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PubMed1990

Infantile tibia vara.

Infantile tibia vara is a developmental condition producing progressive varus deformity of the knee in young children. It appears to have a worse prognosis in the predominantly nonwhite population seen with this condition in the United States than previous studies from Scandinavia would suggest. Early roentgenographic diagnosis is critical, since toddlers can have infantile tibia vara at an early stage instead of physiologic genu varum. Aggressive bracing is appropriate treatment until age three years. Correction to valgus alignment with upper tibial osteotomy predictably can produce complete resolution of the condition if performed by age four years. After that age, the procedure becomes less effective. Prognosis for Langenskiold Grade IV disease is guarded at best, regardless of age, because the physis behaves as if effective growth arrest has already occurred. Young patients with Grade IV or greater lesions should have corrective osteotomy combined with a physeal procedure to attempt restoration of growth in the medial physis. Early effective treatment can prevent permanent intraarticular incongruity.

Age Factors↗

PubMed1990

[Lengthening of the femur and tibia using Wagner's method].

Thirty-nine patients (19 girls and 20 boys with an average age of 14 years) were submitted to 41 lengthening osteotomies by Wagner's method. The average preoperative shortening was 6.4 cm (3.5-25) and the average lengthening achieved in the femur was 6.4 cm (2.0-10.3) while the lengthening achieved in the tibia was 5.5-5.6 cm. In five patients, residual anisomelia varied between 3.5 to 10 cm and two of these patients have subsequently been submitted to supplementary lengthening. Complications occurred in 12 patients and, in particular, the postoperative course was complicated in two patients over the age of 20 years. It is concluded that lengthening of the femur and tibia by Wagner's method, and undertaken before growth has ceased, is a safe method of correction of considerable anisomelia.

Adolescent↗

PubMed1989

Congenital pseudarthrosis of the tibia. Long-term follow-up study.

Review of the literature reveals how difficult it is to assess the results of treatment of pseudarthrosis of the tibia. There is disagreement as to when the result can be considered final. This study reviewed the long-term results of treatment to determine if skeletal maturity could be considered the definitive end point of treatment or if the results deteriorate past skeletal maturity. In addition, the effect of neurofibromatosis on pseudarthrosis of the tibia is analyzed. Forty-one patients were reviewed. Only 25 had sufficient follow-up data to be included in this study. Eighteen of the 25 had neurofibromatosis. The results were classified according to criteria developed by Morrissy et al. At skeletal maturity, there were ten good results, three fair results, and three poor results, with nine patients having had amputation. At long-term follow-up evaluation (average 36 years; range five to 62 years), one patient with a fair result had elected amputation. About one half of the patients with neurofibromatosis required amputation. This study suggests that the results at skeletal maturity are reliable indicators of long-term results.

Adolescent↗

PubMed1989

Limb-sparing surgery for high-grade malignant tumors of the proximal tibia. Surgical technique and a method of extensor mechanism reconstruction.

A surgical technique designed for safe and easy access to the popliteal vessels, resection of a large segment of the tibia and knee joint, and a method of patellar/extensor mechanism reconstruction and soft-tissue coverage that utilizes a transferred medial gastrocnemius muscle is reported. Eleven patients have been treated with this technique, including seven patients with a minimum follow-up evaluation of two years (average, 49.5 months; range, 24.6-84.4 months). There were five males and two females, with an average age of 28.7 years. The histologic diagnoses were osteosarcoma, four patients; malignant fibrous histiocytoma, one patient; chondrosarcoma, one patient; and poorly differentiated sarcoma, one patient. The surgical stages were Stage IIA, one patient, and IIB, six patients. Six intraarticular resections and one extraarticular resection were performed; all were classified as wide excisions. Four prosthetic replacements and three arthrodeses were performed. Pathological specimens showed meniscal and patellar tendon involvement in two patients and pericapsular tibiofibular joint involvement in six patients. Local complications were transient peroneal nerve palsy in four patients and superficial skin slough in one patient. All resections obtained negative margins, and there was no local recurrence or metastatic disease. Functional results (Musculoskeletal Tumor Society System classification) were excellent in one patient, good in four, fair in one, and poor in one. Limb-sparing surgery for high-grade tumors of the proximal tibia is recommended for carefully selected patients.

Adolescent↗

PubMed1989

Congenital pseudarthrosis of the tibia: treatment with local steroid infiltration.

