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At least 19 recordsLinked to original sources
PubMed1979

[The functional cervico-diaphyseal approach. A new route of approach to the hip for surgery of cervico-trochanteric fractures by diaphyseal prosthesis (author's transl)].

The authors report a new route of approach to the hip, specific to cervico-diaphyseal region. Its main application seems to be for the insertion of diaphyseal prostheses in cervico-trochanteric fractures in the eldery. The lack of damage to the capsule, the reconstruction of a solid weight-bearing point on the trochanter, the precise repair of the joint cavity and of muscle continuity make this a simple route of approach with minimal shock, permitting rapid rehabilitation of the patient with immediate weight-bearing.

Femoral Neck Fractures↗
PubMed1994

Age dependence and modulation by gonadectomy of the sex-specific response of rat diaphyseal bone to gonadal steroids.

We have previously reported that diaphyseal bone of prepubertal rats responds in a sex-specific manner to gonadal steroids, 24 h after steroid injection, by increases in creatine kinase (CK) specific activity and the rate of DNA synthesis. We have also shown that hormonal intervention abolished the sex-specific response of diaphyseal bone to sex steroids. In the present study, we examined the responsiveness of diaphyseal bone and cartilage to gonadal steroids in male and female Wistar-derived rats at ages between 5 days and 1 yr. In both diaphyseal bone and cartilage of untreated control rats, a peripubertal peak of CK specific activity was seen, which was more pronounced in females. Diaphyseal bone, unlike epiphyseal cartilage, responded specifically to a single injection of 17 beta-estradiol (E2; 5 micrograms/rat) in females and to 5 alpha-dihydrotestosterone (DHT; 50 micrograms/rat) in males. The highest response occurred peripubertally, but was skewed toward prepubertal ages in males and postpubertal ages in females. To study the effect of gonadectomy on this sex-specific response of diaphyseal bone, rats were gonadectomized at the age of 24 or 180 days and from 4 days to 4 weeks thereafter were challenged with either E2 or DHT. Diaphyseal bones of gonadectomized rats of either sex responded to both E2 and DHT, beginning 7 days after surgery. Thus, in gonadectomized rats, there was a loss of the sex specificity of response to steroid hormones, which could be restored by replenishment, by five daily injections, of the characteristic hormone of each sex. In the epiphyseal cartilage, the same replenishment schedule resulted in acquisition of a sex-specific response in both sexes, not seen previously. These data in conjunction with the previously reported hormonal modulation of sex-specific responses, are consistent with a developmental acquisition of diaphyseal sex steroid specificity that requires for its maintenance the presence of appropriate amounts of the characteristic gonadal steroid in each sex.

Aging↗
PubMedDate not supplied

Regeneration of segmental diaphyseal defects in sheep tibiae using resorbable polymeric membranes: a preliminary study.

