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Acta Ortopedica Mexicana 2016With the recent evolution of hip arthroplasty, new models of short stems have emerged. So far, we do not have a clear strategy to analyze their outcomes, since there is... (Review)
Review
BACKGROUND
With the recent evolution of hip arthroplasty, new models of short stems have emerged. So far, we do not have a clear strategy to analyze their outcomes, since there is confusion around the definition of short stem and there is no consensus for their classification.
PURPOSES
The purpose of this study was to review the current state of the art of cementless short stems considering the main design characteristics; it provides a definition of short stem and proposes a classification, grouping them into families by means of a nomenclature that describes them accurately.
MATERIAL AND METHODS
We conducted a search in the PubMed and Scopus databases and consulted various implant manufacturers, foundations devoted to research on joint arthroplasty, organizations of independent experts on medical device analysis, and national arthroplasty registries. The stems studied were classified according to a new nomenclature system.
CONCLUSIONS
We identified 44 different models that share 84 design variables and may be grouped into three types and 16 generic families. The stems were manufactured by 20 different companies. Short stems are those occupying the neck, metaphysis and the proximal aspect of the limit between the metaphysis and diaphysis, regardless of the geometric type of endosteum present. A wide variety of models was identified, with multiple design variables. In order to classify them, it was necessary to design a whole new nomenclature capable of describing them in an unequivocal, unique and distinctive way.
Topics: Arthroplasty, Replacement, Hip; Hip Prosthesis; Prosthesis Design; Registries; Treatment Outcome
PubMed: 28267912
DOI: No ID Found -
Magnetic Resonance Imaging Clinics of... Nov 2019Normal bone growth of the pediatric knee as well as normal variants of ossification result in different appearances that can be identified on imaging (radiography/MR... (Review)
Review
Normal bone growth of the pediatric knee as well as normal variants of ossification result in different appearances that can be identified on imaging (radiography/MR imaging). Familiarity with these changes is important to avoid confusing normal growth with pathology. This article illustrates the main features related to normal bone growth (growth arrest lines, physeal changes, ossification centers within the epiphysis, hematopoietic marrow within the metaphysis) and physis disappearance (« FOPE »). Variants in femur (epiphyseal irregularities, subchondral anomalies of posterior condyles, periosteal desmoid), tibia (tibial tuberosity ossification), and patella (dorsal defect, bipartite patella, lower pole fragmentation) are also described.
Topics: Bone Development; Child; Humans; Knee; Knee Joint; Magnetic Resonance Imaging; Radiography
PubMed: 31575403
DOI: 10.1016/j.mric.2019.07.013 -
Clinical Anatomy (New York, N.Y.) May 2024Division of the growing long bone into individual basic parts, that is, diaphysis, metaphysis, physes and epiphyses, has become generally accepted and used. However, the... (Review)
Review
Division of the growing long bone into individual basic parts, that is, diaphysis, metaphysis, physes and epiphyses, has become generally accepted and used. However, the origin of these terms is almost unknown. Therefore, we have analyzed the literature in order to identify their sources. The terms epiphysis and apophysis have been used since the time of Hippokrates, although with different meanings. During the time of Galen, the term apophysis was used to describe all types of bone processes, and epiphyses denoted articular ends. The term diaphysis denoting the middle cylindrical part of the long bone was used for the first time by Heister in 1717. The first to use the term metaphysis was Theodor Kocher in his books on gunshot wounds and on bone inflammation of 1895. On the basis of Kocher's study, Lexer published a radiological study of the vascular supply to bones in which he defined metaphyseal blood vessels as a separate group supplying a particular part of the long bone. The epiphyseal growth plate had no particular name from the time of its first description in 1836. During the second half of 19th century, this structure acquired different names. The term "physis" was therefore introduced in 1964 by the American radiologist Rubin in order to label the growth structure between metaphysis and epiphysis clearly. One year later, the term physis also appeared in the radiological literature, and during the following decades it spread in the orthopedic literature.
PubMed: 38778675
DOI: 10.1002/ca.24176 -
Frontiers in Endocrinology 2022Skeletal stem and progenitor cells (SSPCs) constitute a reservoir of bone-forming cells necessary for bone development, modeling and remodeling, as well as for fracture...
Skeletal stem and progenitor cells (SSPCs) constitute a reservoir of bone-forming cells necessary for bone development, modeling and remodeling, as well as for fracture healing. Recent advances in tools to identify and isolate SSPCs have revealed that cells with multipotent properties are present not only in neonatal bone, but also in adult bone marrow and periosteum. The long bone metaphysis and endosteum have been proposed as an additional SSPC niche, although approaches to study their cellular and molecular characteristics are still limited. Here, we describe a comprehensive procedure to isolate and culture SSPCs derived from the metaphysis and endosteum of young-adult mice. Based on flow cytometry analysis of known SSPC markers, we found the presence of putative multipotent SSPCs, similar to neonatal bone tissue. , metaphyseal/endosteal SSPCs possess self-renewing capacity, and their multipotency is underscored by the ability to differentiate into the osteogenic and adipogenic lineage, while chondrogenic potential is limited. Expansion of metaphyseal/endosteal SSPCs under low oxygen conditions increases their proliferation capacity, while progenitor properties are maintained, likely reflecting their hypoxic niche . Collectively, we propose a validated isolation and culture protocol to study metaphyseal/endosteal SSPC biology .
