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Objectives: As intraosseous venous malformations (IVMs) of the zygoma are very rare and clinical features are not typical, a correct preoperative diagnosis may be difficult to make. This study presents 4 cases of IVM of the zygoma and gives a review of their clinical manifestations, radiographic features, preoperative diagnosis, and differentials. Methods: The report of 4 cases was performed with an average 6-year follow-up. Medical records including clinical, radiographic, and histopathological information were reviewed. Results: All the patients were mid-aged women with a complaint of an enlarging mass over the midface. They all failed to receive a definite preoperative diagnosis, and the diagnoses of IVM in all patients were made via pathological evidence. Although they received different surgical treatments, all the follow-up results (2~12 years) were satisfactory. Conclusion: Intraosseous venous malformations of the zygoma are benign lesions caused by abnormal vessel morphogenesis. Patients usually present in their 40s with a tender or painless swelling of the zygoma. The key to the diagnosis is the typical sunburst pattern of radiating trabeculae with intact cortices on computed tomographic scans. Intraosseous venous malformations should be differentiated from other lesions, including intraosseous meningioma, fibrous dysplasia, osteochondroma, osteosarcoma, and ossifying fibroma. [ABSTRACT FROM AUTHOR]

Ribbing disease, or multiple diaphyseal sclerosis, is a rare diaphyseal sclerosis of unknown etiology. Patients with this pathology usually present with asymmetric pain limited to the lower extremities. Though all efforts are made to relieve the progressive pain associated with Ribbing disease, no medical or surgical treatments have been established yet. In this case report, we followed up a Ribbing case with sclerotic bone fenestration for 5 years. The radiological changes and the clinical effects are described, and the different Ribbing treatments are then briefly reviewed. [ABSTRACT FROM AUTHOR]

Background Many risk factors have been confirmed for poor bone health among the general population including age, gender and corticosteroid use. There is a paucity of investigation among people with intellectual disability; however, research points to differing risks namely anti-epileptic medication use, Down syndrome and poor behaviour lifestyle. Methods Data was extracted from the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing in Ireland. In total, 753 participants took part, and data was gathered on participants' health status, behavioural health, health screenings and activities of daily living. The prevalence of osteoporosis and related risk factors were specifically examined. Results Overall, 8.1% reported a doctor's diagnosis of osteoporosis with over 20% reporting history of fracture. Risk identified included older age ( P < 0.0001), female gender ( P < 0.0001), difficulty walking ( P < 0.0001) with older age and being female the stronger predictors for osteoporosis, odds ratio = 6.53; 95% confidence interval 2.82-15.11 and odds ratio = 4.58; 95% confidence interval 2.29-9.17, respectively. There was no gender difference regarding the level of fractures; however, epilepsy and anti-epileptic medication were strong predictors. Overall, 11.1% attended for bone screening diagnostics. Conclusion Despite low levels of reported doctor's diagnosis of osteoporosis risk factor prevalence was high. Considering the insidious nature of osteoporosis and the low levels of diagnostic screening, prevalence could be possibly higher. [ABSTRACT FROM AUTHOR]

This study aimed to summarize clinical experience with Kingella kingae–associated pediatric osteoarticular infections (OAIs). We reviewed 566 cases in the English literature from 2000 to June 2014. More than 80% of the patients were diagnosed between 4 months and 4 years of age, and the male to female ratio was 1.14:1. The most frequent preceding illness was upper respiratory tract infections (82%). The top 3 OAIs types were septic arthritis (73.1%), osteomyelitis (15.7%), and spondylodiscitis (5.4%), and the most affected sites of these types were knee (46%), calcaneus (20%), and L4/5 disc (70%). All cases where polymerase chain reaction (PCR) technique was used were PCR positive, no reported cases of positive cultures for K kingae with negative PCR. The duration of antibiotics use ranged from 2 to 4 weeks. Beta-lactam antibiotics were the most frequently used intravenously and orally. The clinical efficacy was favorable. [ABSTRACT FROM AUTHOR]