OBJECTIVE: To investigate whether a long bone cortex of well-defined thickness can be regenerated by using an anatomically designed membranous resorbable "tube-in-tube" implant and to establish the functions of membranes in the healing of segmental diaphyseal bone defects larger than the "critical size." DESIGN: Bone healing in segmental diaphyseal defects larger than the critical size in the sheep tibiae covered with a single porous tubular membrane or implanted with anatomically shaped porous double tube-in-tube membranes was evaluated. Membranes with different pore structures were applied alone and/or in combination with autogenous bone graft. BACKGROUND: Healing of segmental diaphyseal bone defects in animals can be enhanced by covering the defects with resorbable polylactide membranes. Based on the results of bone healing in defects ten millimeters long in the rabbit radii, it was suggested that the membrane prevents muscle and soft tissue from invading the defect and maintains osteogenic cells and osteogenic substances within the space covered with membrane, thus promoting new bone formation. The functions of membranes may differ, however, depending on the size and the location of the defect and on the experimental species used. Bone defects larger than the critical size may not heal at all, even if membranes are used. The critical-size defect is defined as the smallest bone defect that does not heal spontaneously when covered with polymeric membranes. To heal such defects, it is mandatory that membranes are used in combination with autogenic bone graft and/or a suitable bone substitute. If bone graft is used to fill the defect, the structure and geometry of the covering membrane will determine whether the graft will be vascularized and/or nourished from the surrounding soft tissue and, in consequence, survive. It can be appreciated that bone healing in areas of good vascularity should be more efficient than bone healing in poorly vascularized areas. The influence of all these factors on healing of bone in segmental diaphyseal defects covered with membranes is not known. METHODS: Four-centimeter-long diaphyseal segmental defects in the tibiae of six- to seven-year-old Swiss mountain sheep were covered with resorbable membranes from poly(LDL-lactide). In Group 1, a single microporous external membrane was used. In Group 2, one microporous membrane was inserted into the medullary cavity at the cut ends of the tibiae (internal membrane), and the other microporous membrane was placed on the outer surface of the cortex (external membrane). In Group 3, a single microporous external membrane was also laser-perforated to produce openings with a diameter in the range of 800 to 900 micrometers. In Group 4, the defect was filled with autogenous cancellous bone graft and covered with a single perforated membrane. In Group 5, one perforated internal membrane was inserted into the medullary cavity at the cut ends of the tibiae, and the other perforated membrane was placed on the outer surface of the cortex. Group 6 was identical to Group 5, except that cancellous bone graft was placed in the space between these two membranes. RESULTS: There was no bone healing in Groups 1, 2, 3, and 5. Only in Groups 4 and 6 did the defects heal. In Group 4, new bone was dispersed across the "medullary canal" formed by the membrane. In Group 6, the new bone had grown into the space between the outer and inner membranes, forming the "neocortex." CONCLUSIONS: The resorbable polymeric implant consisting of two concentric perforated membranes (the tube-in-tube implant) used in combination with cancellous bone graft to treat segmental diaphyseal defects in sheep tibiae allows for the reconstitution of the "neocortex" with well-defined thickness. (ABSTRACT TRUNCATED)

Absorbable Implants↗
PubMed1994

Experimental healing of distraction osteogenesis comparing metaphyseal with diaphyseal sites.

Distraction osteogenesis was performed on 32 adult dogs to compare bone healing at metaphyseal and diaphyseal sites. Sixteen dogs underwent proximal metaphyseal corticotomy and 16 dogs underwent middiaphyseal corticotomy of the left tibiae for gradual lengthening. Each major group was then divided into four subgroups of four dogs each on the basis of zero-, seven-, 14- and 21-day latency periods. The standard radiograph, quantitative computer tomography density, and bone-healing index were used to evaluate new bone formation and consolidation. A distraction rate of 1 mm per day for four weeks created an average elongation of 23.9 +/- 3.7 mm in the metaphyseal groups and 23.8 +/- 2.0 mm in the diaphyseal groups, excluding nine premature consolidations. In the 16 metaphyseal lengthenings, there were six premature consolidations (37.5%): four with a 21-day latency, two with a 14-day latency, and one nonunion (6.2%). In the 16 diaphyseal lengthenings, three fused prematurely (18.7%), two with a 21-day latency and one incomplete corticotomy with a seven-day latency. Three lengthenings of the diaphyseal group resulted in nonunion (18.7%). All animals, metaphyseal and diaphyseal, successfully bridged the distraction gap after a zero-day latency. The bone-healing index showed that new bone consolidation was best with a zero-day latency in metaphyseal (22 +/- 7.6 days/cm) and diaphyseal lengthening (26.5 +/- 6.5 days/cm). Comparing the minimum quantitative computer tomography density ratio of the experimental side with the contralateral side indicated a significant difference at the end of distraction (p = 0.001), at fixator removal (p = 0.001), and when the dogs were killed (p = 0.04).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMedDate not supplied

Computerized morphometric analysis of the femoral diaphyseal canal.

