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PubMed1984

The evolution and histopathology of adolescent tibia vara.

This clinical, radiographic, and histologic study clarifies the evolution of the distinct clinical and radiographic disorder known as adolescent tibia vara (Blount's disease). Although previous reports have suggested that the disorder occurs in a limb that has been normally aligned until adolescence, we have found that most children with adolescent tibia vara maintain a mild degree of infantile physiologic genu varum. Then, concurrent with the adolescent growth spurt, certain children with predisposing factors, such as obesity, extreme activity, or rapid growth, injure the posteromedial physis as a result of repetitive trauma due to normal use of a limb already in mild varus. The result is growth suppression, further varus, and a classic radiographic presentation. Histologic examination in two cases suggests injury to the growth plate as demonstrated by fissuring and clefts in the physis as well as fibrovascular and cartilaginous repair tissue at the physeal-metaphyseal junction. Transverse trabeculae, resembling growth arrest lines, were noted in the adjacent metaphysis; however, true bony bridging of the growth plate was not seen. Recommended treatment is corrective osteotomy below the growth plate.

Adolescent↗

PubMedDate not supplied

Radiographic measurement of infantile tibia vara.

The reproducibility of the radiographic measurement of 30 pairs of tibiae being treated for bowing was evaluated. Two methods of measurement were used. The first was the metaphyseal-diaphyseal angle of Levine and Drennan; the second, a metaphyseal-metaphyseal angle based on Cobb's angle for measuring scoliosis. Statistical analysis comparing the two methods showed no significant differences except for an increase in the angle in more severe cases measured by the metaphyseal-metaphyseal method, indicating distal tibial as well as proximal involvement. Computer digitization correlated extremely well with manual measurements. The metaphyseal-diaphyseal measurement is quite reproducible, and may allow early diagnosis and treatment of tibia vara.

Child, Preschool↗

PubMedDate not supplied

Postnatal epiphyseal development: the distal tibia and fibula.

At birth, the distal tibial physis is a transverse structure. However, as the tibia enlarges diametrically and the epiphyseal ossification center matures, the physis becomes increasingly undulated, with peripheral lappet formation. The anteromedial area is the first to develop undulation (Poland's hump). This should not be misinterpreted as an injury or premature epiphyseodesis subsequent to trauma. The tibial secondary ossification center forms within the central epiphysis. The medial margin is irregular and may have peripheral foci of ossification. Between the ages of 7 and 8 years, this secondary center extends into the medial malleolus, reaching the distal tip during adolescence. The malleolar tip may develop accessory ossification. Physiologic epiphyseodesis begins over the medial malleolus and then extends laterally, a pattern of closure that affects fracture patterns (e.g., the fracture of Tillaux). The distal fibular physis also begins as a transverse structure that becomes undulated and has extensive peripheral lappet formation. This physis usually becomes level with the articular surface of the distal tibia after the first year. Enchondromalike extensions of the physis into the metaphysis are common. Accessory ossification may develop at the distal end.

Adolescent↗

PubMedDate not supplied

Three additional cases of focal fibrocartilaginous dysplasia causing tibia vara.

Three additional cases of unilateral tibia vara caused by focal fibrocartilaginous dysplasia are reported in children aged 5, 6, and 18 months. These three cases support the conclusion of our original case report that unilateral tibia vara is most likely a progressive deformity, but that documentation of the progression should be obtained before a valgus osteotomy is performed.

Female↗

PubMedDate not supplied

Spontaneous resolution of congenital anterolateral bowing of the tibia.

In a series of 43 patients diagnosed with congenital anterolateral bowing of the tibia or congenital pseudarthrosis of the tibia treated between 1980 and 1992, the deformities corrected themselves spontaneously in five patients who had no other congenital abnormalities or evidence of neurofibromatosis. At an average follow-up of 58 months (average age at follow-up 80 months), the only residual deformity seen was a limb-length discrepancy in patients with unilateral involvement. In patients with subperiosteal callus formation on the posteromedial concavity of this deformity and an uninvolved fibula, no treatment appears necessary, as this deformity will spontaneously resolve.

