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Fracture healing is a complex physiological process. It involves the coordination of several different types of cells, proteins, and expression of various genes. Bone healing is very essential for fracture management, malfusion, osteomyelitis, removal of bone tumors, joint attachment, and also in joint prothesis. Diverse synthetic and biological grafts are used in bone healing. In this study, we evaluated and compared the effects of nano-bioglass and commercial bioglass on healing of experimental tibial defects in ten white New Zealand rabbits. Three round holes were created in tibial bone with orthopedic drill. One of the hole was left empty as control while the other two holes were filled by experimental grafts. Radiografts were taken after 2 and 6 weeks whereas pathological slides were prepared only after 6 weeks. Radiological and histological evaluation was performed blindly, and the results score were analyzed statistically. The data showed that nano-bioglass is superior to commercial bioglass in bone healing whereas commercial bioglass is better than control.

Purpose The aim of this study was to evaluate the efficacy of rifampin with allogeneic, alloplastic, and heterogeneous bone graft substitutes on osteogenesis of experimentally created bone defects in rat tibias. Materials and methods Twenty-eight male Wistar albino rats were used in this study. In each animal, two bone defects (10 mm length × 3 mm width × 2 mm depth) were created in the left and right tibias, respectively. The animals were divided into four groups. In Group 1, the right defects were irrigated with rifampin alone, and the left defects were irrigated with sterile saline alone. In Group 2, the right defects were filled with rifampin and allogeneic bone graft, and the left defects were filled with allogeneic bone graft alone. In Group 3, the right defects were treated with rifampin and alloplastic bone graft, and the left defects were filled with alloplastic bone graft alone. In Group 4, the right defects were filled with rifampin and heterogeneous bone graft, and the left defects were filled with heterogeneous bone graft alone. Results The animals were sacrified on the 21st postoperative day. Histopathological analysis of samples was performed to evaluate the process of bone regeneration and the presence of spongeous bone, cortex bone, and bone marrow. Bone union ( p = 0.023) and spongeous bone ( p = 0.030) values were higher in Group 1A (rifampin alone) than those in Group 1B (saline alone). Bone union ( p p Conclusions Topical rifampin can accelerate the bone repair process, but the combination of rifampin and allogeneic bone grafts can also reduce new bone formation in osseous defects. Further studies involving long-term follow-up with a larger number of cases and different antibiotic agents should be conducted. These will provide additional data regarding new bone formation, especially in contaminated bone defects, resulting from use of antibiotic-supplemented bone grafts.

The management of nonunions with significant loss of bone remains a very difficult challenge for orthopedic surgeons. Several techniques have been developed, for some with difficult realization, and without convincing result for others. Our study involved ...

A common method to derive both qualitative and quantitative data to evaluate osseointegration of implants is histomorphometry. The present study describes a new image reconstruction algorithm comparing the results of bone-to-implant contact (BIC) evaluated by means ofµCT with histomorphometry data. Custom-made conical titanium alloyed (Ti6Al4V) implants were inserted in the distal tibial bone of female Sprague-Dawley rats. Different surface configurations were examined: Ti6Al4V implants with plasma-polymerized allylamine (PPAAm) coating and plasma-polymerized ethylenediamine (PPEDA) coating as well as implants without surface coating. After six weeks postoperatively, tibiae were explanted and BIC was determined byµCT (3D) and afterwards by histomorphometry (2D). In comparison to uncoated Ti6Al4V implants demonstrating low BIC of 32.4% (histomorphometry) and 51.3% (µCT), PPAAm and PPEDA coated implants showed a nonsignificant increase in BIC (histomorphometry: 45.7% and 53.5% andµCT: 51.8% and 62.0%, resp.). Mean BIC calculated byµCT was higher for all surface configurations compared to BIC detected by histomorphometry. Overall, a high correlation coefficient of 0.70 (p<0.002) was found between 3D and 2D quantification of BIC. TheμCT analysis seems to be suitable as a nondestructive and accurate 3D imaging method for the evaluation of the bone-implant interface.