The constant increase in the use of hip arthroplasty and the continuous search for the best possible adaptation of the implant to femoral anatomy have led to the development of methods of radiographic analysis that are increasingly precise and reliable. Among these the methods that include the use of traditional radiograms-despite their limits-deserve a place of importance. In fact, these methods offer the advantage of being easy to apply and of allowing for a comparison to be made with pre-existing files. Computer science is useful in this field, in particular, computerized analysis, both morphometric and statistical, of the data acquired by digitizer. The protocol of acquisition and analysis that we applied to x-rays in anteroposterior view allowed for an evaluation to be made of some of the morphologic parameters of 354 femurs (corresponding to 264 patients), relating them with the pathologies that led to hip arthroplasty. The duration of a cementless hip prosthesis strongly depends on primary stability. For this reason, an ever-increasing number of studies tends to make a precise evaluation of the morphology of the joint, in order to obtain excellent contact between bone and prosthetic component. The methods used are essentially radiological, with the use of computerized tomography and stereophotogrammetry. Morphometric studies of the proximal femoral area have in particular considered the width of the medullary canal at various levels; the cervico-diaphyseal angle; the flare index of the femoral canal (relationship between the internal metadiaphyseal diameter and that of the isthmus) and the distance between the rotation center of the femoral head and the diaphyseal axis. The evident absence of proportion between femoral sizes and shape of the medullary canal has led to the search for parameters capable of describing in simple fashion the shape of the femoral diaphyseal canal. A good describer of femoral morphology is the flare index, that allows for classification of the various shapes of the diaphyseal canal in three families: "stove-pipe like", "normal", "champagne glass like". The distinction between these groups is not clear, as the passage from one shape to another is gradual. The idea of obtaining more knowledge on femoral morphology, also to the purpose of determining possible new criteria that may be of help in preoperative planning and in the choice of a model to be implanted, has suggested our study on modifications caused by some of the pathologies that most frequently lead to arthroplasty.

Adult↗
PubMed1998

Analysis of shrinkage in human fetal diaphyseal lengths from fresh to dry bone using Petersohn and Köhler's data.

Calculation of gestational age from forensic fetal remains may be problematic. If soft-tissue indicators are not available, then diaphyseal lengths obtained through sonograms on living fetuses in utero or radiographs of long bones can be compared to known European standards, such as Fazekas and Kósa (1978) and Olivier and Pineau (1958, 1960). Radiographic comparison to these European standards, however, requires a correction factor for diaphyseal shrinkage from fresh to dry states. Percent shrinkage is calculated for six diaphyses (humerus, ulna, radius, femur, tibia and fibula) from Petersohn and Köhler's data published in Fazekas and Kósa (1978:362-369). Average shrinkage, standard deviation, minimum and maximum values are calculated for each diaphysis and for all diaphyses during 4-10 lunar months (LM) and newborns. Corresponding average and standard deviation values are as follows: 4 LM-10.09% +/- 2.67%; 5 LM-5.74% +/- 0.84%; 6 LM-3.48% +/- 0.49%; 7 LM-2.32% +/- 0.16%; 8 LM-2.18% +/- 0.51%; 9 LM-1.76% +/- 0.14%; 10 LM-1.90% +/- 0.59%; and newborns-1.28% +/- 0.55%. Analysis of these values suggests that percent shrinkage steadily declines as the fetus ages. This pattern presumably reflects calcification of bone during growth and development in utero. These findings demonstrate a significant shrinkage in the diaphysis early in development, which may alter accurate age estimation in the earliest fetal age groups.

Body Height↗
PubMed1993

Clandestine femoral neck fractures with ipsilateral diaphyseal fractures.

We present a protocol for diagnosis of all femoral neck fractures associated with ipsilateral femoral diaphyseal fractures. A 30% incidence of delayed diagnosis has been reported by other investigators. Between 1982 and 1990, we have treated 32 patients with ipsilateral femoral neck and shaft fractures due to blunt trauma. Only 22 femoral neck fractures were diagnosed on prediaphyseal fixation radiographs. This left the 10 patients in this study who had normal prediaphyseal fixation radiographs and were subsequently found to have femoral neck fractures. The ipsilateral femoral neck fractures were found through a retrospective chart and radiographic review of all 555 femoral diaphyseal fractures identified through our trauma and fracture registries. The clinical and radiologic techniques for diagnosing the femoral neck fractures were presented. The time to union of the femoral shaft and neck was determined, and a preliminary radiologic assessment of the vascularity of the femoral head was made. Ten femoral neck fractures (31%) with normal preoperative radiographs were diagnosed after femoral diaphyseal fixation. One patient did not have a post-diaphyseal fixation radiograph. An incidental radiograph at 6 weeks showed a mildly displaced femoral neck fracture in an asymptomatic patient. At 16 weeks the patient became symptomatic, and a repeat radiograph showed the fracture. Five fractures were diagnosed in asymptomatic patients on routine post-femoral fixation radiographs. Two patients had normal post-femoral fixation radiographs, became symptomatic, and had their femoral neck fractures diagnosed on repeat radiographs at 3 and 7 days. One patient had normal pre- and postfixation radiographs, and on a 25-day routine femoral radiograph, the femoral neck fracture was diagnosed.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1983

