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The radial forearm flap: a biomechanical study of donor-site morbidity utilizing sheep tibia.

The use of vascularized bone grafts to reconstruct extremity and mandibular defects is now commonplace in reconstructive surgery. Fibula, scapula, iliac crest, rib, and metatarsal as well as the radial forearm osseocutaneous flaps have all been utilized for this purpose. Troublesome spiral fractures of the distal radius are the most common fractures associated with the use of the distal radius as a vascularized bone-graft donor site. This study was proposed to investigate the effect of donor-site bone loss on the strength of the radius under torsional (rotational) loading. Previous clinical series and experimental studies have not examined this aspect of distal radius loading after harvesting the bone graft. Fifty pairs of sheep tibiae were utilized in the experiment. Five pairs were used in a pilot study and 45 pairs were used in the main experiment. Five pairs of human radii were used for the control in the pilot study. The pilot study attempted to make a comparison between the human radius and the sheep tibia for experimental purposes. For the biomechanical study of donor-site defects, four study groups were examined with random assignment and matched pairs. The control group (group 1) had no alteration to the bone. Each test condition included five matched pairs of sheep tibiae. Experiment 1 compared the difference in the depth of the osteotomy defect. In doing this, one-third of the total length of the bone was removed in each of the following specimens to include (1a) 30 percent of the cross-sectional area of the total bone, (1b) 37 percent of the cross-sectional area of the total bone, and (1c) 50 percent of the cross-sectional area of the total bone. In experiment 2, the osteotomy shape was varied. Instead of the ends of the cuts being squared, the ends were beveled or rounded. Experiment 3 compared different lengths of bone removed in the osteotomy defect and included the following: In experiment 3a the diameter of the sheep tibia was measured at the incisura fibularis. This dimension was one diameter of bone, and a one-diameter length of bone was removed. In experiment 3b, a two-diameter length of bone was removed. In experiment 3c, a three-diameter length of bone was removed. In experiment 3d, a four-diameter length of bone was removed.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗

The strain distribution in the upper tibia after insertion of two different unicompartmental prostheses.

The strain distribution in the proximal tibia in seven human autopsy specimens was investigated with strain-gauge rosettes attached on the medial proximal aspect of the tibia. The strains measured were about the same on the proximal bone and on the bone in the metaphysis. The direction of the minimal principal strain (compression) was about 45 degrees counterclockwise (left knee). After insertion of a unicompartmental prosthesis medially, a non-constrained prosthesis with a loose meniscus-bearing and a constrained prosthesis, the tensile strain was about four times higher in the most anteromedial gauge. No significant differences were found between prostheses. Tests were also performed with the two prostheses inserted into three plastic models. The constrained prosthesis was more sensitive to outward rotation of tibia versus femur, which made the femoral component climb up the slope of the tibial component and caused a marked change in the strain distribution compared to loading in the neutral position. With the other prosthesis, a malpositioning of the tibial component medially caused the meniscus bearing to lie close to the medial rim of the tibial component. An external rotation of tibia then made the system constrained and dramatically changes the strain distribution.

Biomechanical Phenomena↗

Late-onset tibia vara (Blount's disease). Current concepts.

Idiopathic tibia vara or Blount's disease can be classified into three age-onset groups: (1) infantile, less than three years; (2) juvenile, four to ten years; and (3) adolescent, 11 years or older. The latter two groups comprise late-onset tibia vara, which is much less common than the infantile-onset form. In a comparison of eight juvenile-onset patients (13 knees) and seven adolescent-onset patients (nine knees), there were essentially no significant clinical, roentgenographic, or physeal-histopathologic differences. Both groups had severe obesity, mild to moderate varus deformities, and less-pronounced roentgenographic characteristics. Histopathologic analyses of the entire physis from the proximal tibia in five cases (seven knees) were essentially identical in patients with the infantile form as well as in those with slipped-capital femoral epiphyses, suggesting a common etiology. Recurrence of deformity after surgical correction occurred frequently in the juvenile onset males but not in juvenile onset females or the adolescent onset group. Incomplete correction of the varus deformity occurred more frequently in the latter group. The etiology for tibia vara appears to involve varus stress growth suppression, and disruption of endochondral ossification. The major differences between the three groups is due to the age at clinical onset, the amount of remaining growth, and the magnitude of the medial compression forces across the medial aspect of the knee.

