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PubMed2003

[Double localization of osteoid osteoma of the tibia--case report].

Osteoid osteoma is a common, benign lesion of bone. Most patients who have osteoid osteoma have a history of pain in a limb, that is characteristically worse at night and is relieved dramatically by salicylates. There is general agreement in the literature that complete excision is the treatment of choice and that incomplete removal of the nidus leads to recurrence of symptoms. Usually, the affected bone is easily accessible to the surgeon, and it is not difficult to excise the lesion en bloc or, less commonly, to perform cortical shaving and curettage of the cavity of the nidus. The case nine years old boy of double nidus localization of osteoid osteoma of the tibia is presented. No reports on patients who were treated with double nidus localization have been published, to our knowledge.

Bone Neoplasms↗

PubMed2003

Sinusoidal electromagnetic field of 50 hz helps in retaining calcium in tibias of aged rats.

Effect of 50Hz sinusoidal electromagnetic field (SEMF) on normal bone physiology was evaluated in young and old female and male Wistar rats. Exposure to SEMF resulted in increased 45Ca retention in tibias of aged animals only. Levels of serum calcium in young female and male rats were significantly less than in respective aged rats. These were further decreased after 4 weeks of SEMF exposure. SEMF exposure did not change the serum calcium levels in aged rats, and inorganic phosphates in young and aged animals. Similarly, the levels of tartrate resistant acid and alkaline phosphatase were significantly decreased in young rats, whereas the levels remained unchanged in aged rats of either sex. The results revealed that SEMF of 1mT can prevent bone calcium loss due to aging in animals.

Aging↗

PubMed2004

Brucella osteomyelitis of the proximal tibia: a case report.

Brucellosis is a disease of domestic and wild animals that is transmittable to humans. Although endemic in some parts of the world, brucellosis is an uncommon human pathogen in the United States. The clinical presentation of brucellosis is nonspecific, and brucella osteomyelitis can produce lytic lesions on radiographs that resemble neoplasm. Diagnosis can therefore be difficult unless a high index of suspicion is maintained. We present a case of brucella osteomyelitis of the proximal tibia that demonstrates these features.

Aged↗

PubMed1992

Adolescent tibia vara: alternatives for operative treatment.

We reviewed the cases of fifteen obese patients (twenty-one extremities) who had had adolescent tibia vara and had been followed for at least two years. Of the nine patients (eleven extremities) who had been initially managed with lateral tibial hemiepiphyseodesis, eight (ten extremities) were skeletally mature at the time of the review (mean duration of follow-up, five years). The mechanical alignment was judged to be excellent in three of these ten extremities, fair in three, and poor in four. Excellent mechanical alignment was defined as a value within the reported normal range of 5 degrees of varus to 2 degrees of valgus. A poor result was defined as alignment that was more than 5 degrees outside the normal range. After secondary operative procedures, three of the extremities for which the result had been poor and one for which it had been fair had excellent alignment. Five of the nine patients had bilateral involvement. Two of them were managed with bilateral tibial hemiepiphyseodesis; two, with contralateral proximal tibial osteotomy; and one had a mild deformity on the contralateral side that was not treated. Six extremities in six patients (two of whom had a contralateral hemiepiphyseodesis) were managed primarily with proximal tibial osteotomy and were evaluated an average of seven years postoperatively. Two additional patients were managed with proximal tibial osteotomy because of residual varus deformity after the hemiepiphyseodesis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMedDate not supplied

The effects of ion beam-assisted deposition of hydroxyapatite on the grit-blasted surface of endosseous implants in rabbit tibiae.

