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Acta Ortopedica Mexicana 2023dislocations of carpal bones without associated fractures are considered a rare injury, the most common mechanism of injury being axial loading with wrist in extension... (Review)
Review
INTRODUCTION
dislocations of carpal bones without associated fractures are considered a rare injury, the most common mechanism of injury being axial loading with wrist in extension plus ulnar deviation. The literature reports a wide variety of complex carpal injuries, even so, it is possible to identify previously undescribed injuries.
OBJECTIVE
to present an atypical case of a patient with an injury to the midcarpal stabilizing mechanism and the stabilizing mechanism of the proximal row of the wrist following trauma to the hand that required carpectomy as definitive surgical treatment.
PRESENTATION OF CASE
a 48 year old male patient is presented who is admitted to our hospital unit after presenting injury to the left hand after being run over by a motor vehicle, with axial load mechanism, presenting deformity in the left thoracic extremity, fracture of the proximal metaphysis of the second phalanx of the third finger as well as dislocation of the proximal interphalangeal joint, with traumatic amputation of the second phalanx of the fourth finger plus extensor injury in zone V of the fifth finger with loss of skin coverage of the fourth and fifth finger, attending our hospital unit 24 hours after the injury.
CONCLUSIONS
carpal bone dislocations are an orthopedic emergency, with 20% going unnoticed in trauma centers. Early closed reduction is the initial treatment to avoid severe complications, however, surgical treatment is the gold standard for fixation. Carpectomy is considered a mostly adequate sequelae management treatment, however it is well accepted for complex injuries to the wrist stabilization mechanisms, as it can be performed in a short surgical time and early rehabilitation can be initiated and functional ranges of motion can be achieved with low sequelae.
Topics: Male; Humans; Middle Aged; Scaphoid Bone; Carpal Bones; Wrist Joint; Joint Dislocations; Fractures, Bone
PubMed: 38382455
DOI: No ID Found -
Science Advances Feb 2024Breast cancer often metastasizes to bone, causing osteolytic lesions. Structural and biophysical changes are rarely studied yet are hypothesized to influence metastasis....
Breast cancer often metastasizes to bone, causing osteolytic lesions. Structural and biophysical changes are rarely studied yet are hypothesized to influence metastasis. We developed a mouse model of early bone metastasis and multimodal imaging to quantify cancer cell homing, bone (re)modeling, and onset of metastasis. Using tissue clearing and three-dimensional (3D) light sheet fluorescence microscopy, we located enhanced green fluorescent protein-positive cancer cells and small clusters in intact bones and quantified their size and spatial distribution. We detected early bone lesions using in vivo microcomputed tomography (microCT)-based time-lapse morphometry and revealed altered bone (re)modeling in the absence of detectable lesions. With a new microCT image analysis tool, we tracked the growth of early lesions over time. We showed that cancer cells home in all bone compartments, while osteolytic lesions are only detected in the metaphysis, a region of high (re)modeling. Our study suggests that higher rates of (re)modeling act as a driver of lesion formation during early metastasis.
Topics: Animals; Mice; X-Ray Microtomography; Bone Neoplasms; Bone and Bones; Osteolysis; Disease Models, Animal; Cell Line, Tumor
PubMed: 38381833
DOI: 10.1126/sciadv.adj0975 -
Annals of Anatomy = Anatomischer... Apr 20243 M syndrome is first reported in 1975,which characterized by severe pre- and postnatal growth retardation, skeletal malformation and facial dysmorphism. These three...
