was detected by Rea-l time quantitative PCR. Furthermore,the third-generation rat metaphyseal cartilage stem cells were randomly divided into four groups:control group,simple pressure group (6% deformation),pressure+cytoskeleton relaxin D group,and simple cytoskeleton relaxin D group according to whether or not to apply pressure and cytoskeleton relaxin D.F-actin fibers in each group of cells were stained with phalloidin and placed under a laser scanning confocal microscope.The expression of PTHrP mRNA in each group was detected by Real-time quantitative PCR.Results The results of flow cytometry showed no significant difference in G0/G1,G2/M and S phases between 0%,3%,6% and 12% deformed groups (P＞0.05).There was no significant difference in the apoptosis rate between 3% and 6% deformed groups compared with 0% deformed group (P＞0.05).The apoptosis rate was significantly higher in 1 2 % deformed group than in control group (P＜0.05).The results of laser confocal microscopy showed that the arrangement of F-actin fibers in the pressure group was neat and parallel compared with that in the control group, which was consistent with the direction of force.The intracellular F-actin fiber structure in pressure+cytoskeleton relaxin D group and simple cytoskeleton relaxin D group was destroyed and aggregated into clusters.Real-time quantitative PCR results showed that PTHrP mRNA expression did not significantly differ between 3% and 0% deformed groups (P＞0.05).The expression of PTHrP mRNA in 6% and 12% deformed groups was significantly higher than that in 0% group (P＜0.05).The expression of PTHrP mRNA in the cells of simple pressure group was significantly higher than that in the control group (P＜0.05).There was no significant difference in the expression of PTHrP mRNA between simple cytoskeleton relaxin D group and control group (P＞0.05).The mRNA expression of PTHrP was higher in pressure+cytoskeleton relaxin D group than that in control group,but lower than in simple pressure group (P＜0.05).Conclusion The dynamic pressure of proper intensity can increase the mRNA expression of PTHrP in chondrocytes of metaphyseal hypertrophy in rats,and F-actin is involved in the mechanical signal transduction process.
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Objective To study the effect of dynamic stress stimulation on the expression of Sox9 mRNA and protein in metaphyseal chondrocytes in vitro, and to explore the specific mechanism of mechanical signal transduction. Methods The rat metaphyseal chondrocytes separated and cultured for the 3rd generation in vitro were randomly divided into four groups:control group (all interventions were not applied), simple dynamic pressure group (a dynamic pressure stimulus with a size of 90 mmHg and a frequency of 0.1 Hz was applied using an open pressure control culture system), simple calcium antagonist group (the concentration of 10μmol/L nifedipine was given) and dynamic pressure+calcium antagonist group (a dynamic pressure stimulus with a size of 90 mmHg, frequency of 0.1 Hz and concentration of 10 μmol/L nifedipine were given at the same time). The expression of Sox9 mRNA was detected after 24 h intervention by real-time quantitative polymerase chain reaction (RT-PCR) in four groups. The expression of Sox9 protein was detected by Western blot assay. The intracellular free Ca2+ in metaphyseal chondrocytes was labeled with Fluo-3/AM, and the average fluorescence intensity detected by laser scanning confocal scanning microscopy was compared between four groups. Results The expression of Sox9 mRNA was 3.81 times higher in dynamic stress group than that in the control group, and the protein expression level was 2.33 times higher than that of the control group (P<0.05). There were no significant differences in the expression of Sox9 mRNA and protein between the calcium antagonist group and the control group. The expressions of Sox9 mRNA and protein were lower in dynamic pressure+calcium antagonist group than those in the dynamic stress group, but which were higher than those of control group(P<0.05). The results of average fluorescence intensity showed that there was no significant difference in the intracellular free Ca2+ concentration between four groups (P > 0.05). Conclusion Dynamic stress stimulation can increase the expression of Sox9 mRNA and protein in rat metaphyseal chondrocytes. There is calcium channel involvement in the mechanical signal transduction.
