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PubMed1999

Osseointegration around titanium screws placed into the areas between guided bone augmented sites compared with osseointegration around guided bone graft augmented sites in rabbit tibia.

The aim of this study was to compare the degree of osseointegration around titanium screws placed into the areas between guided bone augmented sites and guided bone graft augmented sites in 8 Japanese white rabbit tibia. The skin and periosteum were incised and lifted to expose the inner surfaces of both tibia. Eight rabbits were divided into 2 groups: 1) a guided bone augmentation (GBA) group of 2 rabbits, and 2) a guided bone graft augmentation (GBCA) group of 6 rabbits. In the GBA group, the bone marrow was penetrated several times in both tibial bones. Three titanium screws were inserted into the bone so that the top of each screw was 3 mm above the bone surface and covered with an expanded polytetrafluoroethylene membrane (ePTFE). In the GBGA group autogenous cortical bone (10 mm x 10 mm x 1 mm) was taken from the left tibia and grafted on the inner surface of the right tibial bone, titanium screws being similarly inserted. The surgical site was covered by ePTFE. After healing for 2 months, the animals were euthanatized, and the experimental area was prepared for histological investigation. New bone had formed on the surgical sites in the GBA group and grafted bone had survived in the GBGA group, with no sign of infection or membrane exposure. The degree of osseointegration around the screw was 67.6 +/- 11.2% (mean +/- SD) in the GBA group and 78.8 +/- 11.9% in the GBGA group. There was no significant difference between the groups (p = 0.29). The ratio of mineralized bone to bone marrow was 45.7 +/- 6.2% in the GBA group and 64.4 +/- 4.4% in the GBGA group. There was a significant difference between the groups (p < 0.05). Although there was no significant difference for osseointegration around the screw placed into the GBA and GBGA sites, the quality of newly generated bone or grafted bone was quite different. Therefore, we suggest that predictable bone augmentation beyond the bone surface can be achieved by either the GBA or the GBGA procedure with ePTFE. However, it was difficult to conclude which procedure was superior with respect to the osseointegration around the titanium screw.

Animals↗

PubMed2003

Use of the proximal portion of the tibia for measurement of the tibial plateau angle in dogs.

OBJECTIVE: To determine whether the canine tibial plateau angle (TPA) can be accurately measured from lateral radiographic views of the stifle joint that include only the proximal portion of the tibia. SAMPLE POPULATION: 282 lateral radiographic views of the stifle joint from 128 dogs. PROCEDURE: 236 radiographs were obtained from 102 dogs with no stifle joint disease, and 46 were obtained from 26 dogs with cranial cruciate ligament rupture. Radiographs were digitized. Tibial plateau angles were determined by measuring the angle between the intersection of the tibial plateau slope line and perpendiculars to 4 tibial axes. The gold standard TPA was based on a reference axis that used the entire length of the tibia and was determined by the line connecting the midpoint of the tibial intercondylar eminence and the center of the talus. Tibial plateau angle1, TPA2, and TPA3 were based on tibial axes that were determined by use of only the proximal portion of the tibia. RESULTS: TPA determined on the basis of the shortest proximal reference axis (TPA1) was not accurate. However, as the length of the reference axis increased, reliability of the TPAs obtained from proximal reference axes improved, and their correlations with the gold standard TPA increased (r = 0.78, 0.86, and 0.92 for TPA1, TPA2, and TPA3, respectively). Equations obtained by regression analysis allowed estimation of the gold standard TPA with some degree of accuracy. CONCLUSIONS AND CLINICAL RELEVANCE: Use of a proximal reference axis to calculate TPA may be an alternative to a calculation based on the full-length axis.

Animals↗

PubMed1985

Muscle transposition for treatment of osteomyelitis of the tibia.