Background: The vascular supply to the acetabular labrum is important in the treatment of labral lesions. However, in vivo blood flow measurements in the acetabular labrum have not been described in the literature. The purpose of this study was to examine this blood flow in vivo using laser Doppler flowmetry (LDF) in patients with acetabular dysplasia. Methods: Periacetabular osteotomy combined with arthroscopy was performed in 47 consecutive patients (three males, 44 females; mean age at surgery, 35.6 years; range, 15-60 years). In all patients, blood flow in the acetabular labrum was measured with LDF during arthroscopy. The acetabular labral lesions were categorized according to the modified Beck classification: detachment and full-thickness labral tears were assigned to the T group and normal labrum to the N group. Blood flow rates in the acetabular labrum were compared between the T and N groups. The associations between labral blood flow and the lateral center-edge angle (CEa) and patient age were also evaluated. Results: The T and N groups comprised 31 and 16 patients, respectively. The mean blood flow rate was 1.94 ±0.41 ml/ min/100 g in the T group and 1.94 ± 0.34 ml/min/100 g in the N group, with no significant difference between the groups (P = 0.884). No association was noted between blood flow and either the CEa or patient age (β = -0.018, P= 0.077 and β= -0.001, P = 0.770, respectively). Conclusions: On LDF, blood flow in the acetabular labrum was present in all patients, regardless of the severity of acetabular labral tears, CEa, or age. [ABSTRACT FROM AUTHOR]

Concerns about bone health and potential fragility in children and adolescents have led to a high interest in bone densitometry. Pediatric patients with genetic and acquired chronic diseases, immobility, and inadequate nutrition may fail to achieve expected gains in bone size, mass, and strength, leaving them vulnerable to fracture. In older adults, bone densitometry has been shown to predict fracture risk and reflect response to therapy. The role of densitometry in the management of children at risk of bone fragility is less clear. This clinical report summarizes current knowledge about bone densitometry in the pediatric population, including indications for its use, interpretation of results, and risks and costs. The report emphasizes updated consensus statements generated at the 2013 Pediatric Position Development Conference of the International Society of Clinical Densitometry by an international panel of bone experts. Some of these recommendations are evidence-based, whereas others reflect expert opinion, because data are sparse on many topics. The statements from this and other expert panels provide general guidance to the pediatrician, but decisions about ordering and interpreting bone densitometry still require clinical judgment. The interpretation of bone densitometry results in children differs from that in older adults. The terms "osteopenia" and "osteoporosis" based on bone densitometry findings alone should not be used in younger patients; instead, bone mineral content or density that falls >2 SDs below expected is labeled "low for age." Pediatric osteoporosis is defined by the Pediatric Position Development Conference by using 1 of the following criteria: ≥1 vertebral fractures occurring in the absence of local disease or high-energy trauma (without or with densitometry measurements) or low bone density for age and a significant fracture history (defined as ≥2 long bone fractures before 10 years of age or ≥3 long bone fractures before 19 years of age). Ongoing research will help define the indications and best methods for assessing bone strength in children and the clinical factors that contribute to fracture risk. The Pediatric Endocrine Society affirms the educational value of this publication. [ABSTRACT FROM AUTHOR]

Iliac bone destruction in children is uncommon and presents various imaging features. Correct diagnosis based on clinical and imaging features is difficult. This research aimed to retrospectively explore the clinical features, imaging, and histopathological diagnosis of children with iliac bone destruction. A total of 22 children with iliac bone destruction were enrolled in this retrospective analysis from two children’s hospitals during July 2007 to April 2015. Clinical features, imaging, and histopathological findings were analysed. The mode of iliac bone destruction, lesion structure, and the relationship between the range of soft tissue mass and cortical destruction were determined based on imaging data. The data were analysed using descriptive methods. Of the iliac bone destruction cases, eight cases were neuroblastoma iliac bone metastasis, seven cases were bone eosinophilic granuloma, two cases were Ewing’s sarcoma, two cases were osteomyelitis, one case was bone cyst, one case was bone fibrous dysplasia, and one case was non-Hodgkin’s lymphoma. Iliac bone destruction varies widely in children. Metastatic neuroblastoma and eosinophilic granuloma are the most commonly involved childhood tumours. [ABSTRACT FROM AUTHOR]

We describe a case of development of painful periostitis deformans in a 39-year-old woman who was receiving long-term voriconazole treatment for Aspergillus infection as a complication of orthotopic liver transplant. Measurement of fluoride levels strongly supports fluorosis to be the mechanism of the voriconazole-induced periostitis deformans and supports the concept that such measurements might be of use in predicting this complication of long-term voriconazole treatment. [ABSTRACT FROM AUTHOR]

