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Ulusal Travma Ve Acil Cerrahi Dergisi =... Mar 2016The aim of the present study was to evaluate functional and cosmetic outcomes of adult patients who underwent intramedullary nailing with newly designed intramedullary...
BACKGROUND
The aim of the present study was to evaluate functional and cosmetic outcomes of adult patients who underwent intramedullary nailing with newly designed intramedullary radius nails for isolated radius diaphyseal fractures.
METHODS
Seventeen adult patients who had undergone intramedullary nailing for radius diaphyseal fractures were retrospectively evaluated. Patients with isolated radius diaphyseal closed fractures were included. Closed reduction was achieved in all patients. Wrist and elbow ranges of movement were calculated at final follow-up. Grip strength was calculated using a hydraulic hand dynamometer. Maximum radial bowing (MRB) and maximum radial bowing localization (MRBL) were calculated for treated and uninjured arms. Functional evaluation was performed using Grace-Eversman evaluation criteria and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire score.
RESULTS
Of the 17 patients with isolated radius diaphyseal fractures evaluated, 11 (64.7%) were male and 6 (35.3%) were female, with a mean age of 35.76 years (range: 23-61 years). Fractures were right-sided in 11 (64.7%) and left-sided in 6 (35.3%) patients. Mean time to bone union was 10.2 weeks (range: 8-20 weeks). Mean supination was 75.35º (range: 67º-80º), pronation was 85.18º (range: 74º-90º). According to Grace-Eversman evaluation criteria, results were excellent in 16 (94%) and good in 1 (6%) patient. Mean DASH score was 12.58 (3.3-32.5).
CONCLUSION
The gold-standard treatment of adult isolated radius diaphyseal fractures is plate and screw osteosynthesis. However, intramedullary nailing of isolated radius fractures is a good alternative treatment method, with excellent functional results and union rates similar to those of plate and screw osteosynthesis.
Topics: Adult; Bone Nails; Diaphyses; Female; Fracture Fixation, Intramedullary; Humans; Male; Middle Aged; Radius Fractures; Range of Motion, Articular; Recovery of Function; Retrospective Studies; Surveys and Questionnaires; Treatment Outcome; Turkey; Young Adult
PubMed: 27193987
DOI: 10.5505/tjtes.2015.87036 -
European Journal of Sport Science 2015Mountain biking (MB), unlike road cycling (RC) involves exposure to ground impact bone strain and requires upper-body muscle forces to maintain stability over uneven...
Mountain biking (MB), unlike road cycling (RC) involves exposure to ground impact bone strain and requires upper-body muscle forces to maintain stability over uneven terrain and therefore may have differential effects on radial bone structure and strength. This study aimed to compare serum bone turnover marker concentration, 1-repetition maximum muscle strength and the radial proximal (diaphysis) and distal (metaphysis) bone structure [bone mineral content, total and cortical area (CoA), density and thickness, diameter and circumference], strength strain indices and muscle cross-sectional area (MCSA) using peripheral quantitative computed tomography (pQCT) between 30 male cyclists (18-34 years) MB (n = 10), RC (n = 10) and non-athletes controls (CON, n = 10). Differences were assessed by ANOVA and an ANCOVA (adjusting for body mass and height) where appropriate. MB radii were characterised by significantly stronger (14-16%), denser (9-27%) and larger (10%) metaphyses and stronger (22-23%) and larger (11-13%) diaphyses compared to RC and CON. RC had significantly 7% higher strength indices and 4% greater CoA and thickness than CON at the diaphysis, with no differences for other bone measurements. Serum C-terminal telopeptides of type-1 collagen concentration (bone resorption marker) was higher in RC than MB (p < 0.05) and above the age-reference range. MCSA and strength were greater in MB than RC (p < 0.05). Muscle forces generated during RC appear to produce an osteogenic stimulus to increase radial bone strength indices with minimal improvement in bone structure. However greater resorptive activity in RC suggests inadequate loading to support bone maintenance. In conclusion, bone loading, muscle size and strength of MB are superior to RC.
Topics: Adult; Bone Density; Collagen Type I; Diaphyses; Growth Plate; Humans; Male; Motorcycles; Muscle Strength; Muscle, Skeletal; Peptides; Radiography; Radius; Young Adult
PubMed: 25005697
DOI: 10.1080/17461391.2014.933881 -
Bone Oct 2019Current interventions to reduce skeletal fragility are insufficient at enhancing both the quantity and quality of bone when attempting to improve overall mechanical...