A series of 24 consecutive patients with osteomyelitis of the tibia and soft tissue defects were treated according to the principle of radical excision of the infected bone together with transposition of muscle flaps and primary skin cover as a one-stage procedure. External fixation was used for stabilization of bone. The mean duration of osteomyelitis before radical operation was 72 weeks and the previous stay in hospital averaged 15 weeks. Twenty-one patients had previously undergone 3.7 operations because of the infection. Staphylococcus aureus was cultured in 50% of the patients, while no bacteria could be identified in six patients. Appropriate antibiotics were given for an average of eight weeks. In four patients a secondary bone transplant and in three patients another skin transplant was necessary. One patient refusing further reconstructive surgery insisted on an above-knee amputation because of persisting infection. After an average observation time of 2 1/2 years no infection or instability of the tibia could be demonstrated, but one patient showed two small skin defects. These results indicate that radical excision of infected bone in combination with muscle transposition and primary skin cover is effective in the treatment of posttraumatic osteomyelitis of the tibia.

Adolescent↗

PubMed2000

Evaluation of LR white resin for histology of the undecalcified rat tibia.

Histology of plastic embedded undecalcified bone represents a challenging problem to the histotechnologist. We outline here an exploration of LR White resin as a suitable medium for histologic study of undecalcified rat tibia. A procedure was developed for light microscopy of rat tibia embedded in LR White and sectioned by sawing-grinding technics. The specimens were fixed in 10% neutral buffered formalin or alcohol-acetic acid-formol, dehydrated in ethanol, defatted in chloroform followed by resin infiltration and heat-curing of embedded blocks. The procedure of dehydration, defatting, infiltration, and polymerization can be completed within 10 days. Cold curing with accelerator provided by the manufacturer did not yield superior results compared to blocks cured with heat. Thick sections were obtained using a diamond wire saw, attached to plexiform slides, then ground and polished. Surface staining with Von Kossa silver reagent or toluidine blue revealed satisfactory morphological preservation of the mineralized bone sections. Artifacts like small bubbles appeared occasionally and could not be avoided despite prolonged infiltration or cold curing of blocks. Our method is relatively simple for base-line histologic study of rat tibia. The method offers advantages such as easy adaptability, reliable stainability, contrast, and resolution of bone architecture and marrow cells. Two other embedding media, Micro-Bed resin and Unicryl, were also tested, but produced inferior results.

Acrylic Resins↗

PubMed1983

Hahn's operation for pseudarthrosis after osteomyelitis of the tibia in children. A report of three cases.

Three children with pseudarthrosis of the tibia after osteomyelitis and extensive sequestration of the diaphysis were operated according to Hahn with transfer of the fibula to the proximal part of the tibia at ages 2-9 years. Because of damage to the distal growth plate, secondary to the infectious process, epiphyseodesis of the proximal ends of the tibia and fibula on the unaffected side was necessary to reduce the length discrepancy. Restored continuity of the tibial diaphysis resulted in restored longitudinal growth proximally and in increased diaphyseal width. In all three cases the operation resulted in good weight-bearing limbs with only slight residual disability at adult age. Hahn's original method is simpler and in children may result in a limb which is closer to normal than the modifications of his method.

Child↗

PubMed1987

Mineral content of upper tibia assessed by dual photon densitometry.

Bone mineral content (BMC, g/cm) and bone mineral density (BMD, g/cm2) of the proximal tibia were determined by dual photon absorptiometry (DPA). Measurements just distal to the subchondral plates of the tibia condyles, where the bone structure is predominantly trabecular, proved to give the most consistent results. The precision of BMC measurements in this region, expressed as the coefficient of variation, was 1.1 per cent and of BMD measurements 2.5 per cent. In a cross-sectional study on 63 normal women and men, BMC and BMD showed a decrease with age at a rate of about 8 and 9 per cent per decade, respectively, in women, but not in men. In normal women, BMC of proximal tibia was correlated with BMC of lumbar spine, femoral neck, and femoral shaft, as well as with body weight and height. DPA may be useful in the study of bone reactions, such as in patients undergoing arthroplasty of the knee.