BACKGROUND
3 M syndrome is first reported in 1975,which characterized by severe pre- and postnatal growth retardation, skeletal malformation and facial dysmorphism. These three genes (CUL7, OBSL1 and CCDC8) have been identified to be respond for 3 M syndrome, of which CUL7 is accounting for approximately 70%. To date, the molecular mechanism underlying the pathogenesis of 3 M syndrome remains poorly understood. Previous studies showed that no Cul7 mice could survive after birth, because of growth retardation at late gestational stage and respiratory distress after birth. The establishment of the animal model of cartilage specific Cul7 knockout mice (Cul7;Col2a1-CreERT2 mice) has confirmed that Cul7;Col2a1-CreERT2 mice can be selective in a time- and tissue-dependent manner, which can provide an experimental basis for further research on severe genetic diseases related to growth plates.
OBJECTIVE
To establish a model of Cul7;Col2a1-CreERT2 mice based on Cre/LoxP system, and to further observe its phenotype and morphological changes in growth plate.
METHODS
The Cul7;Col2a1-CreERT2 mice were taken as the experimental group, while the genotype of Cul7;Col2a1-CreERT2 mice were used as the control group. The gross morphological features and X-ray films of limbs in the two groups were observed every week for 3-6 consecutive weeks, and the length of the mice from nose to the tail, the length of femur and tibia were recorded. In the meantime, The histological morphology of tibial growth plates was compared between the two groups.
RESULTS
A preliminary model of Cul7;Col2a1-CreERT2 mice was established. The Cul7;Col2a1-CreERT2 mice had abnormally short and deformed limbs (P<0.05), increased thickness of growth plate, the disorderly arranged chondrocyte columns, decreased number of cells in the proliferation zone, changes in the shape from flat to round, obviously expanded extracellular matrix, and disordered arrangement, thickening and loosening of bone trabecula at the proximal metaphysis of the femur.
CONCLUSIONS
The knockout of Cul7 gene may affect both the proliferation of chondrocytes and the endochondral osteogenesis, confirming that Cul7 is essential for the normal development of bone in the body.
Topics: Mice; Animals; Growth Plate; Mice, Knockout; Intellectual Disability; Chondrocytes; Growth Disorders; Cullin Proteins; Dwarfism; Muscle Hypotonia; Retinitis Pigmentosa; Spine; Abnormalities, Multiple
PubMed: 38367951
DOI: 10.1016/j.aanat.2024.152224 -
Brazilian Journal of Medical and... 2024"Penumbra sign" is a characteristic finding in magnetic resonance imaging (MRI) of Brodie's abscess, a rare variant of subacute osteomyelitis. We aimed to discuss the...
"Penumbra sign" is a characteristic finding in magnetic resonance imaging (MRI) of Brodie's abscess, a rare variant of subacute osteomyelitis. We aimed to discuss the imaging finding penumbra sign that will help in the diagnosis of osteomyelitis and may be useful to clinicians in differential diagnosis. A 26-year-old male patient presented to the emergency department with complaints of pain and limping in the right knee that did not go away. He had a history of arthroscopic debridement and percutaneous fixation surgery due to osteochondral fragment 3 years ago. There were no additional findings in the patient's vital parameters, physical examination, and medical history. X-ray imaging revealed two screws in the distal femur and a well-defined sclerotic rim surrounding a radiolucent lesion anterior to the screws. MRI revealed a lesion in the distal femoral metaphysis with low-density fluid and hyperintense granulation tissue surrounding it. After surgical abscess drainage and local debridement, bone cement was placed in the resulting cavity. Teicoplanin treatment was started. The patient was discharged and complete recovery was achieved in the second month. The diagnosis of osteomyelitis is often missed or confused with bone tumors in non-traumatic cases presenting with persistent bone pain. MRI imaging is frequently used in differential diagnosis, and detection of characteristic imaging signs such as the penumbra sign accelerates the diagnosis. In this context, emergency department clinicians, in particular, should be cautious and not forget that early treatment can be started by recognizing these signs.
Topics: Male; Humans; Adult; Abscess; Osteomyelitis; Radiography; Femur; Pain
PubMed: 38359272
DOI: 10.1590/1414-431X2023e12976 -
JBJS Essential Surgical Techniques 2023Genu valgum is a common disorder affecting adolescents and young adults. Treatment of this disorder requires restoration of normal mechanical axis alignment and joint...