Child, Preschool↗

PubMedDate not supplied

Proximal tibial osteotomy with compression plate fixation for tibia vara.

A surgical technique for the accurate intraoperative correction of tibia vara deformities with maintainence of postoperative alignment is presented. This was a retrospective study of 13 knees of nine patients with tibia vara deformities treated by proximal tibial and fibular osteotomies using compression-plate fixation. Average age of the patients was 9 + 1 years, with a range of 3 + 1 to 14 + 11 years. The average preoperative deformity was 20 degrees of varus with a range of 15-36 degrees. Average follow-up was 3 + 3 years, with a range of 2 to 4 + 1 years. All patients had intraoperative correction to an average valgus of 5 degrees (range 4-8 degrees valgus), with an overall valgus correction of 25 degrees (range 20-40 degrees). There was one reoperation for unilateral recurrence of deformity in a child who progressed from stage III to stage VI postoperatively. Proximal tibial osteotomy with compression-plate fixation provides an accurate and reliable method for the correction of multiplanar deformities in children and adolescents.

Adolescent↗

PubMed1978

Ultrastructural findings supporting the angioblastic nature of the so-called adamantinoma of the tibia.

Electron microscopy of a case of adamantinoma of the tibia shows features which support a mesenchymal angioblastic origin rather than epithelial. Comparison is made between tissue from this tumour and a squamous cell carcinoma of the femur arising in chronic osteomyelitis. In adamantinoma no desmosomes are found between tumour cells and their cytoplasmic ultrastructure shows features of mesenchymal cell type including evidence of pinocytic activity and bundles of filaments resembling hyperplastic endothelial cells. The stroma shows features similar to fibrous dysplasia of bone with fibroblasts, histiocytes and fibrolipoblastic lipid-laden mesenchymal cells. It is condluded that adamantinoma of the tibia should be considered to be an angioblastic tumour of bone.

Bone Neoplasms↗

PubMed2006

Influence of short-term confinement and exercise on tibia development in growing pigs.

The influence of short-term confinement and moderate exercise on tibia development was investigated in growing pigs (36-41 kg, 10 weeks at the beginning of the study). Animals were kept for 2 weeks either in individual crates of 0.8 m(2) ('confinement', n = 4) or kept in groups of four animals in large crates of 5.6 m(2) without ('control') or with additional exercise (30 min walking at 5 days/week; 'exercise'). Bone density and morphological parameters were evaluated by computer tomography (CT). Periosteal apposition and longitudinal growth were determined after polychrome sequential labelling in weekly intervals. Cortical areas of the cross sections at the mid-shaft and at 75% of the length of the bone measured distal to the carpus by CT were significantly correlated to each other (r = 0.70) and revealed a significant reduction in confined animals. This difference was explained by lower periosteal apposition rates in these animals compared with exercised and group-housed pigs. Similarly longitudinal growth and the formation and calcification of spongiosa of the tibiae were inhibited by confinement. Thus, 2 weeks of confinement led to significant differences in bone growth and metabolism in young growing piglets when compared with animals with moderate activity.

Animals↗

PubMed1981

Adamantinoma of the tibia -- a case report and a statistical review of reported cases.

A case of adamantinoma of the tibia is reported. A 70-year-old man complained of a painful swelling over the lower front of the right tibia. Roentgenograms showed an oval well-circumscribed, multilocular cystic lesion. Curettage and bond grafting were performed, and 17 months later the patient is in good condition. Microscopically the tumor tissue consisted mainly of epithelial islands with an palisading at the periphery and a loose reticular pattern in the center of the tumor cell nests, showing a close resemblance to the ameloblastoma of the jaw bones. Electron micrographs revealed the epithelial nature of the tumor cells, l.e., a continuous basal lamina, desmosomes and bundles of microfilaments, probable tonofilaments. One hundred fifty six cases of this peculiar primary skeletal bone tumor previously reported in the literature were reviewed and discussed.

Aged↗

PubMed1976

A genetic study on the length of tibia.