Topics: Animals; Bone and Bones; Cell Differentiation; Fracture Healing; Mice; Osteogenesis; Stem Cells
PubMed: 35979436
DOI: 10.3389/fendo.2022.930358 -
The Knee Oct 2023Excessive posterior tibial slope (PTS) is an independent risk factor for anterior cruciate ligament reconstruction (ACLR) failure, but it remains unclear how PTS relates...
BACKGROUND
Excessive posterior tibial slope (PTS) is an independent risk factor for anterior cruciate ligament reconstruction (ACLR) failure, but it remains unclear how PTS relates to other proximal tibial morphologic parameters. The purpose of this study was to analyse sagittal tibial metaphysis morphology, and to calculate the correlation coefficients of PTS with anatomical features.
METHODS
The authors retrospectively reviewed lateral radiographs of 350 patients that were scheduled to receive primary ACLR to digitize 15 landmarks on the patella, femur, fibula, and tibia, and measure PTS, patellar height, as well as metaphysis height and inclination. Pearson correlation coefficients (r) were computed to assess the linear relationship of PTS with other parameters.
RESULTS
The PTS was 9.8 ± 3.1° (mid-shaft axis), anterior metaphyseal height and inclination was 30.9 ± 4.6 mm and 33.9 ± 7.2°, and posterior metaphyseal height and inclination was 16.1 ± 4.0 mm and 22.0 ± 5.8°. PTS had a low correlation with anterior (r, 0.225) and posterior metaphyseal heights (r, -0.183). PTS had moderate correlations with anterior (r, 0.385) and posterior metaphysis inclination (r, 0.417).
CONCLUSION
PTS has a low correlation with anterior metaphyseal height, but a moderate correlation with anterior and posterior metaphyseal inclination. The moderate correlation between PTS and metaphysis inclination sheds light on the origin of the deformity, and knees with higher PTS are therefore likely to have metaphyses with greater posterior inclinations. The clinical relevance of these findings is that tibial deflexion osteotomy techniques should attempt to address the underlying deformity of excessive PTS by adjusting metaphyseal inclination rather than making diaphyseal resections.
Topics: Humans; Tibia; Knee Joint; Retrospective Studies; Femur; Radiography; Anterior Cruciate Ligament Injuries
PubMed: 37717277
DOI: 10.1016/j.knee.2023.08.007 -
Journal of Orthopaedic Case Reports Jan 2023Chondromyxoid fibroma (CMF) is an uncommon bone tumor, accounting for <1% of all bone tumors. It generally affects the metaphysis of the long bone of the lower limb and...
INTRODUCTION
Chondromyxoid fibroma (CMF) is an uncommon bone tumor, accounting for <1% of all bone tumors. It generally affects the metaphysis of the long bone of the lower limb and seldom involves the small bones, but the involvement of the flat bones, like ribs, is infrequent.
CASE REPORT
A teenage girl complained of pain on the right side of the chest for the past 6 months, dull aching, and persistent without any diurnal variation. The chest X-ray examination showed a nodular, hyperdense lesion on the lateral chest wall near the 5-7th rib on the right side. A computed tomography scan confirmed the lesion from the sixth rib with ground-glass matrix and cortical thinning with a smooth margin, without any soft-tissue involvement. An enblock excision of the lesion was done. Histopathological studies showed a well-circumscribed tumor with reactive bone formation at the periphery with lobules of chondromyxoid tissue separated by spindle cells and stellate-shaped cells suggestive of CMF. At 1-year follow-up, she is asymptomatic without any recurrence.
CONCLUSION
CMFs are rare benign tumors that require histopathological study to differentiate from other benign lesions of the bone. In flat tubular bones like the ribs, enblock resection is the mainstay of treatment.
PubMed: 37143567
DOI: 10.13107/jocr.2023.v13.i01.3528 -
Revista Brasileira de Ortopedia 2016Impacted valgus fractures of the proximal humerus are considered to be a special type fracture, since impaction of the humeral head on the metaphysis with maintenance of... (Review)
Review
Impacted valgus fractures of the proximal humerus are considered to be a special type fracture, since impaction of the humeral head on the metaphysis with maintenance of the posteromedial periosteum improves the prognosis regarding occurrences of avascular necrosis. This characteristic can also facilitate the reduction maneuver and increase the consolidation rate of these fractures, even in more complex cases. The studies included were obtained by searching the Bireme, Medline, PubMed, Cochrane Library and Google Scholar databases for those published between 1991 and 2013. The objective of this study was to identify the most common definitions, classifications and treatment methods used for these fractures in the orthopedic medical literature.
