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PubMed1999

Prosthetic reconstruction for tumours of the distal tibia and fibula.

We have carried out prosthetic reconstruction in six patients with malignant or aggressively benign bone tumours of the distal tibia or fibula. The diagnoses were osteosarcoma in four patients, parosteal osteosarcoma in one and recurrent giant-cell tumour in one. Five tumours were in the distal tibia and one in the distal fibula. The mean duration of follow-up was 5.3 years (2.0 to 7.1). Reconstruction was achieved using custom-made, hinged prostheses which replaced the distal tibia and the ankle. The mean range of ankle movement after operation was 31 degrees and the joints were stable. The average functional score according to the system of the International Society of Limb Salvage was 24.2 and five of the patients had a good outcome. Complications occurred in two with wound infection and talar collapse. All patients were free from neoplastic disease at the latest follow-up. Prosthetic reconstruction may be used for the treatment of malignant tumours of the distal tibia and fibula in selected patients.

Adolescent↗

PubMed2000

Tibiofemoral movement 1: the shapes and relative movements of the femur and tibia in the unloaded cadaver knee.

In six unloaded cadaver knees we used MRI to determine the shapes of the articular surfaces and their relative movements. These were confirmed by dissection. Medially, the femoral condyle in sagittal section is composed of the arcs of two circles and that of the tibia of two angled flats. The anterior facets articulate in extension. At about 20 degrees the femur 'rocks' to articulate through the posterior facets. The medial femoral condyle does not move anteroposteriorly with flexion to 110 degrees. Laterally, the femoral condyle is composed entirely, or almost entirely, of a single circular facet similar in radius and arc to the posterior medial facet. The tibia is roughly flat. The femur tends to roll backwards with flexion. The combination during flexion of no anteroposterior movement medially (i.e., sliding) and backward rolling (combined with sliding) laterally equates to internal rotation of the tibia around a medial axis with flexion. About 5 degrees of this rotation may be obligatory from 0 degrees to 10 degrees flexion; thereafter little rotation occurs to at least 45 degrees. Total rotation at 110 degrees is about 20 degrees, most if not all of which can be suppressed by applying external rotation to the tibia at 90 degrees.

Adult↗

PubMed2004

Supramalleolar derotation osteotomy of the tibia, with T plate fixation. Technique and results in patients with neuromuscular disease.

Torsional deformities of the tibia are common in children, but in the majority both the torsion and the associated disturbance of gait resolve without intervention. There are, however, a significant number of children and adults with neuromuscular disease who present with pathological tibial torsion, which may require surgical correction. We conducted a prospective study in two centres, to investigate the outcome of supramalleolar derotation osteotomy of the tibia, using internal fixation with the AO-ASIF T plate. A range of outcome variables was collected, prospectively, for 57 patients (91 osteotomies), including thigh foot angle, foot progression angle, post-operative complications and serial radiographs. Correction of thigh foot angle and foot progression angle was satisfactory in all patients. Three major complications were recorded; one aseptic nonunion, one fracture through the osteotomy site after removal of the plate and one distal tibial growth arrest. We found that supramalleolar derotation osteotomy of the tibia, with AO-ASIF T plate fixation is an effective method for the correction of torsional deformities of the tibia and the associated disturbances of gait in children and adults with neuromuscular disease, with a 5.3% risk of major complications.

Adolescent↗

PubMed2006

Obstructive sleep apnoea syndrome in morbidly obese children with tibia vara.

