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Medicina (Kaunas, Lithuania) Feb 2022The treatment of malunion of the lower extremity diaphysis is challenging. Diaphyseal osteotomies require extra care to promote bone healing. This may be enhanced...
The treatment of malunion of the lower extremity diaphysis is challenging. Diaphyseal osteotomies require extra care to promote bone healing. This may be enhanced through osteotomies, which do not produce bone gaps and allow for compression. The focal dome osteotomy allows for rotation around an axis to correct angular deformity. The production of a successful arcuate or focal dome osteotomy requires a suitable soft tissue host. The deformity analysis is not complex but essential to assess the feasibility of correction and is required for perfect execution of the osteotomy. This tutorial explains the technique for focal dome osteotomy to correct angular deformities of the lower extremities, specifically in the diaphysis. Surgical correction for malunion, infected malunion, and infected mal-nonunion case examples are discussed. With meticulous planning and surgical technique, the focal dome osteotomy is a viable option for correcting diaphyseal malunions with compression techniques that allow a stable construct for early weight-bearing.
Topics: Diaphyses; Fractures, Malunited; Humans; Lower Extremity; Osteotomy
PubMed: 35208632
DOI: 10.3390/medicina58020308 -
Zhongguo Xiu Fu Chong Jian Wai Ke Za... May 2024To summarize the research progress in the treatment of distal humeral metaphyseal-diaphyseal junction (DHMDJ) fractures in children and to provide reference for clinical... (Review)
Review
OBJECTIVE
To summarize the research progress in the treatment of distal humeral metaphyseal-diaphyseal junction (DHMDJ) fractures in children and to provide reference for clinical practice.
METHODS
The characteristics and treatment methods of transverse and comminuted DHMDJ fractures in children were summarized and analyzed by referring to relevant literature at home and abroad.
RESULTS
DHMDJ fractures in children are not uncommon clinically, with high fracture line position, multi-directional instability, difficult closed reduction in treatment, and easy to cause complications such as coronal and sagittal deformity of the elbow. The Kirschner wire technique was effective for DHMDJ fractures with the fracture line at the middle and low levels, but was prone to iatrogenic ulnar nerve injury. Elastic stable intramedullary nail is suitable for higher-position transverse DHMDJ fractures. However, this technique requires a second operation to remove the internal fixator, and may cause iatrogenic epiphysis plate injury in children. External fixator is a new way to treat DHMDJ fractures, and it can show satisfactory results for transverse and comminuted DHMDJ fractures. However, at present, there are few relevant studies, and most of them focus on biomechanical studies, and the efficacy lacks high-quality clinical research support.
CONCLUSION
The ultimate goal of DHMDJ fracture treatment in children is to restore the anatomical alignment of the fracture and prevent the loss of reduction. The choice of internal fixator depends on the location of the fracture line and the shape of the fracture to provide personalized treatment.
Topics: Humans; Child; Humeral Fractures; Fracture Fixation, Internal; Bone Wires; External Fixators; Diaphyses; Fractures, Comminuted; Fracture Fixation, Intramedullary; Treatment Outcome; Bone Plates; Bone Nails; Internal Fixators; Child, Preschool; Elbow Joint; Fracture Healing
PubMed: 38752250
DOI: 10.7507/1002-1892.202402044 -
CT measurements of the proximal femoral medullary cavity in healthy adults: a cross-sectional study.JPMA. the Journal of the Pakistan... Dec 2023To analyse the proximal femoral morphology on three-dimensional reconstructed imagery to explore the factors influencing the relevant parameters.
OBJECTIVES
To analyse the proximal femoral morphology on three-dimensional reconstructed imagery to explore the factors influencing the relevant parameters.
METHODS
The cross-sectional study was conducted at Peking University Third Hospital in northern China from January 2019 to August 2020, and comprised healthy adults who underwent computed tomography scanning. Three-dimensional computed tomography reconstruction of the proximal femoral medullary cavity was performed using Mimics 22. The anatomical parameters related to total hip arthroplasty were measured to examine the relationship among gender, age and femoral length. Data was analysed using SPSS 20.
