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Background: The intervertebral disc (IVD) is dependent on nutrient provision through a cartilage layer with underlying subchondral bone, analogous to joint cartilage. In the joint, subchondral bone remodeling has been associated with osteoarthritis (OA) progression due to compromised nutrient and gas diffusion and reduced structural support of the overlaying cartilage. However, subchondral bone changes in IVD degeneration have never been quantified before., Objective: The aim of this study is to determine the subchondral bone changes at different stages of IVD degeneration by micro-CT., Methods: Twenty-seven IVDs including the adjacent vertebral endplates were obtained at autopsy. Midsagittal slices, graded according the Thompson score, were scanned. Per scan 12 standardized cylindrical volumes of interest (VOI) were selected. Six VOIs contained the bony endplate and trabeculae (endplate VOIs) and six accompanying VOIs only contained trabecular bone (vertebral VOIs). Bone volume as percentage of the total volume (BV/TV) of the VOI, trabecular thickness (TrTh) and connectivity density (CD) were determined., Results: An increase in BV/TV and TrTh was found in endplate VOIs of IVDs with higher Thompson score whereas these values remained stable or decreased in the vertebral VOIs., Conclusion: The increase in bone volume combined with the increase in TrTh in endplate VOIs strongly suggest that the subchondral endplate condenses to a more dense structure in degenerated IVDs. This may negatively influence the diffusion and nutrition of the IVD. The endplate differences between intact and mild degenerative IVDs (grade II) indicate an early association of subchondral endplate changes with IVD degeneration., (Copyright © 2010 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.)

Background: In degenerative intervertebral discs (IVDs) collagen type X expression and calcifications have been demonstrated, resembling advanced osteoarthritis (OA), which is associated with hypertrophic differentiation, characterized by the production of collagen type X, Runt-related transcription factor 2 (Runx2), osteoprotegerin (OPG), alkaline phosphatase (ALP) and calcifications., Objective: The aim of this study was to determine if hypertrophic differentiation occurs during IVD degeneration., Methods: IVDs from all Thompson degeneration grades were prepared for histology, extraction of nucleus pulposus (NP) and annulus fibrosis (AF) tissue (N=50) and micro-CT (N=27). The presence of collagen type X, OPG and Runx2 was determined by immunohistochemistry, with OPG levels also determined by Enzyme-linked immunosorbent assay (ELISA). The presence of calcification was determined by micro-CT, von Kossa and Alizarin Red staining., Results: Immunohistochemical staining for collagen type X, OPG, Runx2 appeared more intense in the NP of degenerative compared to healthy IVD samples. OPG levels correlated significantly with degeneration grade (NP: P<0.000; AF: P=0.002) and the number of microscopic calcifications (NP: P=0.002; AF: P=0.008). The extent of calcifications on micro-CT also correlated with degeneration grade (NP: P<0.001, AF: P=0.001) as did von Kossa staining (NP: P=0.015, AF: P=0.016). ALP staining was only incidentally seen in the transition zone of grades IV and V degenerated IVDs., Conclusion: This study for the first time demonstrates that hypertrophic differentiation occurs during IVD degeneration, as shown by an increase in OPG levels, the presence of ALP activity, increased immunopositivity of Runx2 and collagen type X., (Copyright © 2010 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.)