The length of tibia was studied in 1364 males and 1791 females over 10 years of age in an agricultural district of Wakayama Prefecture, Japan. (1) The length markedly increased from 10 to 17 years of age in males, and 10 to 15 in females, but it remained comparatively unchanged from 20 to 79 years in both sexes. The following regressions of tibial length covering 20 to 79 years were obtained: Y male = 0-0183x+34-7892, Y female = -0-0269x + 32-5329. The modified data proved to be a normal distribution on skewness and kurtosis test; they were analysed on a quantitative genetic basis. (2) No significant contribution of X-linked and Y-linked genes to tibial length was found in an analysis of parent-child combinations. (3) There was no indication of maternal effect, since the difference between father-child (r = 0-36 +/- 0-05) and mother-child (r = 0-42 +/- 0-04) correlations was not significant. (4) Correlation coefficients between sibs were significant, the values being 0-57 +/- 0-09 for brother-brother, 0-32 +/- 0-22 for sister-sister, and 0-27 +/- 0-13 for brother-sister. Correlation coeffiecients between parent and child were also significant, the values being 0-36 +/- 0-06 for father-son, 0-35 +/- 0-09 for father-daughter, 0-44 +/- 0-04 for mother-son, 0-35 +/- 0-07 for mother-daughter. The regression coefficients of child on midparent were calculated to be 0-77 +/- 0-12. Thus, the heritability for the length of tibia may be estimated to be 0-77 approximately 0-80. Contribution of dominance variance to total variance was very small (VD = 0-01), in contrast to a far greater additive genetic variance (VA = 0-80).

Adolescent↗

PubMed2001

The effect of dental implant spacing on peri-implant bone using the rabbit (Oryctolagus cuniculus) tibia model.

PURPOSE: This study investigated the effects of implant proximity on inter-implant bone height, density, and osseointegration using digital radiography and histology. MATERIALS AND METHODS: After a feasibility study, a total of 80 endosteal implants were placed in 20 New Zealand White Rabbit tibias. With the aid of a surgical jig, four 8.5-mm implants were placed in the medial aspect of the tibial crest at inter-implant distances of approximately 1, 1.5, and 3 mm. Standardized digital radiographs using a paralleling device were made immediately after placement of implants. Implants were allowed to osseointegrate for 90 days. After this healing period, the animals were sacrificed, and the standardized radiographs were repeated. The tibias were harvested, processed, and invested in epoxy. Sagittal sections were made from each specimen for histologic evaluation. The initial and postmortem digital radiographs were evaluated for inter-implant distances, vertical bone height changes over time and between implant pairs, and bone density changes over time and between implant pairs using a computer image analysis program and computer statistics program. RESULTS: The actual inter-implant distances were consistent in a range of 0.2 mm. Bone height increased significantly from presurgical levels at all 3 locations (p < .0005). Repeated measures analysis of variance comparing change in bone height at the 3 implant pair distances showed significant differences among the 3 (p = .002). Paired t tests showed that the amount of bone growth at the 1-mm separation site was significantly greater than the 1.5-mm site (p = .026) and the 3-mm site (p = .001), whereas bone growth at the 1.5- and 3-mm sites did not show significant differences (p = .162). A repeated measures analysis of variance comparing change in bone density showed no significant differences (p > .05) among the 3 inter-implant distances for either the 8-mm position (approximately crestal bone height) or the 6-mm position (approximately 2 mm subcrestal). CONCLUSION: Within the limits of this study, it seems placing implants closely together does not adversely affect bone height or density. Conversely, it seems that placing implants closer together may increase bone growth.

Analysis of Variance↗

PubMedDate not supplied

Ex vivo biomechanics of Kirschner-Ehmer external skeletal fixation applied to canine tibiae.

