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PubMed1996

Callus formation in femur and tibia during leg lengthening: 7 patients examined with DXA.

We examined the callus formation during leg lengthening in 7 achondroplastic patients who underwent 3 bilateral femoral and 4 bilateral tibial lengthenings. Bone mineral content and bone mineral density (BMD) in the lengthened callus space were evaluated every 1 or 2 weeks for 10 weeks after the start of distraction using dual energy X-ray absorptiometry. The mean rate of callus mineralization in femurs (0.64 g/wk) was higher than in tibias (0.22 g/wk). The mean BMD at 10 weeks after the start was 0.35 g/cm2 in the femur and 0.14 g/cm2 in the tibia. Different rates of callus formation in different kinds of long tubular bones have not been reported previously.

Achondroplasia↗
PubMed2003

Distribution of lengths of the normal femur and tibia in Korean children from three to sixteen years of age.

To develop a standard growth curve of the lower extremity in Korean children from 3 to 16 yr of age, the lengths from a total of 2087 normal long bone segments (582 femurs and 645 tibias in boys, and 417 femurs and 443 tibias in girls) were measured. Children were grouped by years of bone age, which was determined by using the Korean specific bone age standard; TW2-20 method. The growth spurt occurred in girls from eight to eleven years by bone age, and in boys from eleven to thirteen years. The mean tibial length relative to the mean femoral length was 0.78 in boys and 0.79 in girls. The overall growth pattern was similar to that observed in American children in the 1960s. Korean children and adolescents appear to have a different tempo of skeletal maturation during pubertal growth from that of English and American children and adolescents. The Korean standard growth curve and the Korean bone age chart allow determination of the presence of any existent growth abnormalities and prediction of future remaining growth in lower extremities. These normative growth standards can be used for leg-length equalization purposes in children with anisomelia.

Adolescent↗
PubMed1998

Progressive opening-wedge osteotomy for severe tibia vara in adults.

Five patients with tibia vara were treated with progressive opening-wedge osteotomy. The maximum varus deviation of the mechanical axis of the tibia varied from 20 degrees to 12 degrees. The minimum postoperative follow-up was 26 months. Complete correction of the deformity was achieved without any major complications. Progressive opening-wedge osteotomy offers several advantages over conventional osteotomy in adults. First, fibular osteotomy is unnecessary. Second, knee mobility is only slightly restricted immediately following surgery. Third, it is possible to adjust correction postoperatively, and finally, progressive opening-wedge osteotomy does not induce shortening of the lower limb. The most significant disadvantage is the need for prolonged external fixation. This technique should be reserved for patients with severe deformities (minimum of 15 degrees varus) and mild or moderate osteoarthrosis.

Aged↗
PubMed1976

The tuberositas tibiae and extension in the knee joint.

In all 56 tibiae from Lapps and 56 from Norwegians have been studied. These ethnic groups represent different weight bearing situations. Variables dealing with the extension in the knee joint are dealth with. The bone is mainly studied in the AP and the ML planes. The material is analyzed statistically. The distribution form is examined and the deviations from normality are found to be moderate. Chiefly positive skewness occurs. Platykurtosis is found equally 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 variability is about the same in linear and angular variables and in indices. In linear variables females and Lapps show lower mean values than males and Norwegians, respectively. Lapps show the largest indices. In linear variables, contrary to in angular variables and indices, the sex differences exceed the differences between the ethnic groups. As a rule sex differences are largest in Lapps. The variations of the tuberositas tibiae are supposed to be in particular the results of muscular forces in bone remodeling. The relationship between the habitual knee position and extension is discussed.

Computers↗
PubMed1999

Effects of infrared radiation on intraosseous blood flow and oxygen tension in the rat tibia.