BACKGROUND
Genu valgum is a common disorder affecting adolescents and young adults. Treatment of this disorder requires restoration of normal mechanical axis alignment and joint orientation, for which it is important to assess whether the deformity arises from the distal femur, knee joint, or proximal tibia. Most commonly, the deformity originates from the distal femur, and various osteotomies of the distal femur have been described. The presently described wedgeless V-shaped osteotomy is a good option among the various alternative procedures listed below.
DESCRIPTION
The anesthetized patient is placed in the supine position on a radiolucent operating table. A bolster is placed beneath the knee to relax the posterior structures. A medial longitudinal skin incision is made that extends from the level of the medial joint line to 5 cm proximal to the adductor tubercle. The vastus medialis is identified and elevated anteriorly by detaching it from its distal and posterior aspects. The leash of vessels underneath the vastus medialis is identified, and the apex of the V-shaped osteotomy is kept just proximal to it. The anterior arm of the V is kept longer than the posterior one, both of them are kept perpendicular to each other, and the apex of the V is made to point distally. The osteotomy is performed on the medial cortex with use of an oscillating saw or multiple drill holes that are then connected using a thin osteotome. Care is taken not to utilize a saw or drill on the lateral cortex. A gentle valgus thrust is applied to break the lateral cortex without periosteal disruption. The apex of the V osteotomy on the proximal fragment is trimmed, and the deformity is corrected with varus force. The osteotomy site is stabilized with use of an anatomically contoured distal medial femoral locking plate or a medial proximal tibial L-shaped buttress plate (of the contralateral side). The implant position is verified under a C-arm image intensifier. The wound is closed in layers over a suction drain in a standard manner.
ALTERNATIVES
Various types of corrective osteotomies of the distal femur have been described in the literature, including the lateral opening wedge, medial closing wedge, dome, and spike osteotomies. All of these procedures have certain limitations and shortcomings.
RATIONALE
The wedgeless V-shaped osteotomy is another described procedure that is inherently stable. It is a safe procedure and yields good clinical outcomes. The posterior arm of the V-shaped osteotomy is kept smaller than the anterior arm. The proximal cortical bone is allowed to dig into the cancellous bone of the wider distal metaphysis during deformity correction. Trimming the apex of proximal bone end after making the osteotomy facilitates the process.
EXPECTED OUTCOMES
In a study of 46 patients with a mean age of 16.9 years (range, 15 years to 23 years), Gupta et al. reported that the mean radiographic tibiofemoral angle improved from 22.2° (range, 16° to 29°) preoperatively to 5.1° (range, 0° to 10°) postoperatively (p < 0.001). Similarly, the mean lateral distal femoral angle improved from 79.2° preoperatively to 89.1° postoperatively (p < 0.001) and the mean mechanical axis deviation improved from 19.6 mm preoperatively to 3.7 mm postoperatively (p < 0.001). A total of 44 of 46 cases had an excellent functional outcome, with the other 2 having good outcomes. None of the patients in the study had an unsatisfactory outcome.
IMPORTANT TIPS
It is important to keep the whole lower limb accessible to the image intensifier intraoperatively.Identification of the leash of vessels underneath the vastus medialis is important to decide the level of the osteotomy.It is important to preserve the periosteal sleeve on the lateral aspect of the femur.
ACRONYMS AND ABBREVIATIONS
CORA = center of rotation of angulationECG = electrocardiogramLDFA = lateral distal femoral angleMAD = mechanical axis deviationMPTA = medial proximal tibial angle.
PubMed: 38357469
DOI: 10.2106/JBJS.ST.22.00033 -
Cureus Jan 2024Posterior shoulder dislocation is a relatively rare injury representing only 5% of all shoulder dislocations. It is usually the result of a high-energy trauma or an...
