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PubMed1997

Bone dimensional change with age: interactions of genetic, hormonal, and body size variables.

Changes in bony dimensions with age were assessed longitudinally from standardized X-ray films in 170 middle-aged Caucasian women, starting at age 40 years and with a median duration of observation of 21.125 years. Consistent with earlier work, cortical area of the metacarpals and radial shaft declined with age at rates ranging from 0.57 to 0.86%/year. As predicted, estrogen replacement therapy decreased this loss in a dose-dependent manner. Not previously reported is the fact that weight gain over the period of observation reduced upper extremity bone loss. Moreover, this protection was independent of the estrogen effect. In contrast with bone loss in the upper extremity, both femur shaft diameter and femur shaft cortical area increased significantly with age (0.23 and 0.26%/year, respectively). Estrogen replacement therapy inhibited femur shaft expansion but had no effect on femur cortical area. Weight change, however, strongly influenced gain (or loss) of femur cortical area: those in the highest weight change tertile gained 4 times as much cortical area as those in the lowest weight change tertile. VDR genotype also significantly influenced femoral shaft changes: women with the bb genotype had both greater shaft expansion and a greater increase in cortical area. The VDR effects were independent of the effects of weight change and estrogen. Femoral shaft expansion was of sufficient magnitude to suggest that the mechanical properties of the entire femur may change appreciably with age. Finally, contrary to widespread belief, there was significant, if modest, expansion at the femoral neck with age.

Adult↗
PubMed1992

Bone mineral and hormone status in paraplegics.

Nineteen men who had suffered permanent paraplegia a median of 4 years previously were studied. Eight also had varying degrees of neurological deficit of the upper extremities. Bone mineral, biochemical and hormonal values were compared to those in an age-matched control group in order to detect evidence of systemic osteopenia. There were very considerable individual variations in bone mineral density (BMD) deficits among patients compared to controls, probably partly due to methodological problems. Significant BMD deficits were found in the metaphysis (45%) and diaphysis (26%) of the tibia, while the deficit of the distal forearm was barely significant for the group as a whole. There was a negative correlation between time since injury and degree of BMD deficit in the lower extremity. Those with neurological affection of the upper extremities had a greater BMD deficit of their arms than those with neurologically intact arms. It was concluded that osteopenia in paraplegics is largely confined to the paralysed extremities, and thus not systemic. Serum alanine aminotransferase, phosphate, follicle stimulating hormone, and free androgen index (testosterone/sex hormone binding globulin) were mainly within normal limits, but significantly higher in paraplegics than in controls. Osteopenia in these patients is thus not due to gonadal dysfunction.

Adolescent↗
PubMed1996

Quasi-static analysis of muscle forces in the shoulder mechanism during wheelchair propulsion.

During wheelchair propulsion the largest net joint moments and net joint powers are generated around the shoulder. The analysis of the contribution of arm- and shoulder muscles to the joint moments could explain the low efficiency of wheelchair propulsion. Basically, it is assumed that a large magnitude of muscle activity will be needed to stabilize the shoulder. In addition, the muscular requirements for the minimization of negative power are assumed to be of importance. For such an analysis an inverse dynamic model is required. To utilize an inverse dynamic model of the shoulder mechanism, the trajectories of the upper extremity bones are needed. Since at this stage, dynamic non-invasive measurement techniques of scapular motion are not available, the aim of this study was to record the three-dimensional position of the scapula in static situations with the help of a palpation technique. Positions of the trunk, shoulder girdle and upper extremity, and the surface EMG of ten muscles were recorded simultaneously with forces on the rim on a stationary wheelchair ergometer. Four healthy male subjects participated in the experiment. Five hand positions on the rim and five different load levels per hand position were measured for each subject. A previously developed musculoskeletal model of the shoulder mechanism (Van der Helm, 1994a, J. Biomechanics 27(5) 551-569) was used to calculate muscle forces in an inverse static simulation. The measured EMG and the calculated muscle forces compared well except for three muscles. The moment balance between external sources and muscles around each joint axis of the shoulder mechanism is discussed. Results of the experiment indicate that large muscle contributions are needed for joint stabilization. The experimental results on the scapular motions will, in combination with experimental data collected under dynamic conditions, be used for application of the model to dynamic situations. It is concluded that the musculoskeletal model of the shoulder mechanism can be very useful in studies to determine the contribution of muscles and the mechanical load on morphological structures.

