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PubMed2004

Biochemical observations in Blount's disease (infantile tibia vara).

Blount's disease or congenital tibia vara is a clinical entity characterized by tibia bowing, tibia torsion, and beaking of the medial tibia metaphysis on plain radiograph. In our environment, burnt-out rickets patients with biochemical and radiological diagnosis of rickets who after treatment still have residual bone changes despite normal bone biochemistry) can also present with similar clinical and radiological features as Blount's disease. However, certain biochemical variations, including antioxidants, may serve as a basis for differentiation between these two disorders. The serum levels of calcium, inorganic phosphate, zinc, copper, and alkaline phosphatase in 15 patients (10 females and five males) aged between two- and five years (mean 3.8 +/- 1.1 (SD)) with clinical and radiological features of Blount's disease were determined. The mean weight of the patients with Blount's disease was 14.0 +/- 2.4 kg (range: 11.5-16.3 kg). Fifteen subjects (nine females and six males) matched for age and sex without clinical features of any metabolic bone and/or nutritional diseases who were attending the surgical outpatient clinic served as control subjects. The serum concentrations of inorganic phosphate and calcium, though lower in patients with Blount's disease compared with controls, did not reach statistical significance. Alkaline phosphatase activity was increased in the serum of all patients with Blount's disease. In addition, there was an observed significant reduction in serum concentration of zinc (P < 0.03) compared to the control subjects. As for calcium level, the concentration of serum copper in Blount's patients was reduced, but this was not statistically significant. These biochemical observations, especially those of the antioxidant micronuent zinc, may serve as a basis for the differentiaion of the sometimes clinically inseparable disorders of Blount's and rckets and may aid in early differential diagnosis, appropriate treatment as well as prevention of complications.

Alkaline Phosphatase↗

PubMed2004

[Congenital antero-lateral bow of the tibia--description of three cases].

Three cases of antero-lateral bow of the tibia has been presented, all of them had fracture of the tibia during observation. Age of patients varied from 1 to 4 years. In all cases the method of Ilizarov was used for axis correction. Elastic intramedullary nailing of the tibia was performed after axis correction. Good results encourage the usage of Ilizarov's method in the treatment of antero-lateral bow of the tibia in small children.

Bone Diseases, Developmental↗

PubMed2004

[Soft tissue tendon graft fixation in the tibial tunnel with a bioabsorbable screw-EndoPearl combination in tibiae of low bone mineral density: a biomechanical study].

OBJECTIVES: This biomechanical study evaluated soft tissue tendon graft fixation in the tibial tunnel using a bioabsorbable interference screw with or without supplemental EndoPearl device. METHODS: Ten bovine tibiae were stripped of all soft tissues and bone tunnels 7 mm in diameter were drilled with dilation to 9 mm. Tibialis anterior allografts were fixed with a screw (10 mm in diameter, 30 mm in length) in five tibiae of high bone mineral density (1.36 g/cm2), and with a screw-EndoPearl combination in five tibiae of low bone mineral density (0.84 g/cm2). The specimens were cycled 10 times from 10 to 50 N, and 500 times from 50 to 200 N in a servo hydraulic test device prior to ultimate load-at-failure testing at a rate of 20 mm/min. RESULTS: No statistically significant differences were found between the two fixation groups with respect to displacement and stiffness during cyclic testing, and with respect to load at failure, displacement, and stiffness during load-to-failure testing (p>0.05). CONCLUSION: The finding of similar results in both fixation groups with respect to displacement and stiffness during cyclic testing and during load-to-failure testing suggests that a screw-EndoPearl combination in tibiae of low bone mineral density may be helpful in the prevention of graft slippage.

Absorbable Implants↗

PubMed2005

Low-dose infectivity of Staphylococcus aureus (SMH strain) in traumatized rat tibiae provides a model for studying early events in contaminated bone injuries.

Animal models of post-traumatic acute osteomyelitis (OM) that closely mimic human scenarios, including infection prophylactic procedures such as debridement and lavage, may provide a better understanding of OM. We contaminated mechanically traumatized rat tibiae (n = 69) with various doses of a Staphylococcus aureus strain (SMH) known to cause human OM and then performed curettage and lavage. Tibiae were harvested 24 h after lavage for assessment of bacterial load and determination of minimal infective doses for 50% (ID50) and 95% (ID95) of rats. Some experiments varied tibial harvest time after lavage (n = 10); for progressive infection, tibiae were evaluated at 7 and 15 days after contamination (n = 17 for each time point). At 24 h after contamination, the ID50 was 1.8 x 10(3) CFU, and the ID95 was 9.2 x 10(3) CFU. Tibial bacterial loads did not increase with inocula greater than the ID95. Lavage removed many bacteria from bone, but it did not prevent subsequent infection or disease. At 15 days after contamination, most tibiae (14 of 17) were infected, with macroscopic and radiological signs of established OM. This newly described rat OM model, with a low ID95 despite prophylactic curettage and lavage, closely mimics events in contaminated human bone injuries. This situation will allow study of early factors in contaminated bone injuries, including clinical interventions that may reduce infection and prevent disease.