Morbid obesity and its association with obstructive sleep apnoea syndrome have been increasingly recognised in children. Orthopaedic surgeons are often the primary medical contact for older children with tibia vara, which has long been associated with obesity, but are unfamiliar with the evaluation and treatment of sleep apnoea in children. We reviewed all children with tibia vara treated surgically at one of our institutions over a period of five years. Thirty-seven patients were identified; 18 were nine years of age or older and 13 of these (72%) had morbid obesity and a history of snoring. Eleven children were diagnosed as having sleep apnoea on polysomnography. The incidence of this syndrome in the 18 children aged nine years or older with tibia vara, was 61%. All these patients required pre-operative non-invasive positive-pressure ventilation; tonsillectomy and adenoidectomy were necessary in five (45%). No peri-operative complications related to the airway occurred. There is a high incidence of sleep apnoea in morbidly obese patients with tibia vara. These patients should be screened for snoring and, if present, should be further evaluated for sleep apnoea before corrective surgery is undertaken.

Adenoidectomy↗

PubMed2004

Skeletal unloading alleviates the anabolic action of intermittent PTH(1-34) in mouse tibia in association with inhibition of PTH-induced increase in c-fos mRNA in bone marrow cells.

UNLABELLED: We analyzed the effect of unloading by tail suspension on the anabolic action of intermittent PTH in the tibia of growing mice. Unloading alleviated the PTH-induced increase of bone formation and accelerated bone resorption, consequently reducing bone mass. Reduction of the PTH-induced anabolic actions on bone was associated with unloading, which was apparently related to suppression of c-fos mRNA expression in bone marrow. INTRODUCTION: The effects of intermittent parathyroid hormone (PTH) administration on unloading bone have not been well elucidated at the cellular and molecular levels. We tested the effects of PTH on unloaded tibias of tail-suspended mice. MATERIALS AND METHODS: Eighty male C57BL/6J mice, 8 weeks of age, were divided into four groups with loading or unloading and administration of PTH (40 microg/kg body weight) or vehicle five times per week. Mice were killed at 8 or 15 days, and both tibias were obtained. Bone histomorphometry of the trabecular bone in the proximal tibia, development of osteogenic cells, and mRNA expression of osteogenic molecules in bone marrow cells were assessed. RESULTS AND CONCLUSIONS: At 15 days of unloading, bone volume decreased in PTH-treated mice. The increase in the bone formation rate by PTH was depressed, and the osteoclast surface was thoroughly increased. The increase in alkaline phosphatase-positive colony-forming units-fibroblastic (CFU-f) colonies induced by PTH was maintained and that of TRACP+ multinucleated cells enhanced. The PTH-induced increase in c-fos mRNA was depressed, but the increases in Osterix and RANKL mRNA were maintained. Unloading promoted the PTH-associated osteoclastogenesis and seemed to delay the progression of osteogenic differentiation in association with reduction of the PTH-dependent increase of c-fos mRNA in bone marrow cells.

Alkaline Phosphatase↗

PubMed1999

Posttraumatic tibia valga in children. A long-term follow-up note.

BACKGROUND: We reevaluated seven patients who initially had been managed nonoperatively because of a progressive valgus deformity that had occurred within approximately twelve months after satisfactory healing of a proximal tibial metaphyseal fracture sustained at an average age of four years (range, eleven months to six years and four months). All seven patients were described in a previous report from our institution, published in 1986. In that report, spontaneous improvement of the angulation was documented after an average duration of follow-up of thirty-nine months and nonoperative treatment of the deformity was recommended. METHODS: The patients were followed radiographically for an average of fifteen years and three months (range, ten years and four months to nineteen years and eleven months) after the injury. The radiographs were reviewed to determine the metaphyseal-diaphyseal angle, the mechanical tibiofemoral angle, the proximal and distal tibial remodeling angles, the limb-length discrepancy, and the deviation of the mechanical axis of the limb from the center of the knee joint. Knee function was assessed with use of the rating system of the Cincinnati Sportsmedicine and Orthopaedic Center, and ankle function was assessed with use of the rating system of the American Orthopaedic Foot and Ankle Society. RESULTS: Every patient had spontaneous improvement of the metaphyseal-diaphyseal and mechanical tibiofemoral angles. Most of the correction occurred at the proximal part of the tibia. The mechanical axis of the limb remained lateral to the center of the knee joint in every patient, with an average deviation of fifteen millimeters (range, three to twenty-four millimeters). The affected tibia was longer than the contralateral tibia in every patient, with an average limb-length discrepancy of nine millimeters (range, three to eighteen millimeters). The knee score on the affected side was excellent for five patients and fair for two; one of the patients who had a fair score had had a tibial osteotomy at the age of sixteen years because of pain in the lateral aspect of the knee that was thought to be due to malalignment. The ankle score on the affected side was excellent for three patients and good for four. CONCLUSIONS: Spontaneous improvement of the deformity occurred in all patients and resulted in a clinically well aligned, asymptomatic limb in most. We believe that patients who have posttraumatic tibia valga should be followed through skeletal maturity and that operative intervention should be reserved for patients who have symptoms secondary to malalignment.