PURPOSE: This study was undertaken to evaluate ion beam-assisted deposition (IBAD) of hydroxyapatite (HA) on the grit-blasted surface of endosseous dental implants 6 weeks postplacement. MATERIALS AND METHODS: A total of 40 implants was placed in the tibiae of 10 New Zealand white rabbits. Twenty implants were grit-blasted only and the other 20 were grit-blasted and coated with HA by the IBAD method. After 6 weeks of healing, the rabbits were sacrificed and removal torque tests, histomorphometry, and morphometric analysis of microtomographic images were performed. RESULTS: The HA-coated group showed significantly higher removal torque, bone-to-implant contact, and bone volume than the other group. DISCUSSION AND CONCLUSION: In a previous study, the authors suggested that HA coating deposited on a machined surface by the IBAD method showed results comparable to or more favorable than the results obtained with a blasted surface. This study indicated that the HA coating produced by the IBAD method was also very effective on the aluminum oxide-blasted surface, as demonstrated by the early formation of osseointegration. Morphometric analysis by microtomography showed some promise in measuring the osseointegration rate. (More than 50 references.)

Animals↗

PubMedDate not supplied

The Ilizarov method in the treatment of malignant neoplasms of the tibia.

A total of 3 malignant neoplasms of the tibia are presented: 1 is a mesenchymal chondrosarcoma of the tibial pylon (male aged 14 years), and 2 are cases of squamous skin carcinoma of the leg with tibial infiltration (1 male and 1 female aged 32 and 64 years, respectively). The resections carried out (16.5 cm on the average) were treated by bone transport. Simple transport was used in the first patient, double in the other two. At the end of transport a second surgical stage involving astragalotibial arthrodesis was performed in the first case, and revision of the junction site of bone segments transported with application of autoplastic bone grafts was performed in the other two. The regenerate obtained was slowly corticalized in the first patient, submitted to various cycles of chemotherapy during the course of distraction. In the other two cases, which were not treated by chemotherapy during distraction, corticalization occurred over a shorter amount of time. Follow-up was obtained after 10 years in the first case, and after 2 years in the other 2 patients. There was no long-term recurrence.

Adolescent↗

PubMed2005

[Combined external skeletal fixation instrumentation with locked intramedullary nailing for tibia lengthening].

OBJECTIVE: To shorten the time of external skeletal fixation on legs, and enhance quality of limb lengthening, avoid complications of shortening, bending, twisting and etc. METHODS: Insert pin transcortical to attack external skeletal fixation simultaneously, put un-reaming locked intramedullary nail (do not insert distal locked screw) into endosteum of lengthening bone. After the legs achieved predetermined length, insert distal locked screw and then remove external skeletal fixation, locked intramedullary nail, then maintain consolidation of rehabilitation. RESULTS: The group lengthened legs for 412 cases. The range of lengthening was 3 to 18 cm. Mean length was 7.6 cm. The mean time for needed external skeletal fixation was 20 d/cm. The mean time of osteogenesis was 56 d/cm. For complications, there were 3 tibias ununion cases and 1 varus ankle. All cases were treated undergoing twice. CONCLUSIONS: The method reduces the time for needed external skeletal fixation visibly, enhances the quality of limb lengthening remarkably, prevents complications of shortening new bone, deformity, bending and re-fracture which do not effect the healing time. This is a new choice of limb lengthening.

Adult↗

PubMed2004

Treatment for flexion contracture of the knee during Ilizarov reconstruction of tibia with passive knee extension splint.

Joint stiffness is one of the complications of limb procedure. It developes as a result of failure of knee flexors to lengthen in tandem with the bone, especially when there is inadequate physical therapy to provide active and passive mobilization of the affected joint. We are reporting four patients who developed fixed flexion contracture of their knees during bone lengthening procedure for the tibia with Ilizarov external fixator. Three of them were treated for congenital pseudoarthrosis and one was for fibular hemimelia. None of them were able to visit the physiotherapist even on a weekly basis. A splint was constructed from components of Ilizarov external fixator and applied on to the existing frame to passively extend the affected knee. Patients and their family members were taught to perform this exercise regularly and eventually near complete correction were achieved. With this result, we would like to recommend the use of this "Passive Knee Extension Splint" to avoid knee flexion Contracture during limb lengthening procedures with Ilizarov external fixators.

Bone Lengthening↗

PubMed2005

Quantification of the microstructural anisotropy of distraction osteogenesis in the rabbit tibia.