Several reconstructive procedures have been used in management of large tibial bone defects including bone graft, bone transport (distraction osteogenesis) using various external fixators, and vascularized bone graft. Each of these procedures has its limitations and complications. The study describes gradual medial fibular transfer using Ilizarov external fixators in management of patients with large tibial defect, either following infection or trauma. Between May 2011 and June 2013, 14 patients were prospectively included in the current study. The inclusion criteria were large tibial defect due to trauma or infection with severe soft tissue compromise, and small or poor tibial bone remnants making bone lengthening difficult. Exclusion criteria were patients with vascular or nerve injuries. The average age of the patients was 31.64 (± 6.5) years. Medial fibular transfer was done for all patients using Ilizarov at a rate of 0.5 mm twice daily. Iliac bone graft was used in all patients after the transfer. The average segmental bone defect of the tibia was (13.2 ± 2.6), ranging between 8 and 18.6 cm. Union was achieved in all patients with average fixator time was 32.42 (± 4.32) weeks. Average follow-up after removal of the fixator was 40.5 (± 6.9) months. Gradual fibular transfer by Ilizarov external fixator is a reliable technique in management of post-traumatic and post-infection large tibial bone defects with good clinical outcome, and with few complications.

Good to excellent results at long-term follow-up have been published for bone-patellar tendon-bone (BTB) graft anterior cruciate ligament reconstruction. Fixation using screws historically has been the most common choice for femoral and tibial bone blocks, but screws present several disadvantages, which include the risk of blowout (for which prevention implies having to shift the position of the tunnel anteriorly), as well as lesions of the bone blocks and tendons. This article describes a technique using Pullup BTB adjustable-loop length suspensory fixation (SBM, Lourdes, France) on the femoral and tibial sides. The graft is harvested and prepared classically. This device combines the advantages of suspensory fixation (precise position of the tunnel, high tensile strength), with the advantages of the adjustable loop (control of bone block position within the femoral tunnel, possibility of retightening the graft) and allows for double passage of the loop through each bone block for increased safety. So, it could represent an interesting and secure option for anatomic reconstruction of the anterior cruciate ligament when a BTB graft is chosen.

The aim of this study was to evaluate the clinical and functional outcomes of patients with large post-traumatic tibial bone defects managed by double-level bone transport using the Ilizarov technique. We retrospectively reviewed 16 patients of 39.1 years (range, 16.0–65.0 years). The bone defects averaged 10.9 ± 3.8 cm (range: 6.0 cm–20.0 cm) after radical resection and were managed by double-level bone transport. Bone and functional results were evaluated according to the ASAMI criteria. The mean duration of follow-up after frame removal was 29.5 ± 1.8 months (range, 12.0–36.0 months). All patients achieved complete union in both the regenerates and the docking site and eradication of infection. The mean bone transport time was 55.6 ± 23.7 days (range, 30.0–125.0 days). The mean external fixation time was 12.0 ± 3.9 months (range, 5.0–18.0 months), and the mean external fixation index was 1.1 ± 0.3 months/cm (rang, 0.8–2.0 months/cm). The bone results were excellent in ten patients and poor in six patients. The functional results were excellent in 12 patients and good in four patients. Double-level bone transport is a safe, reliable, and successful method for large post-traumatic tibial bone defects. Furthermore, this technique can reduce bone transport time, time in frame, and total treatment time in one stage.

Objective To compare the outcomes of bone transport and bone shortening-lengthening by Ilizarov technique for treatment of tibial bone and soft-tissue defects. Methods Fifty patients with tibial bone and soft-tissue defects were treated by Ilizarov technique from January 2007 to June 2016. Two subgroups were treated by either bone transport (group A) containing 28 cases or bone shortening-lengthening (group B) including 22 cases. Results Bony union was achieved at the distracted sites with a mean of 236 days in group A, while 240 days in group B, showing no significant difference ( t = −0.931, P = 0.308). The mean fixation index was 3.91 d/mm and 3.92 d/mm, respectively. There was no obvious difference ( t = 2.839, P = 0.006) of the mean union time at the docking sites with 376 days and 320 days, respectively. According to the Paley's criterion, 21 patients had excellent bony union and 5 good in group A, as compared to 18 excellent and 4 good in group B, but no significant difference ( X 2 = −0.308, P = 0.741) was observed. The functional results were excellent in 11 patients, good in 10 and fair in 7, as well as 15 complications in group A, compared with 7 excellent, 10 good and 5 fair, together with 12 complications in group B, and there were no remarkable difference ( X 2 = −0.323, P = 0.751; X 2 = −0.590, P = 0.562). Conclusion Overall, the outcomes are similar of bone transport or bone shortening-lengthening by using Ilizarov technique for treatment of tibial bone and soft-tissue defects, although the latter has less union time and higher healing rate.