In order to examine the effects of infrared radiation on intraosseous blood circulation, the intraosseous blood flow and oxygen tension were examined in rat tibiae. Infrared radiation was performed for 5 minutes over the ankle joint approximately 40 cm from the skin surface. The intraosseous blood flow was measured with a hydrogen washout technique. Before and after infrared radiation, the blood flow rates in the proximal metaphysis of the rat tibia were 8.7 +/- 2.5 ml/min/100g and 15.6 +/- 5.4 ml/min/100g, respectively, i.e. the intraosseous blood flow increased approximately 80% with the radiation. The intraosseous oxygen tension and temperature were measured with a Po2 sensor, altered to our own specifications. The former increased from 20.4 +/- 6.2 mmHg to 23.3 +/- 6.7 mmHg (about 15%), and the latter from 29.0 +/- 1.4 degrees C to 31.2 +/- 1.9 degrees C, respectively, during the 5 minutes infrared radiation. The results of the present study show that infrared radiation remarkably improves intraosseous blood circulation, and these effects continue for at least 30 minutes. It is, therefore, suggested that infrared radiation can be used as a measure of thermotherapy in some bones to improve intraosseous blood circulation.

Animals↗
PubMedDate not supplied

Congenital pseudarthrosis of the tibia: a retrospective review.

Treatment of congenital pseudarthrosis of the tibia has been notoriously very difficult. This retrospective review of 36 cases (33 patients) seen at the Shriners Hospital (Springfield, Massachusetts Unit), from 1927 to the present evaluates the different forms of treatment and their long-term results. Adequate information was obtained from 30 patients (33 cases) to include them in this study. Twenty-nine patients (32 cases) underwent 154 surgical procedures, of which 138 were to achieve union of the pseudarthrosis (4.3 per case), and one parent could not recall how many surgeries were performed on her son. Sixteen surgeries were performed to correct leg-length discrepancy. Four cases healed with bracing alone. Of the 30 patients (33 cases), 14 patients (15 cases) required amputation. These patients had undergone multiple attempts at union (average, 4.7 procedures). Patients who went on to union averaged 2.8 surgical procedures. Even with newer techniques available to the trained pediatric orthopaedist, treatment of congenital pseudarthrosis of the tibia remains an elusive problem.

Amputation, Surgical↗
PubMed1999

[Total knee prosthesis and simultaneous corrective tibial osteotomy, for osteoarthritis and severe congenital tibia varum deformity].

INTRODUCTION: Restoration of the normal mechanical axis of the knee and balancing of the surrounding soft tissues have been shown to have an important bearing on the final outcome of total knee arthroplasty. In knees with severe congenital varum deformity these goals may be difficult to achieve. MATERIAL AND METHODS: In four patients with osteoarthritis and severe congenital knee varum deformity of more than 15 degrees, we performed a high tibial valgus osteotomy with opening wedge, combined during the same procedure with total knee arthroplasty. RESULTS: As correction of the extra-articular deformity was obtained by the osteotomy, in none of the cases it was necessary to perform extensive soft tissue release or advancement to restore alignment. Postoperative X-rays demonstrated restoration of the normal mechanical axis in three cases, but in one case the angular correction of the osteotomy was insufficient and we observed a 9 degrees residual varus deformity. DISCUSSION: The osteoarthritic knee must be mechanically realigned for any total knee arthroplasty to be successful in the long term. Most commonly angular deformities are manifestations of the arthritis process, but sometimes, like in congenital varus deformity of the tibia, part of the deformation can be extra-articular in origin. In these cases, restoring alignment and stability may be difficult to achieve. The association of high tibial valgus osteotomy with total knee arthroplasty permits the correction of the extra-articular deformity, by the osteotomy, without performing extensive soft tissue release, as would be needed in total knee arthroplasty alone. CONCLUSION: Total knee arthroplasty associated with high tibial valgus osteotomy seems to be a technically satisfying alternative in patients with osteoarthritis and severe congenital varus deformity of the tibia.

Aged↗
PubMed1999

[Skin and muscle flaps to cover and fill chronic open osteitis of the tibia. Results with 10 cases].

Chronic osteomyelitis is a severe long-term bone infection which retains its mechanical qualities. The authors report 10 cases of osteomyelitis of the tibia treated by muscular and fascio-cutaneous flaps and reviewed at one year follow-up. Four cases concerned the third upper part of the tibia, 3 the middle and 3 the lower third. Two total failures at the third lower part and three complications which finally healed with delay were observed. The results of this small series compared with the reports in the literature suggest the value of large excision with coverage by a well vascularized flap and the need for antibiotics. The choice of flap is related to type and site of the bone defect. Another question should be raised concerning the surgical strategy in one--or two--stage management and the duration of antibiotic therapy.