Current interventions to reduce skeletal fragility are insufficient at enhancing both the quantity and quality of bone when attempting to improve overall mechanical integrity. Bisphosphonates, such as Zoledronate (ZOL), are used to treat a variety of bone disorders by increasing bone mass to decrease fracture risk, but long-term use has been shown in some settings to compromise bone quality. Alternatively, Raloxifene (RAL) has recently been demonstrated to improve tissue quality and overall mechanical properties in a cell-independent manner by binding to collagen and increasing tissue hydration. We hypothesized that a combination of RAL and ZOL would improve mechanical and material properties of bone more than either monotherapy alone by enhancing both quantity and quality. In this study, wildtype (WT) and heterozygous (OIM+/-) male mice from the Osteogenesis Imperfecta (OI) murine model were treated with either RAL, ZOL, or both from 8 weeks to 16 weeks of age. Using the OIM model allows for investigation of therapeutic effects on a quality-based bone disease. Combination treatment resulted in higher trabecular architecture, cortical mechanical properties, and cortical fracture toughness in diseased mouse bone. Two fracture toughness properties, which are direct measures of the tissue's ability to resist the initiation and propagation of a crack, were significantly improved with combination treatment in OIM+/- compared to control. There was no significant effect on fracture toughness with either monotherapy alone in either genotype. Following the mass-based effects of ZOL, trabecular bone volume fraction was significantly higher with combination treatment in both genotypes. Combination treatment resulted in higher ultimate stress in both genotypes. RAL and combination treatment in OIM+/- also increased resilience compared to the control. In conclusion, this study demonstrates the beneficial effects of using combination drug treatments to increase bone mass while simultaneously improving tissue quality, especially to enhance the mechanical integrity of diseased bone. Combination therapies could be a potential method to improve bone health and combat skeletal fragility on both the microscopic and macroscopic levels.
Topics: Animals; Biomechanical Phenomena; Bone Diseases; Calcification, Physiologic; Cancellous Bone; Diaphyses; Drug Therapy, Combination; Femur; Fractures, Bone; Male; Mice, Inbred C57BL; Raloxifene Hydrochloride; Zoledronic Acid
PubMed: 31233931
DOI: 10.1016/j.bone.2019.06.018 -
Scientific Reports Jan 2018Inferring the morphology of the last common ancestor of humans, chimpanzees and gorillas is a matter of ongoing debate. Recent findings and reassessment of fossil...
Inferring the morphology of the last common ancestor of humans, chimpanzees and gorillas is a matter of ongoing debate. Recent findings and reassessment of fossil hominins leads to the hypothesis that the last common ancestor was not extant African ape-like. However, an African great-ape-like ancestor with knuckle walking features still remains plausible and the most parsimonious scenario. Here we address this question via an evolutionary developmental approach, comparing taxon-specific patterns of shape change of the femoral diaphysis from birth to adulthood in great apes, humans, and macaques. While chimpanzees and gorillas exhibit similar locomotor behaviors, our data provide evidence for distinct ontogenetic trajectories, indicating independent evolutionary histories of femoral ontogeny. Our data further indicate that anthropoid primates share a basic pattern of femoral diaphyseal ontogeny that reflects shared developmental constraints. Humans escaped from these constraints via differential elongation of femur.
Topics: Animals; Diaphyses; Femur; Hominidae; Humans; Phylogeny; Principal Component Analysis
PubMed: 29386644
DOI: 10.1038/s41598-018-20410-4 -
Journal of Bone and Mineral Research :... Oct 2000Bone mineral density (BMD) and mechanical strength generally show strong positive correlations. However, osteopetrosis is a metabolic bone disease with increased...
