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Journal of Clinical Orthopaedics and... Aug 2022Chronic posterior dislocation of shoulder (PDS) is an uncommon injury and there are very few publications describing its different injury patterns and their treatment....
PURPOSE
Chronic posterior dislocation of shoulder (PDS) is an uncommon injury and there are very few publications describing its different injury patterns and their treatment. This study was carried out to study the associated injuries in chronic PDS, which can help to classify and guide the treatment.
METHODS
We retrospectively studied 16 chronic posterior dislocation of shoulder. CT scan was used to classify the injury based on the amount of bone loss in humeral head, malunion of greater tuberosity and malunion of proximal humerus metaphysis. Visual analogue score (VAS) for pain, university of California Los Angles (UCLA) shoulder score and American shoulder and elbow surgeon (ASES) shoulder score were recorded pre operatively and at an average of 27 months post operatively.
RESULTS
- Type A1 injury was PDS with <50% humeral head bone loss with intact greater tuberosity (GT). It was managed by modified McLaughlin procedure (MMP). Type A2 injury was PDS with >50% bone loss with intact GT. It was managed by hemi-replacement (HRA). Type B1 injury was PDS with <50% bone loss with severe GT malunion. It was managed by MMP and corrective osteotomy of GT. Type B2 injury was PDS with >50% bone loss and severe GT malunion. It was managed by reverse shoulder arthroplasty (RSA). Type C1 injury was PDS with <50% bone loss and metaphyseal malunion. It was managed by MMP and osteotomy of proximal humeral metaphysis. Type C2 injury was PDS with >50% bone loss and metaphyseal malunion. It was managed by HRA. The VAS, UCLA score and ASES score improved significantly after the surgery in all cases. There was no recurrence of the instability.
CONCLUSIONS
We concluded that chronic PDS could have fractures of tuberosities and/or proximal metaphysis in addition to bone loss in humeral head. The treatment is guided by all three factors-amount of bone loss in humeral head, malunion of GT and proximal humeral metaphysis. The proposed classification can help in choosing the optimum treatment out of joint salvage procedure, anatomic shoulder replacement and reverse shoulder arthroplasty.
PubMed: 35799881
DOI: 10.1016/j.jcot.2022.101926 -
Cureus May 2023Objectives The term "slipper fracture" is used to describe a fracture of the radius at the junction of the metaphysis and diaphysis. This fracture has an "evil"...
Objectives The term "slipper fracture" is used to describe a fracture of the radius at the junction of the metaphysis and diaphysis. This fracture has an "evil" reputation because it often angulates in the cast. Historically, there have been differing opinions on the optimal way to cast slipper fractures either with a long arm cast in pronation or a long arm cast in supination to prevent angulation. The purpose of this study is to report the outcomes of "slipper fractures" treated with casting. Methods Sixteen slipper fractures were retrospectively reviewed. Electronic medical records (EMRs) and radiographs were analyzed to gather data on body weight, cast type, cast position, cast index, loss of reduction, cast wedging, repeat reduction, surgery, and amount of remodeling. Results The average age of the patients was eight years old. The average body weight was 30.4 kg. Initial casting included 14 long arm casts in neutral, one short arm cast, and one sugar tong splint. The average cast index was 0.87. Only one cast had a cast index of less than 0.8. This fracture was treated with a long arm cast and did not displace. Of the fractures, 94% lost reduction in the cast and angulated an average of 26 degrees. Two cases were treated with a cast wedge; 13 were observed. Remodeling occurred at an average rate of 2.7 degrees/month. The average remodeling measured at the last follow-up was 15 degrees. Conclusion Slipper fractures are difficult to treat due to the angulation of the fracture in the cast. The current study indicates that a long arm cast, appropriate cast index, and cast position are key to preventing the loss of reduction or angulation of a slipper fracture.