Adolescent↗
PubMed1999

[Measurement of tibia bone content and fracture threshold by quantitative ultrasonography in normal and fractured women in Taiyuan].

OBJECTIVE: To establish the reference range of tibia bone content in normal female of Taiyuan area and to explore the diagnostic criterion for osteoporotic fracture threshold by quantitative ultrasonography (QUS). METHODS: The tibia bone contents (QUS value) of 1,681 normal women (aged 7-92 years) and 63 fractured women (aged 46-91) in Taiyuan were measured by QUS. RESULTS: The QUS value increased with age in normal women before age 30, and peaked at age 30-40, then decreased and reached significance after age 50. There was a negative correlation between QUS value and duration after menopause (P < 0.01). Taken the mean QUS value of normal female aged 20-40 years minus 2.5 s (3,667 m/s) as a cutoff threshold, 93.7% of the 63 fractured women had their QUS value below this threshold. CONCLUSION: It is suggested that the above cutoff QUS value may be considered as the risk threshold of osteoporotic fracture in women.

Adolescent↗
PubMed1975

[Stimulation of longitudinal growth of long bones through electrical current. Scintigraphic examinations on ribbit tibiae].

Report on szintigraphical examinations using 87-mSr in young rabbits treated by direct current of different intensity varying from 2.5 to 40 micro-Ampère. The current was applicated to one tibia using the other as comparison. Corresponding to the realised growth-increase by electric stimulation there was found an increased uptake of 87m-Sr in the electro-stimulated tibia in all 16 rabbits.

Animals↗
PubMed2001

[Single-compartment knee arthroplasty prosthesis and idiopathic necrosis of the medial tibia surface].

PURPOSE OF THE STUDY: Idiopathic necrosis of the medial articular surface of the tibia is exceptional. Diagnosis is quite difficult and often made late. Among the different treatments proposed, we preferred single-compartment arthroplasty. MATERIAL AND METHODS: We report 8 cases in women with a mean age of 71.1 years. Diagnosis was suspected due to drug-resistant knee pain, particularly frequent at night, initially with radiographically normal knees. The first radiographic signs, seen 3 months after the onset of pain, were pathognomonic for osteonecrosis evidencing subchondral defects of the tibial surface with a dense peripheral rim and apparently "sequestered" in a notch. Bone scintigraphy evidenced intense uptake in the medial compartment. MRI confirmed the diagnosis evidencing a band of low intensity signals completely surrounding a sequestered zone reaching the cortical. This band was stable and irreversible. In 5 cases CT scan and in 3 cases tomography identified the width and height of the necrotic area that was limited to the medial compartment in all cases. All patients were treated with a single compartment implant. The diagnosis of necrosis was confirmed at pathology. RESULTS: At 4,6 years of mean follow up all patients had an excellent outcome, "forgetting" their knee. No lucent lines developed along the femoral or tibial implants. DISCUSSION: Necrosis of the medial articular surface of the tibia is exceptional and often diagnosed late by bone scintigraphy or MRI. Surgical treatment is usually based on tibial osteotomy for valgisation or a single or three-compartment prosthesis. In our 8 cases, the necrosis was limited to the medial compartment, warranting our therapeutic option.

Aged↗
PubMedDate not supplied

Magnetic resonance imaging findings and treatment outcome in late-onset tibia vara.

Several retrospective studies have shown the usefulness of magnetic resonance imaging (MRI) in the evaluation of tibia vara. With respect to the late-onset type, however, there have been no English-language reports on MRI findings. In this article, the authors report on the MRI features of three patients with late-onset tibia vara, the results of treatment that was chosen on the basis of the findings, and the histologic characteristics of the disease. Fat-suppressed MRI revealed partial closure of the tibial physis in one patient and near-closure in another patient. They underwent osteotomy with resection of the bone bridge and have shown no evidence of recurrence. In the third patient, only irregularity of the physis was found on MRI, and she was treated conservatively. Her varus deformity subsequently improved, although it persisted. Histologic examination revealed disorganization and misalignment of the physeal zone and transverse alignment of the trabeculae. The patient with a bony bridge also had discrete ossification centers in the physeal zone.