Adult↗
PubMedDate not supplied

Metacarpal bone mass and upper-extremity strength in 18-year-old boys.

The relation between bone mass and upper-extremity strength in 106 18-year-old boys was investigated. Bone mass was measured radiogrammetrically at the second metacarpal bone, and upper-extremity strength was measured by three power ability tests: vertical jump height, arm pull strength, and bent arm hang time. A significant correlation between arm pull strength and cortical thickness and cortical area was found. There was also a significant correlation between body weight, bone mass, and power tests. After partial correlation study, leaving out weight, a significant correlation between bone mass indices and arm pull strength remained. The larger bone mass in the above-average-fit boy is due to a larger periosteal diameter and smaller endosteal diameter. This study suggests that static strength is one of the determinants of bone gain before maturity.

Adolescent↗
PubMed2005

Upper-extremity phocomelia reexamined: a longitudinal dysplasia.

BACKGROUND: In contrast to longitudinal deficiencies, phocomelia is considered a transverse, intercalated segmental dysplasia. Most patients demonstrate severe, but not otherwise classifiable, upper-extremity deformities, which usually cannot be placed into one of three previously described phocomelia groups. Additionally, these phocomelic extremities do not demonstrate true segmental deficits; the limb is also abnormal proximal and distal to the segmental defect. The purpose of this investigation was to present evidence that upper-extremity abnormalities in patients previously diagnosed as having phocomelia in fact represent a proximal continuum of radial or ulnar longitudinal dysplasia. METHODS: The charts and radiographs of forty-one patients (sixty extremities) diagnosed as having upper-extremity phocomelia were reviewed retrospectively. On the basis of the findings on the radiographs, the disorders were categorized into three groups: (1) proximal radial longitudinal dysplasia, which was characterized by an absent proximal part of the humerus, a nearly normal distal part of the humerus, a completely absent radius, and a radial-sided hand dysplasia; (2) proximal ulnar longitudinal dysplasia, characterized by a short one-bone upper extremity that bifurcated distally and by severe hand abnormalities compatible with ulnar dysplasia; and (3) severe combined dysplasia, with type A characterized by an absence of the forearm segment (i.e., the radius and ulna) and type B characterized by absence of the arm and forearm (i.e., the hand attached to the thorax). RESULTS: Twenty-nine limbs in sixteen patients could be classified as having proximal radial longitudinal dysplasia. Systemic medical conditions such as thrombocytopenia-absent radius syndrome were common in those patients, but additional musculoskeletal conditions were rare. Twenty limbs in seventeen patients could be classified as having proximal ulnar longitudinal dysplasia. Associated musculoskeletal abnormalities, such as proximal femoral focal deficiency, were common in those patients. Eleven limbs in ten patients were identified as having severe combined dysplasia, which was type A in seven of them and type B in four. Four patients with severe combined dysplasia had congenital cardiac anomalies, and four had associated musculoskeletal abnormalities. Three of the four patients with the type-B disorder had a contralateral ulnar longitudinal dysplasia. CONCLUSIONS: We propose that cases previously classified as upper-extremity phocomelia represent a spectrum of severe longitudinal dysplasia, as none of the sixty extremities that we studied demonstrated a true intercalary deficiency. These findings have both developmental and genetic implications.

Child↗
PubMed1989

Long-bone growth in fetuses with Down syndrome.

Short stature is a well-recognized component of Down syndrome. The femur lengths of affected fetuses have been observed to be shorter than normal, with a ratio of actual to expected femur length of less than 0.91 indicating a high risk of trisomy. To further evaluate this finding we have determined the relationship between limb lengths and gestational age in 37 postmortem fetal specimens with trisomy 21. Control values were obtained from 174 normal fetuses. Measurements of the femur, tibia, fibula, humerus, radius, and ulna were made from roentgenograms or by direct measurement of the bone. Most measurements for each bone of the affected fetuses fell below the normal regression line for that bone, but only 3/37 femurs, 4/32 tibias, 5/32 fibulas, 9/32 humeri, 10/32 radii, and 7/32 ulnas fell more than 2 SDs below the mean. The ratios of actual to expected femur lengths were computed and six fetuses with Down syndrome (16.2%) had ratios less than 0.91. The bones of the extremities of fetuses with trisomy 21 are shorter than normal, but the differences are relatively small. The ratio of actual/expected femur lengths was a less efficient predictor of Down syndrome than were either maternal age or maternal serum alpha-fetoprotein tests. The upper extremity bones were shorter than normal more often than were the bones of the lower extremity, and this finding should be explored further in a prospective study.