A longitudinal orientation of fibers and trabeculae has been observed histologically within distracted callus. This study quantified the intensity and angle of orientation of trabeculae within a distracted callus. Sixteen New Zealand white rabbits underwent unilateral tibial callus distraction with an external fixator across a mid-diaphyseal osteotomy. Included were: a seven-day postoperative latency period, ten days of distraction at 0.5 mm every 12 hours, and 20 days of post-distraction consolidation before euthanasia. Tibiae were removed, stripped of soft tissue, sectioned, and processed for decalcified histology. Micrographs of mid-coronal sections of the callus were evenly divided into 12 regions and underwent Fast Fourier Transform (FFT) analysis of the digitized image to determine the angle and intensity of the orientation of the bony trabeculae within the callus. The microstructure of the regenerate callus demonstrated an angle of orientation that uniformly matched that of cortical bone in all of regions of the callus and an intensity of orientation which approached that of cortical bone.

Animals↗

PubMed1992

Mechanical axis deviation of the lower limbs. Preoperative planning of uniapical angular deformities of the tibia or femur.

Angular deformities of the tibia or femur in the frontal plane lead to mechanical axis deviation of the lower limb and malorientation of the joints above and below the level of deformity. Accurate correction of the malalignment and of the joint orientation is important for function and to prevent joint degeneration. An accurate yet simple method to determine the apex of deformity and the type of correction required is based on the joint reference lines of the hip, knee, and ankle, and the individual mechanical axis lines of each bone segment. If the osteotomy is performed at the level of the apex of the deformity, then the only correction needed is angulation. If the osteotomy is performed at a level proximal or distal to the apex, then translation in addition to angulation is necessary to accurately correct the deformity.

Femur↗

PubMed1992

Mechanical axis deviation of the lower limbs. Preoperative planning of multiapical frontal plane angular and bowing deformities of the femur and tibia.

Multiapical deformities complicate the process of preoperative planning. It is necessary to determine the level of each apex of deformity to plan accurate correction. The basic principles of mechanical axis realignment and joint orientation need to be preserved. Using the joint reference lines and mechanical axis of each bone segment, one can accurately determine the apex of each deformity. Bowing deformities are multiapical angular deformities. There are two types of bowing deformities: compensated and noncompensated. Typical examples of compensated bowing are the anterolateral and posteromedial bows of the tibia. A noncompensated bow is typical of the deformity seen in rickets.

Femur↗

PubMed1977

[The role of proximal osteomy of the tibia in the treatment of arthrosis of the knee joint].

The results of heigh tibia osteotomy performed between 1970 and 1975 in 20 cases in the material of the Orthopaedic Department of the "Semmelweis" University Medical School, Budapest, are reported. In 13 cases good--in 6 cases satisfactory results have been obtained. In 1 case the surgical intervention was of no effect. With regard to the explicit pain-relieving effect the operation is recommended by the authors in the treatment of knee arthrosis.

Humans↗

PubMed2006

[Treatment of congenital pseudarthrosis of tibia by vascularized fibular graft].

PURPOSE OF THE STUDY: The aim of the study was to evaluate the results in a group of patients with congenital pseudarthrosis of the tibia treated by transfer of a vascularized fibular graft from the contralateral extremity. MATERIAL: The group included three boys and two girls aged 2 to 8 years at the time of surgery. In two patients, the vascularized graft transfer was preceded by other operations. All patients but one had Crawford type IV pseudarthrosis. The signs of peripheral neurofibromatosis were found in four of the five patients. METHODS: The operation was carried out by two surgical teams, i. e., orthopedic and microsurgery (plastic surgery) specialists. Deep dissection of the pseudarthrosis was performed down to healthy, well vascularized tissue; a vascularized pedicle bone graft was harvested from the contralateral fibula. The graft was inserted and anchored intramedullarily in both tibial fragments, and stability was provided with a K-wire introduced through the calcaneus. Subsequently, the vascular pedicle of the fibular graft was joined to the surrounding vessels (anterior tibial artery and anterior tibial vein). The extremity was immobilized in plaster cast and later a KAFO brace was applied. RESULTS: Graft union partially failed in the proximal end of the graft due to bone resorption of both the graft and the proximal tibial fragment in two patients. This was successfully treated by additional spongioplasty. In all patients bony union was achieved at an average time of 9.8 months (range, 6 to 21 months). An increase by more than 100 % in the diameter of the transplanted fibula was recorded in four patients. The increase, which was of course related to follow-up time, was a clear proof of primary graft vascularization. DISCUSSION: The use of vascularized fibular graft harvested from the contralateral extremity showed high effectiveness in comparison with other methods. This was in agreement with the relevant literature reports. CONCLUSIONS: This method can be used regardless of patients' age and our experience showed that, even in small children, union can be achieved and can thus allow for early weight-bearing and prevention of crus atrophy.

