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PubMed2005

The effect of wire plane tilt and olive wires on proximal tibia fracture fragment stability and fracture site motion.

To analyze the effect of the tilt angle relationship between the crossed wire plane and the bone axis on the stiffness of fine wire external fixation, load-deformation behavior was compared across different tilt angles (0 degree, 10 degrees, and 20 degrees) of the plane containing crossed smooth or olive wires under identical conditions of central axial compression, medial compression-bending, posterior compression-bending, posteromedial compression-bending, and torsion. Stiffness values were calculated from the load-deformation and torque-angle curves. A tilt angle of 20 degrees with olive wires provided significantly greater stiffness compared to smooth wires at any angle in any loading condition (p < 0.05). A tilt angle of 20 degrees with olive wires was also significantly more stiff than a tilt angle of 0 degree with olive wires in any loading condition. In torsion, olive wires with 10 degrees and 20 degrees tilt were not significantly different, while in posterior bending olive wires with 10 degrees tilt were significantly stiffer than olive wires with 0 degree or 20 degrees tilt. With smooth wires, tilting the wire plane caused a decrease in stiffness in posterior bending, posteromedial bending, and torsion. Overall, the use of olive wires in conjunction with tilting the wire plane enhances the fixation stiffness for proximal tibia fractures while allowing more options for wire configurations that avoid neurovascular and musculotendinous structures, and wounds.

External Fixators↗

PubMed2005

Effect of foot orthotics on rearfoot and tibia joint coupling patterns and variability.

The purpose of this study was to compare joint coupling patterns and variability of the rearfoot and tibia during running in subjects who were treated with two types of orthotic devices to that of controls. Eleven subjects with various lower extremity injuries were treated unsuccessfully with a standard orthotic, and then successfully with an inverted orthotic. Three-dimensional kinematic data were collected while subjects ran without orthoses and then in standard and inverted orthoses. Eleven healthy subjects ran without orthoses for comparison. The rearfoot inversion/eversion and tibial internal/external rotation joint coupling pattern and variability relationship was assessed using a vector coding technique. It was hypothesized that when the treated runners ran without orthotic devices, they would exhibit lower joint coupling angles and lower joint coupling variability compared to the controls. In addition, it was hypothesized that there would be no difference in the coupling angle or coupling variability between the standard and no orthotic conditions of the treated runners. Finally, it was hypothesized that coupling angle would decrease and variability would increase in the inverted versus the standard and non-orthotic conditions. No significant differences in joint coupling pattern or variability were observed between the treated and control subjects. In addition, no significant differences were noted between the orthotic conditions in the treated group. These results suggest that foot orthotic devices do not produce significant changes in rearfoot-tibial coupling. Therefore, the relief experienced with the inverted orthotic is likely due to factors other than alterations in this coupling.

Adolescent↗

PubMed2006

Osteophytes, juxta-articular radiolucencies and cancellous bone changes in the proximal tibia of patients with knee osteoarthritis.

OBJECTIVE: To determine differences in tibial cancellous bone organisation in knee osteoarthritis (OA) between the central weight-bearing region and juxta-articular radiolucencies adjacent to small, medium or large marginal osteophytes. METHODS: Patients with medial compartment OA (n = 60; F = 39), mean (SD) age 60.0 (9.7) years, and non-OA reference subjects (n = 21; F = 5), mean (SD) age 36.8 (11.5) years, had x4 macroradiographs digitised by laser scanner. Using a modified Osteoarthritis Research Society (OARS) Atlas, right and/or left knees were graded according to marginal osteophyte size into those with small (n = 30), medium (n = 30) or large (n = 27) marginal osteophytes, identified as OPH1, OPH2 and OPH3, respectively. Non-OA knees (n = 30) were anatomically normal. Computerised method of Fractal Signature Analysis (FSA) quantified differences in cancellous bone structure between non-OA and osteophyte subgroups at two regions of interest (ROIs); central weight-bearing and tibial margin. RESULTS: Compared to non-OA, vertical trabecular number increased significantly (P < 0.05) in all osteophyte subgroups (width range 0.12-1.14 mm) within both ROIs. In OPH3, this increase was significantly (P < 0.05) greater compared to OPH2 in the central ROI, and to OPH2 and OPH1 in the marginal ROI at most trabecular widths (0.12-1.14 mm). In the marginal ROI, compared to non-OA, horizontal trabeculae number decreased in all osteophyte subgroups. This decrease was significantly greater in OPH3 compared to OPH2 and OPH1 at small to medium trabecular widths (0.12-0.54 mm). CONCLUSION: Compared to disease associated bone loss at the central ROI of the tibia, the extent of juxta-articular bone loss appears to be associated with the size of the marginal osteophytes.