Adolescent↗

PubMed1994

Kotz modular femur and tibia replacement. 28 tumor cases followed for 3 (1-8) years.

In the period 1984-1991, 33 lower limb reconstructions were performed with an uncemented Kotz modular femur tibia reconstruction (KMFTR) prosthesis after resection of 32 malignant bone tumors and 1 benign giant cell tumors. Tumor localization was proximal femur in 12, distal femur in 17, and proximal tibia in 4. The mean age of the patients was 38 years. 28 patients with a minimum follow-up of 1 year were studied after 3 (1-8) years. 7 patients were reoperated because of complications. Good or excellent results were obtained in 6 of the 10 proximal and 13 of the 14 distal femur reconstructions. In 2 of the 4 patients undergoing combined distal femur and proximal tibia resection, a deep infection developed, and above-knee amputation was performed. One local recurrence occurred after proximal femur resection.

Adolescent↗

PubMed1996

Adamantinoma of tibia with predominant features of fibrous dysplasia--a case report.

We report a case of adamantinoma of the tibia resembling fibrous dysplasia. The patient was a 55-year-old male, and complained of pain in the right lower leg. Roentgenographs showed a well demarcated osteolytic lesion with small foci of calcification and septation within the diaphysis of the distal tibia. The cortex was partially disrupted. Histologically, initial biopsy specimen showed fibrous connective tissue and trabeculae of immature woven bone, strongly suggestive of fibrous dysplasia. The lesion recurred and the second biopsy revealed nests of spindle cells and tubular epithelial structures embedded in granulation type-fibrous tissue. Immunohistochemically, both the nests of spindle cells and the tubular structures gave a positive reaction for cytokeratin. The present case emphasizes once again that histological diagnosis of fibrous dysplasia of the tibia should be made carefully with exclusion of the possibility of adamantinoma.

Ameloblastoma↗

PubMed1975

Status of the digestive system and tibiae of cropectomized hens at night.

Experiments were conducted to determine the effect of cropectomy on the total amount and calcium content of ingesta in the digestive tract of the laying hen at night, as well as to determine if any abnormal physiological changes had occurred in the cropectomized hens. Treatments were cropectomized, sham operated and unoperated control hens. The gizzards from cropectomized hens contained about twice as much feed at 7:30 p.m. as that of the controls. The gizzard weight, without contents, was also significantly heavier in cropectomized hens than that of the controls. At 7:30 p.m. total contents of the digestive system of cropectomized and control hens were 15.94 gm. versus 24.07 gm., respectively. The control birds also had 2.71 times more total calcium in the digestive system at 7:30 p.m. than the cropectomized birds. The contents of the small intestine of cropectomized birds had 17% more calcium at 7:30 p.m. than did that of the controls. However, by 5:30 a.m. the contents of the small intestine of the control birds had 3.17 times more calcium than did that of the cropectomized birds. No differences were found between treatments or between time periods in relation to tibia breaking strength, calcium content of tibia or percent tibia ash. The degree of dietary calcium deficiency at night appears to be greater with cropectomized hens, even though the gizzard compensates, in part, for the loss in storage capacity of the crop. It is hypothesized from these data that the crop is an important and necessary organ in the laying hen for supplying nutrients throughout the night when the hen is not consuming feed.

Animal Feed↗

PubMed1986

A modular femur-tibia reconstruction system.