The infrequency of malignant disease in diaphyseal aclasis and neurofibromatosis.

The association of diaphyseal aclasis and neurofibromatosis with malignant neoplasms has been variously reported as between 5 and 28% of all cases, but malignant disease invariably presents at hospital and the true frequency from an unselected group is unknown. The current survey reviews not only hospital patients but also their affected relatives, with particular reference to malignant disease and the cause of death in all family members. A survey of 36 index patients and 80 known affected relatives with diaphyseal aclasis and 37 index patients and 33 known affected relatives with neurofibromatosis has been carried out. The observed proportions with associated malignant disease were 0.9% of all cases of diaphyseal aclasis and 4.3% of neurofibromatosis. The authors consider this is still too high an estimate in view of the number of persons in the families only mildly affected by the inherited disease who cannot be identified, although their malignant disease will be known. A more likely figure for malignant change in diaphyseal aclasis is calculated at 0.5% (or 1.3% of those over 21 years) and in neurofibromatosis 2.0% (or 4.2% of those over 21 years).

Adolescent↗
PubMed1978

A generalization of Chevrot's method for determining anteversion and cervico-diaphyseal angles.

Chevrot's method for determining the angle between the axis of the femoral shaft and the axis of the femoral neck (the cervico-diaphyseal angle), and the angle between the axis of the femoral neck and the diacondylar plane (the anteversion angle) has been investigated and generalized. Mathematical formulae giving the anteversion and cervico-diaphyseal angles in terms of two x-ray tube angles and two measured projections of the cervico-diaphyseal angle have been derived. These formulae facilitate preparation of computer programs and tables for the routine clinical determination of the anteversion and cervico-diaphyseal angles.

Femur↗
PubMed1986

Physical properties of autoclaved bone. Torsion test of rabbit diaphyseal bone.

Structural properties of autoclaved diaphyseal bone in the rabbit were investigated by torsional test. Heat propagation into the bone was studied by means of thermocouples. The torsional test included 54 pairs of diaphyseal bones. Autoclaving was performed to the same degree of sterilization, although with variations of time and temperature. Standard autoclaving at 121 degrees C for 20 min was found to cause a moderate decrease (23 per cent) in torsional strength. The decrease was more pronounced (35 per cent) for bones autoclaved at 110 degrees C for 255 min and less (9 per cent) for those autoclaved at 131 degrees C for 2 min. Heat propagation into bone during autoclaving proved to be rapid at both 121 degrees C and 131 degrees C, indicating that complete, uniform sterilization of diaphyseal bone may be performed to an accurate, predetermined degree. Diaphyseal bone subjected to standard autoclaving remains mechanically adequate for skeletal substitution. Reimplantation of autoclaved tumorous bone might provide a simple combined means for tumor devitalization and subsequent reconstruction.

Animals↗
PubMed1990

Biomechanical factors in the metaphyseal- and diaphyseal-lengthening osteotomy. An experimental and theoretic analysis in the ovine tibia.

A post hoc comparison of the mechanical factors that affected the outcome of experimental metaphyseal- and diaphyseal-lengthening osteotomies in sheep tibiae was performed. The resulting motions between bone segments at the metaphyseal and diaphyseal levels were estimated using measured fixator stiffnesses, postural muscle activity, ground reaction forces, and calculated internal and external loads. Relative displacements of bone segments of up to 2.8 degrees were estimated in postural activities; displacements were up to 4.9 times larger at the metaphyseal than at the diaphyseal osteotomy level. The results suggest that due to these increased motions, mechanically inferior conditions for healing at the metaphyseal-lengthening osteotomy level may counteract any supposedly superior biologic healing potential that the metaphyseal region of the bone may have compared with the diaphyseal region. These results correlate well with the clinical findings of the earlier animal study.