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Objective To study the effect of dynamic stress stimulation on the expression of Sox9 mRNA and protein in metaphyseal chondrocytes in vitro, and to explore the specific mechanism of mechanical signal transduction. Methods The rat metaphyseal chondrocytes separated and cultured for the 3rd generation in vitro were randomly divided into four groups:control group (all interventions were not applied), simple dynamic pressure group (a dynamic pressure stimulus with a size of 90 mmHg and a frequency of 0.1 Hz was applied using an open pressure control culture system), simple calcium antagonist group (the concentration of 10μmol/L nifedipine was given) and dynamic pressure+calcium antagonist group (a dynamic pressure stimulus with a size of 90 mmHg, frequency of 0.1 Hz and concentration of 10 μmol/L nifedipine were given at the same time). The expression of Sox9 mRNA was detected after 24 h intervention by real-time quantitative polymerase chain reaction (RT-PCR) in four groups. The expression of Sox9 protein was detected by Western blot assay. The intracellular free Ca2+ in metaphyseal chondrocytes was labeled with Fluo-3/AM, and the average fluorescence intensity detected by laser scanning confocal scanning microscopy was compared between four groups. Results The expression of Sox9 mRNA was 3.81 times higher in dynamic stress group than that in the control group, and the protein expression level was 2.33 times higher than that of the control group (P<0.05). There were no significant differences in the expression of Sox9 mRNA and protein between the calcium antagonist group and the control group. The expressions of Sox9 mRNA and protein were lower in dynamic pressure+calcium antagonist group than those in the dynamic stress group, but which were higher than those of control group(P<0.05). The results of average fluorescence intensity showed that there was no significant difference in the intracellular free Ca2+ concentration between four groups (P > 0.05). Conclusion Dynamic stress stimulation can increase the expression of Sox9 mRNA and protein in rat metaphyseal chondrocytes. There is calcium channel involvement in the mechanical signal transduction.
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Resumen: Introducción: La osteocondromatosis múltiple hereditaria se caracteriza por el crecimiento de múltiples tumores benignos, cartilaginosos, que crecen en forma de exostosis predominantemente en las metáfisis de los huesos largos. Se ha descrito una prevalencia de 1/50,000 individuos. Casos clínicos: Se presenta la información clínica y patrón hereditario autosómico dominante, en el que están afectados los genes de exostosina (familia de genes EXT) en tres miembros de una familia con osteocondromatosis múltiple. Los tres pacientes han presentado alteraciones en los arcos de movimiento de muñecas, hombros o tobillo. El diagnóstico clínico fue confirmado con estudios radiológicos y no hay evidencia de que las lesiones se hayan malignizado. Conclusiones: Esta entidad requiere de supervisión periódica, corrección quirúrgica de las deformaciones que limiten la función, vigilancia de la transformación maligna y consejería genética.
Abstract: Background: Multiple hereditary osteochondromatosis is characterized by the growing of benign cartilaginous tumors in form of exostosis, predominately in the metaphysis of long bones. It is described with a prevalence of 1/50,000 individuals. Case reports: This article presents the clinical information and its autosomal dominant inheritance pattern where exotoxin genes (EXT gene family) were affected in a three-member family with multiple hereditary osteochondromatosis. The three patients showed altered arcs of movement of wrists, shoulders and ankles. Clinical diagnosis was confirmed with radiology and malignancy was ruled out in all patients. Conclusions: This disease requires frequent medical evaluation, surgical bone correction when the normal function is involved, surveillance for malignant transformation, and genetic counseling.
