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Journal of Orthopaedic Trauma Dec 2019
Topics: Debridement; Diaphyses; Fractures, Open; Humans; Plastics; Tibial Fractures
PubMed: 31738732
DOI: 10.1097/BOT.0000000000001669 -
Atencion Primaria 2019
Topics: Adult; Chondroma; Diaphyses; Female; Humans; Humerus; Shoulder Pain
PubMed: 30686678
DOI: 10.1016/j.aprim.2018.12.003 -
The Journal of the American Academy of... Oct 2019Diaphyseal tibia fractures in the pediatric population have dynamic treatment strategies that depend on injury pattern, mechanism, patient skeletal maturity and size.... (Review)
Review
Diaphyseal tibia fractures in the pediatric population have dynamic treatment strategies that depend on injury pattern, mechanism, patient skeletal maturity and size. Treatment strategies include closed reduction and cast immobilization, flexible nails, uniplanar or multiplanar external fixation or plate osteosynthesis. Accepted parameters for sagittal and coronal alignment vary based on age and potential for remodeling, although all fractures should have minimal rotational malalignment and less than 1 cm of shortening. Stable union generally occurs in 3 to 4 weeks for the common toddler's fracture and 6 to 8 weeks in other fracture patterns. Complications such as compartment syndrome are possible with both open and closed injuries, and nonunions, although rare, are more common in patients treated with external fixation or flexible nailing. Overall, treatment should be predicated on a full evaluation of the patient, fracture, local soft tissues, and any concomitant injuries.
Topics: Casts, Surgical; Diaphyses; Fracture Fixation; Humans; Orthopedic Procedures; Postoperative Complications; Radiography; Tibial Fractures
PubMed: 30998564
DOI: 10.5435/JAAOS-D-17-00819 -
The Journal of the Association of... Jan 2023Camurati-Engelmann disease (CED) is a rare autosomal dominant disease. It is characterized by hyperostosis of the long bones and the skull, Clinically patient will have...
INTRODUCTION
Camurati-Engelmann disease (CED) is a rare autosomal dominant disease. It is characterized by hyperostosis of the long bones and the skull, Clinically patient will have limb pain, proximal muscle weakness a wide-based gait. The gene causing CED is located on chromosome 19, this region contains the gene encoding the TGF Beta -1. The diagnosis of CED is established in a proband with the characteristic radiographic findings and molecular genetic testing for TGF Beta-1 mutation. Treatment is with corticosteroids and Losartan.
MATERIALS
A 40 year old lady presented with complaints of Left lower limb pain for 1 year duration. On examination there was tenderness of left greater trochanter, proximal and distal femur was present. Blood investigations showed high PTH and low Vitamin-D3. Imaging showed non specific sclerotic lesions in femur. As patient brother had limp since childhood genetic disorders were and a provisional diagnosis of sclerotic bone disease probable Progressive diaphyseal dysplasia was considered. PET-CT was done which revealed abnormal osteoblastic activity in both femurs, focal hyperostosis in humeral diaphysis suggestive of CED. She was tested Positive for TGF beta 1 mutation consistent with CED. He was started on LOSARTAN. On follow up patient is pain free.
RESULT
Her brother was also evaluated in view of his limp and he was also diagnosed as CED.
CONCLUSION
The diagnosis in this case was based on the clinical history, family history and characteristic radiological findings and genetic testing which confirmed TGF Beta-1 mutation. Family history is crucial in this case which led to diagnosis. References Van Hul W, Boudin E, Vanhoenacker FM, et al. Camurati Engelmann disease. Calcif Tissue Int 2019;104(5):554-560. Camurati-Engelmann Disease. NORD (National Organization for Rare Disorders); 2022.
Topics: Humans; Male; Female; Child; Adult; Camurati-Engelmann Syndrome; Siblings; Positron Emission Tomography Computed Tomography; Losartan; Mutation; Pain
PubMed: 37116016
DOI: No ID Found -
Operative Orthopadie Und Traumatologie Oct 2020Intramedullary nailing of tibia fractures via a suprapatellar, transarticular approach with the knee joint in 20-30° of flexion and the use of specific protection... (Review)
Review
OBJECTIVE
Intramedullary nailing of tibia fractures via a suprapatellar, transarticular approach with the knee joint in 20-30° of flexion and the use of specific protection tubes to preserve intra-articular structures.
INDICATIONS
Extra-articular fractures of the proximal tibia; simple and comminuted fractures of the tibia diaphysis; segmental diaphyseal fractures of the tibia; extra-articular fractures of the distal tibia and fractures with simple intra-articular distal extension; floating knee injuries.
CONTRAINDICATIONS
Gustilo grade 3C open fractures of the tibia; severe soft tissue laceration, contamination or infection in the suprapatellar area; ipsilateral knee joint prosthesis; knee arthrodesis; implants blocking the nail entry point.
SURGICAL TECHNIQUE
Via a suprapatellar, transarticular approach an intramedullary tibia nail is inserted after anatomical reposition of the tibial fracture with the knee joint in 20-30° of flexion. Use of specific protection tubes to preserve intra-articular structures. The proximal and distal locking configuration depends upon the specific fracture characteristics.