Bone mineral density (BMD) and mechanical strength generally show strong positive correlations. However, osteopetrosis is a metabolic bone disease with increased skeletal density radiographically and increased risk of fracture. We have evaluated mechanical strength and mineral density in three osteopetrotic mutations in the rat (incisors-absent [ia/ia], osteopetrosis [op/op], and toothless [tl/tl]) to test the hypothesis that reduced bone resorption in one or more of these mutations results in weaker bones in the presence of greater mineral density and skeletal mass. Peripheral quantitative computed tomography (pQCT) was used to analyze BMD and cross-sectional geometry in the tibial diaphysis and metaphysis as well as the femoral diaphysis and femoral neck. The bending breaking force of tibial and femoral midshafts was obtained using the three-point bending test and femoral neck strength was tested by axial loading. Osteopetrotic mutants were significantly smaller than their normal littermates (NLMs) in each stock. The pQCT analysis showed that BMD and bone mineral content (BMC) were higher than or equal to NLMs in all skeletal sites measured in the osteopetrotic mutants. However, the mechanical breaking force was equal to or lower than their NLMs in all sites. The cross-sectional structure of long bone shafts was markedly different in osteopetrotic mutants, having a thin cortex and a medullary area filled with primary trabecular bone. These results indicate that osteopetrotic mutations in the rat increase bone density and decrease bone strength. The tibial diaphysis was significantly weaker in tl/tl and ia/ia mutants and the tibial metaphysis showed the greatest increase in BMD in all mutants. These data are another illustration that an increased BMD does not necessarily lead to stronger bones.
Topics: Animals; Body Weight; Bone Density; Bone Resorption; Diaphyses; Femur; Fractures, Bone; Histocytochemistry; Leg Bones; Mutation; Osteopetrosis; Phenotype; Rats; Rats, Mutant Strains; Stress, Mechanical; Tensile Strength; Tibia; Tomography, X-Ray Computed
PubMed: 11028442
DOI: 10.1359/jbmr.2000.15.10.1905 -
Osteoporosis International : a Journal... Nov 2009Using in vivo microcomputed tomography (micro-CT), we found in parathyroid hormone (PTH)-treated osteopenic rats linear increases in cortical and trabecular, due to...
UNLABELLED
Using in vivo microcomputed tomography (micro-CT), we found in parathyroid hormone (PTH)-treated osteopenic rats linear increases in cortical and trabecular, due to increased trabecular thickness and number, bone mass. Bone was formed in cavities, leading to restoral of nearly cleaved trabeculae. For the first time, effects in PTH-treated rats were analyzed longitudinally.
INTRODUCTION
Our aims were to over time (1) determine changes in trabecular thickness and number after PTH, (2) compare responses to PTH between the meta- and epiphysis, (3) determine effects of PTH on mineralization and mechanical properties, (4) determine locations of new bone formation due to PTH on a microlevel, and (5) determine the predictive value of bone structural properties for gain in bone mass after PTH.
METHODS
Adult rats were divided into ovariectomy (OVX; n = 8), SHAM-OVX (n = 8), and OVX and PTH treatment (n = 9). Between weeks 8 and 14, PTH rats received daily subcutaneous PTH injections (60 microg/kg/day). At weeks 0, 8, 10, 12, and 14, in vivo micro-CT scans were made of the proximal and diaphyseal tibia. After sacrifice, all tibiae were tested in three-point bending.
RESULTS
PTH increased bone volume fraction linearly over time in meta- and epiphysis, accompanied by increased trabecular thickness in both and increased trabecular number only in the latter one. CT-estimated mineralization increased in trabecular and remained constant in cortical bone. Ultimate load and energy were increased and ultimate displacement and stiffness unaltered compared to SHAM rats. For those trabeculae analyzed, bone was formed initially on places where it was most beneficial for increasing their strength and later on to all surfaces.
Topics: Animals; Bone Density; Bone Density Conservation Agents; Bone Diseases, Metabolic; Bone Remodeling; Diaphyses; Disease Models, Animal; Drug Evaluation, Preclinical; Epiphyses; Female; Ovariectomy; Parathyroid Hormone; Rats; Rats, Wistar; Tibia; X-Ray Microtomography
PubMed: 19262974
DOI: 10.1007/s00198-009-0882-5 -
Physical Therapy Jun 2013People with stroke often have increased bone loss and fracture rate. Increasing evidence has demonstrated a link between cardiovascular health and bone loss in other...
BACKGROUND
People with stroke often have increased bone loss and fracture rate. Increasing evidence has demonstrated a link between cardiovascular health and bone loss in other patient populations.
OBJECTIVE
The study objectives were: (1) to compare the bone density and geometry of the radius diaphysis on the left and right sides in people with chronic stroke and people who were matched for age (control participants) and (2) to examine the relationship between the bone strength index at the hemiparetic radius diaphysis and vascular health in people with chronic stroke.
