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The effects of the interosseous membrane and partial fibulectomy on loading of the tibia: a biomechanical study.

The biomechanical basis for the treatment of delayed union of tibial fractures by partial fibulectomy has yet to be fully evaluated. To gain further insight into this problem, nine intact cadaveric lower extremities were instrumented with strain gauges on the surfaces of the tibia and fibula. The limbs were then subjected to axial loading with the ankle and subtalar joints placed in multiple positions. The specimens were loaded either through the distal femur or by direct loading of the tibial plateau. All specimens were first tested intact then after sectioning of the interosseous membrane and finally after partial fibulectomy. It was shown that during loading of the leg, the primary effects of the interosseous membrane were to stabilize the fibula and constrain its posterolateral bending. The fibular strains were not reduced to zero following sectioning of the interosseous membrane. Tibial strains measured on the anteromedial and anterolateral surfaces were consistently in relative tension, indicating a posterior bending force (anterior bowing) of the tibia. After partial fibulectomy, strains on these surfaces became relatively more compressive. With the ankle and subtalar joints in neutral position (0 degree flexion, 0 degree inversion/eversion) the strains on the anterior surface averaged approximately 10% more compressive relative to the intact condition. Tibial strains were observed to vary with the position of the ankle and subtalar joints. The fact that the anteromedial and anterolateral tibia surfaces were always in tension may explain why partial fibulectomy has not proved to be a uniformly successful treatment method for delayed union of the tibia. Furthermore, it points to the important role of "fracture personality" in the selection of treatment.

Aged↗

Strength distribution in the tibia.

Stress fracture of a tibia is rarely associated with osteoarthros of the knee joint (gonarthrosis), whereas the present authors experienced a case of tibial stress fracture with high level lateral flail. To make an analysis with the statics of an elastic body, the shape of the tibia was read from a roentgenogram with a digitizer. The bend of a tibia was expressed with curvature (the reciprocal with curvature radius); fracture was expected to occur where the curvature was large. From the analysis, the fracture had occurred near one of the maximums of the curvature when the knee side was fixed and a force was applied to the ankle side --walking situation, e.g. The analysis also has indicated that the tibia would be very weak when the ankle side was fixed--skiing situation, e.g.

Aged↗

Bone accretion around polymethylmethacrylate and polyethylene implanted in the rabbit tibia.

This study examines the accretion rate of bone surrounding orthopaedic polymeric implants in different physical forms. Forty mature, female, New Zealand white rabbits were used in the study. Bilateral 6mm drill holes were made in the anteromedial tibias, 1cm from the joint line. The right tibia received a polymeric implant and the left tibia functioned as a prepared but nonimplanted control. The animals were allocated as follows: Group 1--bulk, preformed cooled polymethylmethacrylate (PMMA) plug; Group 2--bulk, doughy PMMA implant; Group 3--cement polymer powder; Group 4--bulk ultra-high-molecular-weight polyethylene (UHMWP) plug; Group 5--UHMWP particles averaging 67.29 mum; Group 6--UHMWP particles averaging 15.68 mum. All animals received the same volume of PMMA or UHMWP. The animals were killed after four months by barbiturate overdose. Beginning four weeks prior to sacrifice, the animals were given tetracycline injections at two-weekly intervals for two consecutive days. The upper tibias were harvested bilaterally and the specimens were processed undecalcified. Using a fluorescent microscope, the distance between successive tetracycline bands was assessed. Doughy PMMA tended to suppress bone formation compared to the control side, whereas preformed PMMA plugs and particulate PMMA polymer did not. This may be due to the heat of polymerization or to the presence of residual monomer in the doughy group. Polyethylene tended to facilitate bone accretion whether in bulk or particulate form when compared to the control side or to doughy cement. This effect was less marked when the cement was in particulate form.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

[Microsurgical repair of the defect with large area of bare tibia].