RESULTS
In all, 61 patients underwent suprapatellar tibia nailing and were under follow-up at least until fracture union. Twelve patients suffered from an open fracture. A total of 17 patients had a distal third fracture, 8 sustained a proximal third fracture and 36 had a shaft fracture. Follow-up focused on patients with distal fractures; 6/17 patients sustained open fractures. Average time to union was 9 weeks. One fracture did not heal and required exchange nailing. Two patients complained about anterior knee pain. Functionally, full range of motion was regained in all patients.
Topics: Bone Nails; Fracture Fixation, Intramedullary; Humans; Tibia; Tibial Fractures; Treatment Outcome
PubMed: 31996965
DOI: 10.1007/s00064-020-00649-9 -
Journal of Feline Medicine and Surgery Jul 2022Cats frequently present with diaphyseal fractures, which require treatment in order to achieve a good return to function. These fractures often occur due to significant... (Review)
Review
PRACTICAL RELEVANCE
Cats frequently present with diaphyseal fractures, which require treatment in order to achieve a good return to function. These fractures often occur due to significant trauma; for example, as a result of road traffic accidents, high-rise syndrome and dog bite wounds. The first priority is to ensure the patient is systemically well before embarking on any specific surgical treatment of a fracture.
CLINICAL CHALLENGES
Surgical management of diaphyseal fractures can be challenging due to the surgical approach for some bones being technically demanding, for example because of the presence of important neurovascular structures, and the small size of feline bones, which limits the choice of implant size and strength. Further, it may be difficult to visualise fracture alignment when using minimally invasive techniques, although the use of intraoperative fluoroscopy can aid with this, and malalignment can be common for some fracture repairs, particularly in cases where anatomical reconstruction is not possible.
AIMS
This review focuses on diaphyseal long bone fractures and aims to assist decision-making, with an overview of the management and treatment options available.
EVIDENCE BASE
Many textbooks and original articles have been published on aspects of managing fractures in small animals. The authors also provide recommendations based upon their own clinical experience.
Topics: Animals; Bone Plates; Cat Diseases; Cats; Diaphyses; Dog Diseases; Dogs; Fluoroscopy; Fractures, Bone
PubMed: 35775308
DOI: 10.1177/1098612X221106354 -
Cureus Dec 2022Osteosarcoma is a tumour that can originate in any bone and is the most frequent malignant tumour of the skeleton. It typically develops close to the metaphyseal growth...
Osteosarcoma is a tumour that can originate in any bone and is the most frequent malignant tumour of the skeleton. It typically develops close to the metaphyseal growth plates in the limbs' long bones. The three most prevalent places are the femur, tibia, and humerus. Additional locations include the pelvis, skull, and jaw. Diaphyseal osteosarcoma involves a smaller population and is highly uncommon. Conventional kinds of osteosarcoma, such as osteoblastic, chondroblastic, and fibroblastic types, as well as telangiectatic, multifocal, parosteal, and periosteal types, are some of the variations of the disease. The primary bone tumour (cancerous) is generated by the formation of immature bone and primarily affects adolescents. We present a case of a 45-year-old menopausal female with left tibial osteosarcoma of the proximal 1/3 diaphysis infected with maggots and complaints of left knee pain and tingling.
PubMed: 36686136
DOI: 10.7759/cureus.32718 -
Clinical Anatomy (New York, N.Y.) Apr 2022The objective of this study was to characterize femur morphology in healthy infants and young children. Anterior-posterior (AP) radiographs of the femur from children...
The objective of this study was to characterize femur morphology in healthy infants and young children. Anterior-posterior (AP) radiographs of the femur from children age 0-3 years with no history of bone disease were obtained from two children's hospitals and one medical examiner's office. Femur morphological measures (bone length, minimum diaphysis diameter, growth plate width, and femur radius of curvature) and sectional structural measures were determined. Measures were described and compared based on subject age and mass. Relationships between measures and age and mass were evaluated. The 169 AP femur radiographs were obtained from 99 children (59.6% males, median age = 12.0 months, IQR = 0-27.5 months, median body weight = 10.0 kg, IQR = 4.4-15.6 kg). Femur length (r = 0.97, p < 0.001; r = 0.89, p < 0.001), trochanter width (r = 0.86, p < 0.001; r = 0.85, p < 0.001), minimum diaphysis diameter (r = 0.91, p < 0.001; r = 0.87, p < 0.001), and growth plate width (r = 0.91, p < 0.001; r = 0.84, p < 0.001) increased with age and weight, respectively. Cross-sectional area (r = 0.87; r = 0.86; p < 0.01), polar moment of inertia (r = 0.91; r = 0.87; p < 0.001), moment of inertia (r = 0.91; r = 0.87; p < 0.001), polar modulus (r = 0.91; r = 0.87; p < 0.001) and medullary canal diameter (r = 0.83, p < 0.001; r = 0.73, p < 0.001) at the minimum diaphysis also increased with age and weight, respectively. Changes during rapid bone growth are important to understanding fracture risk in infants and young children as they transition to independent walking. Femur length, trochanter width, minimum diaphysis diameter and growth plate width increased with age and weight. Structural properties associated with fracture resistance also increased with age and weight.
Topics: Bone Density; Bone Development; Child; Child, Preschool; Diaphyses; Female; Femur; Fractures, Bone; Humans; Infant; Infant, Newborn; Male; Radius
PubMed: 34881441
DOI: 10.1002/ca.23825