DESIGN
This was a case-control study.
METHODS
The radius diaphysis on both sides was scanned with peripheral quantitative computed tomography in 65 participants with chronic stroke and 34 control participants. Large-artery and small-artery elasticity indexes were evaluated with a cardiovascular profiling system.
RESULTS
The paretic radius diaphysis had significantly lower values for cortical bone mineral density, cortical thickness, cortical area, and the bone strength index but a larger marrow cavity area than the nonparetic radius diaphysis in participants with chronic stroke, whereas no bone measurement showed a significant side-to-side difference in control participants. Multiple regression analyses showed that the large-artery elasticity index and grip strength remained significantly associated with the bone strength index at the hemiparetic radius diaphysis after controlling for age, sex, time since stroke diagnosis, body mass index, and physical activity (R(2)=.790).
LIMITATIONS
This study was cross-sectional and could not establish causality. The radius diaphysis is not the most common site of fracture after stroke.
CONCLUSIONS
Both the integrity of the vasculature and muscle strength were significantly associated with the bone strength index at the hemiparetic radius diaphysis in participants with chronic stroke. The results may be useful in guiding rehabilitative programs for enhancing bone health in the paretic arm after stroke.
Topics: Blood Pressure; Bone Density; Case-Control Studies; Cross-Sectional Studies; Diaphyses; Elasticity; Female; Hand Strength; Humans; Male; Middle Aged; Paresis; Radial Artery; Radius; Regression Analysis; Sex Factors; Stroke; Tomography, X-Ray Computed
PubMed: 23431208
DOI: 10.2522/ptj.20120378 -
Journal of Orthopaedic Surgery and... Mar 2022Atypical femoral fractures (AFF) are diaphyseal fractures of the elderly that occur at the end of a minor trauma. The objective of this biomechanical study, using finite...
BACKGROUND
Atypical femoral fractures (AFF) are diaphyseal fractures of the elderly that occur at the end of a minor trauma. The objective of this biomechanical study, using finite element modelling, was to evaluate the variations of the femoral diaphysis fracture indicator according to the variations of the mechanical axis of the lower limb, which can explain all the different atypical fracture types identified in the literature.
METHODS
In order to measure variations in stress and risk factors for fracture of the femoral diaphysis, the distal end of the femur was constrained in all degrees of freedom. An axial compression load was applied to the femoral head to digitally simulate the bipodal support configuration in neutral position as well as in different axial positions in varus/valgus (- 10°/10°).
RESULTS
The maximum stress value of Von Mises was twice as high (17.96 ± 4.87 MPa) at a varus angle of - 10 as in the neutral position. The fracture risk indicator of the femoral diaphysis varies proportionally with the absolute value of the steering angle. However, the largest simulated varus deformation (- 10°) found a higher risk of diaphysis fracture indicator than in valgus (10°).
CONCLUSIONS
Variations in the mechanical axis of the lower limb influence the stress distribution at the femur diaphysis and consequently increase the risk of AFF. The axial deformation in varus is particularly at risk of AFF. The combination of axial deformation stresses and bone fragility consequently contribute to the creation of an environment favorable to the development of AFF.
TRIAL REGISTRATION
'retrospectively registered'.
Topics: Aged; Aged, 80 and over; Biomechanical Phenomena; Diaphyses; Female; Femoral Fractures; Femur; Femur Head; Finite Element Analysis; Humans; Lower Extremity; Male; Weight-Bearing
PubMed: 35292051
DOI: 10.1186/s13018-022-03060-1 -
Orthopaedic Surgery Jun 2019This study was aimed to find the radiographic parameter predicting recurrence of stage 2 Blount's disease.
OBJECTIVE
This study was aimed to find the radiographic parameter predicting recurrence of stage 2 Blount's disease.
METHOD
We retrospectively reviewed radiographs of 82 legs from 49 patients diagnosed with stage 2 Blount's disease by Langenskiöld classification who had failed brace treatment and underwent valgus osteotomy between 1998 to 2016. Age ranged from 26 to 47 months. The metaphyseal-diaphyseal angle was measured preoperatively. The medial metaphyseal slope of the proximal tibia and femorotibial angle were measured preoperatively and 3, 6, 12, and 24 months postoperatively in both non-recurrence (group 1) and recurrence (group 2) group. The receiver operating characteristic curve calculated using MedCalc software was used to determine the medial metaphyseal slope predicting risk for recurrence. Statistical analysis was performed using SPSS software.