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Objective To compare the biomechanical stability of distal femoral fracture with metaphyseal comminution fixed by unilateral or bilateral locking plates. Methods Distal femoral fracture with metaphyseal comminution (AO type C2.3 fracture) models were established in 22 artificial femoral specimens, and randomly divided into single plate group (group A, n=11) and double-plate group (group B, n=11). In group A, the fractures were fixed by lateral anatomic locking plates, and in group B, the fractures were fixed by lateral anatomical locking plates at lateral side and straight locking plates medially, respectively. In each group, 5 specimens were applied with axial compression and 3 specimens were applied with cyclic axial loading to measure medial subsidence, and the remaining 3 specimens were applied with failure loading to record the maximum load to failure. Results For axial compression, the mean medial subsidence of group A and group B were (2.61±0.28) mm and (0.46±0.08) mm, respectively. For cyclic axial loading, the mean medial subsidence of group A and group B were (1.56±0.12) mm and (0.43±0.05) mm, respectively. For failure loading, the maximum loads to failure of group A and group B were (5 567±338) N and (9 147±186) N, respectively, which all showed significant differences in two groups (P＜0.05). Conclusions For fixing distal femoral fracture with metaphyseal comminution, bilateral locking plates show stronger resistance to medial compression than unilateral locking plates and thus increase the stability of medial column of distal femur, which contributes to patient rehabilitation at early stage.
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Objective 36 non-Kaschin-Beck disease villages in five provinces including Jilin,Liaoning,Shaanxi,Shanxi and Inner Mongolia in the severe endemic areas of Kaschin-Beck disease (KBD) were selected.The aim of this project was to provide the basis showing these KBD villages had already eliminated the KBD.Methods Fully digital versatile X-ray radiography systems (DR) was used to shoot children's right hand X-ray,in accordance with the "Kashin-Beck Disease Diagnosis Standard" (WS/T 207-2010) for diagnosis.Results Results indicated that children showing metaphyseal changes only appeared in 13 of the 36 villages,where the rate of change on metaphyseal was less than or equal to three percent.Conclusion When KBD had been eliminated in a village,the rate of change on aged 7 to 12 children' s metaphyseal would have been less than three percent.
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Introducción: las manifestaciones clínicas de las osteoporosis incluyen las fracturas debido a pérdida de masa ósea y cambios estructurales en las trabéculas. En estos casos la osteosíntesis se ve afectada por los factores mecánicos inherentes al proceder y los implantes. Objetivo: mostrar las precauciones que el ortopédico necesita tener en mente al seleccionar el tipo de osteosíntesis (interna o externa) y los implantes que vaya a utilizar. Métodos: se realizó una revisión de las distintas precauciones en cirugía ortopédica sobre fracturas vertebrales y de huesos largos, así como su osteosíntesis de acuerdo a instrumental, implante y proceder operatorio. Resultados: se enfatiza en los avances incorporados, en especial, los sistemas mínimo invasivos de estabilización ósea, el uso de implantes con cerrojos"y el recubrimiento de clavos con hidroxiapatita de calcio y alambres para fijación externa. Conclusión: la osteosíntesis precoz, definitiva y eficaz, es el tratamiento de elección en las fracturas poróticas
Introduction: the clinical manifestations of osteoporosis include fractures due to a loss of bone mass and structural changes in trabeculae. In these cases the osteosynthesis is affected by the mechanical factors inherent to procedure and to implants. Objective: to show the cautions that orthopedist must to take into account at selecting the type of osteosynthesis (internal or external) and the implants to be used. Methods: a review of the different cautions in orthopedic surgery on vertebral fractures and long bones was carried out as well as its osteosynthesis according to the instrumental, the implant and operative procedure. Results: it is emphasize on the incorporated advances, specially the minimally invasive systems of bone stabilization, the use of implants with bolts and nails covering or coating with calcium hydroxyapatite and wires for external fixation. Conclusion: the early, definitive and effective osteosynthesis is the choice treatment in porous fractures
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Aged , Fracture Fixation, Internal/methods , Spinal Fractures/surgery , Spinal Fractures/prevention & control , Bone Nails , Orthopedic Equipment/ethicsABSTRACT
Purpose: Decreased mechanical stress causes disuse bone atrophy characterized by reduced bone mass and weakened bone. However, few studies have measured the mechanism behind such changes in different areas of bone. The present morphological study investigated the effects of decreased mechanical stress on bone mineral density in different areas of the femur by measuring bone mineral density and assessing the microstructure of osteoblasts. Methods: Twenty-one 9-week-old male Sprague-Dawley rats were acclimatized for one week, and then were divided into control, exercise, and cast immobilization groups. The study was conducted over an 8-week period, from age 10 weeks to 17 weeks in the rats. Bone mineral density was measured by dual energy X-ray absorption (QDR-2000) in the proximal epiphysis/metaphysis, diaphysis, and distal epiphysis/metaphysis of the femur. The microstructure of osseous cells was examined by Scanning Electron Microscopy (SEM). Results: Bone mineral density of the distal epiphysis/metaphysis was significantly lower in the cast immobilization group than in the exercise or control groups (p<0.001). In the cast immobilization group, scanning electron microscopy of the distal epiphysis/metaphysis revealed no boundary between small osteoblast and smooth neighboring cells; however, in the exercise group, actively osteoblastic osteoblasts covered the bone surface, resembling a stone wall.Conclusion: Decreased mechanical stress caused a decrease in bone mineral density that varied in different areas of the femur. The largest decrease in density occurred in the distal epiphysis/metaphysis. Osteoblast microstructure played an important role.