BACKGROUND: Tc-99m methylene diphosphonate [MDP] bone scan is the basis of the skeletal imaging in nuclear medicine being a highly sensitive tool for detecting bone diseases. Mechanical stimulation induced by low grade exercise or whole-body vibration appears to be advantageous regarding the maintenance and/or improvement of skeletal mass in humans. We aimed to assess the physiological influence of low grade exercise on the quality of skeletal scintigraphy using Tc-99m MDP. MATERIAL AND METHODS: Tc-99m MDP bone scan was done for 92 volunteers [Group 1; G1]. Five days later, the same subjects were re-scanned [Group 2; G2] after an exercise on treadmill for 5 minutes. Image quality was assessed using quantitative measures whereby equal regions of interest (ROI) were drawn over the femoral diaphysis, and the contralateral adductor area. The total number of counts from the bone [B] ROI and soft tissue [ST] ROI was expressed as a ratio [B:ST ratio] and a mean value for each was established. RESULTS: Statistically significant difference was found between the B:ST ratio means [p = 0.001] in G1 and G2. CONCLUSION: This study raised a physiological influence of low grade exercise on the image quality of tc-99m MDP skeletal scintigraphy by increasing MDP osseous uptake. [ABSTRACT FROM AUTHOR]

Objective SH3 domain-binding protein 2 (SH3BP2) is a signaling adapter protein that regulates the immune and skeletal systems. The present study was undertaken to investigate the role of SH3BP2 in arthritis using 2 experimental mouse models, i.e., human tumor necrosis factor α-transgenic (hTNF-Tg) mice and mice with collagen-induced arthritis (CIA). Methods First, Sh3bp2−/− and wild-type (Sh3bp2+/+) mice were crossed with hTNF-Tg mice. Inflammation and bone loss were examined by clinical inspection and histologic and micro−computed tomography analysis, and osteoclastogenesis was evaluated using primary bone marrow-derived macrophage colony-stimulating factor-dependent macrophages (BMMs). Second, CIA was induced in Sh3bp2−/− and Sh3bp2+/+ mice, and the incidence and severity of arthritis were evaluated. Anti-mouse type II collagen (CII) antibody levels were measured by enzyme-linked immunosorbent assay, and lymph node cell responses to CII were determined. Results SH3BP2 deficiency did not alter the severity of joint swelling but did suppress bone erosion in the hTNF-Tg mouse model. Bone loss at the talus and tibia was prevented in Sh3bp2−/−/hTNF-Tg mice compared to Sh3bp2+/+/hTNF-Tg mice. RANKL- and TNFα-induced osteoclastogenesis was suppressed in Sh3bp2−/− mouse BMM cultures. NF-ATc1 nuclear localization in response to TNFα was decreased in Sh3bp2−/− mouse BMMs compared to Sh3bp2+/+ mouse BMMs. In the CIA model, SH3BP2 deficiency suppressed the incidence of arthritis and this was associated with decreased anti-CII antibody production, while antigen-specific T cell responses in lymph nodes were not significantly different between Sh3bp2+/+ and Sh3bp2−/− mice. Conclusion SH3BP2 deficiency prevents loss of bone via impaired osteoclastogenesis in the hTNF-Tg mouse model and suppresses the induction of arthritis via decreased autoantibody production in the CIA model. Therefore, SH3BP2 could potentially be a therapeutic target in rheumatoid arthritis. [ABSTRACT FROM AUTHOR]

Langerhans cell histiocytosis (LCH) is a benign disorder related to the histiocytes which can infiltrate bone tissue. The most effective method for demonstrating severity of this disease is PET/CT and bone scintigraphy might show bone lesions. We present a seventeen year old male patient with disseminated LCH presented with exophtalmos and having multiple vertebral lesions which were identified by F-18 FDG PET/CT scan and diagnostic CT but not in the bone scintigraphy. [ABSTRACT FROM AUTHOR]