Adult↗

PubMed2006

Trabecular bone status in ultradistal tibia under habitual gait loading: a pQCT study in postmenopausal women.

This study investigated regional volumetric trabecular bone mineral density (tBMD) and bone area at the ultradistal tibia in Chinese women using peripheral quantitative computed tomography. Fifty-six postmenopausal women aged 47-62 yr participated in BMD measurements at baseline and 22 of them were followed at both 1-yr and 3-yr follow-up scans. Regional baseline tBMD, rate of annual bone loss, and trabecular bone area were determined. Baseline measurements showed that the tBMD of both the posterior (252.9+/-63.4 mg/cm(3)) and medial (226.6+/-68.9 mg/cm(3)) regions was significantly higher than that of the anterior (126.3+/-61.9 mg/cm(3)) and lateral regions (149.8+/-50.6 mg/cm(3)), respectively (p<0.001). Both the 1-yr and 3-yr follow-up measurements showed that there was significant physiological annual tBMD loss on an average of 1.61%, at the four regions. Inter-slice regional tBMD and trabecular bone area measurements demonstrated a significant linear decrease from the distal to proximal aspects (p<0.001). Findings suggest that dynamic compressive loading during the heel strike and the body weight vector shifting toward the medial aspect during the stance phase in a normal gait might account for the regional tBMD differences. Increased tBMD and bone area toward the distal tibial endplate may adapt to withstand the axial impact loading. However, the low-impact weight-bearing nature of a normal gait may not be osteogenic to prevent regional bone loss. An exercise program specific to the women at risk should be contemplated.

Adaptation, Physiological↗

PubMed2004

Quantitative assessment of osteoporosis from the tibia shaft by ultrasound techniques.

Bone mineral density (BMD) is used as a clinical estimate of the risk of fracture. Ultrasound provides an alternative or complement to X-ray based methods of bone densitometry for determining BMD. Among ultrasonic characteristics, the speed of sound (SOS) is a useful tool for assessment of osteoporosis because, as recently reported, it represents a combination of density and compressibility of bone tissue. Thus, it might provide better information on bone quality to estimate the fracture risk. In this paper, a dual-transducer ultrasound technique was employed to measure the mean ultrasound propagation speed of the cortical layer as well as the cancellous layer at the tibia shaft. Encouraging results from 18 outpatients showed a high correlation (r = 0.93) between measurements of BMD and those from dual energy X-ray absorptiometry (DEXA).

Absorptiometry, Photon↗

PubMed1984

Diaphyseal Paget's disease: an unusual finding in the tibia.

Paget's disease may present in the tibia without involvement of either end of the bone. Such unusual diaphyseal lesions are invariably lytic and, rarely, may be multifocal. They almost always involve the anterior cortex of the bone and usually have a characteristic 'V-shaped' margin at one or both ends. Expansion of the bone is common. This unusual appearance is frequently an early manifestation of the disease under the age of 40 years. Awareness of this appearance is important in order to prevent incorrect diagnosis and unnecessary biopsy or surgery.

Adult↗

PubMed1989

Tibia vara caused by focal fibrocartilaginous dysplasia.

A case of severe unilateral tibia vara in a young boy is reported. The clinical and radiological features were identical to the only three reported cases of focal fibrocartilaginous dysplasia. With conservative management the child showed a complete recovery. The importance of recognising this condition is emphasised, as unnecessary surgery may be avoided. The radiologist can play a major role in making the diagnosis.