This randomized, controlled, high-intensity strength and sprint training trial in middle-aged and older male sprint athletes showed significant improvements in mid-tibial structure and strength. The study reveals the adaptability of aging bone, suggesting that through a novel, intensive training stimulus it is possible to strengthen bones during aging. High-load, high-speed and impact-type exercise may be an efficient way of improving bone strength even in old age. We evaluated the effects of combined strength and sprint training on indices of bone health in competitive masters athletes, who serve as a group of older people who are likely to be able to participate in vigorous exercise of this kind. Seventy-two men (age 40–85) were randomized into an experimental (EX, n = 40) and a control (CTRL, n = 32) group. EX participated in a 20-week program combining heavy and explosive strength exercises with sprint training. CTRL maintained their usual, run-based sprint training schedules. Bone structural, strength and densitometric parameters were assessed by peripheral QCT at the distal tibia and tibial midshaft. The intervention had no effects on distal tibia bone traits. At the mid-tibia, the mean difference in the change in cortical thickness (ThCO) in EX compared to CTRL was 2.0% (p = 0.007). The changes in structure and strength were more pronounced in the most compliant athletes (training adherence >75%). Compared to CTRL, total and cortical cross-sectional area, ThCO, and the area and density-weighted moments of inertia for the direction of the smallest flexural rigidity (I minA , I minD ) increased in EX by 1.6–3.2% (p = 0.023–0.006). Polar mass distribution analysis revealed increased BMC at the anteromedial site, whereas vBMD decreased (p = 0.035–0.043). Intensive strength and sprint training improves mid-tibia structure and strength in middle-aged and older male sprint athletes, suggesting that in the presence of high-intensity loading exercise, the adaptability of the bone structure is maintained during aging.

Purpose To clarify 1) the force sharing between two portions of BTB graft in anatomic rectangular tunnel (ART) reconstruction and 2) the knee stability in ART technique under anterior tibial load. Methods Eleven fresh cadaveric knees were used. First, anterior-posterior (A-P) laxity was measured with Knee Laxity Tester ® in response to 134 N of A-P tibial load at 20° on the normal knees. Then ART ACL reconstruction was performed with a BTB graft. For graft, the patellar bone plug and tendon portion was longitudinally cut into half as AM and PL portions. After the tibial bone plug was fixed at femoral aperture, AM/PL portions were connected to the tension-adjustable force gauges at tibial tubercle, and were fixed with 10 N to each portion at 20°. Then the tension was measured 1) under anterior tibial load of 134 N at 0, 30, 60, and 90°, and 2) during passive knee extension from 120 to 0°. Next the graft tension was set at 0, 10, 20, 30, or 40 N at 20°, and the A-P laxity was measured by applying A-P load of 134 N. By comparing the laxity for the normal knee, the tension to restore the normal A-P laxity (LMP) was estimated. Results The AM force was significantly smaller at 0° and larger at 90° than the PL force under anterior load, while the force sharing showed a reciprocal pattern. During knee extension motion, the tension of both portions gradually increased from around 5 N to 20–30 N with knee extended. And the LMP was 1.6 ± 1.0 N with a range from 0.3 to 3.5 N. Conclusion The pattern of force sharing was similar to that in the normal ACL in response to anterior tibial load and during passive knee extension motion. LMP in this procedure was close to the tension in the normal ACL. Level of evidence Level IV, a controlled-laboratory study.

Medical implants of fixed size cannot accommodate normal tissue growth in children and often require eventual replacement or—in some cases—removal, leading to repeated interventions, increased complication rates and worse outcomes. Implants that can correct anatomical deformities and accommodate tissue growth remain an unmet need. Here, we report the design and use of a growth-accommodating device for paediatric applications that consists of a biodegradable core and a tubular braided sleeve, with inversely related sleeve length and diameter. The biodegradable core constrains the diameter of the sleeve, and gradual core degradation following implantation enables sleeve and overall device elongation to accommodate tissue growth. By means of mathematical modelling and ex vivo experiments using harvested swine hearts, we demonstrate the predictability and tunability of the behaviour of the device for disease- and patient-specific needs. We also used the rat tibia and the piglet heart valve as two models of tissue growth to demonstrate that polymer degradation enables device expansion and growth accommodation in vivo. An implantable device consisting of a biodegradable core and a tubular braided sleeve autonomously elongates to accommodate tissue growth, as shown with prototypes implanted on a rat tibial bone and a piglet heart valve.