A new treatment was used for 3 cases of congenital pseudarthrosis of the tibia based on the method used for the treatment of simple bone cysts by local infiltration of steroids. All 3 cases achieved consolidation and had no recurrence. This method may be used in association with the numerous other methods used in the treatment of congenital pseudarthrosis of the tibia (bone transplants, vascularized transplants using microsurgical techniques, electromagnetic induction, and the use of external fixators). It is particularly useful for cases treated at a very early age (even at a few months) when other types of treatment could be difficult to carry out and usually fail.

Child, Preschool↗

PubMed1989

Lengthening osteotomy in the metaphysis and diaphysis. An experimental study in the ovine tibia.

In 20 sheep, aged seven to eight months, a tibial lengthening osteotomy was performed to compare the process of repair of the metaphyseal and diaphyseal regions of the bone. Analogous to clinical lengthening, two frame configurations of a bilateral external fixation device were used to obtain adequate fixation of the bone segments in the metaphyseal and diaphyseal lengthening osteotomies. A daily distraction rate of 1 mm for 4.5 weeks yielded an average length increase of 2.6 cm (12.5%). After death at 4.5 weeks postdistraction, the elongated bones were tested mechanically with the contralateral tibiae as controls. No significant difference in relative torsional strength of the elongated tibiae was found between the two groups. Inferior mechanical stability of the bone segments in metaphyseal compared with diaphyseal lengthening (due to differences in frame rigidity and distribution of muscular moments) influenced healing to such an extent that any superior biologic, osteogenic potential in the metaphyseal bone region was nullified. With the clinical use of two configurations of a given external device necessary for fixation of the bone segments in a metaphyseal or diaphyseal lengthening osteotomy, the empirically accepted idea that metaphyseal healing is superior may not be correct.

Animals↗

PubMed1989

[Intermediate term results following supra-tubercular corrective osteotomy of the head of the tibia].

In the operative therapy of gonarthrosis the supratubercular osteotomy of tibia head has a solid position. In the present work the results of subtractive and additive intraligamentous correction osteotomy with following fixation in plaster dressing on the orthopaedic clinic of the district hospital Aue will be explained. In the period from 1982-1987 35 supratubercular tibia head correction osteotomies in 32 patients with unicondylar gonarthroses were carried out. These were examined on an average of 2.8 years (0.8-5.4 years) post operative. The supratubercular correction osteotomies were composed of 27 valgus and 8 varus operations in corresponding axis deviation. 85 per cent of all examinated patients were satisfied and very satisfied with the operation results. This justifies the further execution of the named operative method. Among the 15 per cent of the unsatisfactory operation results were mainly gonarthroses of higher severities and rheumatoid arthritis. The results shows, that in the last cases the indication is stronger to make and the possible unilaterale or totale arthroplasty--especially in higher living age--are take into consideration.

Adult↗

PubMed1989

[The effect of oophorectomy on blood flow, 85Sr uptake and mineral content in the tibia of female rats].

The authors investigated in three experiments the blood flow (by retention of 85Sr microparticles), the 85Sr retention and state of mineralization of the tibia in female rats after oophorectomy (OOX). In the first experiment one month after OOX the retention of 85Sr microparticles is increased significantly to 158.6%, as compared with controls, the blood flow is increased insignificantly to 131.3%. In the second experiment the retention of microparticles is increased maximally 4 weeks after OOX to 152.9%, the blood flow after two weeks to 150.0%, as compared with controls; the weight of the ash per unit of bone volume of the tibia is significantly reduced after 8 weeks following OOX--to 90.8%. The two-hour retention of radioactive strontium 85Sr in the third experiment after OOX rises--significantly after 8 weeks to 133.4%. The results of the experiments are consistent with the idea on an increased metabolic activity of osseous tissue in the initial stage of the demineralization process following OOX.

Animals↗

PubMed1978

Premature fusion of facial sutures with free periosteal grafts. An experimental study with special reference to bone formation with free periosteal grafts from the tibia, the scapula and the calvarium.