PubMed: 37288176
DOI: 10.7759/cureus.38607 -
Orthopaedics & Traumatology, Surgery &... Feb 2021In France, 11,294 proximal tibia fractures occurred in 2018 and 6880 surgical procedures were done to treat them. Most of these were tibial plateau fractures, although... (Review)
Review
In France, 11,294 proximal tibia fractures occurred in 2018 and 6880 surgical procedures were done to treat them. Most of these were tibial plateau fractures, although fractures can occur in the metaphysis only or in the intercondylar eminence. The proximal tibia's poor vascularization justifies sparing it by doing a percutaneous treatment, setting the stage for bone union. The treatment must be based on rigorous planning with 3D imaging to determine the type of fracture accurately. The goals of treatment are first to realign the lower limb and then to reduce the articular surface, while addressing any associated injuries. Percutaneous reduction is based on ligamentotaxis and the use of spatulas or balloons that spare the vascularization. Surgical navigation and arthroscopy are precious tools for verifying the reduction. There are several options for stabilization, ranging from using polymethylmethacrylate cement for a Schatzker III fracture to applying a cannulated screw or doing MIPPO (Minimal Invasive Percutaneous Plate Osteosynthesis) with an anatomical plate and adjustable locking screws placed under the depression in complex fractures. Percutaneous surgery is not about the size of the incisions; the focus is on sparing the metaphysis and its vascularization to ensure high-quality and long-lasting stability. It appears to yield better functional outcomes than open reduction and internal fixation, not only for Schatzker type I, II and III fractures, but also for complex fractures where open fixation is more damaging and the source of complications.
Topics: Bone Plates; Bone Screws; Fracture Fixation, Internal; France; Humans; Tibial Fractures
PubMed: 33316447
DOI: 10.1016/j.otsr.2020.102753 -
Medical Science Monitor : International... Aug 2019Osteosarcoma is a malignant tumor that occurs most commonly in the metaphysis of the long bones in the limbs in children and adolescents. Even with surgery and... (Review)
Review
Osteosarcoma is a malignant tumor that occurs most commonly in the metaphysis of the long bones in the limbs in children and adolescents. Even with surgery and neoadjuvant chemotherapy, the therapeutic effect has reached a peak with 60-70% survival rates. Therefore, new biological targets or molecular mechanisms that enhance the efficacy of osteosarcoma treatments are needed. Circular RNAs (circRNAs) are useful biomarkers that have recently been recognized clinically and in medical research and have been of interest due to the use of next-generation sequencing and bioinformatics analysis. CircRNAs are involved in many diseases, including cancer. Therefore, this review aims to summarize the roles of circRNA in the diagnosis, progression, and prognosis of osteosarcoma.
Topics: Biomarkers, Tumor; Computational Biology; High-Throughput Nucleotide Sequencing; Humans; MicroRNAs; Osteosarcoma; Prognosis; RNA; RNA, Circular
PubMed: 31446435
DOI: 10.12659/MSM.915559 -
Archives of Pathology & Laboratory... Nov 2009Primary bone lymphomas are rare, even though secondary involvement of the bone marrow is a common event in systemic lymphomas. Most primary bone lymphomas are primary... (Review)
Review
Primary bone lymphomas are rare, even though secondary involvement of the bone marrow is a common event in systemic lymphomas. Most primary bone lymphomas are primary bone diffuse large B-cell lymphomas (PBDLBCLs) with a rare occurrence of follicular, marginal zone, anaplastic large cell, Hodgkin, and T-cell lymphomas. The PBDLBCL affects the middle-aged to elderly population, with a slight predominance in men. The patients present with bone pain, palpable mass, fractures, or neurologic symptoms. The metaphysis of bones is a common location of PBDLBCL. Morphologically, the lymphoma consists of a polymorphous mixture of small to large cells with multilobated nuclei, fine chromatin, and inconspicuous to prominent nucleoli. Differential diagnoses for PBDLBCL include chronic osteomyelitis, primary bone sarcoma, leukemic infiltrate, Ewing sarcoma, metastatic sarcomas, and carcinoma. Most PBDLBCLs are treated with combined radiotherapy and chemotherapy with good prognosis.
Topics: Bone Neoplasms; Carcinoma; Chronic Disease; Diagnosis, Differential; Humans; Leukemic Infiltration; Lymphoma; Osteomyelitis; Osteosarcoma; Sarcoma, Ewing
PubMed: 19886726
DOI: 10.5858/133.11.1868 -
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 -
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 -
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