Bone Development↗
PubMed1999

A Kinematic Model of the Upper Limb Based on the Visible Human Project (VHP) Image Dataset.

A kinematic model of the arm was developed using high-resolution medical images obtained from the National Library of Medicine's Visible Human Project (VHP) dataset. The model includes seven joints and uses thirteen degrees of freedom to describe the relative movements of seven upper-extremity bones: the clavicle, scapula, humerus, ulna, radius, carpal bones, and hand. Two holonomic constraints were used to model the articulation between the scapula and the thorax. The kinematic structure of each joint was based on anatomical descriptions reported in the literature. The three joints comprising the shoulder girdle - the sternoclavicular joint, the acromioclavicular joint, and the glenohumeral joint - were each modeled as a three degree-of-freedom, ideal, ball-and-socket joint. The articulations at the elbow and wrist - humeroulnar flexion-extension, radioulnar pronation-supination, radiocarpal flexion-extension, and radiocarpal radial-ulnar deviation - were each modeled as a single degree-of-freedom, ideal, hinge joint. Locations of the joint centers and joint axes were derived by graphically inspecting the three-dimensional surfaces of the reconstructed bones. The relative positions of the bones were defined by fixing a reference frame to each bone; the position and orientation of each reference frame were based on the positions of anatomical landmarks and on the shapes of the reconstructed bone surfaces. Tables are provided which specify the positions and orientations of the joint axes and the bone-fixed reference frames for the model arm.

Journal Article↗
PubMed2000

Severity of injuries due to accidental fall across the life span: a retrospective hospital-based study.

This retrospective study investigated injuries due to accidental fall across the life span for which 19,593 patients were admitted to the Emergency Unit of the Groningen University Hospital during the period 1990 through 1997. 64% of the accidental falls were found for those in the age range between 10 years and 59 years; however, the proportion of accidental falls with regard to other causes of injuries by age group were the highest in youngsters (infants up to 9 years old) and in elderly persons (over 60 years old), 43% or more of these patients having falls with injuries. The clinically treated patients had on the average a statistically greater Injury Severity Score (7.2) than the outpatients (2.4). The highest percentages of medically treated inpatients were the patients of 60 years and over. Their mean ISS score was about the same for elderly inpatients, but the percentage of clinical treatment increased with age as well as the mortality. 30% of the injuries were found in the lower extremities and 30% in the upper extremities. Bone fracture was statistically significantly the major (36%) injury followed by contusion (20%). 34% of the accidental falls occurred at home, and statistically significantly more females, 50 years of age and older, were injured than males.

Accidental Falls↗
PubMed1988

Tissue reaction to implant corrosion in 38 internal fixation devices.

The corrosion characteristics, metallurgical properties, and clinical performance of 38 retrieved internal fixation devices were correlated with the tissue reaction to these devices. Metallurgical parameters included thin and heavy inclusion content, Rockwell hardness, and grain size. The excised fibrous tissue strip was directly overlying each plate at removal and sectioned between screw-hole sites. The material studied from the 38 plates consisted of 201 screw-hole junctions with associated tissue biopsy sites. Clinical histories were obtained on all 38 patients with hardware removal. The average age at the time of plate insertion was 35.6 years (range, 4 to 75 years). Insertion diagnoses included acute trauma (35 patients), joint dislocations (two patients), and fracture nonunion (one patient). The devices included seven upper extremity bone plates, 19 lower extremity bone plates, and 12 hip screw plates. The devices remained in situ an average of 20.4 months (range, 3 to 60 months). Routine asymptomatic removals were performed on 17 of the patients, while the remaining 21 patients were symptomatic at the time of removal. Included in the reasons for symptomatic removal were pain associated with the implant (eight patients), nonunion (four patients), bursae prominence (three patients), and implant breakage (two patients). Significant correlations were found between average tissue reaction scores and average crevice corrosion scores; a trend of increasing average tissue reaction scores with increasing average screw surface corrosion scores also was observed for the 38 devices, although this relationship was not significant. Average crevice corrosion scores and average screw surface corrosion scores were highly correlated for all removals, and for the asymptomatic and symptomatic removal groups. The metallurgical parameters of thin inclusion content and heavy inclusion content also were significantly correlated for all removals, as well as for symptomatic removals. Similarly, significant correlations were found between the individual tissue reaction scores and crevice corrosion scores from the 201 individual sites, again for all devices and for the asymptomatic and symptomatic removal groups. Tissue reaction scores and time in situ showed significant correlation, with tissue reaction decreasing over time. Crevice corrosion and screw surface corrosion scores were not significantly related to time in situ. The results of this study indicate that there is considerable tissue reaction to the corrosion products of this material.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1992

Vascularized bone grafts to the upper extremity. Indications and technique.