Fibrous Dysplasia of Bone↗

PubMed2000

The mechanical strength of bones in torsion application to human tibiae.

How strong is a long bone in torsion? The principle of mechanical engineering of torsion on a beam is applied to the cylindrical tube model of a bone. The deformation and the strength of the tube are calculated. The calculated strength is about twice that of a real, not circular bone (human tibia) with the same cross-sectional area.

Biomechanical Phenomena↗

PubMed2001

The intramedullary skeletal kinetic distractor (ISKD): first clinical results of a new intramedullary nail for lengthening of the femur and tibia.

In 1986, a programme was initiated by the senior author to develop a reliable, mechanically activated, intramedullary lengthening device with a non-invasive means of measuring the progress of lengthening without X-ray. We report results of design, biomechanical testing, in vivo animal testing and clinical implantation of the first 20 intramedullary skeletal kinetic distractors (ISKDs) in adult patients with limb-length discrepancies. Twenty ISKD devices were implanted in 18 patients (14 males and four females). Lengthening was required due to infection (ten), trauma (six), polio (one) and burn (one). Six femurs and 14 tibias were lengthened. Mean patient age was 40 years (range, 18-65 years). No implant related infections, non-unions, malunions or joint contractures were observed. A design change was made following two initial hardware failures, after which there were no further breakages. Average lengthening was 49 mm (range, 29-110 mm). The average lengthening rate was 0.82 mm/day (range, 1.7-0.4 mm/day). Ability to work, walk and drive before, during and after treatment with the ISKD compared favourably with that of similar patients undergoing lengthening using the 'monorail' method in our practice. The ISKD appears to be a safe and cost-effective alternative to external fixators that reduces lifestyle disruption and complications during adult limb-lengthening procedures.

Adolescent↗

PubMed1998

Estimation of artifacts induced by the Ilizarov device in quantitative computed tomographic analysis of tibiae.

This study concerns the estimation of the artifacts introduced by the metallic frame of an Ilizarov apparatus during quantitative computed tomography for the assessment of neoosteogenesis. Ten cadaver tibiae were tomographed before and after the mounting of an Ilizarov device. The increase in mean density and in the relative number of pixels were used as indicators of the artifacts induced by the apparatus. No significant influence by the device was recorded in regions corresponding to a corticotomy site. In regions close to the metallic rings of the Ilizarov apparatus, measurements are distorted significantly, but with no influence on the assessment of neoosteogenesis.

Artifacts↗

PubMed2001

Structural properties of a new design of composite replicate femurs and tibias.

The purpose of this study was to compare the structural properties of a new vs. established design of composite replicate femurs and tibias. The new design has a cortical bone analog consisting of short-glass-fiber-reinforced (SGFR) epoxy, rather than the fiberglass-fabric-reinforced (FFR) epoxy in the currently available design. The hypothesis was that this new cortical bone analog would improve the uniformity of structural properties between specimens, while having mean stiffness values in the range of natural human bones. The composite replicate bones were tested under bending, axial, and torsional loads. In general, the new SGFR bones were significantly less stiff than the FFR bones, although both bone designs reasonably approximated the structural stiffnesses of natural human bones. With the exceptions of the FFR bone axial tests, the highest variability between specimens was 6.1%. The new SGFR bones had similar variability in structural properties when compared to the FFR bones under bending and torsional loading, but had significantly less variability under axial loading. Differences in epiphyseal geometry between the FFR and SGFR bones, and subsequent seating in the testing fixtures, may account for some of the differences in structural properties; axial stiffness was especially dependent on bone alignment. Stiffness variabilities for the composite replicate bones were much smaller than those seen with natural human bones. Axial strain distribution along the proximal-medial SGFR femur had a similar shape to what was observed on natural human femurs by other investigators, but was considerably less stiff in the more proximal locations.