RESULTS
Of the 63 adults, meaning 126 hips, 21(33.3%) were males, meaning 42 (33.3%) hips, and 42(66.6%) were females, meaning 84(66.6%) hips. The overall mean age was 51.5±23.1 years (range: 23-68 years). The inflection point of the medullary cavity curved at 5-10mm distal to the lesser trochanteric line. Most horizontal plane parameters significantly differed between men and women (p<0.05), with the mean medullary cavity being wider in men than women. There was a significant difference between the genders in the sagittal anterior-posterior diameter of the canal flare index (p<0.05). Age was negatively correlated with the coronal medial-lateral diameter and coronal lateral diameter of canal flare index. In the coronal and sagittal planes, there was a positive correlation between the metaphysis and diaphysis, and the coronal and sagittal planes were positively correlated with the orthogonal plane.
CONCLUSIONS
Femoral morphology could be influenced by gender and age. Morphological changes of the proximal femoral medullary cavity were not present in a single plane, but were affected by multiple planes. When the diameter of one plane became larger, its orthogonal plane concomitantly increased.
Topics: Adult; Humans; Female; Male; Middle Aged; Aged; Cross-Sectional Studies; Femur; Arthroplasty, Replacement, Hip; Tomography, X-Ray Computed; Diaphyses
PubMed: 38083913
DOI: 10.47391/JPMA.7538 -
American Journal of Biological... Apr 2022Long bone variations during growth are susceptible to the combined action of nutritional, hormonal, and genetic factors that may modulate the mechanical forces acting...
OBJECTIVES
Long bone variations during growth are susceptible to the combined action of nutritional, hormonal, and genetic factors that may modulate the mechanical forces acting upon growing individuals as they progressively acquire a mature gait. In this work, we explore diaphyseal length and breadth variations of tibia and fibula during ontogeny (a) to test the presence of changes in relation to early toddling, and (b) to further our understanding of developmental patterns in relation to sex.
MATERIALS AND METHODS
Lengths, breadths, and indices were analyzed on right and left leg bones of 68 subadult individuals (Human Identified Skeletal Collection of the University of Bologna, Italy). Analyses included intersex and age classes (1, 0-1 year; 2, 1.1-3 years; 3, 3.1-6 years) comparisons, linear regressions with age and assessment of correlation among tibial and fibular measurements, as well as principal component analysis.
RESULTS
A significant difference emerged among age class 1 and the others. Age class 1 and 3 differ between them, while age class 2 overlaps with the others. No sex dimorphism was detected. All measurements were strongly correlated with age. Tibial and fibular measurements correlated with each other.
CONCLUSIONS
Our results relate the progressive emergence of toddling attempts in growing individuals at the end of the first year of age. No significant sex differences were found, suggesting that tibial and fibula growth might diverge between sexes in later childhood. We provide quantitative data regarding tibial and fibular linear growth and its timing in a modern documented osteological sample from Italy.
Topics: Humans; Male; Female; Child; Tibia; Fibula; Diaphyses; Leg; Italy
PubMed: 36787708
DOI: 10.1002/ajpa.24440 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Jul 2017The aim of this study was to compare solitary tibial diaphysis fractures and tibial diaphysis fractures associated with fibula fracture treated with the intramedullary...
BACKGROUND
The aim of this study was to compare solitary tibial diaphysis fractures and tibial diaphysis fractures associated with fibula fracture treated with the intramedullary nailing method.
METHODS
Records of 254 patients diagnosed with tibial diaphysis fracture and treated with intramedullary nailing between 2010 and 2013 were examined and 30 patients were included in the study. Group 1 comprised patients with solitary tibial diaphysis fracture, and Group 2 was made up of patients with tibial diaphysis fractures associated with fibula fracture. Patients in both groups were compared in terms of time to surgery, duration of surgical tourniquet, time to union, and varus, valgus, recurvatum, and antecurvatum deformities of the tibia at final follow-up.
