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Echinococcosis granulosus/cysticus of the tibia.

Hydatid disease is caused by the parasitic tapeworm Echinococcus. There are three species: E. granulosus, E. alveolaris and E. voegeli. Only E. alveolaris and E. granulosus are important for human infections. These two species are totally divergent in their manner of infestation. Hydatid disease is a rare parasitic disease that primary involves the liver and the lung. Skeletal disease is rare, accounting for less than 2% of all hydatid lesions, and often presents as a clinical and radiologic diagnostic problem. The skeletal involvement is usually due to secondary extension after haematogenous spread of the infection. The vertebral column, the pelvis and the skull are most commonly involved. Treatment is also difficult because of the invasive nature of bony involvement and the spillage of fluid with subsequent contamination seeding. We present a case of primary hyatid cyst of the tibia. We point out the importance of considering osseous hydatidosis in the differential diagnosis of destructive bone lesions and the necessity of radical resection.

Bone Cysts↗

Potential healing benefit of an osteoperiosteal bone plug from the proximal tibia on a mosaicplasty donor-site defect in the knee. An experimental study in the goat.

INTRODUCTION: Autologous osteochondral transplantation is a popular treatment for articular cartilage lesions in the knee joint. The donor defect is commonly left empty and remains a matter of concern. MATERIALS AND METHODS: In 20 knees of 10 goats, we created a standardised donor defect in the knee. In the control group the defects were left empty, whereas in two other groups a bone plug from the proximal tibia was press-fitted into the defect with or without a covering periosteal layer. RESULTS: Histological evaluation after 8 and 16 weeks showed that relatively rapid osteoclastic resorption of the bone plug occurred. Defects were mainly filled with fibrous tissue, and collapse of the adjacent bone and cartilage was visible, especially when the defects were left empty. Occasionally, some consolidation of the graft to the host bone could be detected, and in some samples periosteal chondrogenesis was present. CONCLUSION: Our findings suggest that transplantation of a tibial bone plug with covering periosteum to the donor defect in a cartilage transplantation procedure does not have any additional value in an attempt to minimise the damage at the donor site. The observed resorption of the bone plug and the collapse of the adjacent joint margin remain a matter of concern with this technique.

Animals↗

Acute compartment syndrome following intramedullary pulse lavage and débridement for osteomyelitis of the tibia.

The implantation of gentamicin loaded polymethylmethacrylate (PMMA) beats and other local antibiotic carriers is a common practice in the treatment of chronic osteomyelitis as is the use of local jet lavage débridement. This article presents the case of a patient with chronic osteomyelitis of the tibia, who had no complication after débridement, intramedullary reaming and pulse lavage without tourniquet but sustained a compartment syndrome 2 weeks later during a second procedure in which an intraoperative tourniquet and pulse lavage were combined.

Acute Disease↗

Ultrasound velocity in the tibia in Japanese patients with hip fracture.

The speed of sound in the tibia (tibial SOS) was measured in elderly women to determine whether the tibial SOS declined with age, similarly to bone mineral density (BMD), as determined by dual-energy X-ray absorptiometry (DXA), and whether the tibial SOS in elderly hip fracture patients was lower than that in a control group. The subjects in this study included 38 female patients with hip fracture aged 65 years or more and 38 age-matched women living in a nursing home as the control group. There was a significant decline in the tibial SOS with age in women in the control group, but not in those with hip fracture. In all subjects aged under 80 years, the tibial SOS in women with hip fracture was significantly lower than that in women in the control group. In all subjects who were 80 years or older, the tibial SOS was not significantly different between women with hip fracture and the control group; thus, the tibial SOS in both groups was low, and they were considered to have progressive osteoporosis. The tibial ultrasound velocity can be expected to be useful as an indicator of the risk of limb fracture in the elderly.

Absorptiometry, Photon↗

Unusual arterial complications caused by an osteochondroma of the femur or tibia in young patients.