In this paper, we present a spiral loop type antenna, implanted in the tibial bone. The antenna has been designed for fabrication on commercially available RT Duroid 6010 (ɛr=10.2) substrate and encapsulated in biologically compatible Polydimethylsiloxane (PDMS) material (ɛr=2.6). The antenna has a footprint of 2.6 mm × 2.6 mm and a height of 1.94 mm. The antenna operates at the 2.4 GHz ISM band with the peak gain of -36.2 dBi.

Largest, single-centre study of clinical and functional outcomes of patients who underwent endoprosthetic replacement (EPR) for aggressive distal tibial bone tumours.Retrospective observational study of eight patients was undertaken.Median follow-up was 77 months (range 13-276). Cumulative five and ten year survival was 63% and 42% respectively. Three patients developed either disease recurrence or metastases post-surgery. One patient developed deep infection requiring washout and suppressive antibiotics. No patients required revision surgery. The median MSTS score at last follow up was 66%.EPR of the distal tibia is a viable option and provides good function outcomes.

An experiment was carried out with the objective of determining the bioavailability of calcium phosphate nanoparticles by supplementing calcium phosphate nanoparticles at graded levels from 50 to 100% of phosphorus content to the standard source (Dicalcium phosphate - coarse particle) at 10 per cent increment. Tibial bone morphometry, bone and serum mineral profile and carcass characters in broiler chicken were studied with mash form of feed in 70 male broiler chicks (Cobb 400) from day 1 to 28 indicated that the there was no significant variation in the parameters studied. The tibial bone ash, calcium and phosphorus content are unison for both the control and 50% calcium phosphate nanoparticles supplemented groups. The results indicated that the bioavailability of phosphorus in calcium phosphate nanoparticles was 200 per cent when compared to dicalcium phosphate. This finding may help the poultry managers to minimize the feed transport cost and also minimize the mineral wastages.

Many studies have assessed the effects of either low-level laser therapy (LLLT) or low-intensity pulsed ultrasound (LIPUS) on bone repair; however, an evaluation of the combination of these modalities (LLLT + LIPUS) has not yet been considered. The aim of this study was to demonstrate the effects of LLLT + LIPUS on bone repair. Male Wistar rats (n = 128; four groups of 32) were used; the animals underwent a partial tibial bone osteotomy. One group had the osteotomized limb treated with LLLT, the second group with LIPUS, and the third group with the combined treatment protocols of the LLLT and LIPUS groups; the fourth group received no further treatment (control). Each group was divided into two subgroups for assessment at two different time-points, 14 and 21 days. After the completion of treatment rats were sacrificed and the tibias submitted to a three-point bending test or to histomorphometric analysis. Histological evaluation showed increased bone trabeculae, increased vascularization, and decreased inflammation in the LLLT + LIPUS group. Mechanical evaluation revealed increased biomechanical properties including maximum force, maximum stress, and stiffness, in the LLLT + LIPUS group. Combined LLLT + LIPUS treatment enhanced bone healing both histologically and mechanically, shortening the length of the treatment period, when compared to treatment with LLLT or LIPUS alone.

The purpose of this study was to investigate screws and cement for large tibial bone defects during primary TKA. Of 14,686 consecutive primary TKAs performed between December 1988 and February 2010, 256 received screws and cement for tibial defects. Cox regression was used for the analysis. 20-year survival probability was 0.9897 (screws) and 0.9339 (no screws) (P = .4225 log-rank). Tibial bone condition was significantly worse in knees receiving screws (P < .0001) with 73.0% having defects in the screws group and 3.4% (P < .0001) for non-screws. Radiolucency appeared in 13.7% (screws) and 6.4% (no screws) postoperatively. Screws were $137 each, wedges $910 to $2240. Knees with tibial defects and screws performed similarly if not better than knees without defects at substantially lower cost than alternatives.

Frontal plane varus deviation is one of the mechanisms hypothesized to be involved in the pathogenesis of medial compartment osteoarthritis of the knee. But only a few authors have suggested a role for tibial and femoral torsion. In the current study, CT scan was used to measure bone torsion. The torsional morphology of the lower limb was defined by the “index of cumulative torsions” (ICT). The resulting values were compared to the frontal angular deviation data. The effects of tibial and femoral torsion on the position of the lower limb during the stance phase of walking and the consequences for the knee are discussed.