A 26 piece modular system for the reconstruction of the bones of the lower extremity from the femoral head to the distal third of the tibia is described. This modular system can be implanted without cement and allows for the intraoperative determination of the amount of resection necessary. The implant material is the well-known cast, Co-Cr-Mo alloy Vitallium. From 1982 to the end of 1985, 52 patients were treated with this cementless tumor endoprosthesis of the Kotz Modular Femur-Tibia Reconstruction System (KMFTR) at the University of Vienna, Department of Orthopedics. The locations of the tumors were: proximal femur (28), distal femur (17), and proximal tibia (7). In two cases a total femur was implanted and in another patient a total knee. Indications for the resection of the bone segments and joints concerned included primary bone tumors, metastases, and loosening of conventional endoprostheses and tumor resection endoprostheses. Twenty-one patients with an average follow up of 20.4 months and a minimum follow up of 1 year were evaluated according to Enneking's criteria. Eight patients had proximal femoral replacement. The results were excellent in two, good in five, and fair in one. Eleven patients had undergone replacement surgery in the knee joint area. The overall rating showed five excellent results, four good and two fair. One patient with a total femoral replacement had multiple bone metastases with polytopic pain and was no longer available for regular assessment. Another patient with a total knee replacement suffered a rupture of the patellar ligament after 10 months and had to be revised. Radiologically we have observed excellent bone incorporation of the prosthesis in 15 of 25 evaluated patients. Ten cases showed no changes in radiologic features as compared to the initial findings. These were patients with short follow up periods. Although complications did occur in these major surgical interventions, the final results were very satisfactory and the patients were subjectively content with the operation.

Adolescent↗

PubMed1993

Use of a modified Quengel hinge to prevent posterior displacement of the tibia during treatment of PCL injury.

During treatment of posterior cruciate ligament (PCL) injuries, posterior displacement of the tibia may occur inside the cast due to the effect of gravity on the lower leg. To prevent this problem the authors attempted to apply the original Quengel cast, first described by Mommsen in 1922 and perfected by Jordan, to correct the flexion contracture of the knee in hemophiliacs. However, the authors found that the cast was not effective in preventing the posterior displacement of the tibia during management of PCL injuries. They modified the design of the original Quengel hinge to obtain a more effective anterior traction on the tibia parallel to the knee joint line. Of the 32 patients who used the modified Quengel brace, 15 who could be followed had less than a 3 mm difference between the injured and uninjured knee 3 months postoperatively.

Adolescent↗

PubMedDate not supplied

Effect of diabetes mellitus on the material properties of the distal tibia.

This investigation evaluates the effects of diabetes on the mechanical properties of human bone, specifically, the tibia. Seven diabetic and seven nondiabetic human (male) cadaveric distal tibiae were used in this study. The average age of the diabetic cadaveric samples was 51 years (range, 46-61 years), and the average age of the nondiabetic cadaveric samples was 75 years (range, 67-85 years). Three-point bending tests for strength and stiffness were performed on a small sample of each distal tibia. Each specimen was loaded at a constant rate until failure. From the recorded curve of load versus displacement, the ultimate and yield strength of bone and the bending modulus of bone were calculated. The diabetic samples were generally weaker than the older, nondiabetic samples, but no statistically significant differences were found in the elastic modulus (P = .29), yield strength (P = .90), ultimate strength (P = .46), and fracture toughness (P = .78), leading to speculation that diabetes has an effect similar to that of aging on the musculoskeletal system.

Aged↗

PubMed2002

[Juxtacortical osteosarcoma of tibia from a medieval cemetery of Budapest].

