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Las fracturas de diáfisis tibiales cerradas son las fracturas de huesos largos más comunes, siendo a su vez las fracturas de espina tibial (FET) que conllevan a inestabilidad y artrosis en la rodilla si no es tratada adecuada y oportunamente. El estudio fue observacional descriptivo con una población de 33 pacientes con fractura de espina tibial. De acuerdo con la clasificación de Meyers y Mc-Keever, el tipo I donde no existe desplazamiento y sólo el labio anterior de la espina están ligeramente elevado, sin exposición, fue el tipo de fractura más frecuente. Se obtuvo que el hueso tibial izquierdo fue ligeramente más frecuente (51,5 %) respecto al del lado derecho; el mecanismo de lesión más frecuente fue la hiperextensión de la rodilla (60,6 %), las causas más frecuentes de la lesión fueron accidente tránsito y la lesión deportiva (ambas representaron el 27,3 %). El 78,8 % de las fracturas no fueron expuestas y de acuerdo con la clasificación de Meyers y McKeever, el tipo I fue el tipo de fractura más frecuente (57,6 %). Dentro de las afecciones que suelen acompañar a la fractura de espina tibial, sólo un 15 % presentó afección meniscal y; sólo un 12 % presentó afección al platillo tibial.

Purpose To measure the slope of the medial and lateral posterior horn of the meniscus and its contribution to the overall resulting posterior tibial slope (bone and meniscus combined slope) in anterior cruciate ligament–intact (ACLI) and –deficient (ACLD) knees. Methods Magnetic resonance images of intact menisci in patients 16 to 60 years old were included. Posterior tibial bone slope (PTS) and meniscus slope (MS) were measured 25%, 50%, and 75% from the medial and lateral borders of the tibial plateau. Analysis of variance was used to determine differences in posterior tibial slopes between ACLD and ACLI knees and between sexes for ACLD and ACLI knees. Results 192 ACLI patients (age 35.2 ± 9.6 years, mean ± standard deviation) and 159 ACLD patients (age 34.2 ± 10.3 years) were included. Medial and lateral PTS in ACLD was significantly (P = .00001) higher at 25%, 50%, and 75%. Medial and lateral MS in ACLD was significantly (P = .00001) lower at 25%, 50%, and 75%. There were no significant sex differences for medial or lateral MS in ACLD or ACLI patients (P = .51). The resultant combined medial and lateral slope in ACLD patients was significantly (P = .00001) lower at 25%, 50%, and 75%. There were no significant sex differences in PTS (P = .68), MS (P = .51), or resultant slope (P = .79) Conclusions The results of this study strongly suggest that lower meniscal slopes of both the medial and lateral posterior horns are associated with ACL injuries in both males and females. Although the posterior horns reversed the bone PTS to an anterior inclined slope in both ACLD and ACLI patients, both the meniscus slope and the combined resultant slope were significantly lower and more positive at all 6 measured locations in ACLD knees. Level of Evidence III, retrospective cohort study.

Downstream effects of bariatric weight-loss surgery have been associated with bone resorption, potentially jeopardizing total knee arthroplasty (TKA) implant fixation/ingrowth. This case–control study sought to determine if TKA patients with history of bariatric surgery exhibit altered microanatomy of subchondral bone quality in the tibial plateau compared to controls. With IRB approval, 41 bone samples were evaluated from 12 former bariatric surgery patients and 10 sex-, age-, weight-, height-, and BMI-matched controls. Patient-Reported Outcomes Measurement Information System (PROMIS) surveys were completed prior to TKA. Tibial plateau osteochondral tissues were recovered during the TKA procedure, and samples from the medial and lateral plateaus were dissected into 1 × 2 cm sections, scanned using microcomputed tomography (µCT), and plastic-embedded for histologic sectioning/staining of undecalcified bone. Paired t tests with Bonferroni correction were performed to assess group differences. Female bariatric surgery patients had reduced osteoid/total area and greater osteoclast number asymmetry than female controls (p

Background The femoral cortical suspension device such as fixed loop devices (FLD) and adjustable-loop device (ALD) are used for ACLR technique in recent days. However, there was few studies of clinical and radiographic results for ACLR using ALD. This study was conducted to clarify the clinical and radiographic results, stability and bone tunnel enlargement after ACLR using a ToggleLoc with a zip loop as ALD. Methods 80 patients who had data available from the most recent follow-up at ≥2 years since ACLR were evaluated both clinical and radiographic results. They were divided into single bundle reconstruction group (SBR) and double bundle reconstruction group (DBR). Clinical scores were included subjective scores and objective scores at pre- and postoperatively 2 years. The subjective scores were the Cincinnati knee rating system, Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm score, Tegner activity score, Visual Analog Scale (VAS) and ACL-Return to Sport after Injury (RSI) scale. The objective scores were the isokinetic muscle strength, side-to-side difference in anterior instability and single hop test. In radiographical assessment, femoral and tibial tunnel enlargement was evaluated by three-dimensional computed tomography. Results In both SBR and DBR group, the postoperative subjective scores were significantly improved compared to the preoperative values, except for the Tegner activity score. Similarly, the side-to-side differences in muscle strength, anterior instability and single hop test were significantly improved after surgery. The changes in the femoral and tibial tunnel maximum cross section areas of SBR were 104.3 % ± 21.2 % and 89.2 % ± 15.2 %, respectively, at 2 years post-operatively. In DBR, in the femoral bone volume change of the antero medial (AM) and postero lateral (PL) bundle were 107.0 ± 3.5 % and 108.1 ± 3.3, and in the tibial bone volume change of AM and PL bundle were 90.6 ± 3.3 % and 87.0 ± 4.2 %. At the femoral site, the rate of tunnel enlargement increased for the first 12 months and then decreased through 24 months postoperatively. At the tibial site, by contrast, the rate of tunnel enlargement decreased consistently over the two-year postoperative follow-up. Conclusion This is the first study to include clinical data on ACLR using a ToggleLoc with a zip loop device. ACLR using these devices as ALDs resulted in good clinical outcomes and provided good stability of the knee with relatively little bone tunnel enlargement in both SBR and DBR group.

Aim Intraosseous (IO)-access plays an alternative route during resuscitation. Our study in preterm and term stillborns was performed to find alternative IO puncture sites beside the recommended proximal tibia. Methods The cadavers used were legal donations. 20 stillborns (mean: 29.2weeks, IQR 27.1–39.6) were investigated. Spectral-CT were analysed to calculate the diameter and circumferences of: i) proximal humerus ii) distal femur iii) proximal tibia iv) diaphyseal tibial. Contrast medium was applied under video documentation to investigate the drainage into the vascular system. Results In term newborns, diameter of the cortex of the proximal humeral head is 12.1 ± 1.8 mm, distal end of the femur 11.9 ± 3.4 mm and the proximal tibial bone 12.0 ± 2.4 mm with cross-sectional diameter of 113.5 ± 19.7 mm2, 120.6 ± 28.2 mm2 and 111.6 ± 29.5 mm2, respectively. Regarding the preterm groups, there is a strong age-related growth in diameter and cross -sectional size. The diaphyseal area is the smallest in all measured bones with an age-dependent increase and is about half of that of metaphyseal diameters (proximal and distal) and about one third of that of metaphyseal cross sectional areas. The proximal femoral head region has the largest diameter of all measured bones with an egg-shaped formation with an extensive joint capsula. All investigated metaphyseal areas lack a clearly enclosed bone marrow cavity. Infusion of contrast medium into the distal femoral end and the proximal humerus head demonstrate the drainage of contrast medium into the central venous system within seconds. Conclusion Proximal humeral head and distal femoral end might be alternative IO areas which may lead to further IO puncture sites in neonates.