In the past 2 years three relatively young patients were treated for a severe arterial complication due to an exostosis of the femur or tibia. A 39-year-old man had occlusion of the femoral artery, a 28-year-old man suffered from a popliteal pseudoaneurysm, and a 14-year-old boy presented with occlusion of his femoral artery while stretching his leg. An exostosis on the course of the femoral or popliteal artery, requires additional examination (duplex ultrasonography and magnetic resonance arteriography) in order to exclude an arterial disorder. If arterial compression by an exostosis is shown, an operative procedure to remove the exostosis should be performed.

Adolescent↗

Monostotic Paget's disease of the tibia in Korea.

The incidence of Paget's disease has been estimated to be about 3%, but it is extremely rare in Asia, especially in Korea. In addition, monostotic involvement seems to be far less frequent. In this report, we describe a case of monostotic Paget's disease localized in the right tibia.

Alkaline Phosphatase↗

Subchondral cyst of the tibia secondary to Wilson disease.

We present the case of a 40-year-old male patient who had been suffering from Wilson disease for over 20 years, whose knee was diagnosed as osteoarthritis combined with subchondral cyst of the tibia. Preoperative examinations (X-ray, CT and MRI) confirmed the diagnosis. The microscopic examination detected thickening of the synovial membrane, and histopathological findings revealed that lymphoid cells and plasma cells were infiltrated at the synovial membrane. On copper-specific staining, no copper pigmentation was identified. However, the energy-dispersive X-ray (EDX) microanalysis revealed copper pigmentation in high concentration. These findings may contribute to our better comprehension of the development process of the arthropathy in patients with Wilson disease. The combination of subchondral cyst with Wilson disease is extremely rare, as only about 16 such cases have been reported in the English literature.

Adult↗

Bone defect repair in rat tibia by TGF-beta1 and IGF-1 released from hydrogel scaffold.

Bone repair is one of the major challenges facing reconstructive surgery. Bone regeneration is needed for the repair of large defects and fractures. The ability of TGF-beta1 and IGF-1 incorporated into hydrogel scaffold to induce bone regeneration was evaluated in a rat tibia segmental defect model. External fixation was performed prior to the induction of the segmental bone defect in order to stabilize the defect site. Hydrogel scaffold containing either TGF-beta, IGF-1, TGF-beta + IGF-1, hydrogel containing saline or saline, were inserted in the defect. Calcified material was observed in the defects treated with TGF-beta 2 weeks following the start of treatment. Bone defects treated with TGF-beta, IGF-1 or TGF-beta + IGF-1 revealed significant bone formation after 4 and 6 weeks when compared to the control specimens. X-ray images showed that solid bone was present at the defect site after 6 weeks of treatment with TGF-beta or TGF-beta + IGF-1. A less pronounced bone induction was observed in the control specimens and bones treated with IGF-1. Percent closure ratio of bone defects after 6 weeks were 40, 80, 89, and 97% for saline, hydrogel, IGF-1, TGF-beta and IGF-1 + TGF-beta groups, respectively. It is concluded that hydrogel scaffold can serve as a good osteoconductive matrix for growth factors, and that it provides a site for bone regeneration and enhances bone defect healing and could be used as alternative graft material.

Animals↗

Detection of osteoprotegerin (OPG) and its ligand (RANKL) mRNA and protein in femur and tibia of the rat.