Juxtacortical osteosarcoma occurred on the right tibia and fibula of a 20-22 years old man found in a medieval period cemetery of Budapest. MACROSCOPIC DESCRIPTION: The tumor is located circumferentially on the midshaft of the tibia and fibula and appears cone-shaped. The lesion measured 160 mm in length and 3-5 mm in height. The surface of the tumor is irregular, rough, in some areas shows spicules. These spicules averaged 2-4 mm in length and 1-2 mm in diameter. The anterior and medial surface of the tibia is completely covered by osseous tumor. RADIOGRAPHY: The X-ray study demonstrates the medullary involvement, with mixed osteolytic and osteoblastic areas. Tumor infiltration of the cortex is also apparent as irregular rarefication and lytic lesions. In some areas a "sunburst" picture could be seen. The X-ray picture is characteristic for juxtacortical osteosarcoma. MICROSCOPIC EXAMINATION: stereomicroscopy of specimens shows a sponge-like structure of the surface. The cortical bone is completely destroyed and deep cavities are seen between spiculous and gyrificated neoplastic bone. The spiculae are varied in length and thickness. Irregular bulky bone trabeculae demonstrating uncontrolled neoplastic reaction could be detected. By light microscopic examination severe destruction, osteolytic lesions are seen both in the cortical bone and in the cancellous bone in the peripheral parts of the tumors. Within the neoplastic bone only few remnants of the primary (normal) bone structure could be demonstrated. No reparative reactions were seen next to the osteolysis, the collagen fibers and lamellas are destroyed. Beside the destruction of original bone larger structures composed of irregular newly built nepotistic bone trabeculae can be detected. The newly formed trabeculae (spiculae) contain a tumorous ground substance (probably osteoid tissue) with few collagen fibers, and these areas are covered with a thin bony lamella. In some areas the neoplastic structures are in intimate contact with the original cancellous bone remnants. IMMUNOHISTOCHEMISTRY: Both the osteosarcoma and chondrosarcoma show osteoid and bone neoformation while in the chondrosarcoma type II collagen could also detected. By immunohistochemical reactions no type II and III collagen, only type I collagen reaction was positive. This means that no cartilaginous tissues were present in the tumor. Scanning electron microscopy of these specimens shows sponge-like structures. The tumor reveals irregular trabecular and spicular texture,the spicules are various in diameter and in some spiculae rounded deposits attached to the surface. In our case we found typical radiological and histological picture of the juxtacortical osteosarcoma.

Bone Neoplasms↗

PubMed1998

[Congenital posterior and posteromedial bowing of the tibia and fibula].

Five children with congenital posteromedial bowing of the tibia and fibula and 1 child with posterior bowing of the tibia and fibula have been followed-up. At the final examination age of the patients ranged from 6 months of 16 years (mean 69 months). In most of the cases the angulation had a tendency to decrease, shortening of the tibia remained constant. Pseudoarthrosis appeared in one of the children in 4th month of life at distal tibial diaphysis/metaphysis junction but healed spontaneously in 13 months time.

Abnormalities, Multiple↗

PubMed1976

Variations in the relationship between the diaphysis and the epiphyses of the tibia.

In all 56 tibiae from Lapps and 56 tibiae from Norwegians have been studied. These ethnic groups represent different weight bearing situations. Variables expressing adaptation to non-axial loading are dealt with. The bone is mainly studied in the AP and the ML planes, as well as in the three dimensional space. The material is analyzed statistically. The distribution form is examined and the deviations from normality are found to be moderate. Mainly positive skewness occurs. Platykurtosis is found as often as leptokurtosis. The deviations from a standard normal distribution are not supposed to affect the results significantly. There is a non-systematic pattern of distribution. The variability is generally lower in Lapps than in Norwegians. The standard deviation shows highest numerical values in indices, lowest in linear variables. Systematic group differences, especially in similar variables, are supposed to be of greater importance than isolated differences. The variables giving deviations from the reference planes or the diaphyseal axis, show the largest and the consistent left-right differences. In linear variables Lapps and females show lower mean values than males and Norwegians, respecitvely. In linear variables giving deviations from the reference planes, in angular variables and in indices, Lapps usually show the highest mean values. Lapps tend to show larger sex differences in variables giving deviations from the reference planes or the diaphyseal axis. However, the sex differences within the Lapps are small. The variations of the tibia are supposed to be the results of mechanical factors in bone remodelling. The epiphyseal-metaphyseal parts tend to have a constant shape, the adaptations to non-axial loading predominantly appearing in the diaphysis. The relation between the weight bearing line and the diaphyseal axis is discussed, particularly regarding the ML stability mechanism of the knee joint. The occurrence of torsion and its influence upon the AP and ML projected values regarding the relationship between the epiphyses and the diaphysis are discussed.