Background Interference screw is commonly used for graft fixation in anterior cruciate ligament (ACL) reconstruction. However, previous studies had reported that the insertion of interference screws significantly caused graft laceration. The purposes of this study were to (1) quantitatively evaluate the graft laceration from one single insertion of PEEK interference screws; and (2) determine whether different types of sutures reduced the graft laceration after one single insertion of interference screws in ACL reconstruction. Methods The in-vitro ACL reconstruction model was created using porcine tibias and bovine extensor digitorum tendons of bovine hind limbs. The ends of grafts were sutured using three different sutures, including the bioabsorbable, Ethibond and ultra-high molecular weight polyethylene (UHMWPE) sutures. Poly-ether-ether-ketone (PEEK) interference screws were used for tibial fixation. This study was divided into five groups (n = 10 in each group): the non-fixed group, the non-sutured group, the absorbable suture group, the Ethibond suture group and the UHMWPE suture group. Biomechanical tests were performed using the mode of pull-to-failure loading tests at 10 mm/min. Tensile stiffness (newtons per millimeter), energy absorbed to failure (in joules) and ultimate load (newtons) were recorded for analysis. Results All prepared tendons and bone specimens showed similar characteristics (length, weight, and pre-tension of the tendons, tibial bone mineral density) among all groups (P > 0.05). The biomechanical tests demonstrated that PEEK interference screws significantly caused the graft laceration (P < 0.05). However, all sutures (the bioabsorbable, Ethibond and UHMWPE sutures) did not reduce the graft laceration in ACL reconstruction (P > 0.05). Conclusions Our biomechanical study suggested that the ultimate failure load of grafts was reduced of approximately 25 % after one single insertion of a PEEK interference screw in ACL reconstruction. Suturing the ends of the grafts using different sutures (absorbable, Ethibond and UHMWPE sutures) did not decrease the graft laceration caused by interference screws.

Purpose Meniscus allograft transplantation (MAT) is a possible treatment for patients suffering with pain after meniscectomy. Here, peracetic acid (PAA) sterilised meniscus transplants were investigated on whether they would provide an adequate alternative to fresh-frozen transplants in their viscoelastic and mechanical properties. Methods In this analysis, 31 menisci donors (26 male and 5 female) were included. The average donor age was 49.87 years, ranging from 32 to 65 years. Menisci of matched pairs of knees underwent chemical sterilisation while counterparts were left fresh-frozen. Stiffness and load to failure were determined via suture retention. Further menisci were analysed while attached to the tibial bone block using a novel test device to mimic physiological load distribution. Meniscus relaxation, stiffness and failure loads were determined. Histology and biphasic properties of the menisci were examined and results were analysed using paired t-tests. Results A novel custom built test device allowed the application of physiological loads for suture retention testing and revealed no significant differences between PAA sterilised (14.85 ± 4.46 N/mm, 50.49 ± 17.01 N) and fresh-frozen (18.26 ± 4.46 N/mm, 59.49 ± 21.07 N) regarding stiffness and failure load, respectively. Furthermore, initial 200 N loading showed significantly higher strain in sterilised menisci (18.87 ± 1.56) compared to fresh frozen (13.81 ± 1.04). Load relaxation experiments demonstrated significantly lower relaxation for sterilised menisci (77.71 ± 1.62) compared to fresh-frozen (89.11 ± 1.00, p-value Conclusion Peracetic acid sterilised human menisci performed equally to fresh-frozen counterparts in a suture retention test and in physiological failure testing providing an adequate alternative. However, meniscus relaxation, biphasic properties and strain were shown to be significantly different between the groups. A common problem of MAT is graft extrusion or shrinkage, therefore the parameters measured here should be considered and may influence meniscus extrusion after transplantation. Level of evidence n/a (experimental study)

Finite element (FE) models to evaluate the burden placed on the interaction between total ankle arthroplasty (TAA) implants and the bone often rely on peak axial forces. However, the loading environment of the ankle is complex, and it is unclear whether peak axial forces represent a challenging scenario for the interaction between the implant and the bone. Our goal was to determine how the loads and the design of the fixation of the tibial component of TAA impact the interaction between the implant and the bone. To this end, we developed a framework that integrated robotic cadaveric simulations to determine the ankle kinematics, musculoskeletal models to determine the ankle joint loads, and finite element models to evaluate the interaction between TAA and the bone. We compared the bone-implant micromotion and the risk of bone failure of three common fixation designs for the tibial component of TAA: spikes, a stem, and a keel. We found that the most critical conditions for the interaction between the implant and the bone were dependent on the specimen and the fixation design, but always involved sub-maximal forces and large moments. We also found that while the fixation design influenced the distribution and the peak value of bone-implant micromotion, the amount of bone at risk of failure was specimen-dependent. To account for the most critical conditions for the interaction between the implant and the bone, our results support simulating multiple specimens under complex loading profiles that include multiaxial moments and span entire activity cycles.

Anatomic tunnel formation and remnant preservation are the recent trends in posterior cruciate ligament (PCL) reconstruction. However, it is difficult to observe the anatomical PCL footprint and perform the operation in the process of remnant‐preserving PCL reconstruction. This study describes a single‐bundle, transtibial PCL reconstruction technique with anatomic graft passage over the remnant PCL fibers. A femoral tunnel of PCL is created at 2 mm medial to the roof of the intercondylar notch and 3 mm proximal to the margin of the articular cartilage. The tibial insertion of PCL is observed using a figure‐of‐four position through a posterior trans‐septal portal. A tibial bone tunnel is made below the distal center portion of the tibial insertion of residual PCL fibers. The graft is passed over the PCL through the tibial bone tunnel, the space between the anterior cruciate ligament (ACL) and the residual PCL fibers, to the femoral socket and is fixed by the EndoButton and screw. This technique is able to ensure a reasonable intra‐articular length and optimal isometry. It has been applied in patients with PCL rupture and posterior instability of the knee joint, and no intraoperative or postoperative complications occurred. Our technology provides a valuable new treatment option for PCL rupture. Future comparative studies are needed to further clarify its beneficial effect.

Recovery of the supporting structures of the teeth includes the utilization of an assortment of materials of normal and engineered causes. A definitive point of a genuine connective tissue connection to the cementum, be that as it may, is hard to accomplish and a couple of the materials have demonstrated promising outcomes. In this article we would like to give a idea of the grafting of bone. Keywords: Grafting, Calvarial graft, Square bone block, Tibial bone.

Introductions: Fractures of diaphyseal region of the tibial bone are amongst the most commonly seen extremity injuries in the developing countries. The surgical implant generation network (SIGN) intramedullary (IM) nail was designed for the treatment of long bone fractures in the developing nations. Methods: From March 2008 to December 2018, a total of 104 patients with 104 tibial diaphyseal fractures were treated with SIGN IM nail. The followup visits were arranged at 6, 12, 24 weeks and one-year post operatively. During followup visits, the signs of fracture union clinically as well as radiologically and the presence of complications any were recorded and analyzed. Results: The mean age of the patients was 32.81 (16 – 65) years, male 74 (71.2%) and female 30 (28.8%). Majority of the patients 70 (67.3%) had fractures after road traffic accidents. The mean time of surgery was 13.58 (1 – 463) days. Six (5.8%) patients had delayed union and no non-union was detected. We had 10 cases (9.6%) of mal-alignment but were on acceptable range. Conclusions: In the developing country like Nepal, the SIGN nail is an effective surgical implant for the management of the tibial diaphyseal fractures with good result of fracture union and low rates of nonunion, mal-alignment and manageable complications. Keywords: diaphyseal fracture, intramedullary nailing, SIGN nail, tibial fracture

