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PubMed1996

Synovial effusions at the knee as the inaugural manifestation of stress fracture of the proximal tibia.

Eight patients with an age ranging from 72 to 83 years, seen in an outpatient clinic over a one-year period for stress fractures of the proximal tibia responsible for acute knee pain and effusion were studied retrospectively. Plain roentgenograms were often normal at presentation but subsequently showed sclerosis of the proximal tibia. Radionuclide bone scanning was the most useful investigation for early diagnosis. Potential risk factors were advanced: age, genu varum or valgum, overweight and vitamin D deficiency. Stress fracture of the proximal tibia should be considered in elderly patients with knee pain, effusion and normal roentgenograms. Elimination of weight-bearing ensures healing of the fracture.

Aged↗

PubMedDate not supplied

Isolated fractures of the tibia with intact fibula in children: a review of 95 patients.

Isolated tibial fractures with an intact fibula are the most common tibial fracture pattern in children. When displaced, this fracture can be difficult to reduce and retain in the position because of the splinting of the intact fibula. A 4-year review of 95 children with fracture of the tibia with an intact fibula was performed at the Children's Hospital of Eastern Ontario. Eighty-one percent of the fractures were caused by an indirect rotational twisting force. Seventy-three percent of fractures were localized at the distal third of the tibial shaft. Varus angulation deformity occurred most commonly when the fracture line started distally on the anteromedial side of the tibia and progressed in an oblique or spiral manner to the proximal posterolateral aspect of the tibia. This was postulated to be caused by the posterior flexor muscle forces being more concentrated medially, whereas laterally, the intact fibula acts like a splint, thus producing a bending moment resulting in varus angulation. Close follow-up and monitoring of the isolated tibial fractures with weekly radiographs for the first 3 weeks is recommended.

Accidents↗

PubMedDate not supplied

Management of gap non-union of tibia by tibialisation of ipsilateral vascular fibula.

Gap non-union of tibia following traumatic bone loss or infection dramatically emphasizes the limitation of conventional reconstructive techniques. With presence of significant skin loss or poorly vascularised recepient bed, complications and failure rate increase and solution often lies in amputation. Vascularised ipsilateral fibular grafting offers a viable alternative to this. This is a series of 16 cases of gap non-union of tibia treated by tibialisation of fibula at KEM Hospital, Bombay. All the cases were secondary to osteomyelitis following compound fracture of tibia-fibula or hematogenous osteomyelitis with a large sequestrum. 15 cases had good results with good hypertrophy of bone after union. One case had poor result with fracture going into delayed union with no hypertrophy. We discuss the technique, complications and results of this procedure.

Adolescent↗

PubMed1998

Fracture of the proximal tibia after anterior cruciate ligament reconstruction: a case report.

A case of fracture of the proximal tibia at the site of graft harvest for an anterior cruciate ligament reconstruction is reported. This fracture, at the distal edge of the harvest site on the tibial tubercle, was the result of stress concentration at this location. The patient's tibia fracture was treated with a long leg cast and healed without complication. Fracture of the patella at the graft harvest site has been reported as a complication of anterior cruciate ligament reconstruction. This is the first report of a fracture of the tibia at the site of graft harvest.

Adult↗

PubMed1996

Ectrodactyly and absence (hypoplasia) of the tibia: are there dominant and recessive types?

We present a kindred of brother, sister, and cousin with ectrodactyly and hypoplasia of the tibia. The parents of the cousin are consanguineous; the parents of the sibs originate from the same small Algerian village. We also report on a boy with tibial defect and split hands and feet with consanguineous parents. These observations are further hints for an autosomal recessive type of ectrodactyly with aplasia (hypoplasia) of the tibia, as was favoured by some authors. However, review of the present and reported cases does not demonstrate any clinical differences between the seemingly recessive and the dominant types. Statistical analysis of 17 families with affected sibs and normal parents showed a 1:3.1 ratio of affected:unaffected by the proband method. Despite consanguinity among nine sets of parents, this ratio, and approximately 30 additionally reported families generally are in favour of autosomal dominance with reduced penetrance.

Algeria↗

PubMed1992

The influence of bone and marrow on cartilage hypertrophy and degradation during 30-day serum-free culture of the embryonic chick tibia.