The purpose of this study was to evaluate tunnel position and width in failed primary single-bundle (SB) anterior cruciate ligament (ACL) reconstructions. It was hypothesized that both femoral and tibial bone tunnels are frequently malplaced in terms of a partially anatomic position in the setting of failed SB ACL reconstruction. Patients with recurrent instability following isolated SB ACL reconstruction using hamstring tendon autografts, undergoing revision ACL surgery, were retrospectively included. Further inclusion criteria were age >18 years and availability of preoperative computed tomography (CT) scans and radiographs of the affected knee. Patients with multiligamentous instabilities as well as incomplete or poor radiographs were excluded. Tunnel position was evaluated according to the method described by Harner et al. and Staubli and Rauschning. Tunnel width was determined on CT scans perpendicular to the bone tunnel axis at three different heights of each bone tunnel. Eighty-two patients met the inclusion criteria and were considered for radiological analysis. Femoral tunnels were graded as anatomic in 60% (49 of 82) of all cases. In the remaining 40% (33/82), 27% of the tunnels were placed partially anatomic and 13% were graded as non-anatomic. Tibial tunnel placement was found to be anatomic in 54% (44/82) of all cases, partially anatomic in 45% and non-anatomic in 1% of the cases. No statistically significant difference between anatomic or partially anatomic tunnel position and tunnel diameter, neither for the femoral nor for the tibial side, was observed (n.s.). The present study demonstrates that there is a high incidence of partially anatomic placed tunnels in failed SB ACL reconstruction. Tunnel width was not associated with tunnel position. Clinically, partially anatomic bone tunnels frequently require a staged procedure with bone grafting and subsequent ACL revision surgery. Thus, surgeons should carefully analyse tunnel position and width preoperatively to properly plan ACL revision surgery.

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Background: The incidence of adolescent overuse injuries, including bone stress injuries (BSIs), is on the rise. The identification of a BSI in the early stages is key to successful treatment. The Shin Pain Scoring System (SPSS) was developed to aid clinicians in identifying patients with a BSI. Hypothesis: The SPSS will correlate with magnetic resonance imaging (MRI) grading of a BSI in an adolescent population. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Enrolled in this study were 80 adolescent high school athletes between the ages of 13 and 18 years participating in a variety of sports with more than 1 week of atraumatic shin pain. The SPSS questionnaire was completed for each participant, and physical examination findings were recorded. Each question and physical examination item was allotted a point value, which totaled 29 points. Radiographs and MRI scans of both lower legs were obtained for each participant. The SPSS score was statistically analyzed using logistic regression, a classification matrix, and a 2 × 2 contingency table to evaluate validity and predictability. Results: Logistic regression analysis of our data determined that 3 categories of SPSS scores provided the highest diagnostic value when compared with MRI grading based on the Fredericson classification (0-4). The SPSS correctly identified 43.5% of injuries for category 1 (MRI grades 0-1), 62.5% for category 2 (MRI grade 2), and 50.0% for category 3 (MRI grades 3-4). Overall, the SPSS correctly identified the degree of BSI in 54.4% of all tibias studied. Binary analysis for validity demonstrated a sensitivity of 96%, specificity of 26%, positive predictive value of 76%, and negative predictive value of 71% for the SPSS relative to the “gold standard” MRI results. Conclusion: The SPSS is a potentially valid method to identify tibial BSIs, given the sensitivity and negative and positive predictive values. It also provides helpful categorization to alert clinicians to the presence of a BSI and direct further diagnostics and/or interventions. The SPSS should be considered as an additional tool to use when evaluating adolescents with atraumatic tibial BSIs.

Anterior cruciate ligament (ACL) reconstruction is well established in a single bundle or double bundle technique using hamstrings, quadriceps tendon or patellar tendon. Based on new anatomical findings from the authors about flat ACL and c-shaped tibial insertion, a novel concept was developed to reconstruct the ACL in a more anatomical way. This article describes the new technique of flat ACL reconstruction with graft preparation and creation of flat femoral and tibial bone slits.