For citation: Shchokin OV, Spakhi OV. (2019). The case of application of the retrained operational up-stupe to the tumor located on the borning-interior surface of the top third diaphism of the big-tonal bone. Paediatric Surgery.Ukraine. 4(65): 67-71. doi 10.15574/PS.2019.65.67Article received: Jul 11, 2019. Accepted for publication: Dec 18, 2019.Objective. To develop low-traumatic and safe operative access to the posterior surface of the tibial diaphysis in the upper third and acquaint the operating orthopedic trauma surgeons, oncologists and surgeons with it.Materials and methods. According to the scientific literature, the study and analysis of the topography of anatomical formations of this area were conducted with respect to possible options for access to the posterior external surface of the upper third of the tibial diaphysis. Anterior, anterior and anterior internal accesses were studied. These accesses are offered by most authors in the scientific literature. Along with these approaches, many authors propose to use the posterior and posterior-external accesses, which are located closest to the posterior outside surface of the tibial diaphysis in the upper third. All these approaches are either too traumatic, or with their help it is almost impossible to reach the posterior surface of the tibial diaphysis in the upper third. The least traumatic and safest is a backward access. It is carried out as follows. An incision of the skin triad is performed, retreating 1 centimeter posterior to the posterior inner edge of the tibia and parallel to it. Medial edges of the gastrocnemius and soleus muscles are stupidly and acutely exfoliated. After removal of the muscles posteriorly, the posterior tibial and peroneal vessels and tibial nerve open, which are retracted along with the muscles. After separation of the posterior tibial muscle, access to the upper third of the diaphysis of the inner surface of the tibial bone is opened without damaging the important anatomical structures.Clinical case. A 16-year-old child with two tumors (osteochondromas) located on the inner and posterior surface of the tibial bone in the upper third of the diaphysis from the posterior-internal access was operated on in the clinic. Anatomical structures and structures were not damaged. This confirmed the security of the back door.Conclusion. The case of posterior-internal access, which was carried out to remove a tumor located on the posterior surface of the tibial bone in its upper third, showed that this access is less traumatic and safe.The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the institution’s Local Ethics Committee. The informed consent of the child and his parents was obtained from the studies.

PURPOSE We describe the measurement of bound water T1 ( T1BW ) of cortical bone in vitro and in vivo with a 3D adiabatic inversion recovery ultrashort echo time (IR-UTE) Cones sequence using a clinical 3T scanner. METHODS A series IR-UTE data from 6 repetition times (TRs) with 5 inversion times (TIs) at each TR were acquired from 12 human tibial bone specimens, and data from 4 TRs with 5 TIs at each TR were acquired from the tibial midshafts of 8 healthy volunteers. The pore water nulling point was calculated from exponential fitting of the inversion recovery curve at each TR. Bone specimens and volunteers were then scanned again with the calculated nulling point at each TR. T1BW was derived through exponential fitting of data from IR-UTE images acquired at different TRs using the calculated pore water nulling point for each TR. RESULTS In vitro pore water nulling TIs were 141.3 ± 11.6, 123.4 ± 8.9, 101.3 ± 6.2, 88.9 ± 5.3, 74.8 ± 4.2, and 59.2 ± 3.9 ms for the 6 TRs of 500, 400, 300, 250, 200, and 150 ms, respectively. In vivo pore water nulling TIs were 132.8 ± 12.8, 110.3 ± 10.0, 80.0 ± 7.2, and 63.9 ± 5.4 ms for the 4 TRs of 400, 300, 200, and 150 ms, respectively. Excellent exponential fitting was achieved for IR-UTE imaging of bound water with pore water nulled at each TR. The mean T1BW was 106.9 ± 6.3 ms in vitro and 112.3 ± 16.4 ms in vivo. CONCLUSION Using the 3D IR-UTE Cones with a variable TR/TI approach, T1BW of cortical bone was calculated after complete nulling of pore water signals.

Case The patient sustained a pathologic fracture through chronic osteomyelitis of the tibia. Treatment involved resection of bone and soft tissue, leaving a 15-cm diaphyseal tibial defect. We designed a construct to allow for trifocal bone transport using a magnetic intramedullary lengthening nail connected to cables. This technique uses cables secured to the proximal tibia, the nail, and the transport segments. Conclusion This case details the successful use of trifocal cable-assisted bone transport through a magnetic lengthening intramedullary nail. This technique can successfully be used to reconstruct diaphyseal bone defects that are longer than the stroke length of the magnetic nail.

Aims The main objective of this study is to analyze the penetration of bone cement in four different full cementation techniques of the tibial tray. Methods In order to determine the best tibial tray cementation technique, we applied cement to 40 cryopreserved donor tibiae by four different techniques: 1) double-layer cementation of the tibial component and tibial bone with bone restrictor; 2) metallic cementation of the tibial component without bone restrictor; 3) bone cementation of the tibia with bone restrictor; and 4) superficial bone cementation of the tibia and metallic keel cementation of the tibial component without bone restrictor. We performed CT exams of all 40 subjects, and measured cement layer thickness at both levels of the resected surface of the epiphysis and the endomedular metaphyseal level. Results At the epiphyseal level, Technique 2 gave the greatest depth compared to the other investigated techniques. At the endomedular metaphyseal level, Technique 1 showed greater cement penetration than the other techniques. Conclusion The best metaphyseal cementation technique of the tibial component is bone cementation with cement restrictor. Additionally, if full tibial component cementation is to be done, the cement volume used should be about 40 g of cement, and not the usual 20 g. Cite this article: Bone Joint Res 2021;10(8):467–473.

Objective To determine the stability bovine stifles stabilized with nylon or nitinol superelastic prostheses after transection of the cranial cruciate ligament (CCL). Study design Ex vivo study. Sample population Stifles (n = 15) harvested from adult bovine cadavers. Methods The stifles were randomly assigned pairwise to a ligament reconstruction technique (n = 5): (1) and (2) Hamilton's technique using a prosthesis made of 24 nitinol strands (0.39 mm) braided at 40°or single 600-lb test nylon implant, and (3) nitinol prosthesis placed in femoral and tibial bone tunnels (bone-to-bone). Craniocaudal tibial translation at ±2000 N was applied to the tibia, and mediolateral angular displacement via measured under torsional tibial loading at ±60 Nm on three occasions: intact CCL, transected, and stabilized. Outcomes were evaluated with a mixed effect linear model for repeated measures. Results Bone-to-bone using nitinol was the only repair that decreased tibial translation after CCL transection (p = .001) with a 23% change magnitude compared with intact CCL. Hamilton was the only stabilization reestablishing angular displacement, similar to intact CCL (p = .109 and .134 for nitinol and nylon). Bone-to-bone nitinol stabilization decreased angular displacement after CCL-transection with an 8% change magnitude (p = .040) without returning to normal values. Conclusion CCL replacement with nylon did restore joint stability. Nitinol prostheses passed through single femoral and tibial bone tunnels (bone-to-bone) were the only techniques reducing tibial translation. Clinical significance/impact Bone-to-bone stabilization with a nitinol prosthesis may be considered as an alternative to nylon for CCL replacement in cattle. These results provide evidence to justify clinical evaluation in cattle undergoing CCL replacement.