Bone Diseases, Developmental↗
PubMed1998

A biomechanical analysis of unilateral hooked-sulcated external fixator on osteomined tibia.

Four tibiae removed from 30-40 years males, who died of accidents in less than 12 hours, were osteomized at medium part. Then these tibiae were fixed by an unilateral hooked-sulcated external fixator (UHSEF), and the bone-fixator system was used as a model of external fixation of tibial fracture. The axial compression, distraction, torsion, antero-posterior and lateral bending rigidity and the strain of the pins were determined in this system. Based on the results, we found that compared with the configuration of four paralleled pins, the rigidity of the fan-like configuration didn't decrease significantly if the angle between lateral and medium pins was less than 45 degrees. But the reverse was true when the frame separation increased from 5 to 8 cm. What' more, the pin strain decreased if the rigidity of the system was improved. These data provided a theoretical basis of biomechanics for the improvement of UHSEF.

Adult↗
PubMed2002

Adamantinoma of the tibia in a nine-year-old child.

Adamantinoma of the long bones is a rare, low-grade malignancy with a marked predilection for the tibia and is usually seen in patients during the second to fifth decades of life. Adamantinomas have also been reported in children, but the histological pattern in this age group is different from that seen in adults. We report a case of adamantinoma of the tibia in a 9-year-old boy. Histologically, the lesion was osteofibrous dysplasia with an epithelial component, called "differentiated adamantinoma". An osteofibrous dysplasia-like adamantinoma (differentiated adamantinoma) may be the precursor lesion of the classic type of adamantinoma.

Ameloblastoma↗
PubMedDate not supplied

Effects of irradiation on the appositional and longitudinal growth of the tibia and fibula of the rat with and without radioprotectant.

The effect of therapeutic levels of irradiation on appositional bone growth was compared with its effect on longitudinal growth in the skeletally immature rat model. The widths and lengths of the tibiae and fibulae of young rats were studied at 2, 4, 6, and 12 weeks after exposure to 17.5 Gy x-irradiation to the knee region of the right leg, with and without the aminothiol radioprotectant amifostine 20 minutes before radiation. Irradiation retarded growth in the width of the tibia to a greater extent (19%-27%) than longitudinal growth (9%-21%). The appositional growth discrepancy decreased over time, whereas the length discrepancy increased. The proximal fibula, in contrast, undergoes a normal decrease in width over time, and irradiation retarded this contraction by 14%. Appositional growth does not appear to be spared from the damaging effects of irradiation, but a catch-up phenomenon is observed that is not seen in longitudinal growth. Amifostine reduced the radiation-induced loss in tibial width by 40% to 50% and in length by 12% to 30%.

Amifostine↗
PubMed2002

[Fibular transfer in a nine-week-old infant for complete congenital absence of the tibia].

The treatment of complete congenital absence of the tibia is controversial. The goal of the treatment is to construct a satisfactorily functioning knee joint, for which fibular transfer was described as an appropriate method. We performed reconstructive surgery using a modified Browns procedure in a nine-week-old boy with Jones type 1 congenital longitudinal deficiency of the tibia. In his final control at three years of age a good outcome was obtained according to the criteria by Epps et al. To our knowledge, this is the youngest patient to receive fibular transfer in the literature, to which we ascribed the satisfactory outcome.

Bone Diseases↗
PubMed1998

[A human knee articulate mathematical model on femur-tibia-patella 3-segmetents].

In this paper, based on the previous work of S. Turgut Tumer et al, a human knee articulate mathematical model on femur-tibia-patella 3-segments is established by introducing patella-femur joint. This model includes both rolling and slipping motions of femur-tibia joint and femur-patella joint. It can be employed in simulating the biodynamic response of human lower extremity.

Biomechanical Phenomena↗