In this study, an organ culture system is defined which demonstrates complete loss of cartilage matrix from embryonic chick tibiae. Efficient loss of the cartilage matrix occurs within 30 days of serum-free culture only when the intact tibiae containing bone, marrow, and cartilage tissue are cultured. During organ culture nonhypertrophic chondrocytes become hypertrophic and stain positively for type X collagen and alkaline phosphatase. The cartilage loses Safranin O staining, and finally all cartilage matrix disappears leaving the bony collar and marrow cells. If the tibial cartilage is separated from the bony collar and cultured alone in serum-free medium, the nonhypertrophic chondrocytes also hypertrophy; the matrix loses Safranin O staining; however, some components of the matrix including type X collagen still remain after 30 days. In the presence of serum, the chondrocytes will hypertrophy but cartilage degradation is not evident. The results of this study support the conclusions that 1) hypertrophy is inherently programmed in the chondrocyte and 2) while Safranin O staining of cartilage cultured alone is diminished in serum-free organ culture, the degradation of cartilage is complete only when bone and marrow are also present.

Alkaline Phosphatase↗

PubMed1990

Chondrodysplasia punctata, tibia-metacarpal (MT) type.

We describe 7 patients with a new form of chondrodysplasia punctata. Its principal clinical manifestations are flat midface and nose, short limbs, and otherwise normal development. Consistent radiologic manifestations in the newborn infant are discrete calcific stippling, coronal clefts of vertebral bodies, short tibiae, and shortness of the 2nd and 3rd metacarpal bones. Radiologic findings in the older child include shortness of tibiae and the 3rd and 4th metacarpals.

Abnormalities, Multiple↗

PubMed2003

Body height estimation based on tibia length in different stature groups.

Long bone length is one of the best-known indicators of human stature. Although the long bone length/height ratio differs in tall and short individuals, no detailed study has investigated whether specific formulae should be used to calculate height in different stature groups. This study proposes a new height estimation method. Body height and tibia length were measured in 121 male subjects aged 18.0-34.3 years. Three subgroups were established according to body height (short, medium, or tall), using the 15th and 85th percentiles as cutoff levels. The general formula and a group-specific regression formula were used to estimate height in each subgroup. A control group with the same properties as the study group was analyzed in the same manner. Particularly with "short" and "tall" subjects, the difference between true height and the height predicted by the group-specific formulae was smaller than the difference observed when the general formula was used. These discrepancies were statistically significant. When estimating height based on tibia length, the individual's general stature category should be taken into consideration, and group-specific formulae should be used for short and tall subjects.

Adolescent↗

PubMed1983

Cross-sectional geometry of Pecos Pueblo femora and tibiae--a biomechanical investigation: I. Method and general patterns of variation.

Variation in long bone cross-sectional geometry can be given a more precise functional interpretation using engineering beam theory. However, difficulties in measurement technique have generally prevented studies of large samples of cross sections in this way. In the present study, an automated system utilizing an electronic digitizer and computer software was used to analyze cross-sectional geometric properties of 11 femoral and tibial locations in 119 individuals from the Pecos Pueblo, New Mexico site. The data generated allow identification of clear differences in geometric properties between different regions of the femur and tibia. These differences appear to be related to specific in-vivo mechanical loadings of the lower limb bones, serving to reduce stress and strain under these loadings. The data are also used to investigate possible differences in loading of the femur and tibia in the Pecos and modern samples, and between humans and a nonhuman primate sample.

Animals↗

PubMed1984

Determination of sex from the tibia.

Determination of sex from the tibial shaft as well as the entire bone itself has not been generally investigated by osteologists . This paper is an attempt to fulfill this need. The purpose is to determine sex from both the complete tibia and the shaft at the nutrient foramen level. The sample was obtained from the Terry Collection and included 159 specimens of whites and blacks. The tibial length, and circumference, anteroposterior, and transverse measurements at the nutrient foramen level were analyzed by means of step-wise discriminant function analysis. It was found that the circumference alone could give, on the average, 80% accuracy in determining sex. The addition of other dimensions to the function increased the accuracy by about 4%. Comparisons of this study with those on the femur indicated that sexual dimorphism in the tibia was a result not only of the general growth and musculo-skeletal activity, but also of the genetic structure of the population, i.e., racial variation.

Adult↗

PubMed1991

Sex assessment using the proximal tibia.

The proximal end of the human tibia is sexually dimorphic. Tibial condyles from 100 individuals in the Hamann-Todd Collection were measured. Regression equations retrodicted known sex with 86-95% accuracy. A test sample of 20 individuals also from the Hamann-Todd Collection was classified with 85-100% accuracy. A sample of 20 prehistoric individuals provisionally sexed by using crania and innominate bones was classified with 85-100% agreement. Thus, the proximal tibia may be useful in determining the sex of a skeleton.