Background To compare the clinical and radiological features of intra-/juxta-articular osteoid osteoma and extra-articular osteoid osteoma in skeletally immature patients, paying special attention to the skeletal complications. Methods Osteoid osteoma in 34 children (22 boys and 12 girls, mean age 10.4 years) was dichotomized according to the location of the nidus as intra-/juxta-articular (11 children) or extra-articular (23 children). The following features were compared: diagnostic delay, typical symptoms, synovitis and limited range of joint motion, response to treatment, typical radiographic findings, and skeletal complications. Results Eight of the 11 children with intra-/juxta-articular osteoid osteoma presented with synovitis in the involved joint, which led to a delayed diagnosis for a median 9.5 months. Pain disappeared in all children with surgical or medical interventions, but at the mean 4.9-year follow-up evaluation, skeletal abnormalities around the joint were noted in 5 children (4 proximal femur and 1 distal humerus) with intra-/juxta-articular osteoid osteoma, 2 of whom required subsequent surgeries for limited hip motion caused by femoroacetabular impingement and limited range of elbow motion, respectively. In contrast, typical clinical and radiological features were observed more often in extra-articular osteoid osteoma, and only 1 child showed overgrowth of the tibia, which did not have clinical significance. Conclusions Intra-/juxta-articular osteoid osteomas in growing children exhibit different clinical and radiological features from extra-articular lesions. Skeletal abnormalities mainly develop in intra-/juxta-articular osteoid osteoma, and these may lead to permanent skeletal sequelae. [ABSTRACT FROM AUTHOR]

The computed tomography plays an important role in the diagnosis of anomalies and pathological conditions of the TMJ, providing a complete visualization of joint region, providing a more accurate diagnosis. For evaluation of the images is necessary to the professional the knowledge of sectional anatomy of the joint region, so he can recognize the structural changes. Therefore, it was explained and described in this study the characteristics of normal CT, morphological and pathological conditions commonly found in the region of the temporomandibular joint. The Computed tomography is an imaging exam superior than the conventional imaging exam for TMJ, because it allows an adequate and accurate three-dimensional visualization of all details of the bone, without the limitation of overlap, providing the real size and shape of the anatomical structures, morphological changes and pathological conditions. [ABSTRACT FROM AUTHOR]

Preterm, low-birth-weight neonates are predisposed to metabolic bone disease (MBD). This survey aimed to assess screening, diagnostic, and treatment practices in U.S. level IIIB/IIIC neonatal intensive care units (NICUs). A 29-question anonymous online survey was e-mailed to American Academy of Pediatrics Perinatal Section members. 338 neonatologists, representing 246 IIIB/IIIC NICUs, responded. 86% reported MBD screening. Screening was primarily based on gestational age (71%), with thresholds <26 to <36 weeks. Other criteria included birth weight (64%), total parenteral nutrition duration (48%), X-ray findings (56%), diuretic use (41%), and exclusive breast-feeding (9.6%). Almost universally, diagnosis was based on elevated alkaline phosphatase, most commonly >500 U/L (58.6%). 52% used X-ray for diagnosis. Treatment included human milk fortification (83%), vitamin D (67%), calcium (65%), and phosphorus (65%) supplementation. Our survey confirms widespread awareness of MBD but highlights lack of consensus regarding definition, screening, and treatment. Further research is needed to develop and optimize strategies to prevent, recognize, and manage MBD. [ABSTRACT FROM PUBLISHER]

Background: Developmental dysplasia of the hip (DDH) is associated with chronic pain and limping which especially has a negative impact on the patients’ daily activities, body image, and self‑esteem. Although total hip arthroplasty remains the first choice for treatment of DDH in adults, minimally invasive alternative approaches are being increasingly favored both by the surgeon and the patients with severe DDH. This study aimed to evaluate the outcome of these patients treated with a mono‑lateral external fixator‑based tibial lengthening procedure. Materials and Methods: During the period of month between June 1999 and January 2006, 13 (mean ages 20.8 years) adult patients with unilateral Crowe type‑IV DDH were treated by tibial lengthening using a mono‑lateral external fixator over an intramedullary nail. Bone healing, infection, gait correction and improvement in body image were assessed during postoperative followup. Patients’ overall health status at the end of followup was assessed using the short form‑36 (SF‑36) health survey. Results: Patients were followed up for an average of 7.3 years. Successful bone healing was observed in all 13 patients and no further surgeries were indicated. A mean external fixation index of 12.4 days/cm was achieved. Bone formation fell in good to excellent categories with a mean consolidation index of 50.1 days/cm. Pin‑tract infections were observed in two patients. The degree of limping was reduced from severe or moderate preoperatively to mild postoperatively. Neither equinus deformity nor painful degenerative osteoarthritis and hip dysfunction were observed in any of the patients studied. The SF‑36 questionnaire survey showed that all patients were satisfied with their outcomes. Conclusions: Tibial lengthening may effectively correct gait and satisfactorily improve body image in young patients with unilateral Crowe type‑IV DDH. Mono‑lateral external fixator allows for accelerated postoperative rehabilitation and optimal preservation of ankle movements. Lengthening along with intramedullary nails may significantly reduce the external fixation time and the risk of fixator‑related complications. [ABSTRACT FROM AUTHOR]