Introduction A calcium phosphate (CaP)-hybridized tendon graft improves tendon-to-bone healing. The purpose of the study was to evaluate the progression of morphological changes in the femoral and tibial bone tunnels after anatomic single-bundle anterior cruciate ligament (ACL) reconstruction using the CaP-hybridized tendon graft versus an untreated tendon graft during 2 years of follow-up. Hypothesis We hypothesized that the CaP-hybridized tendon graft would prevent the progression of bone tunnel enlargement compared with the untreated tendon graft. Patients and methods The CaP group comprised 19 patients, while the conventional group comprised 18. Computed tomography was performed at postoperative 1 week, 1 year, and 2 years. The bone tunnel enlargement and tunnel translation at the aperture of the femoral and tibial tunnels were analyzed. Results In the CaP group, the femoral bone tunnel did not expand during 2 years of follow-up. In the conventional group, the femoral bone tunnel diameters at postoperative 1 year and 2 years were enlarged compared with postoperative 1 week, and the proximal and distal walls of the femoral bone tunnel shifted proximally and distally, respectively. The femoral bone tunnel in the CaP group was smaller than that in the conventional group at 1 year postoperatively. Although the tibial bone tunnels expanded for up to 1 year postoperatively in both groups, the expanded bone tunnel reduced during 2 years of follow-up only in the CaP group. Discussion In anatomic single-bundle ACL reconstruction, the femoral bone tunnel in the CaP group did not expand or progress with time compared with the conventional group, while the tibial bone tunnel in the CaP group expanded for up to 1 year postoperatively and then reduced for up to 2 years postoperatively. The CaP-hybridized tendon can prevent the progression of bone tunnel enlargement. Level of evidence Level II, low-powered prospective randomized trial.

Objective: The aim of this study was to evaluate the potential effect of the methanolic extract of plantGlycyrrhiza glabraroots on bone mineral density and femoral bone strength of ovariectomized rats.Methods: Thirty 10-month-old Wistar rats were randomly separated into three groups of ten, Control, Ovariectomy and Ovariectomy-plus-Glycyrrhiza in their drinking water. Total and proximal tibial bone mineral density was measured in all groups before ovariectomy (baseline) and after 3 and 6 months post ovariectomy. Three-point-bending of the femurs and uterine weight and histology were examined at the end of the study.Results: No significant difference was noted in bone density percentage change of total tibia from baseline to 3 months between Control and Ovariectomy-plus-Glycyrrhiza groups (+5.31% ± 4.75 and +3.30% ± 6.31 respectively,P = non significant), and of proximal tibia accordingly (+5.58% ± 6.92 and +2.61% ± 13.62,P = non significant) demonstrating a strong osteoprotective effect. There was notable difference in percentage change of total tibia from baseline to 6 months between groups Ovariectomy and Ovariectomy-plus-Glycyrrhiza (−13.03% ± 5.11 and −0.84% ± 7.63 respectively,P P Glycyrrhiza glabraextract in preserving bone density of the Ovariectomy-plus-Glycyrrhiza group. Three-point-bending did not reveal any statistically significant difference between Ovariectomy and Ovariectomy-plus-Glycyrrhiza groups. Uterine weights of the Ovariectomy-plus-Glycyrrhiza group ranged between the other two groups with no statistically significant difference to each.Conclusions:Glycyrrhiza glabraroot extract notably protected tibial bone mineral density loss in Ovariectomy-plus-Glycyrrhiza rats in comparison with ovariectomized rats, but did not improve biomechanical strength.

An experiment was carried out with 21-d old weaned Wistar rats (n=60) to assess the polyphenols response to dietary manipulations. The rats were divided into six groups with five replicated having two in each. The rats were fed with two different types of cereal sources (corn vs. rice-sorghum combined) as soybean meal served as protein source in both cereal categories. The treatment groups included cornsoybean meal without polyphenol extract (PPE) supplementation (T1), corn-soybean meal with 50 ppm of PPE (T2), corn-soybean meal with 100 ppm of PPE (T3), rice-sorghum-soybean meal diet without PPE (T4), rice-sorghum-soybean meal diet with 50 ppm of PPE (T5) and rice-sorghum-soybean meal diet with 100 ppm of PPE (T6). The rats were maintained under polypropylene cages and reared for 45 d under air-conditioned laboratory animal house. The body weight of rats was significantly higher in corn based diet supplemented with PPE at 50 and 100 ppm than the rice-sorghum based diet. The supplementation of PPE significantly reduced the serum total cholesterol, triglycerides and plasma glucose content in rats irrespective of cereal sources. The organ weights and tibial bone weight did not affect by the combination of cereal sources and PPE levels. The caecal and colon aerobic, E. coli and lactobacillus population remained unaffected by the diet composition and PPE levels. It could be concluded that supplementation of pomegranate peel extract exhibited better performance with corn-soybean meal based diet.