Biomechanical Phenomena↗

PubMed2003

Deformation behaviour and damage accumulation of cortical bone specimens from the equine tibia under cyclic loading.

Despite its clinical importance, the fatigue behaviour of cortical bone has not been examined as widely as its static behaviour. In the present study, specimens from the tibiae of horses have been subjected to load-controlled single step tests. The cyclic deformation behaviour was described by the development of stress-strain hysteresis parameters over the lifetime. The fatigue behaviour of bone is characterised by cyclic softening which is most distinctive towards the end of the lifetime. The microstructural damage accumulated during cyclic loading results in a loss of stiffness, asymmetrical deformation of the bone in tension and compression in cyclic creep. As shown by light and scanning electron microscopy, microcrack formation and growth is the main damage mechanism. The crack growth behaviour is strongly influenced by the microstructure, the stress components and the absolute value of the local stresses. Lower local stresses and/or compressive mean stresses lead to a dominant influence of the shear stress components with shear failure at inner interfaces. With increasing crack length, that is, higher local stress amplitudes, or tensile mean stresses, the microstructure is more and more ignored and failure occurs primarily under the influence of the normal stress components. This can be clearly seen on the fracture and specimen surfaces.

Animals↗

PubMed1998

Finite element analysis of the implanted proximal tibia: a relationship between the initial cancellous bone stresses and implant migration.

The cancellous bone stresses within the implanted proximal tibia were examined using a three-dimensional anatomical finite element model. Three versions of a proximal tibial prosthesis were examined: an all polyethylene press-fit design; a metal backed, stemmed press-fit design and a (horizontally) cemented metal backed, stemmed design. All three designs had published migration and survivorship data. The objectives of the study were (i) to compare the stresses generated by each of the tibial components, (ii) examine the influence of the resected surface morphology and (iii) compare the initial cancellous bone stresses with the published migration and survivorship data. The all polyethylene prosthesis generated the highest cancellous bone stresses. Addition of a metal backing and a stem reduced the stresses, but the cemented device produced the lowest cancellous bone stresses. The surface morphology had a significant effect on the cancellous bone stresses generated by press-fit prostheses. As the bone-prosthesis contact area decreased, the peak cancellous bone stresses increased by as much as 243%. The surface morphology had no effect on the cancellous bone stresses generated by the cemented implant. Good correlation was found between the predicted cancellous bone stresses and the migration and survivorship data, with the implant generating the highest cancellous bone stresses migrating the most and having the poorest survival rates at 5 year. The results support the hypothesis that the progressive failure of cancellous bone is a mechanism of implant migration regardless of the method of fixation and the implantation site.

Biomechanical Phenomena↗

PubMed2002

Effects of phenytoin and/or vitamin K2 (menatetrenone) on bone mineral density in the tibiae of growing rats.

In this study, we investigated 1) whether the administration of phenytoin induced bone loss; and 2) whether menatetrenone could prevent bone loss induced by phenytoin. For this purpose, we previously developed a procedure to measure the bone mineral density using a conventional X-ray absorptiometry method. A long-termed administration of phenytoin (20 mg/kg per day for 5 weeks) produced bone loss in the tibiae of growing rats. The values of bone mineral density (BMD) were significantly decreased in the tibial diaphysis and metaphysis in the phenytoin-treated group. In this period, we measured the serum level of vitamin K-dependent protein, osteocalcin, a marker of bone formation. The serum level of osteocalcin showed a decrease in the phenytoin-treated group compared with the vehicle-treated group. Combined administration of menatetrenone (30 mg/kg in diet per day) with phenytoin for 5 weeks prevented the reduction of BMD, and the level of osteocalcin was slightly increased. Thus, it is suggested that long-termed phenytoin exposure may inhibit bone formation concomitantly with insufficient vitamin K, which, at least in part, contributed to bone loss in rats. Finally, these findings implicated the therapeutic usefulness of menatetrenone on a moderate degree of bone abnormality such as drug-induced osteopenia.

Absorptiometry, Photon↗

PubMed1992

Tibia vara in a patient with Bardet-Biedl syndrome.

The Bardet-Biedl syndrome is characterized by polydactyly, hypogonadism, obesity, mental retardation, and retinitis pigmentosa. Several other skeletal findings include hip dysplasia, short stature, and skull deformities. The patient described in this report has the classic findings of Bardet-Biedl syndrome in conjunction with tibia vara and irregular physes of the lower extremities.

Abnormalities, Multiple↗

PubMed1998

In vivo incidence of apoptosis evaluated with the TdT FragEL DNA fragmentation detection kit in cartilage and bone cells of the rat tibia.

Previous studies have shown the occurrence of cell death by apoptosis in cartilage and bone cells, and have suggested a functional relationship between bone growth and remodelling on one hand, and numbers of apoptotic cells on the other. At present, no in vivo studies are available on the frequency of the apoptotic process measured at one time and in one place using the cartilage and bone cells of single specimens. The aim of the present investigation was to measure the in vivo incidence of apoptosis in cartilage and bone cells of the upper epiphysis and secondary ossification metaphyseal bone of the tibia in normal young adult rats. Apoptotic cells were visualized with the terminal deoxynucleotidyl transferase (TdT) FragEL DNA fragmentation detection kit, which is analogous to the TdT-mediated nick end-labelling (TUNEL) method. In the growth cartilage, only a few TUNEL-positive terminal hypertrophic chondrocytes were found; they were 1.32 +/- 0.70% of the total hypertrophic chondrocytes counted along the chondro-osseous junction. There were only a few apoptotic osteoblastic cells and osteocytes (0.22 +/- 0.22% and 0.15 +/- 0.16% of total osteoblasts and osteocytes respectively). TUNEL-positive osteoclasts were 1.03 +/- 0.57% of the total of osteoclastic cells; they usually showed only one or two apoptotic nuclei. The total number of TUNEL-positive bone marrow cells were also counted (56.78 +/- 10.29/mm2 of bone marrow spaces). Our results confirm that apoptosis does occur in hypertrophic chondrocytes and bone cells, and show that its frequency is very low. However, chiefly because of its short lifespan, the frequency of apoptosis in cartilage and bone may be higher than that shown by the TUNEL method. The static estimate that can be obtained with this method might lead to misleading conclusions on the physiological significance of such a dynamic, rapid and asynchronous process, whose precise importance in bone growth and remodelling remains to be determined.

Animals↗

PubMedDate not supplied

Effects of neurectomy and tenotomy on the bone mineral density and strength of tibiae.

The right hindlimbs of 5 or 6-week old Wistar male rats were sciatic/femoral neurectomized, tenotomized or sham operated. The rats were sacrificed 2 weeks after the surgery and the tibiae were removed. pQCT measurement was performed on total, cortical, and trabecular bone separately at different regions. Reduction of the bone mineral density by unloading was observed more significantly at metaphysis than at diaphysis due to histological heterogeneity between metaphysis and diaphysis; metaphysis is rich in trabecular bone and diaphysis is abundant in cortical bone. Trabecular bone might be more sensitive to unloading because the reduction rate of volumetric bone mineral density in trabecular bone was approximately 10 times and 3 times larger than that of cortical bone in both neurectomy and tenotomy rats, respectively, Unloading also reduced the cross-sectional area and stress strain index at metaphysis.

Absorptiometry, Photon↗

PubMed1994

Osseous reaction to implanted ZOE retrograde filling materials in the tibia of rats.

The osseous reaction of IRM and EBA cement were studied utilizing an intraosseous implant technique in rats. Samples of IRM, EBA cement, and amalgam were placed into polyethylene tubes and subsequently introduced surgically into rat tibias. Specimens of each were evaluated histologically after 7, 14, 21, 56, and 100 days. The IRM and amalgam samples demonstrated essentially complete healing at 56 days. The EBA cement samples displayed a slightly greater inflammatory response up to the 56-day interval; however, they also showed complete healing by 100 days. A favorable osseous reaction was seen with both of these zinc oxide-eugenol materials.

Aluminum Oxide↗