RESULTS
No statistically significant difference was found between the 2 groups in time to surgery, duration of surgical tourniquet, time to union, or varus, valgus, recurvatum, and antecurvatum deformities.
CONCLUSION
Results indicated that intact fibula in tibial diaphysis fracture treated with intramedullary nailing was not a disadvantage; it did not affect rate of union or lead to loss of reduction, non-union, or malunion.
Topics: Bone Nails; Diaphyses; Fibula; Fracture Fixation, Intramedullary; Humans; Retrospective Studies; Tibial Fractures
PubMed: 28762457
DOI: 10.5505/tjtes.2016.46529 -
Clinics in Orthopedic Surgery Sep 2021The aim of this study was to evaluate results of osteoperiosteal decortication and autogenous cancellous bone graft combined with a bridge plating technique in atrophic...
BACKGROUD
The aim of this study was to evaluate results of osteoperiosteal decortication and autogenous cancellous bone graft combined with a bridge plating technique in atrophic and oligotrophic femoral and tibial diaphyseal nonunion.
METHODS
We retrospectively reviewed 31 patients with atrophic or oligotrophic femoral and tibial diaphyseal nonunion treated with osteoperiosteal decortication and autogenous cancellous bone graft between January 2008 and December 2018. Patients with hypertrophic nonunion, infected nonunion, and nonunion treated with autogenous cancellous bone graft alone were excluded. The nonunion site was exposed by using the Judet technique of osteoperiosteal decortication. Nonunion with a lack of stability was stabilized with a new plate using a bridge plating technique or augmented by supplemental fixation with a plate. Nonunion with malalignment was stabilized with a new plate after deformity correction. Autogenous cancellous bone graft was harvested from the posterior iliac crest and placed within the area of decortication. A basic demographic survey was conducted, and the type of existing implants, mechanical stability of the implants, the type of implants used for stabilization, the operation time, the time to bone union, and postoperative complications were investigated.
RESULTS
The average follow-up period was 33.3 months (range, 8-108 months). The operation time was 207 minutes (range, 100-351 minutes). All but 1 nonunion (96.7%) were healed at an average of 4.2 months (range, 3-8 months). In 1 patient, bone union failed due to implant loosening with absorbed bone graft, and solid union was achieved by an additional surgery for stable fixation with a new plate, osteoperiosteal decortication, and autogenous cancellous bone graft. There were no other major complications such as neurovascular injuries, infection, loss of fixation, and malunion.
CONCLUSIONS
Osteoperiosteal decortication and autogenous cancellous bone graft combined with stable fixation by bridge plating showed reliable outcomes in atrophic and oligotrophic diaphyseal nonunion. This treatment modality can be effective for treating atrophic and oligotrophic diaphyseal nonunion because it is very helpful stimulating bone union.
Topics: Adult; Aged; Bone Plates; Bone Transplantation; Cancellous Bone; Diaphyses; Female; Femoral Fractures; Fracture Fixation, Internal; Fractures, Ununited; Humans; Male; Middle Aged; Retrospective Studies; Tibial Fractures; Young Adult
PubMed: 34484621
DOI: 10.4055/cios20227 -
Bone May 2019Currently, clinical determination of pathologic fracture risk in the hip is conducted using measures of defect size and shape in the stance loading condition. However,...
