Identification of the vascular and avascular zones of the human meniscus using magnetic resonance imaging: correlation with histology.

Since the initial employment of magnetic resonance imaging (MRI) to diagnose meniscal tears, a characteristic low-signal intensity, triangular-shaped structure has been interpreted as representing the entire meniscus. The difficulty in diagnosing meniscocapsular separations with MRI has brought attention to our lack of understanding of the appearance on MRI of the outer third of the meniscus and the meniscocapsular junction. We correlated MRIs of the meniscus in cadaver knees with histological sections and found that the low-signal, wedge-shaped structure corresponds only to the avascular (white) zone of the meniscus, whereas the high-signal zone peripheral to it corresponds to the vascularized (red) zone.

Drain entrapment and titanium to ceramic head deposition: two unique complications following closed reduction of a dislocated total hip arthroplasty.

Postoperative dislocation remains one of the most frequent complications following total hip replacement. In this report, a case is presented that illustrates two potential concerns with postoperative dislocation and subsequent closed reduction. The first complication presented in this report is entrapment of a closed drainage system tube in the joint space following closed reduction. The second complication, transfer of metallic debris to a ceramic femoral head from contact with an acetabular shell during closed reduction, was documented by analysis of a femoral head using scanning electron microscopy and energy dispersive x-ray spectrometry. This report emphasizes the need for the surgeon to express caution when relocating a dislocated hip, particularly when a closed drainage system is used postoperatively.

The effects of cobalt chromium upon macrophages.

The purpose of this study was to elucidate the mechanisms by which cobalt chromium particulate wear debris contribute to the aseptic loosening of total joint prostheses. Incubation of macrophages with cobalt chromium led to release of tumor necrosis factor-alpha (TNF-alpha) and prostaglandin E2 (PGE2), but did not lead to release of interleukin-1 beta (IL-1 beta) or interleukin 6 (IL-6). Exposure of macrophages cocultured with osteoblasts to cobalt chromium also led to significant release of TNF-alpha and PGE2, but did not lead to significant IL-6 or IL-1 beta production. The release of PGE2 in the coculture system was greater than that detected when macrophages were exposed to cobalt chromium without the osteoblast contribution. Exposure of radiolabeled calvaria to media from macrophages incubated with cobalt chromium in coculture with osteoblasts led to release of 45Ca. In contrast, exposure of radiolabeled calvaria to media from isolated macrophages incubated with these particles did not result in release of 45Ca. Exposure of macrophages to cobalt chromium was toxic, as reflected by release of the intracellular enzyme lactate dehydrogenase. Macrophages play a role in the initiation of bone resorption at the interface through the phagocytosis of cobalt chromium particles and subsequent release of TNF-alpha and PGE2. The presence of osteoblasts at the interface may be required for amplification of the inflammatory response and ultimately for bone resorption.

Similarities in the phenotypic expression of pericytes and bone cells.

Bovine brain microvessel pericytes, bone cells, and fibroblasts were grown in tissue culture in 3%, 21%, or 60% oxygen for 7 weeks. Alkaline phosphatase activity was highest in bone cells and pericytes grown in 3% oxygen, with the activity higher in the former than the latter. Alkaline phosphatase activity was very low in fibroblasts at every oxygen concentration. Osteocalcin concentration was higher in bone cells than in pericytes, was not detected in fibroblasts, and in bone cells and pericytes the concentration was highest in 21% oxygen. Other bovine brain microvessel pericytes were grown in 3% or 21% oxygen for 3 to 24 days in the presence or absence of bone morphogenetic protein 2 and in the presence or absence of parathyroid hormone. At Day 3 of culture, alkaline phosphatase activity was highest in 21% oxygen in the presence of bone morphogenetic protein 2. By Day 17 of culture, alkaline phosphatase activity was highest in 3% oxygen whether bone morphogenetic protein was present or not. Cyclic adenosine monophosphate production in pericytes in response to parathyroid hormone stimulation was very modest when compared with that of bone cells, and this response was not found to be significantly altered by bone morphogenetic protein 2, duration of culture, or the oxygen concentration during incubation. These findings show that the microvessel pericyte is capable of exhibiting several oxygen dependent, phenotypic characteristics ascribed to osteoblasts.

Supracondylar femur fracture above a mature knee fusion treated with a long locked intramedullary rod.

Fracture around a mature knee fusion has been reported in the orthopedic literature, but little has been written regarding treatment options. Closed long anterograde rodding with interlocking screws offers distinct advantages over other methods of reduction and fixation. The closed nature of the procedure avoids excessive soft-tissue stripping. In comparison with a short unlocked rod or plate, the long locked rod imparts more stability and prevents shortening and rotation. We present a case of a supracondylar femur fracture above a mature knee fusion treated in this manner. The literature on this injury is also reviewed.