Introduction and Objectives. Segmental tibial bone loss from tumor, trauma, or infection is a debilitating, limb-threatening scenario where treatment principles involve aggressive resection of infected tissues usually leading to large defects requiring reconstruction. A systematic review was conducted to determine the best available evidence related to the ipsilateral medial fibular transport using the Ilizarov frame in the management of these massive tibial bone defects. Methods. Multiple medical online database search for articles containing the keywords: ipsilateral medial fibular transport, medial fibula transport, medialization of the fibula using the Ilizarov fixator, ring external fixator, vascularized free fibula, vascularized fibula transfer, and other related MeSH terms was done. Data was summarized to describethe mean age, bone defect, external fixator time, external fixator index, and bone and functional results using the ASAMI criteria. Results. Eight studies with a total of 43 patients with massive tibial bone defects treated by fibular transport using the Ilizarov methods were identified. The mean age was 25.27 years (6.5-44.4) with a mean bone defect of 13.57 cm (9.52-17). The mean length of follow-up was 37.67 months (18-70.2). The bone union rate was 100%. Mean external fixation time was 9.59 months (8.31-10.88) and external fixation index was 0.61 months/cm (0.52-0.70). The majority of patients have an excellent bone (84%) and functional (52%) results. The average rate of complication was determined at 0.74/patient (95% CI, 0.60-0.89). The most common complications include pin-tract infection (37%), residual loss of motion/stiffness of knee and ankle (35%), and pain on the transport site (21%). Conclusion. Ipsilateral medial fibular transport using the Ilizarov frame provides a viable alternative treatment option for the treatment of massive tibial bone defects.

This study was undertaken to investigate the integration of titanium micro-implants installed in conjunction with previously dentin-grafted areas and to study the morphological appearance, mineral content, and healing pattern of xenogenic EDTA-conditioned dentin blocks and granules grafted to cavities in the tibial bone of rabbits. Demineralized and non-demineralized dentin blocks and granules from human premolars were implanted into cavities prepared on the lateral aspects of the tibias of rabbits. After a healing period of six months, micro-implants were installed at each surgical site. Histological examinations were carried out after 24 weeks. Characterization of the EDTA-conditioned dentin blocks was performed by means of light microscopy, dental X-rays, scanning electron microscopy, and energy dispersive X-ray analysis (EDX). No implants were found to be integrated in direct contact with the dentin particles or blocks. On the EDTA-conditioned dentin surface, the organic marker elements C and N dominated, as revealed by EDX. The hydroxyapatite constituents Ca and P were almost absent on the dentin surface. No statistically significant difference was observed between the EDTA-conditioned and non-demineralized dentin, as revealed by BIC and BA. The bone-inductive capacity of the dentin material seemed limited, although demineralization by means of EDTA indicated higher BIC and BA values in conjunction with the installed implants in the area. A 12 h EDTA treatment did not fully decalcify the grafts, as revealed by X-ray analysis.

To evaluate whether medial-sided bone bruising was associated with postero-medial meniscal tears in patients with an acute rupture of their anterior cruciate ligament (ACL). A retrospective analysis of 150 consecutive patients who had an MRI scan within 8 weeks of their ACL rupture that underwent an ACL reconstruction was performed. Based on the intra-operative findings, two groups were identified: Group A (N = 75) had no postero-medial meniscal tear associated with the acute ACL rupture and Group B (N = 75) had a postero-medial meniscal tear found at time of reconstruction. All patients’ pre-operative MRI scans were reviewed for bone bruising in the following anatomic sites: lateral femoral condyle (LFC), lateral tibial plateau (LTP), medial femoral condyle (MFC), and medial tibial plateau (MTP). MTP bone bruising was found to be more prevalent in cases that had a postero-medial meniscal tear in the setting of an acute ACL injury (p = 0.046). MTP Grade 2 or 3 bone bruising was more common in patients that had a postero-medial meniscal tear (p = 0.046). There was a slightly higher incidence of grade 2 or 3 MTP bone bruising in cases with a postero-medial meniscal tear, although this did not reach statistical significance (n.s.) There was no difference in LFC, LTP or MFC bone bruising in patients with or without a postero-medial meniscal tear (n.s) for all. Medial-sided bone bruising; especially present on the posterior tibial plateau may result from a higher injury force during the injury to the ACL. The identification of medial bone bruising on pre-operative MRI imaging following an acute ACL rupture should raise the suspicion of an associated postero-medial meniscal tear. III.

Complex comminuted fractures involving the distal tibia, ankle joint, and talus are often accompanied by bone loss and are highly prone to complications such as soft tissue infection, fixation failure, and posttraumatic arthrosis, with joint reconstruction being difficult in cases with severe joint destruction or bone loss. In this case, bone transport and fusion procedures were performed to treat a patient with an open fracture involving total talar dislocation, talar bone loss, and distal tibial bone loss. Just as in this case, where the surrounding soft tissues remain healthy, limb salvage via segmental bone transport may be a reasonable option in fractures with massive bone loss that include joints.

Bone fixation of the two roots improves meniscal allograft positioning as compared to simple meniscal peripheral wall fixation. An all-arthroscopic 4-point bone fixation technique could provide rigid primary fixation and a more stable allograft. The technique was implemented on 8 fresh cadavers, under arthroscopy, via tibial bone tunnels at the posterior root, popliteal hiatus, anteromedial segment and anterior root, with cortical buttons for tibial graft fixation. Mean surgery time was 65±5minutes (range, 55-80min). The main difficulty lay in creating the tunnel to fix the anterior horn, which sometimes required an additional lateral portal. This 4-point bone fixation technique proved feasible and reproducible, and offers a novel means of stable primary fixation. LEVEL OF EVIDENCE: IV, cadaver study.

Knee osteoarthritis (OA) is a degenerative joint disease that is prevalent in advancing age. The pathology of OA disease is still unclear, and there are no effective interventions that can completely alter the OA disease process. Magnetic resonance (MR) image evaluation is sensitive for depicting early changes of knee OA, and therefore important for early clinical intervention for relieving the symptom. Automated cartilage segmentation based on MR images is a vital step in experimental longitudinal studies to follow-up the patients and prospectively define a new quantitative marker from OA progression. In this paper, we develop a deep learning–based coarse-to-fine approach for automated knee bone, cartilage, and meniscus segmentation with high computational efficiency. The proposed method is evaluated using two-fold cross-validation on 507 MR volumes (81,120 slices) with OA from the Osteoarthritis Initiative (OAI)(1) dataset. The mean dice similarity coefficients (DSCs) of femoral bone (FB), tibial bone (TB), femoral cartilage (FC), and tibial cartilage (TC) separately are 99.1%, 98.2%, 90.9%, and 85.8%. The time of segmenting each patient is 12 s, which is fast enough to be used in clinical practice. Our proposed approach may provide an automated toolkit to help computer-aided quantitative analyses of OA images.

Transtibial pull-out repair is routinely performed to treat medial meniscal posterior root tear (MMPRT). However, data on the postoperative histological evaluation of the repaired medial meniscus posterior attachment after the procedure is scarce. In this report, we present a histological evaluation of the harvested specimen of a patient who underwent unicompartmental knee arthroplasty (UKA) approximately two years and six months after MMPRT transtibial pull-out repair. The patient was a 75-year-old female. Her X-ray showed Kellgren-Lawrence classification grade II and her MRI revealed MMPRT. Arthroscopic transtibial pull-out repair was performed two months after the onset, and her condition was fine two years after the operation. However, her knee pain gradually worsened, and UKA was performed two years and six months after the initial surgery. The medial meniscus posterior root was continuous from the resected tibia. Tissue specimens were prepared and evaluated. There were Sharpey's fiber-like tissues in the tibial bone tunnel. The medial meniscus posterior attachment showed a four-layer structure of ligaments, uncalcified fibrocartilage, calcified fibrocartilage, and subchondral bone zone. The structures were observed 2,000 ㎛ medially from the bone tunnel. The results revealed that the reconstructed graft after a transtibial pull-out repair for the medial meniscus posterior root showed different histological findings compared with the native posterior root and similar to the anterior root of the medial meniscus.