OBJECTIVE: To study the best method in repairing the defect with a large area of bare tibia. METHOD: Three hundred and twenty-two cases of large bare tibia defects were treated by three microsurgical methods. RESULTS: The bare tibiae in the 322 cases ranging from 12 x 3 cm to 24.0 x 3.5 cm were covered with myocutaneous flaps. Primary wound healing was achieved in 300 cases and delayed healing in 22 cases. All the cases were followed-up for 1 to 5 years. The function of the lower limbs was evidently improved. None of them was amputated due to deficit of skin coverage. The patients were all satisfied with the operative results. CONCLUSION: Transposition of the bridging skin flap pedicaled with the contralateral posterior tibial blood vessels can cover extensive bare tibia to avoid amputation. Other myocutaneous flaps from thoraco-umbilical, tensor muscle of fascia lata and scapular-lateral chest areas are good options too.

Accidents, Traffic↗

[Dual x-ray absorptiometry assessment of bone density of the proximal tibia in advanced-stage degenerative disease of the knee].

PURPOSE OF THE STUDY: Axial deformity secondary to degenerative joint disease of the knee can modify stress forces. Certain studies have reported an inversely proportional relationship between degenerative disease and osteoporosis. The aim of this prospective study was to quantify the horizontal linear distribution of bone density using dual x-ray absorptiometry (DXA) of the proximal tibia as a function of the femoral neck bone density in patients with knee osteoarthritis. MATERIAL AND METHODS: Between September 1996 and March 1998, 90 cases of primary degenerative joint disease of the knee were programmed for total knee arthroplasty. Prior to the procedure, the patients were assessed clinically and radiologically according to the International Knee Society (IKS) criteria. The mechanical femorotibial angle was measured in all patients and the varus angles were recorded. Most of the patients were women (65 p. 100) with a mean age of 70 +/- 5 years. Valgus knees were excluded from this series. The mean mechanical femorotibial angle was 172 +/- 5 degrees. Fifteen patients had a normal axis (16 p. 100), 32 had a varus measuring 4 degrees to 10 degrees (35 p. 100) and 43 had a varus measuring 10 degrees or more (48 p. 100). The overall varus distance was 6.4 +/- 2 cm. All patients had two DXA explorations: femoral neck to determine the bone status according to the WHO criteria (normal, osteopenia, osteoporosis), knee to determine the linear distribution of bone density of the proximal tibia. A 7 mm high band including 7 regions of interest covering the width of the tibia were explored in the area where the tibial cut was to be made. These 7 regions of interest were: R1, R2 under the lateral compartment, R6, R7 under the medial compartment, and R3, R4, R5 on either side of the tibial spines. The level of significance was set at 5 p. 100. RESULTS: The mean Z score (0.54 +/- 1) in the 90 patients showed a symmetrical distribution. These patients were representative of their age range. Their T score was - 1.40 +/- 1 (m +/- SD) and most had osteopenia (54 p. 100) according to the WHO criteria, although 16 p. 100 had osteoporosis. Mean bone density of the knee was 0.898 +/- 0.163 g/cm(3) and was correlated with that of the femoral neck (r=0.61, p=0.001). There were significant correlations between the differences in the bone densities of the knee compartments (R6-R2, R7-R1) and the mechanical femorotibial angle [(r=0.39, p=0.0001); (r=0.52, p=0.001)]. Irrespective of the overall bone density, there was a strong medial compartment overloading, which correlated with the degree of varus deformation. CONCLUSION: DXA assessment of bone mineral density of the proximal tibia is a simple, reliable, precise and reproducible method. The distribution of bone density in the degenerative knee depends on the degree of deformation. The average level depends on the subject's general state of mineralization. Osteoporosis does not protect against degeneration of the knee joint since 16 p. 100 of our patients had osteoporosis according to the WHO criteria.

Absorptiometry, Photon↗

Unilateral late-onset tibia vara associated with bilateral proximal femoral growth disturbance in monozygotic twins: case report.