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PURPOSE: To evaluate the results of operative treatment for metaphyseal pathologic fracture of long bone in children using Locking Compression Plate (LCP). MATERIALS AND METHODS: Six children were enrolled in this study. The locations of fracture were proximal femur in five children and distal femur in one child. Pathologic diagnosis was aneurysmal bone cyst, in three children and simple bone cyst, enchondroma, and nonossifying fibroma, in other three children. All six children were underwent curettage of bone lesion and bone grafting, then the fractures were internally fixed using LCP. RESULTS: All fractures were united at six to ten weeks after operation. Healing of bone lesions except one case was observed. There were no mechanical complications, no loss of reduction and malunion. Also, we couldn't find any complication associated with physeal injury, such as leg length discrepancy of lower extremities. CONCLUSION: Internal fixation of metaphyseal pathologic fracture of long bone using LCP in children is technically easy and offers secure fixation despite anatomic and biologic characteristics of this type of fracture due to biologic and biomechanical advantages of LCP.
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Child , Humans , Aneurysm , Bone Cysts , Bone Transplantation , Chondroma , Curettage , Femur , Fibroma , Fractures, Spontaneous , Leg , Population CharacteristicsABSTRACT
[Objective]To summarize the surgical management and clinic results of the minimally invasive percutaneous plate osteosynthesis(MIPPO) technique in treatment of proximal metaphyseal fractures of tibia.[Method]Twenty-five patients with proximal metaphyseal fracture of tibia underwent the MIPPO operation in our department.There were 18 males and 7 females,with a mean age of 42.6 years(ranged from 21 to 66 years).According to AO classification,17 cases were type 41-A,and 8 cases were type 41-C,of the 25 cases,8 were multiple injuries,4 of these were open fractures(2 cases of Gustilo-Anderson type Ⅱ and 2 cases of type ⅢA).According to creiteria of Johner-Wruch,excellent in 14 cases,good in 9 cases,fair in 2 cases,the excellent and good rate was 92%.[Result]The average intra-operative time was 90 minutes(ranged from 70 to 115 minutes).The average blood loss was 260 ml.No patient received blood transfusion.There were no superficial and deep infection occurred in this group.All patients were available for follow-up at an average of 1.8 years(ranged,1 to 2.5 years) after surgery.The mean time for bony union on X ray was 13.8(10～20)weeks,while the mean time for full weight bearing was 14.5(11～28) weeks.No malunion and failure of fixation were observed.[Conclusion]MIPPO is a safe and effective technique for the proximal metaphyseal fracture of tibia with the advantage of less invasion,steady fixation,low infection rate and higher union rate,which is accordant with biological fixation.