Posterior shoulder dislocation is a relatively rare injury representing only 5% of all shoulder dislocations. It is usually the result of a high-energy trauma or an epileptic seizure. Diagnosis is challenging with half of these injuries missed in the emergency room (ER). Often the dislocation is accompanied by a lesser tuberosity fracture as a result of the impact between the posterior glenoid and the proximal humerus. Additionally, fractures of the greater tuberosity or even the metaphysis are extremely rare, and their treatment remains challenging. We present a rare case of posterior locked shoulder dislocation with a concomitant lesser and greater tuberosity fracture in a young patient. A 29-year-old male was brought to the ER following a motor vehicle accident. The patient reported significant pain and inability to move his left shoulder. The arm was locked in an internal rotation and was neurovascularly intact. Simple radiographs revealed a locked posterior dislocation with fractures of both the lesser and greater tuberosity. The CT scan confirmed the fracture pattern and excluded metaphyseal fracture. Surgical treatment was decided. Under general anesthesia and a classic thoracodeltoid approach, both tuberosities were recognized and the dislocation was gently reduced. Fixation of the tuberosities with an anatomic plate and Ethibond No. 5 sutures was performed. He was discharged the next day with a 30-degree abduction sling cast. He was instructed to perform passive shoulder and scapula exercises once a day. After one month, the sling was removed and active elevation and rotation exercises were started. Plane X-rays were performed at one, six, and twelve months. The reduction remained stable and the patient recovered full range of motion with a slight loss of external rotation (10 degrees) compared to the contralateral limb. He returned to his previous activities without any complications. Posterior shoulder dislocations with additional fractures of the tuberosities are rare and severe injuries requiring open surgery as the humeral head may remain locked prohibiting closed reduction. Even after the reduction, the stable fixation of the tuberosities is crucial for shoulder stability and postoperative clinical and functional results.
PubMed: 38357043
DOI: 10.7759/cureus.52312 -
Journal of Cellular and Molecular... Feb 2024Blood vessels are essential for bone development and metabolism. Type H vessels in bone, named after their high expression of CD31 and Endomucin (Emcn), have recently... (Review)
Review
Blood vessels are essential for bone development and metabolism. Type H vessels in bone, named after their high expression of CD31 and Endomucin (Emcn), have recently been reported to locate mainly in the metaphysis, exhibit different molecular properties and couple osteogenesis and angiogenesis. A strong correlation between type H vessels and bone metabolism is now well-recognized. The crosstalk between type H vessels and osteoprogenitor cells is also involved in bone metabolism-related diseases such as osteoporosis, osteoarthritis, fracture healing and bone defects. Targeting the type H vessel formation may become a new approach for managing a variety of bone diseases. This review highlighted the roles of type H vessels in bone-related diseases and summarized the research attempts to develop targeted intervention, which will help us gain a better understanding of their potential value in clinical application.
Topics: Humans; Osteogenesis; Bone and Bones; Osteoporosis; Bone Diseases, Metabolic; Fracture Healing; Neovascularization, Physiologic
PubMed: 38353470
DOI: 10.1111/jcmm.18123 -
Journal of Imaging Informatics in... Apr 2024Diffusion tensor imaging of physis and metaphysis can be used as a biomarker to predict height change in the pediatric population. Current application of this technique...
Diffusion tensor imaging of physis and metaphysis can be used as a biomarker to predict height change in the pediatric population. Current application of this technique requires manual segmentation of the physis which is time-consuming and introduces interobserver variability. UNET Transformers (UNETR) can be used for automatic segmentation to optimize workflow. Three hundred and eighty-five DTI scans from 191 subjects with mean age of 12.6 years ± 2.01 years were retrospectively used for training and validation. The mean Dice correlation coefficient was 0.81 for the UNETR model and 0.68 for the UNET. Manual extraction and segmentation took 15 min per volume, whereas both deep learning segmentation techniques took < 1 s per volume and were deterministic, always producing the same result for a given input. Intraclass correlation coefficient (ICC) for ROI-derived femur diffusion metrics was excellent for tract count (0.95), volume (0.95), and FA (0.97), and good for tract length (0.87). The results support the hypothesis that a hybrid UNETR model can be trained to replace the manual segmentation of physeal DTI images, therefore automating the process.