The present study was undertaken to obtain more information on the bone forming mechanisms with free periosteal grafts and to study premature synostosis of facial sutures achieved with free periosteal grafts. The results are based on a material of 196 rabbits operated on at the age of two weeks. It was found that the bone forming mechanism with free periosteal grafts from the tibia, the scapula and the calvarium is essentially the same. When implanted in the tibialis anterior muscle of the leg of the same animal they all produced bone. The mechanism of bone formation is reminiscent of the enchondral bone formation seen in fracture healing. There is no difference in the bone forming mechanism with the periosteum from an enchondrally ossifying bone when compared with the periosteum of an intramembranously ossifying bone. In all the three different periosteal grafts studied, there was a cartilage stage before bone formation. In the muscle, all these three periosteal grafts, in spite of their tubular or membranous bone origin, produced bones tubular in shape. When the transplants were overlying the membranaceous facial bones, membrane shaped bone developed via intramembraneceous type of ossification in the recipient area. It can be concluded from these experiments that the shape and type of bone developed with free periosteal grafts depends mainly on the environmental conditions in the recipient area. Fusion of the premaxillo-maxillary and fronto-nasal sutures was achieved with free periosteal grafts from the tibia. Free periosteal grafts from the scapula and the calvarium failed to develop premature fusion of the sutures. The fusion developed due to increased bone formation in the suture area. The fusion of the premaxillo-maxillary suture stopped the growth in this area and caused a severe growth disturbance of the whole snout. The fusion of the fronto-nasal suture by the bone bridge retarded the growth of the nasal bone on the fused side and led to deviation of the snout to the operated side. Compensatory changes developed in other sites of the cranio-facial skeleton in order to minimize the effects of the growth disturbance. The fused fronto-nasal suture was used as a model to study the treatment of premature synostosis of facial bones. Resection of the fused area led to correction of the developed growth disturbance and to subsequent normal growth of the snout.

Animals↗

PubMed1988

[Effects of antirheumatics on the glycosaminoglycan distribution pattern of fetal tibia cultured in vitro].

The glycosaminoglycan (GAG) distribution pattern of murine fetal tibiae cultured for 6 days in vitro was determined and the effects of drugs on the growth of the tibia explants in vitro, on their total GAG content and on their GAG distribution pattern were studied. The explants contained chondroitin-4-sulfate and chondroitin-6-sulfate in a relation of about 4:1; hyaluronic acid was not detected. During the incubation period of 6 days in vitro a mean increase in size of 47% and of the total GAG content of about 80-90% was observed; the GAG distribution pattern was practically unchanged. Incubation of the explants in a medium without ascorbic acid by contrast to a medium containing ascorbic acid (5 and 50 micrograms/ml) lead to a reduction of growth and total GAG content. The nonsteroidal antiphlogistic drugs phenylbutazone (20 and 200 micrograms/ml), ibuprofen (25 and 200 micrograms/ml) and alclofenac (25 and 400 micrograms/ml) effected a concentration dependent decrease of the growth and of the GAG content of the explants mainly due to a reduction of chondroitin-4-sulfate. Prednisolone (10 micrograms/ml) caused a significant increase of the GAG content of the explants leaving their GAG distribution pattern nearly unchanged. Aurothioglucose (400 micrograms/ml) induced a reduction of the growth and of the GAG content of the explants without altering the GAG distribution. Under low concentrations of Na-pentosanpolysulfate (5 micrograms/ml) an increase in growth and in the GAG content by a nearly unaltered GAG distribution pattern was observed, high concentrations (200 micrograms/ml), however, caused a reduction of growth and of the GAG content.

Animals↗

PubMed1987

The treatment of adamantinoma of the tibia by wide resection and allograft bone transplantation.

Since 1975, nine patients who had adamantinoma of the tibia were treated by the orthopaedic oncology service of the Massachusetts General Hospital and the Children's Hospital, Boston, Massachusetts. All patients were followed for two years or more or until a relapse occurred (mean length of follow-up, 5.3 years). Five of the patients were female and four were male; their ages ranged from fourteen to fifty-six years (mean, 19.1 years). The treatment consisted of staging, wide surgical resection of the tumor, and insertion of a segment of intercalary bone allograft (eight patients) or an osteoarticular segment (one patient). All grafts were fixed with compression plates and screws. All but two of the allografts had united at both the proximal and the distal host-donor junction site by twelve months. None of the patients had a local recurrence but pulmonary metastases developed in one. Four of the patients had complications that affected the final result. The functional results were excellent in five patients, good in one, fair in one, and a failure in two. Seven of the nine patients were asymptomatic and fully functional at the time of writing; only one needed a brace to walk. On the basis of this experience we recommend wide resection and implantation of an intercalary allograft in the treatment of adamantinoma of the tibia.

Adolescent↗

PubMed1988

Chronic osteomyelitis. Use of ipsilateral fibular graft for diaphyseal defects of the tibia.

Acute haematogenous osteomyelitis is a major disease in this area, affecting 10% of the children seen in orthopaedic clinics. Few patients report early enough to benefit from antibiotic treatment, so the majority are seen quite late, usually in the chronic stage with discharging sinuses or chronic ulcers. In adults, chronic osteomyelitis results from inadequately treated open fractures. Injudicious sequestrectomy or very severe disease may lead to loss of length of the bone. A 5-year-old boy and a 30-year-old man suffered loss of length of tibia (averaging 8 cm). In an experimental work, a non-vascularised ipsilateral fibular graft was used to bridge the gaps in both tibiae, fixation was achieved with a tubular plate in one instance and an intramedullary rush nail in the other case. Both patients bore weight at 4 and 6 months, respectively. Amputation should therefore be avoided.