Introduction: Bone defects are a challenging problem encountered occasionally during primary knee arthroplasty. These defects should be meticulously addressed so as to avoid malalignment and premature loosening and failure. Out of the many options available to deal with these defects, impaction bone grafting provides a more biological solution, which is especially important in case of primary knees.Materials and methods: A retrospective analysis was done and patients with severe varus deformity of more than 20 degrees who had undergone primary knee arthroplasty with impaction bone grafting of the tibial condyle defect were followed up.Results: Between 2008 and 2014, out of the 1124 patients who underwent primary total knee arthroplasty, only 26 knees in 23 patients met the inclusion criteria. The amount of varus deformity ranged from 20 to 35 degrees. Follow-up ranged from 3 to 8 years with an average of 6 years. The average pre-operative Knee Society Score (KSS) and Western Ontario McMaster Universities (WOMAC) score were 24.2 and 78, respectively. There were significant improvements in the post-op scores, with the average KSS being 90.2 and the WOMAC being 38.Conclusion: Impaction bone grafting provides an invaluable option to the orthopedic surgeon for managing bone defects, especially in case of primary knee arthroplasty as it reconstitutes the bone stock.

1. Growth and skeletal responses to different dietary concentrations of riboflavin and biotin were compared in turkey poults from hatch to 21 d of age. The birds were fed on a turkey starter diet with different concentrations of supplementary riboflavin (0, 20 and 40 mg/kg) and biotin (0, 0.3 and 0.6 mg/kg) in a factorial design.2. Poults fed on diets with no supplementary riboflavin had poor gait scores, decreased times to sit and higher rates of culling compared to poults fed on the control diet (20 mg biotin and 0.3 mg riboflavin/kg diet). Histologically, riboflavin deficiency was associated with a peripheral neuropathy similar to that described previously in chicks and, unexpectedly, in growth plate abnormalities.3. Tibiae of poults fed on the control diet were larger, more dense, stronger and stiffer than the diets with no supplementary riboflavin.4. Increasing supplementary biotin in poults fed on diets with no supplementary riboflavin was associated with a decrease in tibia weight, density, strength and stiffness.5. The results demonstrated that riboflavin deficiency in fast-growing turkey poults was associated with growth retardation, growth plate disturbance and peripheral nerve dysfunction leading to an inability to walk.

There still is no consensus on the treatment of choice in revision knee arthroplasty associated with severe femoral and/or tibial bone loss. A total of 44 patients underwent revision knee arthroplasty procedures using porous tantalum cones (TM cones) to reconstruct tibial and/or femoral bone defects. At latest follow up after 37 months (32-48), 38 patients remained in the study. Tibial and femoral bone loss was categorized according to the AORI-Classification. The average preoperative KSS improved from 34 (range, 6-90) to 63 points (range, 7-90 points). The VAS improved from 7.5 to 4.8. Two patients required a re-revision due to aseptic loosening. There was no correlation between the different types of knee prosthesis implanted. Our study shows favourable clinical and radiological outcomes using TM cones in managing significant bone loss in revision total knee surgery.

Stress shielding resulting in diminished bone density following total knee replacement (TKR) may increase the risk of migration and loosening of the prosthesis. This retrospective study was designed to quantify the effects of the method of fixation on peri-prosthetic tibial bone density beneath cemented and uncemented tibial components of similar design and with similar long-term survival rates. Standard radiographs taken between two months and 15 years post-operatively were digitised from a matched group of TKRs using cemented (n = 67) and uncemented (n = 67) AGC tibial prostheses. Digital radiograph densitometry was used to quantify changes in bone density over time. Age, length of follow-up, gender, body mass index and alignment each significantly influenced the long-term pattern of peri-prosthetic bone density. Similar long-term changes in density irrespective of the method of fixation correlated well with the high rate of survival of this TKR at 20 years, and suggest that cemented and uncemented fixation are both equally viable.Cite this article: Bone Joint J 2013;95-B:911–16.