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PURPOSE: To evaluate the clinical and radiographic results of interlocking intramedullary nailing for the distal metaphyseal fractures of the tibia and to identify the usefulness of the interlocking intramedullary nailing. MATERIALS AND METHODS: Thirty four patients who underwent interlocking intramedullary nailing for distal metaphyseal fractures of the tibia were reviewed with a follow-up period of more than 2 years. Clinical result was assessed using the Olerud score and this score was marked as percentage of prefracture state. Radiographic results were assessed with varus-valgus angle, anterior-posterior angle, and bone union time. We checked the cases of complication and need for additional surgery after interlocking intramedullary nailing. RESULTS: Clinically, Olerud score averaged 92.1% (76~100%). Radiographically, average varus-valgus angle was 1.6+/-2.9 degrees and average antero-posterior angle was 0.8+/-3.3 degrees. Bone union time averaged 18.7 weeks. As complications, there were one deep infection and two breakages of distal interlocking screw. In additional surgery, there were 1 debridement and soft tissue flap, and one dynamization of nail at postoperative 12 weeks. CONCLUSION: Interlocking intramedullary nailing is one of safe and reliable method for distal metaphyseal fractures of the tibia, considering less soft tissue injury, possibility of early range of motion exercise, high bone union rate, and low complications rate.
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Humans , Debridement , Follow-Up Studies , Fracture Fixation, Intramedullary , Range of Motion, Articular , Soft Tissue Injuries , TibiaABSTRACT
PURPOSE: This study was designed to clarify the osseointegration of the titanium screw coated with CMP, in regard to the time schedule, through the characteristic of early osseointegration. MATERIALS AND METHODS: Mechanical, radiological and histomophometric measurements were performed in 28 rabbit tibial proximal metaphyseal cortical bone screws 6, 12, 26 and 52 weeks after surgery for the in vivo comparison of the osseointegration of titanium screws (3.75 mm diameter, 5 mm length) with different surface treatments: CMP coating group, with the sol-gel method (experimental group) and uncoated group (control group). RESULTS: 1. Radiology: There were no differences between the two groups without a radiolucent line or in regard to the time schedule. 2. Histology: There were no differences between the two groups without a fibrous tissue intervening surface or in regard to the time schedule. 3. Torque test: The test results for the CMP coated group were 1.5 times higher than those for the uncoated group, which was statistically meaningful, but there was no difference in regard to the time schedule. CONCLUSION: CMP coating is an option to increase the osseointegration of the titanium screw.
Subject(s)
Appointments and Schedules , Bone Screws , Ceramics , Osseointegration , Tibia , Titanium , TorqueABSTRACT
PURPOSE: To evaluate the results of MIPPO (minimal invasive percutaneous plate osteosynthesis) technique for distal tibial metaphyseal fractures. MATERIALS AND METHODS: It is a retrospective study of 13 patients who were treated by MIPPO technique for distal tibial metaphyseal fractures from Jan. 2001 to Jan. 2003. The average age was 46.7 years and mean follow-up period was 13.3 months. According to AO classification, there were 8 cases of A1, 3 cases of A2, 1 case of B1 and 1 case of C2. One case of A1 was a Gustilo-Anderson type I open fracture and fibular fractures were combined in 12 cases. We applied anatomical reduction and internal fixation for the fibular fractures and internal fixation on the medial side of the tibia by MIPPO technique for distal tibial metaphyseal fractures. Clinical results were evaluated using radiographic results, Neer score, the starting time of postoperative exercise and clinical complications. RESULTS: According to the Neer score, all cases showed satisfactory results. Active ankle ROM was started at average 2.4 weeks (2~4 weeks) and full weight bearing ambulation at average 5.2 weeks (4~8 weeks) postoperatively. Union of fractures was obtained by average 14.4 weeks (8~18 weeks) postoperatively. Two cases showed 5 degrees limitation of motion without functional deficits and other cases showed satisfactory ROM results. One case had 6 degrees valgus deformity without functional deficits. There were not any other complications like soft tissue problems and delayed-or non-union. CONCLUSION: MIPPO technique for the treatment of distal tibial metaphyseal fractures is a feasible technique with a good clinical outcomes.