Clinical and histopathological similarities and rare association of Blount's disease with various proximal femoral physeal affections (i.e. adolescent coxa vara and slipped capital femoral epiphysis) are well known. Association of tibia vara with another epiphyseal disease of the proximal femur has not been reported previously. In this paper, a monozygotic set of twins with concordant bilateral epiphyseal growth disturbance of the proximal femur and unilateral late-onset tibia vara is presented. Radiological characteristics of the affected knees revealed a wedging in the proximal tibial epiphysis, depression of the medial joint surface and varus deformity of the tibia. Proximal femurs of both cases showed aspheric congruity, coxa magna, shortness of the femoral neck, and subchondral cystic changes. The presented cases support the genetic etiology of tibia vara, and association of the two conditions is unique.

Adolescent↗

[Effect of sodium fluoride on bone turnover and bone loss of vertebrae and tibia in ovariectomized rats].

OBJECTIVE: To investigate the effect of sodium fluoride on bone turnover and bone loss of vertebra and tibia of ovariectomized rats. METHODS: 34 female Wistar rats, 16 weeks old, were divided into 3 groups: sham-ovariectomy (CON), bilateral ovariectomy (OVX) and both OVX and NaF-treatment groups (OVX + NaF, 1.0 mg/kg BW). All of the rats were sacrificed 12 weeks after the treatment. Serum was collected for the analysis of estradiol, calcium, phosphorum and alkaline phosphotase. Temur was used for the analysis of calcium content. Tibiae and the first lumbar vertebral bodies were decalcified for histomorphometry. RESULTS: After treatment with NaF, bone resorption was not inhibited, but bone formation was significantly increased. The trabecular bone volume of vertebrae (18.73% +/- 3.04%) and tibiae (14.30% +/- 5.87%) was significantly increased in comparing with of OVX rats (15.07% +/- 2.45% and 8.81% +/- 2.60%, P < 0.05), but it was markedly lower than that of CON rats (22.44% +/- 1.82% and 24.87% +/- 4.02%, P < 0.05 and P < 0.01). CONCLUSIONS: NaF could not decrease bone turnover and it, has only a partial protective effect against bone loss of either vertebra or tibia.

Animals↗

[Study of normal range of speed of sound in tibia in Beijing area].

OBJECTIVE: To study the normal reference value of adult tibial speed of sound (tibia SOS) in Beijing region. METHODS: 951 normal volunteers (male/female = 461/490) were included in this study. Speed of sound were measured in the middle of tibia by ultrasound scan (Sound Scan 2000, Myrid, Isereal). According to their gender and age, all subjects were divided into different subgroup by 10 year-age period. RESULTS: The peak value of SOS presented in 30-39 years period in both male and female. The peak value was higher in males than in females. After reach the peak value, the tibial SOS begin to decline. The decreasing rate was fast in SOS were found at 50-59 period in female and over 50-59 years old in male. The tibia values of SOS of postmenopausal was obviously lower than that of premenopausal women. The relationship of menopausal duration and the values if tibial SOS was found to be a non-linear curve, which included 3 stages: the quick decrease, stabilization and further decrease. CONCLUSION: The tibia values of SOS provides a kind of meaningful diagnostic criteria of osteoporosis.

Adult↗

[Biomechanical response of the femur-tibia model under impact loading of the body weight].

OBJECTIVE: To study the biomechanical response and the role of articular surface on the femur-tibia model under impact loading of the body weight. METHODS: A three-dimensional finite element (FE) model of the femur-tibia composite was reconstructed using the image data of the knee joint of Virtual Chinese Human No.1 Male, and FE calculation was performed to simulate the impact of the body weight on the knee joint while walking. RESULTS: The femur-tibia composite was compressed during the impact with obvious protrusive movement. Diffusion and attenuation of the stress occurred during its conduction to the articular surface. CONCLUSION: The femur-tibia composite is unstable under the vertical impact loading of the body weight, with obvious protraction movement, and the articular surface may serve as the buffer of the impact.

Biomechanical Phenomena↗

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↗