Female↗

PubMed1992

Estimating femur and tibia length from fragmentary bones: an evaluation of Steele's (1970) method using a prehistoric European sample.

Steele's (1970) regression method for estimating femur and tibia length from fragmentary bones is tested on a sample of complete femora (female N = 26; male N = 33) and tibiae (female N = 16; male N = 22) from a number of European Mesolithic and Neolithic sites. Over half of the regression equations given by Steele for predicting maximum length of the bone from the length(s) of one or more of its constituent segments are shown to produce inaccurate predictions in this test sample. However, a closer evaluation of these results, including calculation of regression equations for the test sample itself, reveals that this inaccuracy does not derive from any inherent flaw in Steele's method. Rather, it is shown that differential distribution of maximum bone length among the various bone segments as defined by Steele may occur due to variation in muscular activity pattern and intensity. This argues for the retention of Steele's basic method, with care being taken to match closely the activity pattern typical of the sample from which regression equations are derived with that of the population to which the equations are to be applied. The equations calculated in this study thus are provided for use where deemed appropriate.

Europe↗

PubMed1994

Fibrous tissue on the tibia plateau of the kangaroo. A theory on the pressure absorption of joint surfaces.

The central part of the articular surface on the tibia plateau of Macropus agilis consists of fibrous cartilage of soft consistency and the fiber arrangement is macroscopically visible. The peripheral portions of the plateau are covered by hyaline cartilage but do not communicate with the hyaline articular surfaces of the femur, as they are covered by the menisci. The fibrous cartilage covering of the tibia plateau is a compliant or readily deformed pad that could serve the function of deforming enough under high joint loads to allow surrounding regions of the articular cartilage to share in carrying those loads, thereby magnifying the articular contact surface and decreasing the magnitude of the peak unit loads in the region of the fibrous tissue pad. This pressure-absorbing mechanism represents the evolutionary response to the higher articular stress resulting from kangaroo locomotion.

Animals↗

PubMed2003

Finding an ideal site for intraosseous infusion of the tibia: an anatomical study.

Intraosseous infusion is a technique used for the administration of fluids to a hemodynamically shocked child in whom attempts to access the vascular system have been unsuccessful. Although few complications are seen, injury to the epiphyseal growth plate during the performance of this technique remains a serious problem. This study investigates the relationship between the site of insertion of the intraosseous needle and the epiphyseal growth plate, and the ease of needle insertion into various locations of the tibia in newborn infants. Fourteen newborn infant cadavers (28 tibias in total) were dissected after placement of four needles: 1). through the tibial tuberosity (Site A); 2). 10 mm distal to the tibial tuberosity (Site B); 3). 20 mm distal to the tibial tuberosity (Site C) and; 4). 10 mm proximal to the tibial tuberosity (Site D). Distances from the distal end of the epiphyseal growth plate were measured. A high number of needle placements at Site A were inserted into the epiphyseal growth plate. Most placements at Site B were between 10 and 16 mm from the epiphyseal growth plate on the right side and between 10 and 15 mm on the left side, and all were inserted without difficulty. Although far from the epiphyseal growth plate, most placements at Site C were very difficult to insert because of the thick cortical bone. All placements at Site D entered the epiphysis or the epiphysis and joint space of the knee. An insertion site of at least 10 mm distal to the tibial tuberosity is therefore recommended to avoid epiphyseal growth plate injury and ensure ease of insertion.

Cadaver↗

PubMed1990

The effects of bulk versus particulate titanium and cobalt chrome alloy implanted into the rabbit tibia.

Twenty-eight mature New Zealand white female rabbits were allocated into 4 groups of 7 rabbits. Group 1 received a coiled wire of cobalt chrome alloy (Vitallium) (16 gauge x 1 cm). Group 2 received an equal weight of cobalt chrome particles averaging 15.4 microns in diameter. Group 3 received a coiled wire implant of commercially pure (C.P.) titanium (16 gauge x 1 cm). Group 4 received the same weight of C.P. titanium particles averaging 3.8 microns. The implants were placed through a drill hole in the proximal right tibia; the left tibia served as a prepared but nonimplanted control. The animals were killed after 16 weeks and quantitative histology was performed on undecalcified sections of the implant area. Bulk cobalt chrome and titanium implants were surrounded by a thin, incomplete, fibrous tissue layer with decreased numbers of cells. Trabeculae of bone were present within this connective tissue envelope. Fingerlike projections of bone enveloped the implant where it abutted endosteal bone. Clumped and loosely scattered cobalt chrome and titanium particles were surrounded by a minimal amount of fibrous connective tissue. Smaller particles were present within cells. Hematopoietic cells abutted the bulk or particulate implants directly. There was no evidence of acute or chronic inflammation or foreign body reaction. These results should be contrasted with those of Howie et al. in which intraarticular cobalt chrome particles stimulated a rapid proliferation of macrophages and synovial degeneration after 1 week. This may be due to a direct toxic effect of metals in an intra-articular environment, the smaller particle size used in that study, or to abrasive injury to the hyaline cartilage and subsequent synovitis. Our results underscore the general inert properties of these metals in the short term, when implanted into bone in the sizes and physical forms chosen.