Adolescent↗

[Regional blood flow and uptake of 99mTc-MDP and 85Sr in the femur and tibia in rats: regional differences and mutual relations].

We established blood flow (by means of 85Sr-microparticles) and 24 hours 99mTc-methylendiphosphonate (MDP) catchment and that of 85Sr (at different time intervals) in five portions of femur and 4 portions of tibia in rats. 1. We detected a marked differentiation in blood flow among all measured portions with the highest values in growth active distal femur metaphysis and proximal tibia metaphysis and with the lowest value in distal terminal tibia portion. 99mTc-MDP catchment is also highest in both metaphysis parts, and in the other parts it is differentiated similarly as the blood flow. 85Sr catchment in the early phase is very high in both metaphyses, but in several weeks it decreases to very low values; in the other parts the differences are small as well as the changes in the course of several weeks. 2. There is a considerable similarity in blood flow and 99mTc-MDP, in 85Sr catchment only high initial catchment in growth active metaphysis parts corresponds with blood flow. The time course of 99mTc-MDP and 85Sr catchment in the first hours after an intravenous injection is almost identical. The experiments showed great (up to 15-fold) local differences in blood flow among growth active and the other parts of femur and tibia in rats and a similar differentiation in 99mTc-MDP catchment, suggesting a certain relationship (but not quantitative dependency).

Animals↗

Bonding behavior of a glass-ceramic containing apatite and wollastonite in segmental replacement of the rabbit tibia under load-bearing conditions.

Glass-ceramic implants containing apatite and wollastonite were studied under load-bearing conditions in a segmental replacement model in the tibia of the rabbit. Alumina-ceramic implants were used as a control. A sixteen-millimeter segment of the middle of the shaft of the tibia was resected at a point distal to the junction of the tibia and the fibula. The defect was replaced by a fifteen-millimeter-long hollow, cylindrical implant that was fixed by intramedullary nailing using a Kirschner wire. Two groups of eight rabbits each (one group with a glass-ceramic implant and the other with an alumina implant) were killed twelve weeks after implantation. Two similar groups were killed twenty-five weeks after implantation. The segment of the tibia that contained the implant was excised and tension-tested. The load to failure of glass-ceramic implants containing apatite and wollastonite increased with time. The loads to failure of the glass-ceramic and alumina implants at twelve weeks after implantation were 19.8 +/- 7.06 and zero newtons, respectively. The loads to failure of glass-ceramic and alumina implants at twenty-five weeks after implantation were 126.4 +/- 32.54 and 19.6 +/- 13.92 newtons, respectively. No glass-ceramic implants broke. A calcium-phosphorus layer at the interface of the glass-ceramic and the bone was observed by scanning electron microscopy and electron-probe microanalysis. There was no interposition of soft tissue between the glass-ceramic and the bone, as observed by Giemsa surface staining.

Aluminum Oxide↗

[Congenital defects of tibia and fibula].

This study comprised 7 patients with longitudinal anomalies of the knee and leg classified in accordance with the 'classification of congenital limb deficiencies' introduced by Frantz and O'Rahilly. The anomalies were paraxial hemimelia of the fibula (4 instances), paraxial hemimelia of the tibia (6 instances). In the absence of the proximal tibia, therapy consisted of knee reconstruction according to Brown. In the absence of the distal part of the tibia a proximal tibiofibular synostosis was performed. In one instance corrective osteotomy of the tibia was required in the absence of the fibula. Exarticulation according to Syme was resorted in order to cope with an incorrigible abnormal position of the foot and for leg length inequality. The therapy should aim at giving the child walking ability at a normal time. Exarticulation has to be preferred to amputation in the treatment of these patients.

Child, Preschool↗

Infantile tibia vara.