OBJECTIVE To compare the outcomes and complications of bone transport over a nail (BTON) with those of bone transport over a plate (BTOP) for segmental tibial bone defects. DESIGN Retrospective matched study design. SETTING A major metropolitan tertiary referral trauma center. PATIENTS Thirty-six patients with segmental tibial bone defects of >4 cm were included in this study. INTERVENTION Either BTON or BTOP was performed on 18 patients. MAIN OUTCOME MEASUREMENTS We compared the healing of the distraction process and of the docking site between the techniques. Distraction parameters including external fixator (EF) time, external fixation index, and healing index were compared. Bone and functional results were compared according to the Paley-Maar classification. Complications associated with each procedure were compared. RESULTS Both BTON and BTOP achieved similar rates of primary union (83% vs. 89%) at the distraction or docking site. Significantly less time wearing an EF was needed for BTOP than for BTON (2.8 vs. 5.4 months; P < 0.01). The external fixation index was significantly lower for BTOP than for BTON (0.45 vs. 0.94 mo/cm; P < 0.01), whereas the healing indexes were similar. The final outcomes and complication incidences were not significantly different. CONCLUSIONS The EF time was significantly shorter for BTOP than for BTON; however, the final outcomes were similar. Therefore, BTOP could be considered an attractive option for bone transport in patients with segmental tibial defects. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

SUMMARY Large segment bone defects of the tibia are challenging problems. Although caused by a wide range of conditions, tibial critical bone loss defects often require complex reconstructive plans with prolonged inability to weight-bear on the effected extremity. Reconstruction options frequently require harvesting of autograft leading to further morbidity. Distraction osteogenesis allows reconstruction of large segmental defects of the tibia while avoiding donor site morbidity. Historically, distraction osteogenesis of tibia was most reliably performed with circler ring external fixation. This process allowed early weight-bearing but unfortunately has considerable drawbacks. Negative effects include pin tract irritation and inability to wear normal clothes. The advent of the bone transport nail now allows management of tibial critical bone loss defects through distraction osteogenesis negating the need for external fixation. This new technique allows treatment of large segmental tibial defects by means of distraction osteogenesis with an all-internal device avoiding the negative effects of external fixation while simultaneously allowing early weight-bearing.

In bone, structural components such as mineral extend across length scales to provide essential biomechanical functions. Using X-ray micro-computed tomography (µCT), and focused ion beam scanning electron microscopy (FIB-SEM) in serial-surface-view mode, together with 3D reconstruction, entire mouse skeletons and small bone tissue volumes were examined in normal wildtype (WT) and mutant Hyp mice (an animal model for X-linked hypophosphatemia/XLH, a disease with severe hypomineralization of bone). 3D thickness maps of the skeletons showed pronounced irregular thickening and abnormalities of many skeletal elements in Hyp mice compared to WT mice. At the micro- and nanoscale, near the mineralization front in WT tibial bone volumes, mineralization foci grow as expanding prolate ellipsoids (tesselles) to abut and pack against one another to form a congruent and contiguous mineral tessellation pattern within collagen bundles that contributes to lamellar periodicity. In the osteomalacic Hyp mouse bone, mineralization foci form and begin initial ellipsoid growth within normally organized collagen assembly, but their growth trajectory aborts. Mineralization-inhibiting events in XLH/Hyp (low circulating serum phosphate, and increased matrix osteopontin) combine to result in decreased mineral ellipsoid tessellation - a defective mineral-packing organization that leaves discrete mineral volumes isolated in the extracellular matrix such that ellipsoid packing/tessellation is not achieved. Such a severely altered mineralization pattern invariably leads to abnormal compliance, other aberrant biomechanical properties, and altered remodeling of bone, all of which indubitably lead to macroscopic bone deformities and anomalous mechanical performance in XLH/Hyp. Also, we show the relationship of osteocytes and their cell processes to this mineralization pattern.

Bone is a unique living tissue, which responds to the mechanical stimuli regularly imposed on it. Adolescence facilitates a favorable condition for the skeleton that enables the exercise to positively influence bone architecture and overall strength. However, it is still dubious for how long the skeletal benefits gained in adolescence is preserved at adulthood. The current study aims to use a rat model to investigate the effects of in vivo low‐ (LI), medium‐ (MI), and high‐ (HI) intensity cyclic loadings applied during puberty on longitudinal bone development, morphometry, and biomechanics during adolescence as well as at adulthood. Forty‐two young (4‐week‐old) male rats were randomized into control, sham, LI, MI, and HI groups. After a 5 day/week for 8 weeks cyclic loading regime applied on the right tibia, loaded rats underwent a subsequent 41‐week, normal cage activity period. Right tibias were removed at 52 weeks of age, and a comprehensive assessment was performed using μCT, mechanical testing, and finite element analysis. HI and MI groups exhibited reduced body weight and food intake at the end of the loading period compared with shams, but these effects disappeared afterward. HI cyclic loading increased BMD, bone volume fraction, trabecular thickness, trabecular number, and decreased trabecular spacing after loading. All loading‐induced benefits, except BMD, persisted until the end of the normal cage activity period. Moreover, HI loading induced enhanced bone area, periosteal perimeter, and moment of inertia, which remained up to the 52nd week. After the normal cage activity at adulthood, the HI group showed increased ultimate force and stress, stiffness, postyield displacement and energy, and toughness compared with the sham group. Overall, our findings suggest that even though both trabecular and cortical bone drifted through age‐related changes during aging, HI cyclic loading performed during adolescence can render lifelong benefits in bone microstructure and biomechanics. © 2020 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.

According to recent anatomic studies, the anterior cruciate ligament (ACL) appears to be a flat, "ribbon-like" structure, with a thin, oval-shaped insertion on the femur and a C-shaped tibial insertion. According to this anatomy, we describe an ACL-reconstruction technique that aims to approximate this natural anatomy. The basic principle of this technique is not to use conventional round tunnels but create tunnel shapes that resemble more closely the original ACL insertion sites. Using either a rectangular quadriceps tendon graft or a "flat" hamstring graft may not only provide a biomechanical advantage with increased rotational stability but also improve bone-tendon healing due to increased bone-tendon contact and decreased diffusion length. Creating a C-shaped tibial tunnel also avoids laceration of the anterior horn of the lateral meniscus, which is frequently harmed during conventional tibial tunnel drilling.

Human lower limb anatomy varies widely, and a systematic approach, using right-angled femoral and tibial bone cuts (Mechanical Alignment) leads to important anatomic alterations for many subjects. The restoration and preservation of pre-arthritic knee anatomy and ligament laxities during TKA has gained interest in recent years. The kinematic alignment (KA) technique represents a resurfacing of articular surfaces, removing equivalent amounts of bone and cartilage to match implant thickness. Concerns remain about restoring extreme anatomies, which may not be compatible with current TKA prostheses and fixation methods. Some knee anatomies may be inherently biomechanically inferior, or may have been altered by trauma, tumors, childhood deformity, or previous surgery. Keeping in mind these uncertainties, the senior author (PAV) developed a restricted KA (rKA) protocol. rKA aims to perform KA bone resections for most cases, but performing adjustments for patients outside a “safe range” defined by the following criteria: independent tibial and femoral cuts must be within 5° of the mechanical axis of the respective bone and the overall resulting Hip–Knee–Ankle angle (HKA) must fall within 3° of neutral. rKA may be the best compromise, by helping the surgeon to preserve native knee ligament balance during TKA and avoid residual instability, whilst keeping the lower limb alignment within a safe range.

