Meniscal ossification. I. Human.

Ossicles appearing in the medial menisci of three patients appeared to be post-traumatic in two and developmental in one. The histologic analysis in the two post-traumatic patients showed relatively normal bone and cartilage, but without the specific structural cartilaginous adaptations found in a naturally occurring large animal model. The third patient, with tibia vara and TAR (thrombocytopenia--absent radius) syndrome, developed the ossicle spontaneously. He is the youngest reported patient, to date, to develop this anatomic variation.

Athletes on Anabolic-Androgenic Steroids.

In brief We performed a retrospective review to determine the efficacy of the clinic we established to diminish health problems among athletes who used or were considering using anabolic-androgenic steroids. The clinic evaluated 18 patients by standard questionnaire, history, physical exam, and laboratory tests. Intervention included counseling, explaining any evident steroid-health connections to the patient, medical referral, and treatment of detectable problems. The patients who had considered steroid use remained steroid-free, and the patients who had follow-up visits minimized their steroid use and exhibited fewer health problems.

Avulsion fractures of the patella.

Forty-seven skeletally immature patients with marginal fractures of the patella were evaluated. We showed that avulsion fractures may affect the superior, inferior, and medial margins of the patella, separating through the subchondral bone along the biomechanically susceptible margin of progressive chondroosseous transformation and expansion of the ossification center. In children, the small size of the osseous fragment may belie the actual size of the more peripheral, radiolucent cartilaginous component. Treatment may be either conservative or operative, depending on the extent of separation of the fragments and the functional capacity of the patellar/quadriceps mechanism.

Tibial fractures associated with civilian gunshot injuries.

Forty patients with 41 fractures of the tibia produced by civilian gunshot injuries were reviewed. The usual patient was male, 28 years of age, and had been shot by an unknown assailant. Thirty-two of the 41 fractures (78%) were the result of low-energy missiles (less than 500 foot pounds or 680 Nm) while six (15%) were from intermediate (500 to 1,200 foot pounds or 680-1,627 Nm) and three (7%) from high-energy missiles (greater than 1,200 foot pounds or 1,627 Nm). Characteristic fracture patterns for the low energy group consisted of the drill hole, unicortical, oblique, spiral, butterfly, and comminuted. All of the intermediate- and high-energy missiles produced highly comminuted fractures. Intermediate- and high-energy missile injuries resulted in significantly longer initial hospitalization, higher incidence of fibular fracture, neurologic deficit, type 2 or 3 wound, and a higher incidence of infection. The time to fracture union was also higher with these injuries, even though the two nonunions in the series occurred with low-energy missiles. Factors other than the energy of the missile, however, may have contributed to the healing failure in those two patients. These factors included an intact fibula in one and advanced age in the other.

Plastic bowing of the femur in a neonate.

Acute plastic bowing injuries in children characteristically heal with little periosteal callus and exhibit a limited potential to remodel. A case of plastic bowing of the femur in a neonate is reported in which follow-up radiographs demonstrated periosteal new bone formation and rapid remodeling of the deformity. This report suggests that plastic bowing injuries in the neonate show a greater remodeling potential than similar lesions in older children.