Background. The incidence of infantile Blount disease is rising in parallel to the increasing obesity in children. Material and methods. Seven children (3 female) between the ages of 17 and 30 months (21.8 ± 4.3 months) were included in the study. Results. All patients had complaints of inward bowing of the legs and excess weight gain. The biochemical and hormonal assessments of all patients yielded normal results. Patients were diagnosed with infantile Blount disease based on clinical, laboratory, and radiological findings. Conclusion. This disease should be differentiated from physiological genu varum, and the potential psychosocial and physical complications are prevented with early diagnosis and treatment. [ABSTRACT FROM PUBLISHER]

Primary bone lymphangiomatosis is a disease of unknown etiology that can cause lytic lesions in long bones, the pelvis, the spinal column and the cranium. We are presenting the case of a woman with localized bone lymphangiomatosis in the left knee. The authors believe this is the first case in which percutaneous osteoplasty was used in long bones for the treatment of bone lesions resulting from this disease showing good clinical results. [ABSTRACT FROM AUTHOR]

Bhan et al discovered low rates of testing and treatment for mineral and bone disorders in patients with chronic kidney disease (CKD) in the primary care setting. In this study, bisphosphonates were prescribed more frequently than vitamin D as treatment for CKD mineral and bone disorders. Bhan's study concluded that a lack of knowledge exists about the treatment of metabolic mineral and bone disorders related to chronic kidney failure. The purpose of this article is to increase awareness about the appropriate treatment of metabolic mineral and bone disorders related to CKD. [ABSTRACT FROM AUTHOR]

We describe a case of lamellar ichthyosis with bilateral genu valgum. The association of genu valgum with congenital ichthyosis is rare. Our patient, a 22-year-old girl, had lamellar ichthyosis and was born with a collodion membrane. She developed progressive valgus deformity of the knees of 5 years duration associated with difficulty in walking. On evaluation, she had generalised scaly skin lesions along with bilateral genu valgum and biochemical evidence of vitamin D deficiency. Skin serves as an important site for vitamin D synthesis and thus skeletal deformities secondary to vitamin D deficiency may occur in cases of congenital ichthyosis, causing a diagnostic dilemma due to the unusual association. This case serves as a reminder that clinicians need to be aware of such an association in order to prevent, appropriately diagnose and adequately treat the rare case of congenital ichthyosis with rickets and osteomalacia. [ABSTRACT FROM AUTHOR]

The article reports on the role that bone scintigraphy plays in helping to diagnose malignant bone lesions in patients. A discussion of several types of benign bone lesions, including fibrous dysplasia, Paget disease and endochroma, which can resemble malignant lesions in staging bone scans, is presented.

Abstract: Physeal fractures account for approximately one third of all childhood fractures. Growth arrest is a serious complication of these injuries which, if not managed correctly, can lead to angular deformity, limb length discrepancy, or both. This in turn may cause pain, loss of function and disability. The article reviews the evaluation of a child with suspected traumatic physeal growth arrest including patient history, physical examination and imaging strategies for the early detection of physeal growth arrest and measurement of limb length discrepancy. Various anatomical classifications of physeal growth arrest are also presented. Finally, we discuss an approach to the management of a child with confirmed traumatic physeal growth arrest depending on the nature of the arrest and limb deformity. [Copyright &y& Elsevier]