Animals↗

PubMed1992

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↗

PubMed2005

Intraorgan biodistribution and dosimetry of 153Sm-ethylenediaminetetramethylene phosphonate in juvenile rabbit tibia: implications for targeted radiotherapy of osteosarcoma.

UNLABELLED: Targeted radiotherapy using 153Sm-ethylenediaminetetramethylene phosphonate (153Sm-EDTMP) is currently under investigation for treatment of primary osteosarcoma. Human osteosarcoma most frequently occurs in skeletally immature individuals, and previous studies in a juvenile rabbit model demonstrated that clinically significant damage to developing physeal cartilage might occur as a result of systemic 153Sm-EDTMP therapy. The aim of this study was to determine the distribution of 153Sm-EDTMP within the tibias of juvenile rabbits and estimate the radiation-absorbed doses delivered to the physeal cartilage. METHODS: Eight-week-old New Zealand White rabbits were injected intravenously with 7.57 kBq (280 microCi) of 153Sm-EDTMP. At 21 h after injection, the biodistribution of 153Sm in the epiphysis, metaphysis, diaphysis, and red marrow of the tibia was obtained. Two-dimensional digital autoradiography was performed on 2-mm sections of tibias for qualitative comparison with the biodistribution data. Self-tissue and cross-tissue absorbed doses were calculated using absorbed fractions generated by the Monte Carlo particle transport code MCNP-4C. RESULTS: The highest uptakes (percentage injected dose per gram [%ID/g] of tissue) of 153Sm, 1.99-2.56 %ID/g, were found in the proximal and distal metaphyses, 70%-73% of which localized within 3 mm of the physeal cartilage. The second highest tissues of uptake were the proximal and distal epiphyses, at 0.33-0.62%ID/g. Digital autoradiography imaging confirmed that the majority of 153Sm deposited in the tibia localized to these tissues. Radiation-absorbed doses to the proximal and distal metaphyses were 183 and 130 mGy/MBq, respectively, and those to the proximal and distal epiphyses were 141 and 43.4 mGy/MBq, respectively. These tissues represented the only source compartments contributing to the physeal cartilage doses of 50.0 mGy/MBq for the proximal physis and 39.2 mGy/MBq for the distal physis. CONCLUSION: The 153Sm absorbed doses to the physeal cartilage were consistent with values that can cause dose-limiting damage to rapidly proliferating and differentiating chondrocytes. The pronounced uptake in the juvenile epiphysis indicates that the proliferating zone of the physis can be irradiated from multiple areas, which could increase the expression and degree of radiation damage. Further investigation of the effects of 153Sm-EDTMP on immature physeal cartilage is warranted to develop optimized treatment regimens.

Analgesics, Non-Narcotic↗

PubMed2006

Focal fibrocartilaginous dysplasia of the tibia: long-term evolution.

Focal fibrocartilaginous dysplasia of the tibia (FFCD) is a rare and benign condition associated with unilateral tibia vara in childhood. The first description was done by Bell in 1985. Since then more than sixty cases have been reported. The aetiology remains unknown. Five new cases are retrospectively reported. Four of them with tibia vara less than 30 degrees showed a spontaneous correction. One patient had a severe varus deformity (> 30 degrees) leading to physeal impairment and underwent a tibial valgus osteotomy. Biopsy is not necessary as radiographs are typical. The infantile growth plate is able to correct a tibia vara due to FFCD if less than 30 degrees. In case of spontaneous resolution, a long-term follow-up remains necessary because of a possible progressive leg length discrepancy.

Age Factors↗

PubMed2006

[The effect of bone marrow ablation on regional biomechanical properties of rat tibia].