Impact of CT scan on treatment plan and fracture classification of tibial plateau fractures.

OBJECTIVE: To evaluate the interobserver and intraobserver agreement for both treatment plan and fracture classification of tibial plateau fractures using plain films alone and with computed tomography (CT) scans. DESIGN: Prospective study to assess the impact of an advanced radiologic study on the agreement of treatment plan and fracture classification of tibial plateau fractures. SETTING/PARTICIPANTS: Two orthopaedic traumatologists, two orthopaedic residents, and two skeletal radiologists were presented with twenty-one cases of tibial plateau fractures imaged with plain films and with CT scans. MAIN OUTCOME MEASURES: Agreement was measured using kappa coefficients. RESULTS: Using plain films alone, the mean interobserver kappa coefficient for classification was 0.62, which decreased to 0.61 after addition of CT scans. Using plain films alone for formulating a treatment plan, the mean interobserver kappa coefficient was 0.58, which increased to 0.71 after addition of CT scans. The mean intraobserver kappa coefficient for fracture classification using plain films was 0.70, which increased to 0.80 with addition of CT scans. The mean intraobserver kappa coefficient for treatment plan based on plain films alone was 0.62, which increased to 0.82 after addition of CT scans. Class was changed in an average of 12 percent of cases after addition of CT scans. Treatment plan was changed an average of 26 percent of the time after addition of CT scans. CONCLUSION: Addition of CT scans to plain roentgenograms increases the interobserver and intraobserver agreement on treatment plan.

Mechanical strain-induced proliferation of osteoblastic cells parallels increased TGF-beta 1 mRNA.

It is well known that mechanical stimulation can prompt healing of bone fractures. However, the mechanism involved is less clear. In this study, we found that a 0.17% cyclic, biaxial mechanical strain delivered at 1 Hz increased proliferation of MC3T3-E1 cells, a clonal osteoblastic cell line. Mechanical strain also increased the level of TGF-beta 1 mRNA determined by quantitative reverse transcription/ polymerase chain reaction. Previous reports have shown that neomycin and W-7, which are inhibitors in the inositol phosphate/calmodulin pathway, blocked mechanical strain-induced proliferation of the osteoblast cells. Interestingly, we found that neomycin and W-7 can also block mechanical stimulation-induced elevation of TGF-beta 1 mRNA. Finally, using an antibody which blocked the action of TGF-beta 1, we found that the increased MC3T3-E1 cell proliferation induced by mechanical strain did not depend on the action of TGF-beta 1.

Severe restriction in jaw movement after routine injection of local anesthetic in patients who have fibrodysplasia ossificans progressiva.

OBJECTIVE: To determine the relationship of dental procedures to immediate ossification and ankylosis of the jaw in patients who have fibrodysplasia ossificans progressiva. STUDY DESIGN: A mail survey was conducted of the 60 patient-members of the International Fibrodysplasia Ossificans Progressiva Association. All 41 patients (18 males, 23 females) who responded were examined. Instantaneous exact hazard rates for ossification of the jaw were calculated by the Weibull model. RESULTS: Thirty-six patients had dental procedures performed. Twenty-one (58%) patients had received an injection of local anesthetic. Five (24%) patients had an immediate flare-up of fibrodysplasia ossificans progressiva with ossification and permanent ankylosis of the jaw (expected occurrence, 0.031; p < 0.0001). None of the 12 patients who had comparable dental work without injections developed heterotopic ossification (expected occurrence, 0.019; not significant). CONCLUSION: Injections of local anesthetic during dental procedures pose serious and immediate risk for inciting heterotopic ossification and ankylosis of the jaw in patients who have fibrodysplasia ossificans progressiva and should be assiduously avoided.

Proarrhythmic and antiarrhythmic effects of flecainide on nonsustained reentry around the canine atrial tricuspid ring in vitro.

The effect of flecainide, 0.3 mg/L and 1.0 mg/L, on inducible nonsustained reentry was studied, in vitro, in the canine tricuspid ring. Nonsustained reentry was engineered by cutting the ring and reconnecting it with an adjustable electronic delay. Delays were used that produced reentry lasting 1-3 beats (group A), 4-10 beats (group B), and 11-25 beats (group C). Reentry was initiated multiple times at each selected delay. A proarrhythmic effect, defined as a significant increase in the duration of reentry, was observed in all 14 trials at the low dose and in two of 15 trials at the high dose in seven experiments. In four more trials a transient proarrhythmic response was seen initially during exposure to the high dose. In five of seven experiments, reentry became sustained after at least one dose of flecainide. Proarrhythmic responses resulted when flecainide increased the tachycardia cycle length more than the effective refractory period and there was less cycle length oscillation after initiation. Antiarrhythmic responses resulted either from a marked increase in effective refractory period at the site of block or production of fixed block.