We studied the applicability of Langenskiöld's classification to a predominantly nonwhite population with infantile tibia vara. Age at presentation was younger than that in previously published studies. Forty-seven tibiae averaging 6 years 7 months of follow-up had 66% good results. Poor results increased in proportion to stage at presentation. Brace treatment for early lesions was only 50% effective. Single tibial osteotomy before 4 years of age gave good results in 85% of tibiae, and multiple osteotomies gave good results between 4 and 8 years of age. One-half of tibiae treated with osteotomy developed recurrent varus. This review documents earlier stages at presentation, a more malignant course, and poorer results than Langenskiöld's series would suggest. We question the accuracy of Langenskiöld's estimate of prognosis when applied to this patient group.

Black People↗

Indentation stiffness of the cancellous bone in the distal human tibia.

Total ankle arthroplasties tend to fail mainly on the tibial side. Fifteen fresh amputation specimens were used for assessment of the stiffness of the cancellous bone in the distal tibia. Because all current ankle replacements sacrifice the subchondral bone plate, the change in stiffness of cancellous bone was studied in transverse sections taken proximal to the subchondral plate of the ankle. The articular cartilage was removed from the tibial plafond, and serial 1-cm sections were taken, radiographed, and tested in compression on an Instron 1125 Universal Testing machine with the use of a 4-mm-diameter indentor. In the distal tibia, it was found that subchondral bone has an elastic modulus on the order of 300-450 MPa; removal of the subchondral bone plate reveals bone with a compressive resistance that is 30%-50% lower than with the bone plate intact; there is virtually no resistance to compression in the trabecular bone at a distance of more than 3 cm proximal to the subchondral bone plate; and stiffness characteristics in the distal tibia parallel the radiographic appearance of the trabeculae. The strongest cancellous bone in the region of the distal tibia is that near the subchondral bone plate. This material should be preserved, if possible, in the surgery for total ankle implants.

Biomechanical Phenomena↗

[Anatomical investigations on the lower leg and foot in cases of hypoplasia and aplasia of the tibia (author's transl)].

Deformities associated with absence or defect of the tibia were investigated on 3 lower legs and feet. In case of bilateral hypoplasia of the tibia, the deformities are nearly identical regarding the muscles and the skeletal system. The main vessels and nerves are developed normally. The extent of malformations seems to be greater in case of aplasia of the tibia. The question, wether some abnormalities typical for a defect of the tibia exist, is discussed. For this our own observations are compared with similar cases described in the literature.

Adolescent↗

The influence of physeal injury upon growth correction of deformed rat tibia.

Experimentally produced angulatory deformities of rat tibia with and without physeal injury were observed at two to three-week intervals for an eight-week period by x-ray studies, in order to estimate the spontaneous correctability of tibial deformity in growing rats. The results obtained were as follows: 1) In the retrocurvated rat tibia with intact physes or with distal physeal injury, roughly one quarter of the initial angle was corrected during the eight-week observation period, with greater correction occurring during the first five weeks in both groups. 2) Injury of the distal physis hardly influenced the correction capacity of the deformed tibia. 3) The physis and diaphysis played equally important roles in the remodelling process of rat tibia with intact physes. However, early remodelling took place on a considerably larger scale and with greater rapidity through physeal growth, and late remodelling similarly through the diaphyseal appositional growth.

Animals↗

[Corrective osteotomies of the head of the tibia (indications, technique and results) (author's transl)].

The best indication for corrective osteotomy of the head of the tibia is unilateral osteoarthrosis of the knee joint in which the apical angle of the deformity lies in the head of the tibia or in the joint. Full-length radiographs of the leg are indispensable to determine the level of the osteotomy and the angle of correction required. The indications for high openwedge osteotomy of the tibial condyles and high osteotomy of the head of the tibia are discussed, and some of the technical details of the osteotomy and its fixation are described. Between 1970 and 1977, 139 corrective osteotomies of the head of the tibia were carried out in our clinic. Seventy nine adult patients with 100 operated knees were followed up approximately 3.5 years after operation. In 80% there was an improvement with regard to pain and walking distance when compared with the praeoperative state. The results depend on the kind of deformity (varus deformities generally show a better result) and the seriousness and duration of pre-existing osteoarthrosis and laxity of the ligaments.