OBJECTIVES: Regional (metaphyseal-diaphyseal) biomechanical properties of normal rat tibia, and changes on these biomechanical properties after bone marrow ablation, a model of fracture healing, were examined. METHODS: The study included 24 Sprague-Dawley rats that underwent tibial marrow ablation, and eight control rats with no surgical procedure. Proximal metaphyseal, proximal diaphyseal, distal diaphyseal, and distal metaphyseal samples were prepared from the tibias of all rats. In the control group, stiffness (elastic modulus, E), strength (maximum strength, Smax), and toughness (total energy absorption, U) parameters of the regional tibial segments were evaluated under compression loads. In the experimental group, compression was applied following bone marrow ablation on days 1, 3, 7, 9, and 15, and ablation-induced changes in the regional biomechanical properties were studied. RESULTS: The lowest E, Smax, and U values were obtained from the proximal metaphysis. The highest E and Smax values were from the distal diaphyseal, and the highest U values were from the proximal diaphyseal regions. In ablation-induced rats, decreases were observed in all the mechanical test values during days 1 to 7, followed by slight increases on days 7 to 9, and eventual decreases on days 9 to 15. There were significant differences between the two groups with respect to biomechanical parameters (p<0.05), but no significant differences were found between the tibial regions (p>0.05). CONCLUSION: Biomechanically, the most resistant and the weakest anatomic regions of normal rat tibia are the diaphyseal region and proximal metaphysis, respectively. The metabolic changes occurring after bone marrow ablation lead to changes in the mechanical properties of the tibia. The most affected tibial segments from ablation-induced intramedullary injury are the metaphyseal segments.

Animals↗

PubMed2005

Early proximal tibial valgus osteotomy as a very important prognostic factor in Thai children with infantile tibia vara.

OBJECTIVES: To find the effectiveness of the early surgery (2-3 years of age)as a very important prognostic factor affecting the outcomes in Thai children with infantile tibia vara and all the prognostic factors including the usefulness of arthrographic study in correcting the deformity. MATERIAL AND METHOD: From 1994 to 2004, sixteen children aged average 3.61 years old (2.08-7.0) were treated in Siriraj Hospital and diagnosed as infantile tibia vara by Langenskiold radiographic staging were included in the present study and retrospectively reviewed with an average of 6.4 years follow up (range 6 month - 11.1 years). All cases were initially treated by surgery because of low compliance for brace or brace failure. They consisted of 3 boys and 13 girls. There were 24 legs including the bilateral involvement in 8 cases (2 boy and 6 girls). After arihrography, the midshaft fibular osteotomy was performed then the proximal tibial dome-shaped valgus osteotomy was done and fixed with 2 pins. The desired position was 12 degree knee valgus . The patients were divided in two groups, 1)group A,the successful group with the knee becoming normal without any deformity after single osteotomy, 2)group B,the recurrent group with recurrence of the varus deformity required further corrective osteotomies to make normal axis of the knee. All variables were analyzed and compared between group A and group B. The general characteristics and radiographic findings were recorded in 1)age, 2)sex, 3)side, 4)weight in kilogram and in percentage of normal or overweight(obesity) compared with the standard Thai weight chart, 5)tibiofemoral angle (TFA) pre and postoperative treatment, 6) metaphyseal diaphyseal angle (MDA), 7)the medial physeal slope angle (MPS, 8)The preoperative arthrographic articulo-diaphyseal angle (ADA), 9.arthrographic articulo-medial physeal angle (AMPA). RESULTS: There were 14 legs in group A and the remaining 10 legs were in group B (average 2.4 operations). All cases healed in good alignment of the legs without major complication. All patients who were operated on early before 3 years old were 100% cured by single osteotomy in group A(11 legs). Arthrography was useful in evaluating the knee joint and drawing the angle. Considering the prognostic factors affecting the outcomes after surgery, there were 6 prognostic factors . First, the age less than 3 years old (P<0.001). Second, the normal weight (P<0.047). Third, the Langenskiold stage 1-2 (P=0.002). Fourth, the MPS angle equal or less than 59 degree (P < 0.001). Fifth, the ADA preperative angle equal or less than 18 degrees (P<0.001). Sixth and the last factor, the TFA angle postoperative treatment, equal or more than 10 degrees valgus (mean 13 degrees valgus) (P=0.009).In multivariate analysis with stepwise logistic regression of these 6 prosnostic factors, the MPS angle had the most important significance. The proximal tibial valgus osteotomy was a very important factor(P < 0.001). CONCLUSION: The 6 prognostic factors and usefulness of arthrography were identified. The authors suggest that surgery should be performed early in Thai children who have met these criterias 1)age of the patients more than 2 years old, 2)Langenskiold roentgenographic characteristics of infantile tibia vara stage 2 or more at the time of diagnosis, 3)Low compliance for brace treatment.or brace failure but not more than 3 years old. The surgery should not be delayed more than 3 years of age by waiting for effectiveness of brace treatment in Thai children with infantile tibia vara. The early proximal valgus dome- shaped osteotomy was a very important controllable prognostic factor by surgeon decision.

Arthrography↗

PubMed1990

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↗

PubMed1989

[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↗

PubMed1989

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↗

PubMed1988

[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↗

PubMedDate not supplied

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↗

PubMed1985

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↗

PubMed1980

[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↗

PubMedDate not supplied

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↗

PubMed1978

[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↗