The purpose of this study was to determine the respective contribution of each of the following parameters to the compressive, bending, and torsional rigidity of the Kirschner-Ehmer (KE) external fixation splint as applied to canine tibiae with an osteotomy gap: bilateral versus unilateral splints; increasing the number of fixation pins; altering the diameter of fixation pins and side bars; decreasing side bar distances from the bone; increasing pin separation distances in each pin group; decreasing distances between pin groups; altering pin clamp orientation; and altering side bar conformation. Bilateral splints were 100% (mean) stiffer than unilateral splints, with stiffness enhanced to the greatest extent in mediolateral bending and torsion. Increasing pin numbers stiffened both bilateral (mean, 41%; 8 versus 4) and unilateral splints (mean, 14%; 8 versus 4). Medium KE splints were 85% (mean) stiffer than small KE splints. Decreasing side bar distances to the bone from 1.5 cm to 1.0 cm to 0.5 cm increased stiffness of both bilateral and unilateral splints by a mean of 13% to 35%. Widening pin spacing from 1.67 cm to 2.5 cm increased stiffness in craniocaudal bending only (56% increase, bilateral splints; 73% increase, unilateral splints). Decreasing the distance between pin groups from 5.84 cm to 2.5 cm increased stiffness in torsion between 23% (unilateral splints) and 45% (bilateral splints) and decreased stiffness of unilateral splints by 29% in craniocaudal bending. Altering pin clamp configuration so that the bolts of the clamp were inside the side bar rather than outside the side bar increased stiffness in axial compression only (73% increase, bilateral splints; 54% increase, unilateral splints). Conforming the lateral side bar to the tibiae increased only axial compressive stiffness by 77% but was no different than placing the clamps inside the side bars of an unconformed bilateral splint. These results quantify the relative importance of specific parameters affecting KE splint rigidity as applied to unstable fractures in the dog.

Animals↗

PubMed2005

Bone healing in surgically created defects treated with either bioactive glass particles, a calcium sulfate barrier, or a combination of both materials. A histological and histometric study in rat tibias.

OBJECTIVE: The purpose of this study was to histologically analyze the influence of bioactive glass and/or a calcium sulfate barrier on bone healing in surgically created defects in rat tibias. MATERIAL AND METHODS: Sixty-four rats were divided into 4 groups: C (control), CS (calcium sulfate), BG (bioactive glass), and BG/CS (bioactive glass/calcium sulfate). A surgical defect was created in the tibia of each animal. In Group CS, a calcium sulfate barrier was placed to cover the defect. In Group BG the defect was filled with bioactive glass. In Group BG/CS, it was filled with bioactive glass and protected by a barrier of calcium sulfate. Animals were sacrificed at 10 or 30 days post-operative. The formation of new bone in the cortical area of the defect was evaluated histomorphometrically. RESULTS: At 10 days post-operative, Group C presented significantly more bone formation than Groups CS, BG, or BG/CS. No statistically significant differences were found between the experimental groups. At 30 days post-operative, Group C demonstrated significantly more bone formation than the experimental groups. Groups CS and BG/CS showed significantly more bone formation than Group BG. No statistically significant differences were found between Group CS and BG/CS. CONCLUSIONS: (a) the control groups had significantly more bone formation than the experimental groups; (b) at 10 days post-operative, no significant differences were found between any of the experimental groups; and (c) at 30 days post-operative, the groups with a calcium sulfate barrier had significantly more bone formation than the group that used bioactive glass only.

Animals↗

PubMedDate not supplied

Morphometric assessment of the proximal portion of the tibia in dogs with and without cranial cruciate ligament rupture.

Based on the clinical observation that dogs with a steep tibial plateau slope had variable tibial morphology, we hypothesized that these dogs could be further characterized using measurements developed by examining computer generated models of specific proximal tibial malformations. A 3D tibial model was created from a normal canine tibia. The model was manipulated to reproduce two specific proximal tibial anomalies representing deformities originating from the tibial plateau or the proximal tibial shaft. Data from these models were used to create specific measurements that would characterize the shape of these anomalies. These measurements included the diaphyseal tibial axis (DTA)/proximal tibial axis (PTA) angle, which defined the orientation of the proximal portion of the shaft in relation to the tibial mid-shaft. These measurements were then made on radiographs of dogs with and without cranial cruciate ligament (CCL) rupture. Models with tibial plateau and proximal shaft deformities had a steep tibial plateau slope (TPS). Models with proximal shaft deformity had a markedly increased DTA/PTA angle. The model with a 10 degree proximal shaft deformity had a DTA/PTA angle of 11.23 degrees. Six dogs (9.0%) had a DTA/PTA angle larger than 11.23 degrees (range, 11.4-13.9 degrees). Dogs in this group had ruptured CCL and a steep TPS. Dogs with CCL rupture had higher TPS (mean, 31.8 +/- 4.1 degrees) and DTA/PTA angle (mean, 6.0 +/- 3.3 degrees) than dogs without CCL rupture (means, 23.6 +/- 3.4 degrees and 4.1 +/- 2.2 degrees, respectively). Dogs with proximal shaft deformity represented a distinct group, which could not be identified using the magnitude of the TPS alone. Characterizing more precisely the shape of the proximal portion of the tibia in dogs contributes to our understanding of the pathogenesis of steep TPS and may facilitate the optimization of the surgical management of dogs with CCL rupture.