Postoperative spondylodiscitis after anterior cervical decompression and fusion (ACDF) is rare, but the same occurring at adjacent levels without disturbing the operated level is very rare. We report a case, with 5 year followup, who underwent ACDF from C5 to C7 for cervical spondylotic myelopathy. He showed neurological improvement after surgery but developed discharging sinus after 2 weeks, which healed with antibiotics. He improved on his preoperative symptoms well for the first 2 months. He started developing progressive neck pain and myelopathy after 3 months and investigations revealed spondylodiscitis at C3 and C4 with erosion, collapse, and kyphosis, without any evidence of implant failure or graft rejection at the operated level. He underwent reexploration and implant removal at the operated level (there was good fusion from C5 to C7) followed by debridement/decompression at C3, C4 along with iliac crest bone grafting and stabilization with plate and screws after maximum correction of kyphosis. The biopsy specimen grew Pseudomonas aeruginosa and appropriate sensitive antibiotics (gentamycin and ciprofloxacin) were given for 6 weeks. He was under regular followup for 5 years his myelopathy resolved completely and he is back to work. Complete decompression of the cord and fusion from C2 to C7 was demonstrable on postoperative imaging studies without any evidence of implant loosening or C1/C2 instability at the last followup. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this article was to evaluate the radiologic findings of adult pelvis and appendicular skeletal Langerhans cell histiocytosis (LCH), emphasizing the CT and MR findings.Materials and Methods: The images of nine patients with pathologically proven LCH (five men and four women; mean age, 37.11 years) were retrospectively reviewed. Imaging analysis was confined to the long and flat bones. CT scans were performed in five patients and MR imaging was performed in eight. Images were assessed for the following features on CT and MRI: the location and number of lesions; the presence of cortical destruction, endosteal scalloping, and a periosteal reaction on CT or MRI; the margin of soft tissue masses, the presence of bone marrow edema, and a "budding" appearance on MRI; and the presence of sclerotic margins or septations on CT.Results: The involved skeletal sites were the pelvis (seven), femurs (five), humeri (two), tibias (two), fibula (one), clavicle (one), scapula (one), and sternum (one). Endosteal scalloping, a periosteal reaction, and a budding appearance were common on MRI or CT images. Although cortical destruction and the soft tissue lesion formation were rare, soft tissue masses had well-defined margins.Conclusions: Endosteal scalloping and a budding appearance with a periosteal reaction on CT and MRI may be helpful signs for differentiation of LCH from malignant tumors in adults. [ABSTRACT FROM AUTHOR]

Abstract: The etiology and pathogenesis of Kashin-Beck disease (KBD) remain uncertain at present. A deficiency of selenium and iodine is considered common in KBD-affected areas. Supplying selenium and iodine for the prevention of KBD has been performed in the past few decades in affected areas in China. Supplying selenium and/or iodine has produced positive http://www.iciba.com/different/effects in most KBD-affected areas, but there are some affected areas where the effects have been unclear and supplementation with selenium and/or iodine has not eliminated this disease. From animal and vitro experiments, we explore whether a deficiency of selenium and/or iodine may be the environmental factor causing KBD. KBD may have multiple etiologies. The role of selenium and iodine in KBD mainly involves antioxidation and maintenance of thyroid function according to the present review. Other important roles of selenium and iodine in KBD and a certain etiology of this disease need further study. [Copyright &y& Elsevier]

About 90% of individuals with multiple myeloma will develop osteolytic bone lesions from increased osteoclastic and decreased osteoblastic activity. Severe morbidities from pathologic fractures and other skeletal events can lead to poor circulation, blood clots, muscle wasting, compromised performance status, and overall poor survival. Supportive care targeting bone disease is an essential adjunct to antimyeloma therapy. In addition, the maintenance of bone health in patients with multiple myeloma can significantly improve quality of life. Oncology nurses and other healthcare providers play a central role in the management of bone disease and maintenance throughout the course of treatment. Safe administration of bisphosphonates, promotion of exercise, maintenance of adequate nutrition, vitamin and mineral supplementation, scheduled radiographic examinations, and monitoring of bone complications are among the important functions that oncology nurses and healthcare providers perform in clinical practice. [ABSTRACT FROM AUTHOR]

Background and purpose Slipped capital femoral epiphysis (SCFE) is often treated by surgical fixation; however, no agreement exists regarding technique. We analyzed the outcome of in situ fixation with Steinmann pins. Patients and methods All 67 subjects operated for slipped capital femoral epiphysis at Haukeland University Hospital during the period 1990--2007 were included. All were treated by in situ fixation with 2 or 3 parallel Steinmann pins (8 mm threads at the medial end). The follow-up evaluation consisted of clinical examination and hip radiographs. Radiographic outcome was based on measurements of slip progression, growth of the femoral neck, leg length discrepancy, and signs of avascular necrosis and chondrolysis. Results 67 subjects (41 males) were operated due to unilateral slips (n == 47) or bilateral slips (n == 20). Mean age at time of diagnosis was 13 (7.2--16) years. Mean age at follow-up was 19 (14--30) years, with a mean postoperative interval of 6.0 (2--16) years. The operated femoral neck was 9% longer at skeletal maturity than at surgery, indicating continued growth of the femoral neck. At skeletal maturity, 12 subjects had radiographic features suggestive of a previous asymptomatic slip of the contralateral hip. The total number of bilateral cases of SCFE was 32, i.e half of the children had bilateral SCFE. 3 subjects required additional surgery and mild avascular necrosis of the femoral head was seen in 1 patient. None had slip progression or chondrolysis. Interpretation In situ pinning of SCFE with partly threaded Steinmann pins appears to be a feasible and safe method, with few complications. The technique allows further growth of the femoral neck. [ABSTRACT FROM AUTHOR]