Animals↗

PubMed1992

Mineral apposition rate in rat cortical bone: physiologic differences in different sites of the same tibia.

The mineral apposition rate (MAR) is a commonly used parameter for the characterization of bone formation and is often determined to test for experimental effects on cortical bone. We investigated whether there are physiologic variations in rat cortical MAR dependent on the side or site of measurement. In our experiment we used female rats. The animals were sacrificed on day 8, after double-fluorochrome labeling with calcein and tetracycline was performed. The MAR was calculated at 3.6, 5.4, 7.2, 9, and 10.8 mm from the epiphyseal growth plate of the lateral as well as of the medial endosteum of both right and left tibiae. We found a physiologic significant difference in the MAR between the lateral and the medial endosteal sites of the same tibia (p < 0.0001), especially near the epiphyseal growth plate. Regarding the same cortical side, there is a significant decrease (p < 0.0001) in the endosteal MAR with increasing distance from the epiphyseal growth plate. We conclude that the observed differences in endocortical MAR must be due to specific mechanical challenges. Because these differences are statistically significant, it is necessary to standardize the area of histomorphometric measurement not only with respect to the distance from the epiphyseal growth plate, but also with respect to the cortical side.

Analysis of Variance↗

PubMed1995

Effect of physical training on bone adaptation in three zones of the rat tibia.

This study as been conducted to examine the effects of physical exercise on the bone trabecular network and the cellular adaptations in three different areas of a single bone, the tibia. Male Wistar rats (9 weeks old) were treadmill-trained for 0, 3, 4, or 5 weeks at 60% of their measured maximal O2 consumption (VO2max). Histomorphometric analysis of the proximal tibia of running and age-matched control groups was performed in the epiphyseal trabecular bone, in the primary spongiosa and in the secondary spongiosa. Dynamic and static bone cell activities and serum calcium and phosphorus levels were measured. VO2max increased significantly by 18.4% after 5 weeks of training. In the epiphysis, a 9% increase in bone volume, associated with more numerous trabeculae (8%) was detected the third week of training. In primary spongiosa a significant increase (6.7%) in newly formed trabeculae was found. In secondary spongiosa bone volume increased significantly by 26.2% the fifth week of exercise and was associated with thicker trabeculae. The number of osteoclast profiles was significantly depressed. Osteoid surfaces and bone formation rate increased significantly in weeks 3 to 5. Serum calcium levels were found to be significantly decreased in weeks 3 and 4. There was no change in osteoid thickness or mineral apposition rate. These results suggest 1) a rapid increase in osteoblastic recruitment without change of the cell activity in response to moderate exercise; 2) a decreased bone resorption associated with a marked increased in bone formation from the third week of training; 3) adaptation of the trabecular network to exercise that seems to be bone-site-dependent, suggesting a cell sensitivity to training-engendered strain distribution within the bone or to strain-related local factors.

Adaptation, Physiological↗

PubMed1985

Bone ingrowth into three different porous ceramics implanted into the tibia of rats and rabbits.

Three different porous ceramics--calcium aluminate, calcium hydroxyapatite, and tricalcium phosphate--were implanted into the proximal tibia in rats and rabbits to study the interactions between these ceramics and a bony site that is abundant in bone marrow. New bone was consistently formed within the bone marrow surrounding and adjacent to all three types of ceramics. Calcium hydroxyapatite and tricalcium phosphate ceramics permitted bone ingrowth into their pores. The newly formed bone was found only in the part of the ceramic intruding into the bone, not in the portion protruding in the soft tissues outside the tibia. Partial replacement of the new bone opposite the medullary portion by new hemopoietic marrow occurred with longer implantation times. In contrast, no bone was seen within the pores of any of the calcium aluminate implants.

Aluminum↗