Adolescent↗

Dynamic axial external fixation in the surgical treatment of tibia vara.

Osteotomy is the well-established treatment of Blount's disease (tibia vara), although the types of fixation used vary considerably. The use of dynamic axial external fixation to stabilize osteotomies for tibia vara until solid union occurs without the use of supplemental casting has not been reported by other authors. From 1985 until the present, we have used osteotomy with dynamic axial external fixation as treatment of 31 tibiae in 23 patients. All osteotomies healed and there was no postoperative loss of correction. There was an average correction of 20 degrees between the pre- and postoperative mechanical axis. Advantages of dynamic axial external fixation include ease of application, adjustability, early weight bearing, the ability to lengthen the extremity, and no second operation for removal of hardware. Based on our results, we believe that dynamic axial external fixation is an excellent form of osteotomy stabilization in the surgical treatment of tibia vara.

Adolescent↗

Longitudinal and cross-sectional analysis of raloxifene effects on tibiae from ovariectomized aged rats.

To extend and confirm previous data, we examined the effects of raloxifene on the proximal tibia of ovariectomized rats, aged 6 months, longitudinally and cross-sectionally by computed tomography (pQCT) and then compared the effects to those of orally dosed estrogen. Comparative analysis of phantoms and rat bones showed that the pQCT is precise and correlates with a Hologic QDR 1000W (DXA) with R = 0.999 but is capable of measuring significant differences between groups when the DXA cannot. This may reflect the ability of the pQCT to determine bone volume, mineral content (mg) and volumetric mineral density (mg/cm3), compared with two-dimensional analyses performed with DXA. Longitudinal analysis of the proximal tibia in vivo showed a significant 17% reduction in mineral density 31 days after ovariectomy. Examination of the images from ovariectomized rats showed a progressive increase in the cross-sectional area of the proximal tibiae, loss of trabecular bone, widening of marrow spaces and thinning of the cortical bone wall opposite the fibula. Regression analysis of the dose-dependent protective effects of raloxifene showed the half-maximal efficacy on tibiae mineral density to be ED50 = 0.4 mg/kg/day per os by pQCT and 0.2 mg/kg/day by DXA. By comparison, 17 alpha ethynyl estradiol showed dose-dependent effects with ED50 = 0.013 mg/kg/day per os by pQCT. Both raloxifene and ethynyl estradiol had beneficial effects on serum lipids, producing 50% reduction of cholesterol at 0.1 mg/kg/day raloxifene and 80% reduction with 0.01 mg/kg/day ethynyl estradiol. However, raloxifene up to 10 mg/kg/day had little effect on uterine weight, whereas 0.01 mg/kg/day ethynyl estradiol increased uterine wet weight by 300%.(ABSTRACT TRUNCATED AT 250 WORDS)

Aging↗

The longitudinal growth of tibia in oestradiol-treated and restrictedly fed immature male rats.

The effect of oestradiol administration and restricted feeding on longitudinal tibia growth was investigated in immature male rats. The restrictedly fed animals had a significantly longer tibia, greater thickness of the growth plate, faster rate of longitudinal tibial growth as well as the greater rate of [methyl-3H]thymidine incorporation into the growth plate of the tibia compared with oestradiol-treated animals. The results indicate that, in immature male rats, exogenous oestradiol can decrease the longitudinal growth of the tibia (at least partly due to inhibition of cell proliferation in the growth plate) independently of its anorexic effect.

Animals↗

[Determination of height from tibia fragments].

In a study involving the skeletal identification of stature, the Authors have performed multiple regression analysis between the measurements taken from 80 tibias (40 male and 40 female) and the living stature of the subjects to whom the tibias belonged to in life. The goal was to allow the forensic investigator to estimate the living stature by integral tibias or fragments just using association or single tibial measurements. The regression equations obtained allow to estimate living stature from different associations of well defined segments of tibia. This is a useful aid in forensic investigations, where it may be necessary to ascertain the individual's height during his/her life from isolated fragmented or mixed skeletal remains.