Bone Transplantation↗

PubMed2006

Intraosseous neurilemmoma involving the distal tibia and fibula: a case report.

Schwannoma, or neurilemmoma, is a benign nerve sheath tumor most commonly located in the soft tissue. Occasionally, Schwannomas involve osseous structures. Involvement of two adjacent long bones was not found in a review of the English language medical literature. We present the case of a neurilemmoma affecting both the distal fibula and tibia. Although rare, intraosseous neurilemmoma should be included on the differential diagnosis of painful, radiographically benign-appearing lesions arising in long bones.

Adult↗

PubMed1991

[Roentgenological parameters of the fibular incisure of the tibia in fractures of the lateral malleolus. Results in the framework of a follow-up study].

In order to check the correct position of the fibula in the Incisura fibularis tibiae by means of X-ray, four radiological parameters could be distinguished in patients with surgically or conventionally treated fractures of lateral malleolus. In spite of easy access, inserting the fibula into the incisure can be difficult in the case of bony or ligamentous injuries of the distal tibiofibular syndesmosis. With the help of these easily measurable X-ray parameters, an incongruence in the distal tibiofibular syndesmosis, which have to be corrected in any case, can easily be detected. The clinical relevance of these results could be verified in 105 patients.

Adult↗

PubMedDate not supplied

[Dynamics of the structural recovery of the rat's tibia from suspension-produced osteopenia].

The qualitative histomorphometric techniques were used to study the dynamics of tibia structural recovery from osteopenia in 30 female rats previously suspended by tail for 30 days. The suspension was found to have caused osteopenia in the tibial proximal metaphysis that was fully gone only after 60 day; in other words, readaptation took twice as much time as the osteopenia development. This fact should be taken into consideration by designers of rehabilitative methods.

Adaptation, Physiological↗

PubMedDate not supplied

Lower gastrointestinal bleeding due to small bowel metastasis from leiomyosarcoma in the tibia.

Small bowel metastasis from primary bone leiomyosarcoma is very rare. Here we report on a 50-year-old man who presented with general weakness, weight loss (six kg in two months) and intermittent tarry stools for two months. He had undergone an above-knee amputation for left tibia leiomyosarcoma seven years previously. No local recurrence and/or distant metastasis developed during a seven-year period of follow-up. Subsequent imaging study revealed a multilobulated mass in the ileum. He received segmental resection of the small bowel and a multilobulated mass was noted in the submucosal layer of the ileum with mucosa ulceration. His postoperative course was uneventful. Histopathological examination of the resected mass revealed small bowel metastatic leiomyosarcoma. No local recurrence or distant metastases were detected during a six-month follow-up period. To the best of our knowledge, this is the first report of small bowel metastasis from primary bone leiomyosarcoma presenting with lower gastrointestinal bleeding.

Bone Neoplasms↗

PubMed1991

Blood supply and structural changes of canine intact tibia following plate fixation with different rigidities.

To study the causes of osteopenia after plate fixation in the treatment of fractures and bone diseases, intact tibiae of 26 dogs were fixed by 3 different plates at various rigidities. The dogs were killed at 24 hours 3, 6, 12, 20 weeks. Disulphine blue was injected intravenously before killing. The results showed that in addition to stress shielding the disturbance of blood supply was the main cause of osteopenia in the early stage. Reaction to the implant might be another cause in the middle stage. The disuse of the affected limb was the most important factor in the late stage. Osteopenia can be treated by active exercises and normal weight-bearing before plate removal.

Animals↗