Currently, clinical determination of pathologic fracture risk in the hip is conducted using measures of defect size and shape in the stance loading condition. However, these measures often do not consider how changing lesion locations or how various loading conditions impact bone strength. The goal of this study was to determine the impact of defect location on bone strength parameters in both the sideways fall and stance-loading conditions. We recruited 20 female subjects aged 48-77 years for this study and performed MRI of the proximal femur. Using these images, we simulated 10-mm pathologic defects in greater trochanter, superior, middle, and inferior femoral head, superior, middle, and inferior femoral neck, and lateral, middle, and medial proximal diaphysis to determine the effect of defect location on change in bone strength by performing finite element analysis. We compared the effect of each osteolytic lesion on bone stiffness, strength, resilience, and toughness. For the sideways fall loading, defects in the inferior femoral head (12.21%) and in the greater trochanter (6.43%) resulted in the greatest overall reduction in bone strength. For the stance loading, defects in the mid femoral head (-7.91%) and superior femoral head (-7.82%) resulted in the greatest overall reduction in bone strength. Changes in stiffness, yield force, ultimate force, resilience, and toughness were not found to be significantly correlated between the sideways fall and stance-loading for the majority of defect locations, suggesting that calculations based on the stance-loading condition are not predictive of the change in bone strength experienced in the sideways fall condition. While stiffness was significantly related to yield force (R > 0.82), overall force (R > 0.59), and resilience (R > 0.55), in both, the stance-loading and sideways fall conditions for most defect locations, stiffness was not significantly related to toughness. Therefore, structure-dependent measure such as stiffness may not fully explain the post-yield measures, which depend on material failure properties. The data showed that MRI-based models have the sensitivity to determine the effect of pathologic lesions on bone strength.
Topics: Aged; Computer Simulation; Diaphyses; Female; Femur; Femur Neck; Finite Element Analysis; Humans; Magnetic Resonance Imaging; Middle Aged; Models, Theoretical; Nonlinear Dynamics
PubMed: 30851438
DOI: 10.1016/j.bone.2019.03.005 -
Journal of Forensic and Legal Medicine Aug 2018Femur fractures are a common orthopedic injury in young children. Falls account for a large portion of accidental femur fractures in young children, but there is also a...
BACKGROUND
Femur fractures are a common orthopedic injury in young children. Falls account for a large portion of accidental femur fractures in young children, but there is also a high prevalence of femur fractures in child abuse, with falls often provided as false histories. Objective information regarding fracture potential in short distance fall scenarios may aid in assessing whether a child's injuries are the result of abuse or an accidental fall. Knowledge of femur loading is the first step towards understanding likelihood of fracture in a fall.
OBJECTIVE
Characterize femur loading during feet-first free falls using a surrogate representing a 12-month-old child.
METHODS
The femur and hip joint of a surrogate representing a 12-month-old were modified to improve biofidelity and measure femur loading; 6-axis load cells were integrated into the proximal and distal femur. Femur modification was based upon CT imaging of cadaveric femurs in children 10-14 months of age. Using the modified 12-month-old surrogate, feet-first free falls from 69 cm and 119 cm heights onto padded carpet and linoleum were conducted to assess fall dynamics and determine femur loading. Femur compression, bending moment, shear and torsional moment were measured for each fall.
RESULTS
Fall dynamics differed across fall heights, but did not substantially differ by impact surface type. Significant differences were found in all loading conditions across fall heights, while only compression and bending loads differed between carpet and linoleum surfaces. Maximum compression, bending, torsion and shear occurred in 119 cm falls and were 572 N, 23 N-m, 11 N-m and 281 N, respectively.
CONCLUSIONS
Fall dynamics play an important role in the biomechanical assessment of falls. Fall height was found to influence both fall dynamics and femur loading, while impact surface affected only compression and bending in feet-first falls; fall dynamics did not differ across carpet and linoleum. Improved pediatric thresholds are necessary to predict likelihood of fracture, but morphologically accurate representation of the lower extremity, along with accurate characterization of loading in falls are a crucial first step.
Topics: Accidental Falls; Anthropometry; Biomechanical Phenomena; Child Abuse; Diagnosis, Differential; Diaphyses; Femoral Fractures; Femur; Forensic Medicine; Humans; Infant; Manikins; Printing, Three-Dimensional; Tomography, X-Ray Computed
PubMed: 29680494
DOI: 10.1016/j.jflm.2018.03.017 -
World Journal of Surgical Oncology Jun 2018Some patients experience a non-traumatic pain in the tibial diaphysis similar to that in the clinical and radiological findings of a tumor, an infection or a stress...