Massive autogenous bone grafts with an intact vascular pedicle decrease the time to bony union and immobilization required for treatment of segmental bony defects. These techniques have been shown to be effective in treatment of segmental defects of more than 6 cm after trauma or tumor resection in relatively avascular beds. Additionally, in the upper extremity, the free vascularized bone graft is in the developmental phase for employment in the reconstruction of epiphyseal arrest and congenital radial club hand. There are disadvantages to free vascularized bone transfers compared with conventional techniques. For example, a free vascularized fibular transfer requires a team skilled in microvascular technique, a long operative time (6 to 10 hours), and the sacrifice of a major vessel to the lower extremity. If the anastomosis fails, however, the free vascularized fibula will act as a conventional bone graft, thereby minimizing adverse effects. We think that by proper patient selection, appropriate evaluation and preparation of the bony defect, meticulous microvascular anastomosis, and correct fixation and immobilization of the graft a good outcome can be achieved in those patients with large bony defects that defy the use of conventional methods.

Adolescent↗
PubMed1985

Free vascularised bone grafts in reconstruction of the upper extremity.

Free vascularised bone grafting was performed on six patients with large segmental bone defects following trauma, osteo-cutaneous defects and large bony defects following tumour resection. A free vascularised fibular graft was performed in five patients and a free iliac osteo-cutaneous flap was performed in one patient. In all patients, bony fusion was achieved by two to three months, without infection or recurrence of bone tumour. The donor site deficit was minimal.

Adult↗
PubMed1998

Vascularized bone grafts to the upper extremities.

From 1979 to 1995 in our clinic, vascularized bone grafting was performed in 29 patients with large bone defects, established nonunion, congenital pseudoarthrosis, or avascular necrosis in the upper extremity. Four patients had traumatic bone defects, six had posttraumatic nonunions, two had congenital pseudoarthroses, five had amputations, nine had defects following tumor resection, and three had other lesions. Reconstructed sites were the humerus in 7 patients, the radius in 12, the ulna in 2, both radius and ulna in 1, and the metacarpal and phalangeal bones in 7. Donor bones were fibula in 19 cases, radius in 6, scapula in 2, and medial condyle of the femur in 2. Postoperative circulatory disturbances and venous thrombosis resulted in revision surgery in two patients. Thrombectomy and reanastomosis to other veins were performed, and these flaps took successfully. No patients required additional bone grafts. The mean period required to obtain radiographic bone union was 4 months (fibula, 4.5 months; scapula, 3.5 months; radius, 2.6 months; medial condyle of the femur, 4 months). Vascularized fibula graft is indicated in patients with large bone defects in the humerus, radius, and/or ulna. The scapula is easy to transfer to the proximal humerus on its pedicle. This donor is indicated in young women because operative scars can be hidden. The radius is usually harvested with skin, and its use is indicated in patients with bone loss in the hand including thumb amputations. Thin corticoperiosteal graft from the femur is indicated in patients with established nonunion of the humerus and radius without significant bony defects.

Adolescent↗
PubMedDate not supplied

[Age-related changes in large joints and long tubular bones of the upper extremity in children (echographic data)].

Two hundred and ten children at the age of 17 days up to 15 years have been examined. Echocameras, working in the grey scale regime have been used. At examination of the arm, forearm, brachial, elbow and radiocarpal joints in the children the most informative are longitudinal echographic approaches. At examination of the brachial bone head in the children older than 10 years only the anterior longitudinal approach is informative. To perform the echographic investigation of various elements of the locomotor apparatus of the upper extremities in children older than 9-10 years is difficult. The echographic reveal of additional nuclei of ossification and synostosis stages of the long tubular bones of the upper extremities in children often coincide in time with roentgenological data.

Adolescent↗