PubMed: 27069878
DOI: 10.1016/j.rboe.2016.01.004 -
Arkhiv Patologii 2015Classical osteosarcoma is one of the most common primary malignant bone tumors in children and adolescents. It more frequently occurs in the areas of the highest growth... (Review)
Review
Classical osteosarcoma is one of the most common primary malignant bone tumors in children and adolescents. It more frequently occurs in the areas of the highest growth plate proliferation: limb long bones particularly in the distal femur (30%), proximal tibia (15%), and proximal humerus (15%). In the long bones, the tumor is located usually in the metaphysis (90%), less frequently in the diaphysis (9%), and very rarely in the epiphysis. This paper considers the clinical, radiological, and histological diagnosis, and prognosis in this pathology.
Topics: Adolescent; Bone Neoplasms; Bone and Bones; Child; Diagnosis, Differential; Femur; Humans; Osteosarcoma
PubMed: 27077157
DOI: 10.17116/patol201577568-74 -
Der Unfallchirurg Feb 2019Intramedullary nailing was originally conceived for the stabilization of shaft fractures of long bones. Due to new nail designs and multiple interlocking possibilities,... (Review)
Review
Intramedullary nailing was originally conceived for the stabilization of shaft fractures of long bones. Due to new nail designs and multiple interlocking possibilities, the spectrum of nailing has significantly increased. Nailing of fractures beyond the isthmus is technically challenging because fractures need to be reduced before the nailing procedure starts. Indirect techniques of reduction include the use of an extension table, a large distractor or an external fixator. Direct reduction with pointed reduction forceps, lag screws, a cerclage wire or a short plate can optimize indirect reduction. The choice of the correct entry portal is of utmost importance for an optimal operative result. The location of the entry portal is dependent on the local anatomy and the bend of the nail. The optimal entry portal at the proximal tibia is directly behind the patellar tendon and accessible with the knee in more than 90° of flexion, alternatively through a suprapatellar approach with a slightly flexed knee joint. Insertion of the nail through the suprapatellar approach is possible without stress on the reduced fracture fragments. Blocking screws create an artificial isthmus in the metaphyseal area and force the guide wire in the desired direction. Blocking screws help to avoid axial malalignment during nail insertion. Interlocking of the nail with screws coming from different directions prevents secondary dislocation.
Topics: Bone Nails; Bone Plates; Fracture Fixation, Internal; Fracture Fixation, Intramedullary; Humans; Tibial Fractures
PubMed: 30276432
DOI: 10.1007/s00113-018-0560-1 -
Injury Jun 2021The fracture repair process is known to be delayed in postmenopausal women, under estrogen-deficient status. Osteoporotic fracture mainly occurs in the metaphyseal...
The fracture repair process is known to be delayed in postmenopausal women, under estrogen-deficient status. Osteoporotic fracture mainly occurs in the metaphyseal region of the long bone; however, most studies on fracture healing have focused on the diaphyseal region. In this study, we compared the repair process between metaphysis and diaphysis of ovariectomized (OVX) and Sham mice, and analyzed the effects of short-term estrogen administration in OVX mice. Mice were divided into four experimental groups, including Sham, OVX, OVX + vehicle, and OVX + 17β-estradiol (E2). Bone apertures were formed in the tibial metaphysis and diaphysis. The samples were collected and examined by micro-computed tomography, and using histological, histochemical, and immunohistochemical analysis at different time points after the surgery. The cartilaginous callus was formed at the diaphysis site of both the groups, which was sequentially replaced by bone on the periosteum side. Medullary callus was formed in all the groups; however, the volume of the callus in OVX mice was significantly lesser (˜30%) than that in Sham mice. Furthermore, in the metaphysis, no differences were observed in the medullary callus and bone mineral density between the two groups from day 21 to 28. The diaphysis of OVX group was not completely repaired even by day 28. In both the sites of OVX mice, ALP activity and disappearance of Gr-1 positive cells were delayed compared to that of Sham. Estrogen administration improved medullary callus formation in the diaphysis, however not in the metaphysis. The effect of ovariectomy on the repair process in diaphysis was greater than that in metaphysis. Our findings clarify the differences between the metaphysis and diaphysis repair process using OVX mouse model and suggest that the estrogen sensitivities differ between the sites during the bone repair process.
Topics: Animals; Bone Density; Bone and Bones; Diaphyses; Female; Humans; Mice; Osteoporosis; Ovariectomy; X-Ray Microtomography
PubMed: 33610313
DOI: 10.1016/j.injury.2021.02.020