Background:Glenoid reconstruction with distal tibial allografts offers the theoretical advantage over Latarjet reconstruction of improved joint congruity and a cartilaginous articulation for the humeral head.Hypothesis/Purpose:To investigate changes in the magnitude and location of glenohumeral contact areas, contact pressures, and peak forces after (1) the creation of a 30% anterior glenoid defect and subsequent glenoid bone augmentation with (2) a flush Latarjet coracoid graft or (3) a distal tibial osteochondral allograft. It was hypothesized that the distal tibial bone graft would best normalize glenohumeral contact areas, contact pressures, and peak forces.Study Design:Controlled laboratory study.Methods:Eight cadaveric shoulder specimens were dissected free of all soft tissues and randomly tested in 3 static positions of humeral abduction with a 440-N compressive load: 30°, 60°, and 60° of abduction with 90° of external rotation (ABER). Glenohumeral contact area, contact pressure, and peak force were determined sequentially using a digital pressure mapping system for (1) the intact glenoid, (2) the glenoid with a 30% anterior bone defect, and (3) the glenoid after reconstruction with a distal tibial allograft or a Latarjet bone block.Results:Glenoid reconstruction with distal tibial allografts resulted in significantly higher glenohumeral contact areas than reconstruction with Latarjet bone blocks in 60° of abduction (4.87 vs 3.93 cm2, respectively; P < .05) and the ABER position (3.98 vs 2.81 cm2, respectively; P < .05). Distal tibial allograft reconstruction also demonstrated significantly lower peak forces than Latarjet reconstruction in the ABER position (2.39 vs 2.61 N, respectively; P < .05). Regarding the bone loss model, distal tibial allograft reconstruction exhibited significantly higher contact areas and significantly lower contact pressures and peak forces than the 30% defect model at all 3 abduction positions. Latarjet reconstruction also followed this same pattern, but differences in contact areas and peak forces between the defect model and Latarjet reconstruction in the ABER position were not statistically significant ( P > .05).Conclusion:Reconstruction of anterior glenoid bone defects with a distal tibial allograft may allow for improved joint congruity and lower peak forces within the glenohumeral joint than Latarjet reconstruction at 60° of abduction and the ABER position. Although these mechanical properties may translate into clinical differences, further studies are needed to understand their effects.Clinical Relevance:Glenoid bone reconstruction with a distal tibial osteochondral allograft may result in significantly improved glenohumeral contact areas and significantly lower glenohumeral peak forces than reconstruction with a Latarjet bone block, which could play a role in improving postoperative outcomes after glenoid reconstruction.

Patient matched instrumentation is a new operative tool in the field of total knee arthroplasty. Custom made cutting blocks are designed to perform distal femoral and tibial bone cuts according to a pre-operative planning. This study evaluates the Visionaire system of Smith & Nephew. Thirty-one patients, operated with the Visionaire technique, were compared to an equal control group for different clinical and radiographic outcome parameters. Between both groups, no statistical significant difference could be found in post-operative pain, satisfaction, functional outcome, hospital stay, blood loss, radiographic alignment and precision of bone cuts. Only tibial plateau backslope can be created with more precision in the Visionaire group. But there was a statistical significant difference for residual flexion deformity after a mean follow-up time of 200 days.

During open-wedge high tibial osteotomy, fracture occurring in the insufficient osteotomy before distraction of the osteotomy gap is an important complication. The objective of this study was to evaluate bone mineral density (BMD) around the proximal tibiofibular joint (PTFJ) and the osteotomy hinge. The hypotheses of this study were (1) BMD would be higher in the level of PTFJ, compared with that of above—or below—the level of PTFJ, (2) BMD of the posterolateral side of the hinge would be higher than that of the anterior or lateral side. Computed tomography was used to determine the BMD of the lateral aspect of the proximal tibia around the PTFJ and the osteotomy hinge. The means and standard deviations of the regions of interest were measured. To verify the first hypothesis, a coronal reconstructed image showing the beginning of the fibula head was used and an axial reconstructed image showing the beginning of the fibula head was used for verification of the second hypothesis. BMD of the lateral aspect of the proximal tibia at the level of the PTFJ was significantly higher, compared with that of above (P = 0.04)—or below (P

Mechanical properties of tibial bone at compressive strain rates of 50–200/s are obtained through a Split Hopkinson pressure bar. Cylindrical specimens of 12–15 mm diameter and 2–5 mm thickness were prepared. The Young's moduli are calculated from linear portion of stress–strain curves. For both cortical and cancellous part of the bones, the Young's modulus was found to increase with the increasing strain rates. