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PubMed1994

T-lymphocytes are not necessary for particulate polyethylene-induced macrophage recruitment. Histologic studies of the rat tibia.

Immunological processes involving T-lymphocytes have been implicated in the mechanisms of aseptic loosening of joint endoprostheses. We report the histological reaction of bone to phagocytosable particles of high-density polyethylene (HDPE) in normal and T-cell deficient rats. A bolus of 3 x 10(7) polyethylene particles averaging 4.7 microns in size, mixed in 0.1 mL of sodium hyaluronate, was injected into the right proximal tibia of 10 normal and 10 T-cell deficient (nude) Rowett rats from the same litter. The left control side was injected with sodium hyaluronate alone. The animals were killed after 6 weeks. Transverse paraffin-embedded sections stained with hematoxylin and eosin were made of the implant area. On the control side, there was normal bone marrow without evidence of foreign body reaction. On the HDPE side, in both normal and T-cell deficient rats, macrophages were found to surround and engulf the particles, with no differences in the histological reactions. We conclude that T-lymphocytes are not necessary for the recruitment of macrophages to sites in which phagocytosable particles of HDPE have been implanted.

Animals↗

PubMed1994

Osseointegration of titanium implants in the tibia. Electron microscopy of biopsies from 4 patients.

We studied the ultrastructure of bone tissue around implants of pure titanium inserted into the tibia in 4 patients with arthrosis or rheumatoid arthritis. Three main appearances of the interface were noted. First, a close contact between titanium and calcified bone with living osteocytes inside the newly-formed bone was observed in all samples. Secondly, a close contact was also seen between the implant and osteoid, the newly formed collagenous matrix being either uncalcified or calcifying. Thirdly, a loose extracellular matrix with fibrillar and nonfibrillar materials was sometimes observed between bone mineral and implant. There was no inflammatory reaction at the interface. We concluded that the titanium implants were osseointegrated, but the calcification of the bone tissue was not complete even after 20 months. However, mineralization of osteoid and living bone cells revealed the presence of an active tissue.

Arthritis, Rheumatoid↗

PubMed1995

Muscle function after endoprosthetic replacement of the proximal tibia. Different techniques for extensor reconstruction in 17 tumor patients.

We analyzed in 17 patients the outcome of various surgical techniques for reconstruction of the extension apparatus after resection of the proximal tibia and tumor prosthesis implantation. The mean follow-up period was 5 (1.5-11) years. Knee extension and flexion strength were measured isokinetically by dynamometer and muscle activities of the vastus medialis, the vastus lateralis and the rectus femoris muscles determined by means of EMG. Muscle function of the operated leg was compared to that of the contralateral extremity by using various surgical techniques: fibula transposition, transposition of the gastrocnemius muscle, and combination technique. The results concerning the operated leg were compared within the 3 groups and the activity and strength of both legs were compared to those of a control group of healthy subjects matched for age and weight. The strength of extensor muscles of the healthy leg was greater than that of the control group in flexion position (60 degrees-90 degrees); the hamstring strength values were within the normal range. The strength of extensor muscles of the operated leg differed between groups II and III at 90 degrees in favor of group II (p < 0.01) and at 60 degrees to 20 degrees (p < 0.001) in favor of group III. Expressed in percentage ranges (nonoperated leg set at 100 percent) the flexor muscles averaged 30 percent, the extensor muscles represented on average 12 percent (9-17 percent) in group I, 9 percent (5-18 percent) in group II and 16 percent (6-26 percent) in group III, depending on the knee angle.(ABSTRACT TRUNCATED AT 250 WORDS)

Biomechanical Phenomena↗

PubMed1995

Changes in bone mineral density of the proximal tibia after uncemented total knee arthroplasty. A 3-year follow-up of 25 knees.

We measured bone remodeling of the proximal tibia prospectively for 3 years after uncemented total knee arthroplasty (TKA) in 25 knees with primary arthrosis. In the trabecular bone below the tibial component, bone mineral density (BMD) was measured in 6 different regions of interest (ROI), using dual photon absorptiometry (DPA). In the tibial condyles, where the change in knee alignment indicated that the load was reduced postoperatively, a fast bone loss of 7-20% was seen during the first 6 months after surgery. A small, but significant increase in BMD of 2-7% was seen in the tibial condyles, where the load was increased. On average, the density for all ROI below the tibial component showed a significant and progressive decrease in BMD, reaching 22% at 3 years follow-up.

Absorptiometry, Photon↗

PubMed1997

Reconstruction of tibia by ipsilateral vascularized fibula and allograft. 12 cases with malignant bone tumors.

We treated 12 patients with a primary sarcoma of the tibia by resection and centralization of the ipsilateral vascularized fibula with preserved vascularization. The reconstruction was combined with an allograft. The median bone defect after tumor resection was 14 (8-24) cm. The anastomosis between the allograft and the recipient bone was stabilized by a plate or screws or Kirschner-wires. To reconstruct the soft tissues, 8 patients underwent a gastrocnemius plasty and 2 patients a free vascularized flap of the latissimus dorsi muscle. The mean follow-up period was 2.5 (2-3.5) years. 2 years after implantation, union > or = 75% of the anastomosis area was noted in 10 patients. A deformity or fracture of the distal junction occurred in 7 patients with a screw or Kirschner-wire fixation. Neither deformity nor fracture developed in the 5 patients with plate-fixation.

Adolescent↗

PubMed1985

1,25-Dihydroxyvitamin D3 decreases alkaline phosphatase activity in cultures of embryonic chick tibiae.

The influence of 1,25-dihydroxyvitamin D3 [1,25(OH)2D3] on the alkaline phosphatase (AlPase) activity in cultures of chick embryo tibiae was determined. A dose-related, decreased release (30-47%) of AlPase from the bones was seen with the metabolite at 0.05-0.5 ng/ml of medium with a similar effect on the bone content of enzyme. The highest dose (1 ng/ml) decreased the bone content by 38% without further effect on AlPase release. Combining a low level of 1,25(OH)2D3 (0.05 ng/ml) with parathyroid hormone (PTH, 1 U/ml) reduced release of enzyme additively, but caused no greater decrease in bone content of activity than PTH alone. No effects of 24,25-dihydroxyvitamin D3 [24,25(OH)2D3, 0.5 ng/ml] on release or bone content of AlPase were found when this metabolite was added alone or in combination with PTH; however, 24,25(OH)2D3 did prevent the inhibition of release of AlPase when added with 1,25(OH)2D3. After a 1-day exposure to 1,25(OH)2D3, continued incubation in metabolite-free medium resulted in an 89% increase in bone content of AlPase. The results suggest that 1,25(OH)2D3, as well as PTH, may have regulatory roles in bone growth through their effects on AlPase.

Alkaline Phosphatase↗

PubMed1986

Histology and histomorphometry of the tibia growth in two turkey strains.

Qualitative and quantitative histological methods on decalcified and undecalcified specimens were used for comparing the linear and radial growth of the tibia in two turkey strains: a light strain, Betina, without leg problems and a heavy strain, Maxiboul, with leg problems. Groups of 10 clinically healthy male turkeys of each strain were studied at 2, 6, 8, 16, and 20 weeks of age. Three histomorphometric parameters of longitudinal growth were quantitated in the proximal growth plate and metaphysis. These were: height of the proliferative zone, density of ossification buds (metaphyseal sprouts), and volume of metaphyseal trabecular bone. Four histomorphometric parameters of radial growth were quantitated in the diaphysis. These were cortical thickness, active zone/total surface, density of maturing osteons in the active zone, and bone apposition rate at the maturing primary osteons level. The results showed some evidence for factors predisposing to leg problems in the Maxiboul strain. At 8 weeks, the Maxiboul strain had a lower ossification bud density (13.1/mm2 vs. 20.7/mm2; P less than .05) and a lower metaphyseal trabecular bone volume (16.4% vs. 22.0%; P less than .05) when compared to the Betina strain. No difference was detected in the cortical thickness of the diaphysis in the two strains except at 2 weeks of age (799 microns vs. 387 microns; P less than .001), despite the heavier weight of the Maxiboul strain.

Animals↗

PubMed1994

Continuous submarginal phosphorus with broilers and the effect of preslaughter transportation: carcass defects, further-processing yields, and tibia-femur integrity.

Broiler males were given a series of feeds from 0 to 8 wk having all nutrients advocated by the NRC (1984) and were compared with birds offered feeds with available P continuously 10% below recommendation. At termination, birds in pens were divided for cooping, and coops were either subjected to 6 h of truck transportation and 4 h of preslaughter rest or held stationary for 10 h. High summer temperatures existed throughout experimentation, and low dietary P reduced body weight gain through the first 6 wk, whereas an advantage in feed conversion and mortality occurred from 6 to 8 wk. Weight loss increased when birds were subjected to transportation, regardless of P nutriture, and a portion of the loss was recovered during processing as gain in relative chilled carcass yield. Proportions of abdominal fat and skinless boneless meats from chilled carcasses were unaltered, regardless of treatment. Increased incidence of deformed drumsticks occurred because of low P as did drumstick bruising, which was further accentuated when birds had been transported. Back bruising was prominent when P was adequate and birds were held stationary, whereas the converse occurred with transportation. Tibia length was reduced as a consequence of low P, whereas the femur suffered in terms of decreased mineral density at the epiphyses and resistance to Instron-applied stress. Although transportation in itself did not affect any bone measurement, inadequate P weakened the skeleton to increase likelihood of carcass defects during preslaughter stress.

Animal Husbandry↗

PubMed1986

Vascularized fibular grafting for the treatment of congenital pseudarthrosis of the tibia.

Six patients with congenital pseudarthrosis of the tibia were treated with vascularized fibula transplantation after the abnormal pseudarthrosis site had been radically debrided. At the time of surgery, the patients' ages ranged from 18 months to 5.5 years, and follow up was from 9 months to 4.5 years. All the fibular transplants healed and the patients were all fully weight bearing in a brace 6-months postoperatively. Age at fracture or surgery, site of the fracture, or radiographic appearance were not contraindications to the use of this technique. Although three of the patients required one further operation, the short- and long-term problems have been relatively minor. This technique has proven successful in managing many resistant patients with this difficult orthopedic problem.

Child, Preschool↗

PubMed1989

Answer please. Blount's disease: tibia vara.

Infantile tibia vara, although uncommon compared to normal physiologic bowing, is significant due to the resultant progressive deformities if not diagnosed early. The key radiographic finding is medial tibial metaphyseal beaking and fragmentation. Although the etiology is unclear, it appears to be an acquired growth disturbance of the proximal medial tibial epiphysis, ossification center, and metaphysis rather than any type of avascular necrosis. The Langenskiöld six-stage classification is useful for the diagnostic, prognostic, and treatment staging of the disease. The adolescent form is less common and less severe with only slight irregular thickening of the physis present on radiograph. The MDA appears to be the most reproducible method for measuring angular deformities in both variants of the disease. Treatment of the infantile stages I or II consists of observation and bracing. Stage III or IV disease in children over age 3 years with more than 5 degrees of varus angulation should be treated with corrective valgus osteotomy. Stages V or VI may require repeated surgical treatment with multiple osteotomies and possible contralateral epiphysiodesis. The adolescent form frequently requires surgery when there is significant physical impairment related to the severe genu varum.

Child↗

PubMedDate not supplied

Adamantinoma of tibia: a case of late local recurrence along with lung metastases.

Adamantinomas of long bones are rare primary low-grade malignant tumours composed of cells with epithelial and fibrous characteristics. Local recurrence, though scarce, occurs 5-15 years after the onset of diagnosis. We report a case of local recurrence of an adamantinoma localised in tibia, along with the presence of two lung metastases, 24 years after diagnosis and surgical therapy of the primary tumour. The local recurrence and the lung metastases were removed surgically. The patient remains free of the disease for 3 years.

Adult↗

PubMed2005

Chronic posttraumatic osteomyelitis and infected nonunion of the tibia: current management concepts.

Chronic posttraumatic osteomyelitis and infected nonunion of the tibia are complex problems that result in considerable morbidity and can threaten viability of the limb. Development of infection may result from compromised soft tissue and bone vascularity, systemic compromise of the host, and virulent or resistant organisms. Biofilm formation on implant and devascularized bone surfaces protects pathogens and may lead to persistence of infection. Management is based on a detailed evaluation of the patient, the involved bone and soft tissues, degree of associated lower extremity injury, and type of bacterial pathogens. Infection control is achieved with radical débridement, skeletal stabilization, and microbial-specific antibiotics. Local antibiotic delivery is a useful supplement to systemic administration. Local or free muscle flaps may be necessary to achieve soft-tissue coverage. Restoration of bone defects and bony union can be accomplished with bone grafting. However, large defects require complex reconstructive procedures, such as distraction osteogenesis and vascularized bone grafting.

Chronic Disease↗

PubMedDate not supplied

A simple technique for correcting footdrop: suspension tenodesis of the tibialis anterior tendon to the distal tibia.

Surgical correction of the footdrop deformity caused by various neuromuscular diseases is a time-honored technique, with most surgical procedures intended to correct the absence of active dorsiflexion and a concomitant cavovarus foot deformity. We describe suspension tenodesis of the tibialis anterior tendon to the distal tibia to correct the footdrop deformity. This technique is simpler to perform and more secure than transferring the distal attachment of a tendon to a new location in the foot itself or using tendon weaving techniques. In addition, compared with an ankle fusion, our technique allows for a certain amount of shock absorption during gait and is much less invasive, and a future ankle fusion could be performed if needed for full stability and definitive correction of the symptomatic footdrop. Finally, the technique we describe is easily reproducible and seems to remain stable over time.

Foot Deformities, Acquired↗

PubMed1997

Pediatric aneurysmal bone cyst of the distal tibia.

A rare, large pediatric aneurysmal bone cyst with pathologic fracture of the distal tibia of a 4-year-old female was presented. Classic radiographic and magnetic resonance imaging findings have been discussed. In a comprehensive review of the literature, aneurysmal bone cysts are an infrequently reported neoplasm of the foot and ankle bones. Lesions are characteristically seen in patients younger than 20 years of age, but rarely younger than 5 years. The benign cyst has a 2:1 female-to male predilection. In long bones, the lesion is typically metaphyseal in nature. Although the pathogenesis is still unknown, there exists the possibility of two types of aneurysmal bone cysts: a primary type without preexisting lesion and a secondary form associated with some other lesion. The diagnosis of aneurysmal bone cyst can be strongly suspected by correlating the radiographic and magnetic resonance imaging findings. For definitive diagnosis, accurate histologic evaluation is imperative to rule out any confusion or possibility with a malignant tumor.

Bone Cysts, Aneurysmal↗

PubMed1998

[The methods of treatment for comminuted intra-articular fractures of the tibia in the materials of Department of Orthopedic Injuries at the Military Special Hospital in Lublin].

Twenty-one patients (9 males, 12 females) aged 14-73 years (mean 46 years) with proximal tibia fracture were treated between 1993 and 1995. Surgery was performed in 12 recent cases and in 3 inveterate ones. Non-surgical treatment was used in 5 recent fractures and 1 inveterate. Follow-up ranged from 0.5 to 6 years. "L" plate, "T" plate, spongious screws, Kirchner wires were used for fixation. Lateral condyle depression used to be elevated and supported by bone graft harvested from the iliac crest. Functional treatment or 4 weeks plaster cast immobilization was used postoperatively. In majority of cases pain free knee joint with flexion over 90 degrees was found 3 months after surgery. All patients returned to work. There were 7 excellent results and 5 good ones according to Rasmussen criteria.

Adolescent↗

PubMed1999

[Pathologic fracture of the tibia associated with Charcot-Marie-Tooth disease].

The authors report a case of pathologic fracture of the distal tibia associated with Charcot-Marie-Tooth disease. Pathologic fracture was visible four weeks after initial pain. Treatment consisted in a short leg walking cast for six weeks. Charcot-Marie-Tooth disease is a slowly progressive neurogenic muscular atrophy affecting the distal parts of the lower limbs. The muscular atrophy is responsible for radiographic bony changes including narrowing of the shaft with thinning of the cortex, rarefaction at the end of the long bones and relative widening of the medullary cavity. Pathologic fractures in neuromuscular disease are rare; a few cases have been reported following application of very small forces. The authors draw attention to the increased risk of pathologic fractures in patients with neuromuscular disease. Ambulatory treatment of fractures should be used whenever possible; prolonged immobilization could result in further loss of function.

Adult↗

PubMed1976

Axial deviations of the knee with secondary arthrosis. Correction by high osteotomy of the tibia and fibula.

The authors describe a surgical technique for high tibio-fibular osteotomy used eighty seven times to correct varus or valgus deviations causing arthrosis of the knee. Osteotomy of the tibia is carried out above the tibial tuberosity. Fixation is by two nails with a compression device. This allows immediate movement of the knee, thereby preventing stiffness. After forty five days the osteotomy is usually consolidated. Of the complications, only the neuro-muscular type is of importance and the possible causes of this are discussed. The overall results are good and the technique described has proved to be effective in the treatment of mechanical arthrosis of the knee.

Adult↗

PubMed1999

Agenesis of tibia with ectrodactyly/Gollop-Wolfgang complex associated with congenital heart malformations and additional skeletal abnormalities.

We report on a child with bifid femur, absent tibiae, hypoplastic hallux, bilateral club feet, congenital heart defects, and segmentation anomalies of the spine and ribs. Parents are consanguineous, from a region where other consanguineous families with similarly affected individuals have been reported. Clinical and genetic controversies of the tibial aplasia-ectrodactyly syndrome/Gollop-Wolfgang complex are discussed.

Femur↗