PubMed: 38321313
DOI: 10.1007/s10278-024-00993-3 -
International Journal of Surgery Case... Mar 2024Aneurysmal bone cyst (ABC) is a benign, rapidly growing, osteolytic and could have hemorrhagic lesion. This cyst mostly occurs in females under 20 years old and is...
INTRODUCTION AND IMPORTANCE
Aneurysmal bone cyst (ABC) is a benign, rapidly growing, osteolytic and could have hemorrhagic lesion. This cyst mostly occurs in females under 20 years old and is located predominantly in the metaphysis of long bones, followed by the pelvis and spine. ABC of the scapula is a rare case, and their treatment still remains controversial.
CASE PRESENTATION
A 7-year-old girl has had a growing lump on her left shoulder since two years ago. Physical examination revealed local tenderness and a firm and immobile mass, which limit shoulder motion. The radiological and histopathological results confirmed the diagnosis of ABC of the scapula. The patient underwent a left total scapulectomy and humeral suspension reconstruction and was augmented with surgical mesh. There were no signs of postoperative infection or recurrence during the 1-year follow-up. The MSTS score was 24.
CLINICAL DISCUSSION
There are many options for ABC treatment. Resection of the cyst is the treatment of choice for aggressive tumors (Enneking stage 3) or lesions in less essential bones. In scapula, the ABC treatment with total scapulectomy followed by humeral suspension is an effective method to decrease complications and reduce the risk of recurrence with a good clinical outcome.
CONCLUSION
ABC of the scapula is a rare case. Tumor resection for aggressive ABC should be considered to decrease the recurrence rate. Total scapulectomy with humeral suspension is an effective method for treating ABC scapula (Enneking stage 3).
PubMed: 38320415
DOI: 10.1016/j.ijscr.2024.109339 -
Journal of Imaging Informatics in... Apr 2024Common pediatric distal forearm fractures necessitate precise detection. To support prompt treatment planning by clinicians, our study aimed to create a multi-class...
Common pediatric distal forearm fractures necessitate precise detection. To support prompt treatment planning by clinicians, our study aimed to create a multi-class convolutional neural network (CNN) model for pediatric distal forearm fractures, guided by the AO Foundation/Orthopaedic Trauma Association (AO/ATO) classification system for pediatric fractures. The GRAZPEDWRI-DX dataset (2008-2018) of wrist X-ray images was used. We labeled images into four fracture classes (FRM, FUM, FRE, and FUE with F, fracture; R, radius; U, ulna; M, metaphysis; and E, epiphysis) based on the pediatric AO/ATO classification. We performed multi-class classification by training a YOLOv4-based CNN object detection model with 7006 images from 1809 patients (80% for training and 20% for validation). An 88-image test set from 34 patients was used to evaluate the model performance, which was then compared to the diagnosis performances of two readers-an orthopedist and a radiologist. The overall mean average precision levels on the validation set in four classes of the model were 0.97, 0.92, 0.95, and 0.94, respectively. On the test set, the model's performance included sensitivities of 0.86, 0.71, 0.88, and 0.89; specificities of 0.88, 0.94, 0.97, and 0.98; and area under the curve (AUC) values of 0.87, 0.83, 0.93, and 0.94, respectively. The best performance among the three readers belonged to the radiologist, with a mean AUC of 0.922, followed by our model (0.892) and the orthopedist (0.830). Therefore, using the AO/OTA concept, our multi-class fracture detection model excelled in identifying pediatric distal forearm fractures.
PubMed: 38308069
DOI: 10.1007/s10278-024-00968-4