Adult↗

PubMed1988

Osteogenic sarcoma of the tibia in a patient with epidermolysis bullosa dystrophica.

An osteogenic sarcoma of the tibia occurred in an eight-year-old boy with epidermolysis bullosa dystrophica hereditaria (EBDH) (Hallopeau-Siemens type). The patient had had the congenital skin disease since the time of birth. A painful swelling appeared in the proximal portion of his right tibia, which was diagnosed as osteogenic sarcoma on biopsy study. The patient died of massive pulmonary metastases and cachexia four months after the onset of the tumor. Osteogenic sarcoma in a patient with EBDH seems not to have been previously reported. EBDH has been known to be occasionally associated with squamous cell carcinoma. Whether an impairment of the patient's defense mechanism by the chronic skin disease might have enhanced the rapid progression of the associated bone malignancy is unknown.

Bone Neoplasms↗

PubMed1987

Morphometric study of cartilage dynamics in the chick embryo tibia. II. Dexamethasone-treated embryos.

The cartilage dynamics in the tibia of dexamethasone-treated chick embryos has been studied by means of morphometric methods. Treated embryos showed a delay in the longitudinal growth of the tibia, as well as in the growth of all structures enclosed by the perichondrium-periosteum. The cartilage formation rate remained nearly unchanged (above 1 mm3/day) from Day 12 to Day 14, whereas the cartilage resorption rate was zero up to Day 13, and showed a non-significant increase from Day 13 onwards. This might be related to the scarcity of resorptive cells found in the cartilage-marrow interface. By Day 14 a certain recovery of the growth rhythm was observed. These results indicate that the greatest effect of dexamethasone occurs at the level of cartilage resorption.

Animals↗

PubMed1986

Roentgen rounds #81. Posteromedial bowing of the tibia.

Posteromedial bowing of the tibia is a rare deformity which is being recognized more frequently. It is frequently associated with and may be the result of a calcaneovalgus foot deformity. It has a better overall prognosis than the other two categories of congenital angular deformity of the tibia. It does not, however, have a prognosis of normality. The frequent sequelae of LLD and foot hypoplasia should be taken into account when counseling parents of children with PMBT. The need for clinical follow-up with interval scanograms should be emphasized.

Child↗

PubMedDate not supplied

Posteromedial bowing of the tibia and fibula: a literature review and case presentation.

Congenital bowing of the tibia and fibula is a serious orthopedic condition rarely encountered by a podiatrist. However, with the increased number of hospital based podiatrists, it becomes imperative that a thorough knowledge of this disorder and the possible treatments be well understood. Deformities of this type are not very common. Most of the literature describes anterior and anterolateral bowing with pseudoarthrosis. The authors have only been able to document 128 cases of posteromedial bowing in the literature with no mention of it in the podiatric literature. This report will present a review of congenital angulation of the tibia and fibula with its associated deformities. Concentration will be given primarily to posteromedial bowing, including a case presentation from the Scholl College of Podiatric Medicine, Pediatric Foot Clinic.

Female↗

PubMed1987

Congenital pseudarthrosis of the tibia associated with cleidocranial dysostosis and osteogenesis imperfecta. A case report.

A neonatal boy with cleidocranial dysostosis presented with congenital pseudarthrosis of the tibia. Clinical observation later revealed he also had osteogenesis imperfecta. The osteogenesis imperfecta was classified as Type I and the congenital tibial pseudarthrosis as Type II. Cleidocranial dysostosis, osteogenesis imperfecta, and congenital pseudarthrosis of the tibia have not been previously reported to coexist in one individual.

Abnormalities, Multiple↗

PubMedDate not supplied

Posttraumatic tibia valga: a case demonstrating asymmetric activity at the proximal growth plate on technetium bone scan.

Posttraumatic tibia valga is a well-recognized complication following fracture of the upper tibial metaphysis in young children. We present a case of a child who developed a valgus deformity following fracture of the proximal tibia and fibula in which quantitative bone scintigraphy at 5 months after injury demonstrated increased uptake at the proximal tibial growth plate with proportionally greater uptake on the medial side. This finding suggests that the valgus deformity in this patient was due to a relative increase in vascularity and consequent overgrowth of the medial portion of the proximal tibial physis.

Child↗