Animals↗
PubMed1990

Full-length diaphyseal sequestrum as a consequence of segmental transverse fractures of the large metatarsal bone in a calf.

A 1-week-old calf was treated for fractured right metatarsus; however, at 3.5 months of age, the fracture site again became unstable. Radiography disclosed segmental transverse metatarsal fractures with an isolated, full-circumference diaphyseal sequestrum. Arteriography and nuclear scintigraphy confirmed the isolation and necrosis of the diaphyseal segment. Diaphyseal sequestra usually develop as cortical or partial circumferential necrotic fragments. The finding of a full-length diaphyseal sequestrum was unusual.

Animals↗
PubMed1984

Progressive diaphyseal dysplasia: genetics and clinical and radiologic manifestations.

Progressive diaphyseal dysplasia was found in a three-generation family including 13 affected individuals, the largest family reported to date. Our study confirms that progressive diaphyseal dysplasia, also known as Engelmann's or Camurati-Engelmann disease, is an autosomal dominant disorder with variable osseous and muscular manifestations. Disease distribution among patients, within a given patient, or even in individual bones is unpredictable. The femur is the most commonly and severely affected bone and hence most useful for radiographic screening of possible patients. Radiographs provide a meaningful assessment of disease activity and extent. The severity of symptoms is generally proportionate to severity of involvement shown by roentgenography. Exophthalmos due to osteosclerotic dysplasia of the skull occurred in more than half of the patients with progressive diaphyseal dysplasia. Twelve-year follow-up of this family, with affected individuals ranging in age from 6 months to 12 years, indicates that progressive diaphyseal dysplasia may progress or become quiescent and be remarkably inactive despite advanced osteosclerosis and structural deformity.

Adolescent↗
PubMed1982

Physiological bowing and tibia vara. The metaphyseal-diaphyseal angle in the measurement of bowleg deformities.

The metaphyseal-diaphyseal angle is the angle created by the intersection of a line through the transverse plane of the proximal tibial metaphysis with a line perpendicular to the long axis of the tibial diaphysis. This angle represents the degree of deformity of the proximal end of the tibia in a patient with clinical bowleg deformity and permits early differentiation between infantile tibia vara and physiological bowleg, before the appearance of the radiographic changes of tibia vara. In twenty-nine of thirty affected extremities with an initial metaphyseal-diaphyseal angle of more than 11.0 degrees, radiographic changes of tibia vara later developed. However, only three of fifty-eight extremities with a metaphyseal-diapyseal angle of 11.0 degrees or less had any of the diagnostic changes. In addition, the ratio of the metaphyseal-diaphyseal angle (proximal tibial metaphyseal deformity) to the tibiofemoral angle (deformity of the entire extremity) showed that approximately 60 per cent of the deformity in tibia vara originates in the proximal metaphysis, whereas only 20 per cent of the deformity in physiological bowing originates there. The metaphyseal-diaphyseal angle allows accurate early diagnosis of bowleg deformity, as well as accurate assessment of its progression.

Bone Diseases, Developmental↗
PubMed1995

Clinical and radiologic effects of diaphyseal stem extension in noncemented total knee replacement.