RESULTS
The mean follow-up time was 4.83 ± 0.38 years. The mean age was 34.57 ± 5.76 in group 1 and 33.2 ± 1.48 in group 2 (P = 0.258). The mean preoperative metaphyseal slope was 62.39° ± 9.75° in group 1 and 73.22° ± 6.59° in group 2 (P = 0.02). The mean preoperative femorotibial angle (FTA) was -14.31° ± 8.25° in group 1 and -18.89° ± 7.74° in group 2 (P = 0.1). The mean preoperative metaphyseal diaphyseal angle (MDA) was 14.75° ± 4.21° in group 1 and 20.11° ±5.16° in group 2 (P = 0.001). Demographic data including age, gender, weight, height, and body mass index showed no statistically significant difference between both groups. Out of 82 legs, 9 (10.97%) had recurrence. Preoperatively, the metaphyseal-diaphyseal angle showed statistical significance between both groups. The medial metaphyseal slope showed statistically significant difference between group 1 and group 2 at 3, 6, 12, and 24 months postoperatively. The receiver operating characteristic curve showed that a medial metaphyseal slope more than 70° at 12 months (sensitivity 88.89% and specificity 69.86%) and more than 62° at 24 months postoperatively (sensitivity 100%, specificity 52.3%) was a predictor for recurrence of stage 2 Blount's disease.
CONCLUSION
Medial metaphyseal slope more than 62° over the 24-month follow-up was associated with recurrence of varus deformity.
Topics: Bone Diseases, Developmental; Child, Preschool; Diaphyses; Female; Femur; Follow-Up Studies; Humans; Male; Osteochondrosis; Osteotomy; Radiography; Recurrence; Retrospective Studies; Sensitivity and Specificity; Tibia; Treatment Outcome
PubMed: 31243919
DOI: 10.1111/os.12491 -
Journal of Anatomy Jun 1996The nutrient foramina in the human femoral diaphysis were counted in 109 cleaned and dried bones, ranging in age from 38 to 98 y. Although statistical analysis for...
The nutrient foramina in the human femoral diaphysis were counted in 109 cleaned and dried bones, ranging in age from 38 to 98 y. Although statistical analysis for univariate associations found that foramen number was not linked to age, sex (male/female) or side (R/L), multivariate logistic analysis revealed a significant interaction between the effects of sex and side (P < 0.01). Univariate analysis for sex and for side separately revealed a significant difference in for men number between the results for men and women for R bones 62% (18/29) vs 33% (8/24) (P < 0.04), but not for L bones 35% (9/26) vs 48% (13/27) (P < 0.28). One lower limb from 15 cadavers was perfused with a barium sulphate suspension to show the blood supply of the femoral diaphysis. Twelve were in the age group 59-88 y and considered to be senescent material. In addition, 3 more femora were perfused, 1 from a young male aged 21 y, another from a 42-y-old male considered to show early senescent changes, and a third from a man aged 56 y with a hip prosthesis in situ, to provide an example of a cortex deprived entirely of its medulla. All perfused femora were fixed and decalcified, and sections were then radiographed. Cross-sections through the middiaphysis showed that aged bone cortex is supplied predominantly from the periosteum in contrast to the medullary supply in young human and animal material. The change is attributed to increasingly severe medullary ischaemia with age, brought on by atherosclerosis of the marrow vessels. An examination of the findings reported by investigators of animal bone blood supply in the past 40 y shows a large measure of agreement. Long standing controversy seems to be based on a failure to recognise that marrow ischaemia accompanies natural senescence, affecting transcortical haemodynamics, and entraining an increasing periosteal supply for bone survival in old age. The change over from a medullary to a periosteal blood supply to bone cortex is the consequence of medullary ischaemia and reduced marrow arterial pressure, brought about by medullary atherosclerosis.
Topics: Aged; Aged, 80 and over; Aging; Arteriosclerosis; Bone Marrow; Diaphyses; Female; Femur; Hip Prosthesis; Humans; Ischemia; Male; Middle Aged; Periosteum
PubMed: 8763478
DOI: No ID Found