Animals↗

PubMed2001

Rupture of the cranial cruciate ligament associated with deformity of the proximal tibia in five dogs.

Excessive mechanical stress due to caudal sloping of the tibial plateau may result in early breakdown of the cranial cruciate ligament (CrCL). Five dogs with CrCL rupture associated with caudal sloping of the proximal tibial plateau are described. All were small dogs, of between three and six years of age, with a mean bodyweight of 9.3 kg, which had acute hindlimb lameness. Radiographic examination revealed cranial displacement of the tibia, with a tibial angle varying from 58 to 60 degrees. All cases were treated with a lateral fabellotibial suture and cranial cuneiform osteotomy of the proximal tibia. All dogs were using the operated limb three days after surgery, with normal gait re-established after a mean period of 10 days. Excessive tibial plateau sloping is not a frequent cause of hindlimb lameness in small animals, although it is important to consider it as a predisposing factor for rupture of the CrCL.

Animals↗

PubMed1967

The effect of thyrocalcitonin on blood-bone calcium equilibrium in the perfused tibia of the cat.

1. In the isolated tibia of the cat, perfused with blood from its own carotid connected to popliteal artery via a pump, infusion of porcine thyrocalcitonin causes an arteriovenous difference in calcium concentration of up to 5%, corresponding to net retention of calcium in bone.2. When taken in conjunction with determinations of radiocalcium clearance in the tibia, the effect is of the right order of magnitude to account for the hypocalcaemic action of thyrocalcitonin in the whole animal.3. Calcium retention was accompanied by a small increase in acidity of outflowing venous blood whereas verification of the hypothesis of calcium regulation by pH change in the bone substance would require a decrease.

Animals↗

PubMed2004

Feasibility of bone assessment with leaky Lamb waves in bone phantoms and a bovine tibia.

In this study, the effect of cortical thickness variation on the propagation of leaky Lamb waves is investigated by using an axial transmission technique commonly used to characterize long bones. Three Lucite plates with thicknesses of 1, 3, and 5 mm as bone phantoms and one bovine tibia with a cortical thickness of 2 mm were used at various low frequencies. Experimental measurements in bone phantoms show that the peak frequency and amplitude of excited Lamb modes strongly depend on the thickness of the Lucite plate. In the bovine tibia, the S0 and A0 Lamb modes are consistently observed in the frequency-thickness region from 0.2 to 1.0 MHz mm, and can be effectively launched at a frequency of 200 kHz, suggesting 200 kHz to be the optimal signal frequency for in vivo clinical applications. It can be also seen that both modes are affected by the frequency-thickness product, but the effect is greater for the A0 mode. Hence, the A0 Lamb mode seems more sensitive to cortical thickness change due to aging and osteoporosis. This study suggests that the use of leaky Lamb waves is feasible for ultrasonic bone assessment.

Animals↗

PubMed1995

Absence/hypoplasia of tibia, polydactyly, retrocerebellar arachnoid cyst, and other anomalies: an autosomal recessive disorder.

Absence or hypoplasia of the tibia has been reported to occur as an isolated hereditary malformation as well as a feature of several autosomal recessive and autosomal dominant syndromes. We report three sibs with absence or hypoplasia of the tibia in association with other malformations whose parents are first cousins once removed. These infants appear to have a "new" autosomal recessive syndrome.

Abnormalities, Multiple↗