Osteoprotegerin (OPG) and the receptor activator of nuclear factor (NF)-kB ligand (RANKL) are key regulators of osteoclastogenesis. The present study had the main aim of showing the localization of OPG and RANKL mRNA and protein in serial sections of the rat femurs and tibiae by immunohistochemistry (IHC) and in situ hybridization (ISH). The main results were: (1) OPG and RANKL mRNA and protein were co-localized in the same cell types, (2) maturative/hypertrophic chondrocytes, osteoblasts, lining cells, periosteal cells and early osteocytes were stained by both IHC and ISH, (3) OPG and RANKL proteins were mainly located in Golgi areas, and the ISH reaction was especially visible in active osteoblasts, (4) immunolabeling was often concentrated into cytoplasmic vacuoles of otherwise negative proliferative chondrocytes; IHC and ISH labeling increased from proliferative to maturative/hypertrophic chondrocytes, (5) the newly laid down bone matrix, cartilage-bone interfaces, cement lines, and trabecular borders showed light OPG and RANKL immunolabeling, (6) about 70% of secondary metaphyseal bone osteocytes showed OPG and RANKL protein expression; most of them were ISH-negative, (7) osteoclasts were mostly unstained by IHC and variably labeled by ISH. The co-expression of OPG and RANKL in the same bone cell types confirms their strictly coupled action in the regulation of bone metabolism.

Animals↗

Individual and combined effects of calciotropic hormones and growth factors on mineral metabolism in embryonic chick tibiae.

We have investigated single and combined effects of calciotropic hormones and growth factors on the regulation of alkaline phosphatase (ALP) activity and calcium metabolism in an optimized serum-free bone organ culture system of embryonic chick tibiae. Parathyroid hormone PTH(1-34) alone mobilized calcium from bone tissue time- and dose-dependently and inhibited ALP activity. Both the bisphosphonate (BM 21.0955) and to a lesser extent salmon calcitonin alone slightly increased calcium uptake and inhibited the stimulation of bone resorption by PTH(1-34). 1,25(OH)2D3 mobilized calcium and inhibited ALP activity in contrast to 24,25(OH)2D3 which inhibited ALP activity but had no significant effect on calcium metabolism. Interestingly the combination of PTH(1-34) with 1,25(OH)2D3 but not 24,25(OH)2D3 reduced calcium mobilization. The combination of the midregional fragment PTH(28-48), which by itself has no effect on calcium metabolism, with 1,25(OH)2D3 reduced calcium mobilization more efficiently. Several PTH-regulated mediators have been assayed in this system. Of the tested growth factors, IGF-I at high concentrations caused bone resorption with no effect on ALP activity. TGF-beta 1 (transforming growth factor beta) and BMP-2 had no significant effect on calcium metabolism; however, ALP activity was inhibited by TGF-beta 1 and induced dose dependently by BMP-2. Of the other factors known to be present in bone, platelet-derived growth factor (PDGFA/B) and epidermal growth factor (EGF) had a small effect on calcium mobilization but had no effect on ALP activity. bFGF reduced ALP activity slightly without an effect on calcium metabolism. Our results show that this in vitro system can mimic some interactions of calciotropic hormones in vivo and allows the assaying of mediators in terms of regulation of ALP activity and of calcium metabolism.

Alkaline Phosphatase↗

The effect of active vitamin D3 analogs and dexamethasone on the expression of osteocalcin gene in rat tibiae in vivo.

We tested the effects of 1 alpha,25-dihydroxyvitamin D3 (1,25-(OH)2D3), 2 beta-(3-hydroxypropoxy)-1 alpha,25-dihydroxyvitamin D3 (ED-71) and dexamethasone on osteocalcin mRNA levels in rat tibiae in vivo. Northern blot analysis showed that both 1,25-(OH)2D3 and ED-71 caused an increase in osteocalcin mRNA levels in bone: 1,25-(OH)2D3 induced a transient increase in the mRNA levels followed by a decrease in the control level by 12 h post administration. In contrast, ED-71 caused a persistent increase in osteocalcin mRNA level for seven days post administration. Serum osteocalcin levels paralleled the osteocalcin mRNA level in bone in both groups. Dexamethasone caused a marked reduction in both osteocalcin mRNA and serum osteocalcin levels. Suppressive effect of dexamethasone on osteocalcin expression was persistent for seven days at higher dose. Our results represent the first demonstration of the effect of active vitamin D and corticosteroid on the expression of osteocalcin mRNA in bone in vivo.

Amino Acid Isomerases↗

A method for making reproducible experimental fractures of the rabbit tibia.