Bone damage in children with chronic kidney disease (CKD) is a challenge for pediatric nephrologists. Areal measurements of bone mineral density (BMD) by dual x-ray absorptiometry (DXA) have been routinely performed to assess bone mass but recent international guidelines have concluded that DXA was of less value in CKD. The aim of this study is to evaluate bone quality in CKD children using new bone imaging techniques in a pilot cross-sectional single-center study. We performed bone imaging (high-resolution peripheral quantitative computed tomography, HR-pQCT, XtremeCT, Scanco Medical AG, Switzerland), to assess compartmental volumetric BMD and trabecular microarchitecture in 22 CKD children and 19 controls. In seven younger patients (i.e., under 10 years of age), we performed bone texture analysis (BMA, D3A Medical Systems, France) in comparison to 15 healthy prepubertal controls. Among older children, CKD patients had significantly lower height and body weight without significant impairment of BMD and microarchitecture than healthy controls. In univariate analysis, there were significant correlations between cortical BMD and glomerular filtration rate ( r = -0.46), age ( r = 0.60) and body mass index ( r = 0.67). In younger children, bone texture parameters were not different between patients and controls. Our results did not show significant differences between healthy controls and CKD children for compartmental bone densities and microarchitecture, but the small sample size and the heterogeneity of the CKD group require caution in the interpretation. Novel bone imaging techniques seem feasible in children, and further longitudinal studies are required to thoroughly explore long-term cardiovascular and bone consequences of phosphate-calcium metabolism deregulation during CKD. [ABSTRACT FROM AUTHOR]

Objective:To review the phenomenon and implications of temporal bone and craniofacial bone staining in the context of prolonged exposure to tetracycline antibiotic.Methods:Case report and literature review.Results:A 52-year-old male with a 5-year history of tetracycline use presented to undergo tympanomastoidectomy and was found to have an unusual rusty green pigmentation of the entire aspect of the exposed temporal bone. A literature review revealed more than 20 cases of tetracycline-induced pigmentation of intraoral maxillary and mandibular bone, and 2 prior cases involving the cranial bones.Conclusion:Tissue and organ pigmentation is an unexpected and unfavourable consequence of the use of tetracyclines, particularly minocycline. Tetracycline is contraindicated in children because of the risk for dysosteogenesis and enamel hypoplasia. In adults, although the unusual staining may present as an unexpected dilemma upon surgical exposure, current research shows no significant clinical consequences for this type of pigmentation. [ABSTRACT FROM PUBLISHER]

Imaging alone cannot differentiate various isolated atypical lytic lesions involving the skull. Clinical and radiological correlation is mandatory in reaching to a diagnosis. Histopathology remains the gold standard. We describe few atypical cases presenting as isolated lytic lesions of skull with characteristic imaging findings and a brief clinical approach to reach towards the diagnosis. [ABSTRACT FROM AUTHOR]

The article describes the case of a 6-year-old Korean male with metatropic dysplasia and its follow-up after corrective surgery for spine and limb deformity. Children with metatropic dysplasia are described as having a long trunk and short limbs. The differential diagnosis of the patient is discussed. The patient showed improvement in thoraco-lumbar kyphoscoliosis after corrective spine surgery.

Osteopikilosis is a rare benign sclerosing bone dyspalsia transmitted with an autosomal dominant pattern. The diagnosis is often accidental. Only 15-20% of pacients are symptomatic. They may have mild arthalgia and joint effusion. The diagnosis is radiological, with bones look like "spotted bones" because there are multiple small radiodense foci located in metaphises and epiphyses of long bones, in tars bones, carp bones and pelvis bones. Our pacient was hospitalized for symmetric distal arthitis. Hand radiograph performed to determine the etyology of joint suffering revealed multiple lesions characteristic for osteopoikilosis. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented regarding the synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) syndrome in a 12-year-old female patient who was presented at the hospital with right hip and low back pain.