Objective: To determine the relationship of bone marrow lesions (BMLs) with phenomena such as clinical symptoms, histological subchondral bone damage, and development of osteoarthritis, a reliable and reproducible method to localize and quantify BMLs accurately is indispensable. Therefore, the goal of the current study was to develop and validate a novel semiautomated segmentation method based on the KNN classification technique on T2-weighted (T2w) SPIR and proton density-weighted (PDw) magnetic resonance images (MRIs), as this would provide an accurate, reliable, and reproducible tool., Materials and Methods: Twenty PDw and T2w SPIR MRIs were selected and manually segmented as a learning set for the software system. The manual segmentations were considered the gold standard. Automated segmentation based on the KNN classification technique was carried out on the same MRIs. To determine the accuracy and validity of the system, the automated segmentations were compared to the gold standard using the Dice Similarity Index (DSI)., Results: The KNN classification system resulted both visually and statistically in an accurate segmentation of BMLs on T2w SPIR MRIs with an excellent mean optimal DSI of 0.702 (±0.202; range, 0.409-0.908). Elimination of specific areas smaller than 10 voxels improved the accuracy. The accuracy was independent of BML size. The segmentation of BMLs on PDw MRIs was less reliable with a mean optimal DSI of 0.536 (±0.156)., Conclusion: Although the applicability of this method is limited on PDw MRIs, the KNN classification system provides an accurate, reliable, and reproducible tool for semiautomated segmentation of BMLs in T2w SPIR MRIs of the knee.

Objective: Newly developed regenerative cartilage interventions based on the application of 3D-scaffolds require a further evaluation of the surgical techniques involved. The present study compared four different scaffold fixation techniques [fibrin glue (FG), transosseous (TS) fixation, biodegradable pin (BP) fixation and continuous cartilage sutures (CS)] to implant a custom-printed porous PEOT/PBT1000/70/30 scaffold in a human cadaver knee model., Methods: After implantation, the knees were subjected to a vertically oriented loaded continuous passive motion (CPM) protocol. The fixation techniques were evaluated after 60 and a subsequent 150 motion cycles, focusing on area coverage, outline attachment and scaffold integrity. After the total of 210 cycles, also an endpoint fixation test was performed., Results: The fixation techniques revealed marginal differences for area coverage and outline attachment after 60 and 150 cycles. The FG scored higher on scaffold integrity compared to TS (P<0.05) and CS (P=0.01). Endpoint fixation was highest for the CS, whereas FG showed a weak final fixation strength (P=0.01)., Conclusions: This study showed that optimal fixation cannot be combined always with high scaffold integrity. Special attention devoted to scaffold properties in relation to the fixation technique may result in an improvement of scaffold fixation, and thus clinical cartilage regenerative approaches involving these scaffolds., (Copyright 2009 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.)

We report what is, to our best knowledge, the first case of pyogenic spondylitis following ear piercing, a common and popular cosmetic procedure. The spondylitis was adequately treated with antibiotics and brace. The value of additional diagnostic measures in differentiating between spondylitis and discitis is discussed.

A 3-year-old boy had pain on the medial side of his left knee after his father fell on him. When the pain still persisted 4 days later, further diagnostics revealed dislocation of the hip. The pain disappeared and function was restored after closed reposition under fluoroscopic control followed by immobilisation with a plaster cast. Traumatic dislocation of the hip in childhood is a relatively rare injury, but may have far-reaching consequences. As the sensitivity to pain in children differs from that in adults, an examiner must be on the alert for a traumatic dislocation of the hip whenever a child presents with a fitting history and dysfunction ofthe leg, regardless of the localisation of the pain. Pain in the knee is often reported in case of hip disorders. Avascular necrosis of the caput femoris is a well-known and dreaded complication of traumatic dislocation of the hip in children. The risk of complications is certainly increased sharply if the hip luxation goes unnoticed and reposition takes place after more than 6 hours. Closed reposition as rapidly as possible or alternatively open reposition of the dislocated hip under general anaesthesia is the indicated treatment.

Ortolani's manoeuvre is used to detect hip instability. It is intended to be used to establish the mobility of a dislocated femoral head with respect to the acetabulum in newly-born infants. Barlow's modification attempts to dislocate a reduced but unstable hip out of the acetabulum. Ortolani's manoeuvre is a primarily tactile, proprioceptive sensation and has nothing to do with the usually inconsequential audible and palpable clicks in infant hips. It has been found that widespread use of Ortolani's manoeuvre cannot prevent all late diagnoses of hip dysplasia. This is because neonatal hip instability is only part of the total spectrum of hip dysplasia, and because the examination requires a relaxed newly-born infant and an experienced examiner. In the Dutch situation, general screening with Ortolani's manoeuvre is not advisable as this will lead to many false-positive and false-negative outcomes due to this neonatal examination being carried out by various physicians and midwives with insufficient experience. Better results may be expected from ultrasound screening at child welfare clinics. This is presently being investigated in a large population study.