OBJECTIVE: To determine the clinical and radiologic effects of the addition of a diaphyseal stem extension to the tibial component in noncemented total knee replacement. DESIGN: A cohort study. SETTING: A university-affiliated institution specializing in elective orthopedic surgery. PARTICIPANTS: One hundred and twenty-one patients with arthritis of the knee underwent noncemented total knee arthroplasty with a diaphyseal stem extension. All agreed preoperatively to prolong postoperative follow-up. Forty-six of the patients had a 100-mm stem extension, 56 had a 50-mm stem extension and 19, who had good bone with no intraoperative micromotion, had no stem extension. One patient died 6 weeks after operation and was excluded, leaving 120 knees available for study. Follow-up was 6 months to 3 years. INTERVENTION: Noncemented total knee replacement with the Tricon II prosthesis. MAIN OUTCOME MEASURES: Clinical effects of the diaphyseal stem extension as determined by the Hospital for Special Surgery rating system and radiologic effects as determined by the Cameron classification. RESULTS: Clinically there was little difference between the three groups, with more than 90% in all groups scoring good or excellent. Radiologically, after elimination of single-zone lucency, both stem-extension groups showed a profound decrease in stem lucency. In patients who had a 100-mm stem extension, 90.9% had type IA lucency and 9.1% had type IB; no type II or type III lucency was seen. There was no correlation between radiologic and clinical results. CONCLUSION: The addition of a diaphyseal stem extension to the Tricon II prosthesis reduces the amount of radiolucency in the tibial component in noncemented total knee replacement.

Arthritis↗
PubMed1998

Methods for improving the efficiency of estimating total osteon density in the human anterior mid-diaphyseal femur.

In order to preserve whole bone integrity and minimize destruction, paleohistologists often rely on histomorphometric data obtained from small areas (1.5-50 mm2) sampled within the anterior mid-diaphyseal femur. Because bone exhibits significant histological variation, the validity of results based on such sampling is questionable. The accuracy of various subareas (columns, rows, squares approximating dimensions and locations assessed by paleohistologists) in predicting total osteon density in the anterior mid-diaphyseal femur is assessed in the present study. Thirty-five specimens (12.7 mm wide, 100 microm thick, average area 56.7 mm2) were chosen at random from a skeletal population of 94 Inuits and Pueblo agriculturists. The specimens were photographed and enlarged; an acetate grid (12 columns, 10 rows, 120 squares, square = 1 mm2 of bone surface) was superimposed over the photograph; and secondary osteons and fragments were identified. Alternate columns (50% total area, T.Ar) predicted over 98% of entire section total osteon density. Two column combinations (15% T.Ar), separated by at least one column, predicted 91 to 95% of total osteon density. Individual column (8% T.Ar) predictability ranged from 48 to 86%. Two row combination (32 to 40% T.Ar) predictability values ranged from 86 to 95%. Individual rows (<1 to 20% T.Ar) predicted from 45 to 92% of total variation. Combinations of squares approximating areas and locations assessed by other paleohistologists ranged in predictability values from 80 to 94%. The results demonstrate that subareas of as little as 15% predict 95% of variation in total osteon density in the entire anterior mid-diaphyseal femoral section. A minimization of histological area evaluated without the loss of accuracy allows for a minimization of time invested in data collection and the utilization of partially damaged specimens.

Adolescent↗
PubMed1997

Intramedullary nailing of unstable diaphyseal fractures of the tibia with distal intraarticular involvement.

OBJECTIVE: To evaluate the efficacy of intramedullary nailing in diaphyseal tibia fractures with distal intraarticular involvement. DESIGN: Retrospective. SETTING: Henry Ford Hospital, a level I trauma center. PATIENTS/PARTICIPANTS: Twenty patients with twenty fractures at an average of twenty-two months of follow-up were evaluated. There were fifteen closed and five open fractures. INTERVENTION: All fractures were stabilized with lag screw fixation (with or without supplemental plates) of the intraarticular-fracture extension or ankle fracture, and intramedullary nailing of the diaphyseal tibia fracture. MAIN OUTCOME MEASUREMENTS: Time to bony union, malunion, knee and ankle range of motion, early arthrosis, and any complications of treatment were assessed. RESULTS: Nineteen fractures healed, with an average time to bony union of seventeen weeks. One nonunion after a grade IIIB open fracture required exchange nailing and healed after sixty-two weeks. Nineteen fractures had excellent alignment after healing. There were no infections. CONCLUSIONS: The indications for intramedullary nailing of unstable diaphyseal tibia fractures may be extended to include certain fractures with distal extension into the ankle joint, as well in a tibial shaft fracture occurring in combination with a noncontiguous ipsilateral ankle fracture.

Adult↗