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Humans , Ankle , Classification , Congenital Abnormalities , Follow-Up Studies , Fractures, Open , Retrospective Studies , Tibia , Walking , Weight-BearingABSTRACT
Objective To report the therapeutic results of Hybrid external fixator in treatment of open metaphyseal fractures of the tibia.Methods From March 2000 to July 2004,19 cases of proximal tibial meta- physeal fractures and six cases of Pilon fractures were treated with Hybrid external fixators.By Gustilo classification, eight cases were of typeⅡ,10 typeⅢA,five typeⅢB and two typeⅢC.The wounds were closed directly after thorough debridement in 21 cases,and closed by pedicled flap transposition or free flap transplantation in four. Fasciotomy was performed in three.Closed indirect reduction of the fractures was done in 11 cases,while open reduction was carried out through an extended wound or a limited incision in 14.Anatomical reduction was done for the articular fractures,if any,and Hybrid external fixators were employed to stabilize fractures in all the cases in this series.Results All the patients had a mean follow-up of 15.7 months (ranging from 9 to 26 months) which re- vealed bone union of the fracture in all cases with a mean healing time of 8.8 months.Two patients had their external fixators replaced with plates and iliac bone graft to get fracture union.The fixators were removed 2.9 to 21 months (mean,9.4 months) after operation.Except for two cases of secondary healing,all the wounds healed primarily without serious complication,such as infection.The final follow-up revealed a knee motion range of more than 90?in 15 cases,less than 70?in four,whose knee motion range was improved to more than 90?after knee release performed one year later.In all the six cases of Pilon fractures,the ankle joint recovered normal range of motion.Traumatic arthritis occurred in two cases of Piion fracture 11 months after operation.Evaluation by Rasmussen's functional and radiological scoring system demonstrated excellent knee function in 13 cases,good in three,fair in two and poor in one,with a good to excellent rate of 84.2%.The ankle function was excellent in three cases,good in two and poor in one,with a good to excellent rate of 83.3%.Conclusions In treatment of open tibial metaphyseal fractures, the Hybrid external fixator can well maintain the stability of the fragments with a low incidence of soft tissue com- plications and insignificant interference with the knee motion.However the bone healing time can be prolonged with a definite rate of nonunion.
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PURPOSE:. To review the efficiency of the primary closed IM nail in 15 cases of distal tibial metaphyseal fractures. PATIENTS AND METHODS: From January 1997 to August 1998, 15 patients were treated by closed intramedullary nailing for distal metaphyseal tibial fracture. All operations were done on the fracture table in supine position, and any fracture extending into the ankle joint was stabilized by supplementary cannulated screw. RESULT: According to Robinson classification, there were 5 type I fractures (33%) , 6 type IIa fractures (40%) , 2 type IIb fractures (13%) , and 1 type IIc fracture (7%) . The mean distance between the distal end of fracture and tibial plafond was 2.3cm (range 0 to 4.5cm) . Three intraarticular fractures were stabilized by a supplementary cannulated screw. The mean score was 93.7 point ( excellent 7 cases, good 4 cases, fair 4 cases ) by Baird ankle scoring system There were no poor results. Fourteen patients (93%) went on to union at average of 18weeks (range 12-28weeks) . One type IIIa open fracture failed to unite and one patient had a valgus deformity of 7 degrees. Nonunion was succesfully treated by bone graft. There was no soft tissue necrosis or infection. CONCLUSION: In this study, we confirmed that IM nailing is one of the safe and effective methods for treating distal tibial metaphyseal fractures.