This study examined the difference in postoperative bacteriuria in total joint arthroplasty after use of either an indwelling catheter or intermittent catheterization. Previous studies showed a preference for an indwelling catheter over intermittent catheterization to resolve postoperative urinary retention in total joint arthroplasty, but these studies generally used 48 hours of antibiotic prophylaxis. Increasing awareness of costs and bacterial resistance to antibiotics have prompted many centers to reduce prophylaxis to only 1 preoperative dose A prospective, randomized, controlled trial was conducted in primary total hip and primary total knee arthroplasty patients. One dose of cefazolin, 1 g, was administered intravenously immediately preoperatively. Five of 13 (38%) men in the indwelling catheter group and 0 of 14 (0%) men in the intermittent catheterization group developed postoperative bacteriuria (P =.016), and 6 of 33 (18%) women in the indwelling catheter group and 3 of 39 (8%) women in the intermittent catheterization group developed postoperative bacteriuria (not significant). A total of 11 (24%) patients in the indwelling catheter group (n = 46) and 3 (6%) patients in the intermittent catheterization group (n = 53) developed postoperative bacteriuria (P =.018). In this setting with 1-dose antibiotic prophylaxis, intermittent catheterization resulted in a lower incidence of postoperative bacteriuria compared with an indwelling catheter. For men, this difference is significant.

Congenital anterolateral bowing of the lower leg usually is a symptom of (impending) fracture because of congenital pseudarthrosis. This article reports a case of anterolateral bowing of the lower leg that is characterized by spontaneous correction and combination with duplication of the hallux. A review of the literature showed 10 comparable cases. This article is the first report on the magnetic imaging of this entity and describes its differentiation from congenital pseudarthrosis.

20 radiographs of pertrochanteric femoral fractures were classified as to fracture "group" and "sub-group" according to the AO/ASIF Fracture Classification (type 31A) by 15 observers. 3 months later, the same radiographs were reviewed by the same observers. Mean agreement of the observers with the final consensus ranged from 53% (with subgroup classification) to 81% (without subgroup). The mean kappa value for interobserver reliability was 0.33 and 0.34 for classification with subgroup in both observer sessions, respectively. Omission of the subgroup classification resulted in better mean kappa values (0.67 and 0.63, respectively). Mean intraobserver reliability was 0.48 in the fracture "subgroup" and 0.78 in the "group" classification. In conclusion, the results show that the AO/ASIF classification for pertrochanteric fractures is reliable for fracture subgroups 31A1, A2 or A3. The group classification should be used to compare scientific data and determine the best treatment. Further classification of fracture subgroups leads to poor reproducibility of results.

A hernia developed in the region of the inferior lumbar triangle of Petit 1.5 years after a full thickness bone graft had been taken from the part of the iliac crest that forms the base of the triangle.

Ultrasonography has emerged in recent literature as a reliable technique to visualise the infant hip. Its advantages are that non-osseous structures can be seen as well as bone, that a dynamic investigation can be performed, and that it lacks ionising radiation. This article describes the results of a screening study in 307 newborns. 13.4% of all clinically normal (stable) hips showed ultrasound abnormalities. 96.3% of these normalised spontaneously, however. Apparently the natural history of ultrasound abnormalities at birth is relatively mild. Furthermore, in a group of older children, Graf's alpha angle was related to the acetabular index on the radiograph. There was no linear relationship, but a tendency was noted to find higher (better) alpha angles together with lower (better) acetabular indices. Possibly ultrasound is superior to standard radiography in depicting subtle disturbances in ossification of the lateral edge of the acetabulum.