Biometry↗

PubMed1999

Comparison of autogenous cancellous bone grafts obtained from the sternum and proximal portion of the tibia of llamas.

OBJECTIVE: To describe the anatomy of the sternum in llamas, define the surgical approach to the sternum for collection of cancellous bone graft tissue, and compare the histologic appearance of graft tissue obtained from the sternum with that obtained from the proximal portion of the tibia. DESIGN: Prospective study. ANIMALS: 12 llamas, 3 to 19 years old, that had been submitted for necropsy. PROCEDURE: Radiographs were taken of the sternum and left tibia of the llamas. Measurements of the sternum were determined from the radiographs and adjusted for magnification. Sternebrae volumes were estimated from these measurements. Anatomic dissections to the center of the fourth sternebra and the proximal portion of the tibia were made, and a surgical approach to the sternum was developed. Cancellous graft tissue was obtained from each site and submitted for histologic evaluation. RESULTS: Sternebrae 3, 4, and 5 were significantly larger in volume than the other sternebrae. The ventral aspect of the fourth sternebra was readily accessed for removal of graft tissue by making a 6-cm-long ventral midline incision centered 17 cm craniad to the xipnoid. Mean soft tissue thickness overlying the ventral aspect of the fourth sternebra was 3.1 cm. More tissue was obtained from the sternal (mean, 9.11 g) than from the tibial (mean, 5.16 g) sites. Sternal graft tissue consisted of trabecular bone spicules with predominantly hematopoietic marrow, whereas tibial tissue consisted of trabecular bone spicules with only fatty marrow. CONCLUSIONS AND CLINICAL RELEVANCE: The fourth sternebra in llamas is readily accessible for obtaining autogenous cancellous bone graft tissue that consists of predominantly hematopoietic marrow.

Animals↗

PubMed1999

Paget's disease of the tibia.

Paget's disease of the bone is perceived to be rare in Asia. We report the first documented case of Paget's disease of the bones in Taiwan. A 66-year-old native Taiwanese woman was admitted to hospital with a 10-year history of pain and a bowing deformity of her left leg. Laboratory data disclosed elevated serum calcium and alkaline phosphatase levels, but no leukocytosis. A plain X-ray film of the left leg showed a curved tibia with thickening of the tibial cortex, while a technetium 99m bone scan revealed abnormal uptake in the left tibia. Elevated serum levels of bone-specific alkaline phosphatase and urinary collagen N-telopeptide were also noted. Histologic examination of a biopsy specimen of the left tibia lesion confirmed the diagnosis of Paget's disease in the bone. The patient received treatment with sodium chlodronate, and the symptoms improved rapidly. Laboratory data then revealed decreased levels of serum calcium, bone-specific alkaline phosphatase, and urinary collagen N-telopeptide after treatment.

Aged↗

PubMed1997

[Drilling decompression of the proximal tibia for osteoarthritis of the knee].

OBJECTIVE: To investigate the effect of drilling decompression of the proximal tibia for the Osteoarthritis of the Knee. METHOD: The drilling decompression of the proximal tibia were performed in 21 patients (38 knees) of osteoarthritis with 99mTc-MDP scintingraphy and the intraosseous phlebography made pre-postoperatively. Knee function scores and scales were evaluated. RESULT: During 6-12 months follow-up, the preoperative score of the knee function was 18-48 (average 30.78) and the postoperative score was 61-96 (average 87.95); the rates of fair and good of knee scales rose from 5% preoperatively to 86.84% postoperatively. CONCLUSION: Drilling decompression of the proximal tibia is a simple, safe, less traumatic and effective method to relieve the pain and improve the function for the early osteroarthritis of knee, For late cases it is a method to relieve pain. 99mTc-MDP scintingraphy can be used as a method to diagnose the early stage of the osteoarthritis.

Adult↗