Objectives In this research it was aimed to that evaluation of the effects of systemic metformin administration on the periimplant bone tissue response of TiAl6Va4 implants in experimental rat model. Materials and method Firstly TiAl6Va4 implants were inserted surgically in the metaphyseal part of the tibial bone and after, the rats were randomly separated into two groups: Controls (CNT) (n = 10) and Metformin group (M) (n = 10). No additional treatment was applied to the controls during the 4-week experimental period. Rats received 40 mg/kg metformin in every day during the four week experimental period in M group. At the end of the 28-day follow-up period, the TiAl6Va4 implants with surrounding bone were used for the histopathologic analysis. To analysis of the datas between M and CNT Student-T Test was used. Result Periimplant bone tissue filling ratios (%) were detected higher in M group compared with the CNT (P Conclusion Systemic administration of metformin may increases titanium implant osseointegration in non-diabetic rats.

Background We conducted this study to determine the optimal length of patellar and tibial bone blocks for the modified transtibial (TT) technique in anterior cruciate ligament (ACL) reconstruction using the bone-patellar tendon-bone (BPTB) graft. Methods The current single-center, retrospective study was conducted in a total of 64 patients with an ACL tear who underwent surgery at our medical institution between March 2015 and February 2016. After harvesting the BPTB graft, we measured its length and that of the patellar tendon, patellar bone block, and tibial bone block using the arthroscopic ruler and double-checked measurements using a length gauge. Outcome measures included the length of tibial and femoral tunnels, inter-tunnel distance, length of the BPTB graft, patellar tendon, patellar bone block, and tibial bone block and graft-tunnel length mismatch. The total length of tunnels was defined as the sum of the length of the tibial tunnel, inter-tunnel distance and length of the femoral tunnel. Furthermore, the optimal length of the bone block was calculated as (the total length of tunnels - the length of the patellar tendon) / 2. We analyzed correlations of outcome measures with the height and body mass index of the patients. Results There were 44 males (68.7%) and 20 females (31.3%) with a mean age of 31.8 years (range, 17 to 65 years). ACL reconstruction was performed on the left knee in 34 patients (53%) and on the right knee in 30 patients (47%). The optimal length of bone block was 21.7 mm (range, 19.5 to 23.5 mm). When the length of femoral tunnel was assumed as 25 mm and 30 mm, the optimal length of bone block was calculated as 19.6 mm (range, 17 to 21.5 mm) and 22.1 mm (range, 19.5 to 24 mm), respectively. On linear regression analysis, patients' height had a significant correlation with the length of tibial tunnel (p = 0.003), inter-tunnel distance (p = 0.014), and length of patellar tendon (p < 0.001). Conclusions Our results indicate that it would be mandatory to determine the optimal length of tibial tunnel in the modified TT technique for ACL reconstruction using the BPTB graft. Further large-scale, multi-center studies are warranted to establish our results.

Some researchers have suggested that bone bruises are evidence of rotational instability. The hypothesis was that the extent of lateral bone edema is correlated with the presence of an anterolateral ligament (ALL) injury. The main objective was to determine whether there was a correlation between the presence of an ALL injury the extent of bone bruises. A prospective diagnostic study enrolled all the patients who suffered an acute anterior cruciate ligament (ACL) who were operated on within 8 weeks. The extent of bone bruising according to the ICRS classification was measured on preoperative MRIs by two independent blinded raters twice with an interval of 4 weeks. Dynamic ultrasonography (US) to look for ALL injury and the pivot shift test were performed before the ACL surgery. The correlation between ALL injury and bone bruises, and the correlation between an ALL injury and a high-grade pivot shift test were determined. Sixty-one patients were included; 52% of patients had an ALL injury on US. The extent of lateral bone bruise was not related to the presence of an ALL injury, nor related to the presence of a high-grade pivot shift. A grade 2 or 3 pivot shift was significantly correlated with an ALL injury (p

International audience; Background: During medial unicompartmental knee arthroplasty (UKA), tibial tray implantation requires compromise between bone coverage and rotational position. It was hypothesized that morphometric tibial tray (MTT) would improve implant positioning and subsequently clinical outcomes as compared to symmetric tibial tray (STT). Methods: A total of 106 patients who underwent medial UKA in our department between January 2017 and March 2018 were included matched on gender and age (53 in each group). Inclusion criteria were symptomatic medial femorotibial osteoarthritis, functional anterior cruciate ligament, primary arthritis, or osteonecrosis. Rotation of the tibial implant, tibial bone coverage, medial and posterior overhang were assessed with a postoperative computed tomography scan. The Knee Society Score (KSS), the Knee injury and Osteoarthritis Outcome Score Short Form (KOOS SF), and the quality of life score EuroQoL 5-Dimensions 3-Levels (EQ5D3L) were assessed at a minimum of 1-year follow-up. Results: Implants of the STT group exhibited more external rotation (6.3 ± 4.02 vs 4.6 ± 3.59 ; P ¼ .04), and medial and posterior overhang >3 mm (35% vs 0% and 22% vs 0%; P < .0001) but no difference for tibial bone coverage (97.3% ± 11.35% vs 94.7% ± 10.89%; P ¼ .23). Global KSS (188.6 ± 6.6 vs 175.2 ± 31.7; P < .01), KOOS SF (16.9 ± 6.1 vs 22.5 ± 11.8; P < .003), and EQ5D3L (1 ± 0.1 vs 0.9 ± 0.2; P < .001) were higher in MTT group. According to the multivariate analysis, MTT had a positive independent effect on the KSS, KOOS SF, and EQ5D3L. Conclusion: The use of an MTT in medial UKA allowed better implant positioning when decreasing the rate of overhang; superior short-term clinical outcomes were found as compared to STT.

Several studies have demonstrated that alcohol consumption can decrease bone density and alter its structure. However, most of the studies did not investigate the effects of specific alcoholic beverages. This study determined the effects of chronic consumption of cachaca (a Brazilian beverage containing alcohol) on body weight (BW), tibia bone density and on the tibia collagen density in middle-aged Wistar rats. Rats with 9 months old were submitted for 100 days, to a liquid diet of cachaca diluted in water with a progressive and controlled concentration (10°GL, 15°GL, 20°GL, 25°GL, and 30°GL). Chronic cachaca intake produced a significant decrease in BW and altered bone remodeling, decreasing trabecular bone density. In chronic cachaca-treated group (CT), the production of collagen fibers in bone tissue has predominantly green birefringence. It appears that they are immature fibers that do not exist in the control group, in which there are standard predominantly yellowish mature fibers. In conclusion, chronic cachaca consumption affects the structure of the tibial bone of middle-aged rats by decreasing the bone density and reducing the density of mature collagen fibers.

Introduction: This is a retrospective study to assess the outcomes of tibial bone grafts in secondary grafting of alveolar clefts. Tibial cancellous bone harvested from upper-end diaphysis is believed to be qualitatively similar to iliac bone without the known morbidities of the donor site. Patients and Methods: The study comprises of 54 patients with complete alveolar clefts treated at our institute. The quality of graft take was graded radiologically using Bergland's criteria. The patients were followed up for complications, longest follow-up being 10 years. Results: The success rate was 96.3% for the sample. There were two cases, one of complete and one of partial bone loss each with recurrence of fistulae. A single case of wound infection at donor site was seen. On long-term evaluation, we had one case of slight hypertrophic scarring. Conclusion: Tibial cancellous bone graft provides good quality of viable bone for alveolar bone grafting without the accompanying morbidity. Hence, it is an excellent alternative to iliac crest bone grafting.