Subject(s)
Humans , Ankle , Ankle Joint , Classification , Congenital Abnormalities , Fracture Fixation, Intramedullary , Fractures, Open , Intra-Articular Fractures , Necrosis , Supine Position , Tibial Fractures , TransplantsABSTRACT
Fibronectin(FN) is a multifunctional glycoprotein with ARG-GLY-ASP(RGD) sequences that has been known as an important constituent of extracellular matrix in bone. 17-beta estradiol, bone active hormone has been reported to stimulate the in vitro production of several extracellular matrix proteins. Though it is known that estrogen withdrawal causes a significant diminition in PTH induced FN production, the hormonal regulation of FN production in bone has not been thoroughly studied. Especially the study using immunoelectron microscopy about FN production is rare. So, the author undertook tile present study to pursue the effect of estrogen on the distribution of fibronectin in the process of bone matrix formation with immunoelectron microscopy. Four to five weeks old female Sprague-Dawley rats, weighing about 150 gm, were used as experimental animals. It was grouped as ovariectomy group, sham operation group, ovarectomy with estrogen injection group, and normal control group. Each group was sacrificed at 1 week, 3 weeks and 5 weeks postoperatively. Ovaries were removed under the pentobarbital anesthesia, and for the estrogen injection group, 0.25 mg/kg of 17-beta estradiol was injected subcutaneously after oophorectomy. Immunoelectromicroscopic findings were as follows. 1 At the one week after operation, the distributions of gold particles, show the fibronectin reaction in osteoid, are similar in the control group, sham operation group, and ovariectomy with estrogen injection group at intermediate reactions, but it is severely decreased in the ovariectomy group as a weak reaction. 2. At there weeks after operation, the distributions of gold particle are similar in the control group, sham operation group and ovariectomy with estrogen injection group as intermediate reactions, but it is also decreased in the ovariectomy group as a weak reaction. 3 At the five weeks after operation, all the groups have similar distributions of gold particles as intermediate reaction. It is suggested that the estrogen secreted in ovary, partially effects on the fibronectin formation in the matrix of developing bone, and other factors stimulate and compensate the fibronectin formation with removal of ovaries.
Subject(s)
Animals , Female , Humans , Rats , Anesthesia , Bone Matrix , Estradiol , Estrogens , Extracellular Matrix , Extracellular Matrix Proteins , Fibronectins , Glycoproteins , Microscopy, Immunoelectron , Ovariectomy , Ovary , Pentobarbital , Rats, Sprague-Dawley , TibiaABSTRACT
The present study has been undertaken to pursue the cytotoxic effects of cis-Platin on the osteoid formation in metaphysis of rat tibia. By using the immunohistological staining method for type I collagen in rat tibial osteoid, the author detected the deposition of type I collagen, which is the collagenous constituent of endochondral osteoid, after administration of cis-Platin in experimental animals. For the immunological reactions of type I collagen, we used the rabbit anti-rat collagen type I polyclonal antibody as primary antibody and biotinylated goat anti-rabbit IgG as secondary antibody. The distributions of immunohistological reactions in the each of metaphyseal osteoids were analyzed with an image analyzer, and we studied the variances of type I collagens by statistical probabilities. In 12 hours after cis-Platin injection, immunoreactive area in the osteoid of metaphysis was distinctly decreased. Immunoreactive area of type I collagen in osteoids of 1 day and 3 days group metaphysis was increased more than that of 12 hours group and the type I collagen in the metaphysis showed weak immunoreactions of type I collagens with an image analyzer. In the osteoids of 7 days group after cis-Platin injection, the immunoreactive area was similar to that of control group. It is consequently suggested that cis-Platin would induce the decrease of type I collagen in the osteoid. But the type I collagen in tibial osteoid shows the increase from a few days after cis-Platin injection.
Subject(s)
Animals , Rats , Collagen , Collagen Type I , Goats , Immunoglobulin G , TibiaABSTRACT
Aneurysmal bone cysts are lytic lesions that have been described in virtually every portion of the skeleton but most commonly occur as solitary lesions in the metaphyseal portions of long bones. One fifth of aneurysmal bone cysts occur in the spine where they most frequently involve the posterior elements. In the spine, aneurysmal bone cyst have been reported to occur in the lower thoracic and lumbar regions, but their occurrence in the cervicodorsal area is uncommon. In this case, the second cervical vertebral body and posterior elements are affected. Fortunately, the lesion didn't invade into the spinal canal. The main symptom on admission was pressure pain, tenderness and motion limitation of the cervical spine. We removed the lesion involving posterior elements of second cervical spine and used horse-shoe shaped pediatric C-D device for occipito-cervical fixation. The clinical symptoms were resolved after operation. The clinical, radiologic, operative and pathological findings are reported and the corresponding literature are reviewed.