Adolescent↗

PubMed1992

Effect of dietary sodium zeolite A and graded levels of calcium and phosphorus on growth, plasma, and tibia characteristics of chicks.

Sodium zeolite A (SZA), a synthetic sodium aluminosilicate having a high ion exchange capacity, has been shown to influence Ca and P utilization in chickens. A 3 x 2 x 2 factorial arrangement of treatments was used to investigate the effect of dietary P (.41, .55, and .69% total P), Ca (.6 and 1%), and SZA (0 and .75%) on growth, plasma, and tibia characteristics of chicks from 5 to 15 days of age. Growth, feed intake, gain:feed ratio, and tibia characteristics were influenced by dietary Ca and P in a manner consistent with dietary recommendations for these macro minerals. The addition of Ca, SZA, or both exacerbated the adverse effects of feeding low-P diets, yet alleviated the adverse effects of feeding a low-Ca, high-P diet. Dietary SZA had no effect (P greater than .5) on plasma Ca or alkaline phosphatase; however, SZA reduced (P less than .01) plasma P. Dietary SZA increased (P less than .02) tibia Mn, Zn, Cu, and Al. The SZA-induced increase in tibia Al was most evident in chicks fed low levels of P (SZA by P interaction, P less than .02). The overall response to dietary SZA addition paralleled the response observed from Ca supplementation, indicating that SZA increased Ca utilization, reduced P utilization, or contributed to both of these effects. These data demonstrate that the effects of SZA are influenced by the dietary concentration of Ca and P and that the addition of SZA to diets low in P results in bone Al accumulation.

Alkaline Phosphatase↗

PubMed1992

Effects of dietary aluminum and niacin on chick tibiae.

Effects of dietary aluminum chloride and niacin on bone mineral content and bone structural measurements were studied using young male Leghorn chicks. Standard chick rations containing .8% Ca and .4 or .5% available P were fed as control diets in three experiments. Experimental diets contained .05, .1, or .3% Al, or 1.0 or 1.5% niacin, or both and were fed for 2 wk. Tibia weights were decreased by 1.5% niacin, .3% Al, and by .1% Al plus 1.5% niacin (P less than .05). Breaking strength of tibiae was decreased (P less than .05) by 1.5% niacin, .1% Al, and .1% Al plus 1.5% niacin. Ultimate stress, which is force per unit area, was decreased by .3% Al and .05% Al plus 1.5% niacin (P less than .05). Niacin had no significant effect on bone mineral content. In Experiment 3, .3% Al decreased P, Ca, Mg, and Zn content of the tibiae (P less than .05). These findings indicate that feeding high levels of supplemental niacin results in decreased bone strength in chicks with no change in mineral content of the tibiae. Aluminum fed at levels of .3% of the diet causes a decrease in bone strength with concomitant changes in bone mineral content.

Aluminum↗

PubMed1995

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↗

PubMed1998

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↗

PubMed1993

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↗

PubMed1998

[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↗

PubMed2001

[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↗

PubMedDate not supplied

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↗

PubMed2000

[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↗

PubMed2001

[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↗

PubMed2003

[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↗

PubMed1992

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↗