Adult↗

Prevalence of late-onset tibia vara.

We wished to determine the prevalence of late-onset tibia vara in an at-risk population. From a group of 1,117 boys aged 13-19 years, we selected all those who weighed at least 210 pounds. The 140 boys (80 black, 60 white) who met this inclusion criterion were examined for varus alignment. Radiographs of the seven boys who screened positive showed that two boys had late-onset tibia vara. Both boys were black and weighed > 280 pounds. The prevalence of late-onset tibia vara in this obese adolescent black male population was 2.5% (two of 80 boys). Recently, the number of reported cases of late-onset tibia vara has increased dramatically probably owing to an increase in the prevalence of morbid obesity.

Adolescent↗

Effect of the distraction rate on the activity of the osteoblast lineage in distraction osteogenesis of rat's tibia. Immunostaining study of the proliferating cell nuclear antigen, osteocalcin, and transglutaminase C.

The purpose of this study was to investigate kinetics of the osteoblast lineage in the periosteum and endosteum according to different distraction rates in distraction osteogenesis of rat's tibia. An osteotomy was performed on 144 rats at the proximal diaphysis of the left tibia. The lengthening process was started after a latency period of 3 days, with varying distraction rates of 0.25 mm (group I), 0.5 mm (group II), 0.75 mm (group III), 1.0 mm (group IV) and proceeded until a 3.5 mm length gain was achieved. The animals that had an osteotomy alone, without lengthening, served as a control (group V). Immunohistochemical staining of proliferating cell nuclear antigen (PCNA), osteocalcin, and transglutaminase C (TGase C) were done on the four animals in each group sacrificed at post-distraction days 1, 3, 5, 7, 14, and 28 in order to observe the temporal changes among the experimental and control groups. Also, in order to compare the staining rates at a given length gain among the groups, animals in each group were additionally sacrificed 2 days post-distraction in group II; 2 and 4 days in group III; and 1.5, 2 and 2.5 days in group IV. The results of the expression rates of PCNA, osteocalcin, and TGase C in each group were analyzed quantitatively. The immunohistochemical study on callotasis of rat's tibia revealed that the osteoblast lineage in the periosteum is more activated than that in the endosteum for proliferation and differentiation by distraction, suggesting that the periosteum plays a more important role in neoosteogenesis in the distraction gap. Daily distraction rates ranging from 0.25 mm to 0.75 mm in two increments is appropriate for successful distraction osteogenesis of rat's tibia, but the rate of 0.25 mm a day is significantly better than that of 0.75 mm as was made evident in the immunohistochemical observations.

Animals↗

Intraepiphyseal resection of the proximal tibia and its impact on lower limb growth.

From 1989 through 1996, 10 children affected by high grade bone tumors of the proximal tibia underwent an intraepiphyseal intercalary resection. The residual epiphyseal bone segment measured less than 2 cm in thickness in all cases and reconstruction always was performed using the combination of a vascularized fibular autograft and a massive bone allograft. The proximal epiphyseal osteosynthesis was fixed by small fragment screws. The aim of this study was to report the growth pattern of the residual proximal tibial epiphysis and to evaluate any possible lower limb discrepancy and/or deformity after the end of skeletal maturity. At current followup six patients were available for the final evaluation. Radiographic documentation included computed tomography scan of both knees before surgery, a panoramic radiographic view and a computed tomography scan of both lower limbs after the end of skeletal growth. The length of both femurs and tibias, the size of the tibial plateau and of the opposite distal femur, and any possible deformity of femur or tibia were measured and compared with the preoperative data. No patient had a limb length discrepancy greater than 3.5 cm. In all cases the ipsilateral femur had a valgus deformity of the hip develop. In two patients this deformity was associated with an elongation of the femur, partially compensating for the shortening of the tibia. The tibial plateau close to reconstruction grew less than the contralateral one (range 2%-8%) but maintained its normal relationship with the distal femur. None of these patients reported any restriction in recreational activities. They could walk, run, and jump. Their functional result according the International Society of Limb Salvage functional grading system was satisfactory in all cases.

Bone Neoplasms↗