BACKGROUND
Some patients experience a non-traumatic pain in the tibial diaphysis similar to that in the clinical and radiological findings of a tumor, an infection or a stress fracture and cannot be definitively diagnosed even after biopsy. In this study, our aim was to exhibit the challenges in the diagnosis of this patient group and to evaluate this type of patients with a limited population in the literature.
METHODS
Eighteen extremities of 16 patients, whose complaints of non-traumatic pain in the tibial diaphysis were evaluated by our tumor council and T2-weighted MR scans of the medullary bone had shown hyperintense signal changes or tumor-like appearances, were evaluated with histological, radiological, and clinical results.
RESULTS
Lesions were detected in 18 extremities of the 16 patients (seven males, nine females; mean age 23 [range 7 to 51] years). Four of the lesions were in the right tibial diaphysis, ten were in the left, and two were bilateral. Laboratory findings of the patients were normal. Based on the decision of the tumor council, biopsy was performed on 12 patients. All patients' complaints were gone and MRI findings decreased during the follow-up period. The complaints of the three patients who did not have a biopsy decreased after a mean period of three months.
CONCLUSIONS
Medullary stress syndrome has been reported in the literature in various forms and in a limited number of cases, including longitudinal stress fracture and transient medullary edema of the bone. In light of our findings, we deduced that biopsy of the diaphyseal lesions in this patient group is essential and that the complaints of this patient group declined in the earlier term in comparison to the patients who were not performed biopsy.
Topics: Adolescent; Adult; Biopsy; Bone Diseases; Bone Marrow Diseases; Child; Diaphyses; Edema; Female; Humans; Male; Middle Aged; Musculoskeletal Pain; Prognosis; Tibia; Young Adult
PubMed: 29884195
DOI: 10.1186/s12957-018-1405-7 -
Medical Science Monitor : International... May 2016BACKGROUND Understanding the nutrient foramina is critical to clinical practice. An insult to the nutrient foramina can be caused by trauma and/or surgical dissection...
BACKGROUND Understanding the nutrient foramina is critical to clinical practice. An insult to the nutrient foramina can be caused by trauma and/or surgical dissection and lead to devascularization and bad outcomes. Few studies have looked at the humerus, and no studies have described relative information of humeral nutrient foramen related to anatomical structures that might be located by palpable landmarks. In this study, we analyzed the anatomical features of the nutrient foramina of the diaphyseal humerus and provide a discussion of clinical relevance. MATERIAL AND METHODS We dissected 19 cadavers and analyzed the relative positions of the foramina and surrounding muscles, and the number, direction, diameter, and location of the nutrient foramina. Foramina index and a new landmark index were used to calculate the location. We compared the data from both sides and the relationships between transverse and longitudinal locations, diameter and total length, and foramina index and landmark index were also analyzed. RESULTS The humeri had one or two main nutrient foramina located in a small area between the coracobrachialis and brachial muscles and oriented toward the elbow. The mean diameter was 1.11±0.32 mm. The mean index and landmark index were 43.76±4.94% and 42.26±5.35%, respectively. There were no differences between sides in terms of diameter, length, or nutrient foramina index. There were no significant correlations between transverse and longitudinal locations or diameter and total length. The foramina index and landmark index showed strong positive correlation (r=0.994, p<0.0001). CONCLUSIONS Our study provides details about the nutrient foramina that will benefit clinicians who treat injuries and diseases of the humerus. Surgeons should be mindful of soft tissue in the foraminal area during surgical procedures.
Topics: Adult; Arteries; Cadaver; Diaphyses; Female; Haversian System; Humans; Humerus; Male
PubMed: 27180828
DOI: 10.12659/msm.898361