Functional tests with incrementing axial load on the affected limb were performed in patients with humerus, tibia and fibula fractures, or undergoing tibial bone lengthening using the Ilizarov apparatus (n = 75). It was found that oossification was associated with a decrease in the blood flow velocity in the arteries of the bone regenerate. In the humerus, the exercise tolerance was two to three times lower, while the micromotion rate of bone fragments and the blood flow velocity were higher. The micromotion rate and the blood flow velocity decreased by the end of the fixation period, since they were no longer affected by the incrementing load.

The purpose of this study was to histologically observe a specimen of a calcium phosphate (CaP)-hybridized tendon graft-bone interface at the posterior side of tibial bone tunnel obtained during the revision anterior cruciate ligament (ACL) reconstruction. We present the case of a 15-year-old female who was returning to sports 7 months and 12 days after primary anatomic single-bundle ACL reconstruction with no instability. Re-rupture was diagnosed 9 months and 12 days after the surgery. At the joint aperture site, a firm biological fixation via direct bonding area, cartilaginous tissue, and dense collagen fiber were observed without the presence of a nonbonding gap area.

Purpose In this study, particulate cancellous bone marrow was harvested from the tibia for alveolar bone grafting, and postoperative complications at the donor site were compared between patients aged 10 years or older (29 tibias) and those aged younger than 10 years (42 tibias). Patients and Methods Enrolled patients were those who underwent tibial bone graft harvesting at the Department of Oral and Maxillofacial Surgery, Aichi Gakuin University, during a period of 3 years and 1 month from March 2012 through March 2015. We examined clinical findings at the time of harvesting and changes in symptoms during hospital admission in study 1. Follow-up examinations and survey questionnaires on symptoms also were investigated to clarify medium- to long-term postoperative outcomes in study 2. Results In both age groups, medium- to long-term postoperative findings showed no apparent adverse events, except for acceptable levels of scar tissue. Clinical findings on harvesting and early postoperative findings showed that intraoperative blood loss, early postoperative pain, and gait disorders were similar between the group aged younger than 10 years and the group aged 10 years or older. However, the latter group needed a considerably longer time for ambulation and weight-bearing pain to disappear and for every movement in daily activities to return to normal. Regarding patients with a bilateral alveolar cleft, we found no significant difference between the first and second harvesting in the factors affecting postoperative morbidity. Conclusions Our findings suggest that tibial bone graft harvesting is safe and requires a shorter recovery period even in patients aged between 8 and 10 years.

The occurrence of posterior root tear of both the lateral and medial menisci, combined with anterior cruciate ligament rupture, is rare. Problems may be encountered such as the difficulty to access the medial meniscal root tear, the confusing circumstances about which structure to repair first, and the possibility of the tunnel for each repair to become taut inside the tibial bone. We present the arthroscopy technique step by step to overcome the difficulties in an efficient and time-preserving manner.

Purpose This study aims to identify the effectiveness of the medial cortical line for attaining a more accurate tibial component alignment in proximal tibial resection using an extramedullary alignment rod. Materials and methods The study examined 100 cases of total knee arthroplasty performed from December 2013 to February 2014 in a retrospective manner. On a preoperative anteroposterior (AP) radiograph of the entire tibia, we identified the medial cortical line that runs parallel to the tibial anatomical axis and passes the medial tibial spine, and measured the point where the medial cortical line crosses between the medial malleolus and the lateral malleolus in the ankle joint. Results The preoperative AP radiograph of the tibia showed the medial cortical line passing the point 40.4%±0.8% medial to the distance from the medial malleolus to the lateral malleolus including the skin thickness in the ankle joint. When the proximal tibial resection was performed with the extramedullary tibial cutting guide aligned with the medial cortical line, the tibial component angle averaged 0.7°±0.3° varus and the alignment accuracy of the tibial component within 0°±3° varus amounted to 97.0%. Conclusions The use of the medial cortical line in proximal tibial resection with an extramedullary tibial cutting guide allowed for relatively accurate alignment of the tibial component.

Displaced tibial eminence fractures are commonly encountered in pediatric patients and are often considered to be functionally equivalent to an anterior cruciate ligament (ACL) rupture. While a variety of techniques are available for fixation of this injury, we describe an anchorless technique relying on suture fixation tied over a bone bridge. This technique also relies on two intra-articular Hewson suture passers to quickly and effectively pass and shuttle sutures through the ACL and tibial bone tunnels in order to reduce and fix the fracture fragment. We also briefly review various types of fixation used for tibial eminence fractures.

The aim of this report was to present the use of flow-through free fibula osteocutaneous flap for the repair of complex tibial bone, soft tissue, and main artery segmental defects.Five patients with bone, soft tissue, and segmental anterior tibial artery defects were included. The lengths of injured tibial bones ranged from 4 to 7 cm. The sizes of impaired soft tissues were between 9 × 4 and 15 × 6 cm. The lengths of defect of anterior tibial artery segments ranged from 6 to 10 cm. Two patients had distal limb perfusion problems. Flow-through free fibula osteocutaneous flap was performed for all 5 patients.Patients were followed for 12 to 18 months. All wounds healed after 1-stage operation, and all flow-through flaps survived. The distal perfusion after vascular repair was normal in all patients. Superficial necrosis of flap edge was noted in 1 case. After the local debridement and partial thickness skin graft, the flap healed uneventfully, and the surgical operation did not increase injury to the donor site. Satisfactory bone union was achieved in all patients in 2 to 4 months postoperation. Enlargement of fibula graft was observed during follow-up from 12 to 18 months. The functions of adjacent joints were recovered, and all patients were able to walk normally.Flow-through free fibula osteocutaneous flap was shown to be an effective and efficient technique for repairing composite tibial bone, soft tissue, and main artery segmental defects. This 1-stage operation should be useful in clinical practice for the treatment of complex bone, soft tissue, and vessel defects.

The isometric exercise induced tibial bone strength adaptations due to various prescribed net resultant forces generated by a leg arranged with specified hip, knee, and ankle joint angles were examined using a computationally based bone shape adaptation model. With the leg straight, or the knee flexed at 90°, and the hip either neutral or flexed by 45°, a force was repeatedly generated at the toe either anteriorly, posteriorly, superiorly, or inferiorly, in paired sequences of these directions, or in a clockwise pattern of all four directions. Model-predicted individual muscle forces, amounts of cortical bone surface accretion or resorption, and the resulting changes in bone stress distributions were compared. Similarities between adaptations to specific combinations of joint angles and net resultant force directions were found to follow similarities in the bone stress distributions rather than in muscle activity. The ratio of standard deviation to the surface-averaged measure of local stress was a good predictor of potential improvement in overall stress state uniformity. With flexed knee and neutral hip, greater adaptive improvements in tibial surface stress uniformity were found than with both joints flexed. Flexed configurations caused greater changes and overall strength improvements than exercises performed with a straight leg. Regions of local tibial cortical thickening were identified for specific joint angles and single-load resultant force directions. Sequential series of loads were also identified to enhance these effects and mitigate concurrent thinning in other regions. The presented information can aid in the design and analysis of targeted muscle and bone strengthening exercises.

The purpose of this study was to investigate whether the bone tunnel impaction technique performed by dilators could dwindle the tibial tunnel enlargement after anterior cruciate ligament (ACL) reconstruction with hamstring tendon using both extracortical suspensory fixation devices at femoral and tibial site. Thirty-one consecutive patients undergoing primary ACL reconstruction with the hamstring autograft were enrolled in this research. Patients were randomly allotted to group A (bone tunnel impaction technique using dilators) or group B (regular extraction bone tunnel drilling). Results The average follow-up was 16.2 months. The mean femoral tunnel widening was 1.05 mm and 1.02 mm respectively in group A and B. The mean tibial tunnel widening was 0.61 mm and 1.08 mm respectively in group A and B. There was no statistical difference for tunnel enlargement between the two groups at the femoral site (P = 0.62) but significant difference at the tibial site (P < 0.0001). Conclusion Bone tunnel impaction technique leaded to a reduction of tibial bone tunnel enlargement after ACL reconstruction with hamstring tendon using both extracortical suspensory fixation devices at femoral and tibial site.