An introduction to the journal is presented in which the guest editors discusses the epiphyseal growth disorder of the skeleton which known as Trevor's disease or dysplasia epiphysealis hemimelica that dealt with by a resection.

The article presents a case study of a man in his 40s with a three-month history of diffuse myalgias, bilateral leg pain, weight loss and fatigue. He was diagnosed with periostitis of the long bones, which is a revealing manifestation of polyarteritis nodosa (PAN). The patient was treated with oral corticosteroids, which led to improvement of his weight loss and leg pain.

The article presents the case of a 66-year-old Japanese woman that highlights sarcoidosis as a rare cause of fever of unknown origin or of periosteal and tracheal lesions found on imaging. Topics include sarcoidosis lesions of a swollen trachea, periosteum of sclerotic femoral bone with high fluorodeoxyglucose uptake, and periosteal or upper airway involvement in sarcoidosis.

The article describes the case of a 55 year old woman with a history of psoriasis who experienced debilitating pain in the right jaw for 4 years which was associated with episodes of trismus related to flares of febrile inflammation in the same area. A bone scintigraphy was performed which confirmed synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) sydrome. Subcutaneous anti-tumor necrosis factor therapy was implemented that lead to complete regression of the symptoms.

A letter to the editor is presented in response to the article about valgus deformity due to dysplasia epiphasealis hemimelica in the knee in the April-June 2014 issue.

Information about several papers discussed at the Sanford-Burnham Medical Research Institute (SBMRI) Fourth Annual Rare Disease Day Symposium on calcification disorders from hardened arteries to soft bones, held in La Jolla, California on February 28, 2013. Topics include the diagnosis and treatment of vascular calcification, generalized arterial calcification of infancy (GACI), and the pathogenesis and treatment of soft bones. The meeting featured William A. Gahl as keynote speaker.

Purpose: joint preserving treatment of osteochondral lesions (OCL) in younger sportive patients remains a big challenge for the orthopaedic surgeon. Isolated OCL of the distal tibia are rare and no clear treatment guidelines have been established. With this case we report the successful use of Autologous Matrix Induced Chondrogenesis (AMIC) aided reconstruction for OCL of the distal tibia. Methods: a 29 year old male patient complained about persisting pain (Visual Analogue Scale (VAS) 4) and recurrent swelling 12 months after an ankle sprain. Sport activities were no longer possible. The AOFAS Ankle-Hindfoot Scale was poor with 61 points. MRI revealed a large OCL at the lateral distal tibia. The osteochondral defect was debrided followed by microfracturing of the underlying sclerotic bone. A cancellous bone plug from the iliac crest was impacted into the defect. A collagen membrane (Chondro-Gide, Geistlich, Wolhusen, Switzerland) was used to cover the defect. Results: at 12 and 36 months the patient had a VAS of 0 points and returned to a full time job and full sports. AOFAS hindfoot score increased from 61 points preoperatively to 100 points after 12 and 36 months. Conventional radiographs at one year showed successful osseous integration of the plug and a nearly anatomic shape of the tibial joint line. MRI dGEMRIC scans at 36 months showed intact cartilage layer over the defect and glycosaminoglycan content indicating fibrous cartilage repair. Conclusion: this case demonstrates AMIC aided reconstruction of large osteochondral lesions of distal tibia to be a promising treatment method. [ABSTRACT FROM AUTHOR]

Osteochondral lesions of the talus are well recognised clinical entities, however this report illustrates a rare case of an osteochondral defect in the distal fibula. A 15 year old male was referred to the orthopaedic services with a 9 month history of persistent ankle pain following an initial inversion injury. Plain X-ray was unremarkable but MRI and CT imaging revealed an osteochondral lesion at the level of the fibular physeal scar. The patient underwent an ankle arthroscopy where an unstable chondral flap was debrided and the associated fissure decompressed. The patient made an uneventful recovery and returned to normal sporting activities, symptom free. This diagnosis should be considered in patients presenting with chronic ankle pain particularly with a history of an inversion injury. The purpose of this report is to raise awareness of this condition. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 73-year-old white woman presented with complaints of lumbosacral and left pain radiation. The patient had a lumbar spine x-ray that demonstrated a degenerative disc disease with multilevel vacuum disc. She was also identified as having a restricted straight leg raising and had just recently recovered from a left knee arthroplasty. The article also introduces information about the intervetebral osteochondrosis.