A method for making reproducible fractures of the tibia of the rabbit is described. The fractures may be stabilized by plating with either metallic compression, or plastic plates. If a stainless steel dynamic compression plate is used, the rigid immobilization of the fragments leads to direct Haversian remodelling across the fracture, i.e. primary healing, whereas when a plastic plate is used, the fixation is unstable and this leads to secondary healing with the development of a cartilaginous callus. Thus the method of healing may be determined predictably.

Animals↗

Pilon fractures of the tibia: a study based on 19 cases.

Twenty-seven pilon fractures of the tibia were identified from 733 adult tibial and ankle fractures admitted to the Coventry and Warwickshire Hospital in 5 years. Nineteen of the 27 were reviewed. The fractures were classified into types I, II and III according to the AO/ASIF system. Treatment was by splintage in plaster-of-Paris or open reduction and internal fixation, and an external fixator for one type III. Non-operative treatment produced good functional results in all type I fractures, poor results in type II and was not applicable to type III. Eight of 11 types II and III fractures, treated by internal fixation achieved good functional results. Hindfoot disability was assessed from subtalar movements. It is concluded that open reduction and internal fixation is indicated in types II and III pilon fractures. Subtalar motion is negligibly restricted in type I fractures, while in types II and III internal fixation is followed by recovery of hindfoot function.

Adult↗

Locked intramedullary nailing of fractures of femur and tibia.

The results of 194 consecutive interlocking nailings for 95 fractures in the tibia and 99 fractures in the femur with a median observation time of 22 months are presented. Three fractures were not consolidated radiologically at follow-up; three deep infections were recorded, all of which healed. Shortening greater than 1 cm was recorded in 17 fractures, rotatory malalignment greater than 5 degrees in 21, and angular malalignment greater than 5 degrees occurred in 17. The end result was excellent in 121 fractures, good in 41, fair in 28, and poor in 4.

Adolescent↗

Ultrasonic measurements of deer antler, bovine tibia and tympanic bulla.

Longitudinal sonic plesio-velocity, density and mineral volume fraction of the three bone types plus bovine bone matrix are reported. The axial sonic velocity in km/s and the mineral volume fraction for each is as follows: deer antler 3.08, 0.33; bovine tibia 3.89, 0.44; tympanic bulla 4.53, 0.85; bovine matrix 1.82. A brief discussion of the deer antler and tympanic bulla histology is included.

Animals↗

The femur-tibia control system of stick insects--a model system for the study of the neural basis of joint control.

In a form of top-down analysis, the femur-tibia control system of stick insects is investigated. Open-loop experiments show that it is mainly velocity-sensitive with an extremely low velocity-threshold, that it possesses a very high gain and that it has only a very small phase reserve and thus works close to instability. The closed-loop system generates catalepsy. The system consists of a single sense organ with approximately 80 sense cells with known characteristics, a small number of interneurones (mainly non-spiking ones) and a small number of motor neurones. The characteristics of the whole system can quantitatively be attributed to the characteristics of its elements. The gain of the loop is state-dependent and the system is 'switched off' during active movements and replaced by a control system with different attributes. It is discussed that most of the characteristics of this system are, at least qualitatively, similar to joint control systems in other animals. Because the described system can be more easily investigated than other systems (especially in vertebrates) it can serve as a model against which more complicated joint control loops may be compared.

Animals↗

X-ray diffraction by collagen in the fully mineralized cortical bone of cow tibia.

X-ray diffraction patterns were recorded from fully mineralized and demineralized sections of the cortical bone from cow tibia. The results were used to obtain a measure, d, of the mean side-to-side spacing (equatorial diffraction spacing) of the molecules in the type I collagen fibrils of bone. Mineralized bone yielded a d value of 1.23 nm; for the demineralized tissue this value increased to 1.52 nm. Thus it appears that mineralization of bone compacts its collagen molecules within the fibrils.

Animals↗