The content of myeloid stem CFU in bone marrow karyocytes from the tibial bone of C57Bl/6 mice was evaluated after a 30-day Bion-M1 pace flight/ground control experiment and subsequent 7-day recovery period. After the space flight, we observed a significant decrease in the number of erythroid progenitors in the bone marrow, including common myeloid precursor - granulocyte, erythrocyte, monocyte/macrophage, megakaryocyte CFU. After 7-day readaptation, CFU level in flight animals did not recover completely. In the ground control, the count of erythroid burst-forming units was higher than in vivarium animals. Comparison of the changes observed in fight and ground experiments demonstrated effects associated space flight factors and manifesting in suppression of the bone marrow erythropoiesis.

International audience; Objectives: To examine whether trabecular bone texture (TBT) parameters assessed on computed radiographs could predict knee osteoarthritis (OA) progression.Methods: This study was performed using data from the Osteoarthritis Initiative (OAI). 1647 knees in 1124 patients had bilateral fixed flexion radiographs acquired 48 months apart. Images were semiautomatically segmented to extract a patchwork of regions of interest (ROI). A fractal texture analysis was performed using different methods. OA progression was defined as an increase in the joint space narrowing (JSN) over 48 months. The predictive ability of TBT was evaluated using logistic regression and receiver operating characteristic (ROC) curve. An optimization method for features selection was used to reduce the size of models and assess the impact of each ROI.Results: Fractal dimensions (FD's) were predictive of the JSN progression for each method tested with an area under the ROC curve (AUC) up to 0.71. Baseline JSN grade was not correlated with TBT parameters (R < 0.21) but had the same predictive capacity (AUC 0.71). The most predictive model included the clinical covariates (age, gender, body mass index (BMI)), JSN and TBT parameters (AUC 0.77). From a statistical point of view we found higher differences in TBT parameters computed in medial ROI between progressors and non-progressors. However, the integration of TBT results from the whole patchwork including the lateral ROIs in the model provided the best predictive model.Conclusions: Our findings indicate that TBT parameters assessed in different locations in the joint provided a good predictive ability to detect knee OA progression.

Introduction Despite advances in treatment, chronic osteomyelitis and infected nonunion after trauma remain a challenge to the orthopaedic field. The Papineau technique, firstly described in 1973, is an alternative to treat such conditions in hospitals where microsurgery is not available, making closure of defect using flap is not feasible. We described our experience in treating patients with chronic osteomyelitis and infected non-union of tibial fractures using the Papineau technique. Methods We reviewed the records of patients with severe open tibial fractures with bone defects who were treated using the Papineau technique at Cipto Mangunkusumo Hospital, Jakarta, Indonesia during the period of January 2017 to August 2019. Those with diabetes mellitus, severe liver disease, or malignancies were excluded. All surgical procedures were performed by one senior orthopedic surgeon. Results A total of four subjects were enrolled in this study. All subjects were male, with a mean age of 29 ± 6.16 years of age. The mean time to granulation tissue was 21.5 ± 1.29 days, and the mean time to union was 6 ± 0 months. There were no complications. Conclusions The Papineau technique may provide successful eradication of infection, reconstruction of bone defect, and soft-tissue closure. In addition, this technique is feasible and safe, and it could be performed in small healthcare centres., Highlights • Cases of chronic osteomyelitis and infected nonunion after trauma remain a challenge. • No consensus regarding the best method. • In Indonesia studies regarding the use of the Papineau technique never been conducted. • The Papineau technique could be performed in small healthcare centres.

This study aimed to investigate the effects of chronic restraint stress (RS) and a high-fat diet (HFD) on the osseointegration of titanium implants in a rat model. After the surgical insertion of titanium implants into the metaphysis of the tibial bone, the rats were randomly divided into four equal groups (n = 8 each): control (CNT), restraint stress (RS), high-fat diet (HFD), and restraint stress plus high fat diet (RS-HFD). CNT: Rats received no further treatment during the 92-day experimental period. RS: Stress was applied to the rats beginning from two days after the implant surgery for one hour per day for the first 30 days, two hours per day for the next 30 days, and three hours per day for the last 30 days. HFD: Rats were fed a HFD for the following 90 days starting two days after surgery. RS-HFD: Rats were fed a HFD and RS was applied to rats for the following 90 days, starting two days after surgery. At the end of the experimental period, the rats were euthanized, and the implants and surrounding bone tissues were removed for histological analysis. Statistical analysis was performed by one way ANOVA and Bonferrroni tests. There were no significant differences in the bone–implant connection levels between the groups (p > 0.05), but in the HFD and RS-HFD groups, the bone filling ratios were found to be lower compared with the controls (p < 0.05) The data analyzed in this study suggest that an HFD with or without chronic RS adversely affected bone tissue in the rats during the 90-day osseointegration period.

The aim of this study was to elucidate the impact of autologous umbilical cord blood cells (USSC) on bone regeneration and biomechanical stability in an ovine tibial bone defect. Ovine USSC were harvested and characterized. After 12 months, full-size 2.0 cm mid-diaphyseal bone defects were created and stabilized by an external fixateur containing a rigidity measuring device. Defects were filled with (i) autologous USSC on hydroxyapatite (HA) scaffold (test group), (ii) HA scaffold without cells (HA group), or (iii) left empty (control group). Biomechanical measures, standardized X-rays, and systemic response controls were performed regularly. After six months, bone regeneration was evaluated histomorphometrically and labeled USSC were tracked. In all groups, the torsion distance decreased over time, and radiographies showed comparable bone regeneration. The area of newly formed bone was 82.5 &plusmn, 5.5% in the control compared to 59.2 &plusmn, 13.0% in the test and 48.6 &plusmn, 2.9% in the HA group. Labeled cells could be detected in lymph nodes, liver and pancreas without any signs of tumor formation. Although biomechanical stability was reached earliest in the test group with autologous USSC on HA scaffold, the density of newly formed bone was superior in the control group without any bovine HA.

The aim of this study was to assess the characteristics of the CaP/Col composites, in powder and fiber form, via scanning electron microscopy (SEM), pH and calcium release evaluation after immersion in SBF and to evaluate the performance of these materials on the bone repair process in a tibial bone defect model. For this, four different formulations (CaP powder - CaPp, CaP powder with collagen - CaPp/Col, CaP fibers - CaPf and CaP fibers with collagen - CaPf/Col) were developed. SEM images indicated that both material forms were successfully coated with collagen and that CaPp and CaPf presented HCA precursor crystals on their surface. Although presenting different forms, FTIR analysis indicated that CaPp and CaPf maintained the characteristic peaks for this class of material. Additionally, the calcium assay study demonstrated a higher Ca uptake for CaPp compared to CaPf for up to 5 days. Furthermore, pH measurements revealed that the collagen coating prevented the acidification of the medium, leading to higher pH values for CaPp/Col and CaPf/Col. The histological analysis showed that CaPf/Col demonstrated a higher amount of newly formed bone in the region of the defect and a reduced presence of material. In summary, the results indicated that the fibrous CaP enriched with the organic part (collagen) glassy scaffold presented good degradability and bone-forming properties and also supported Runx2 and RANKL expression. These results show that the present CaP/Col fibrous composite may be used as a bone graft for inducing bone repair.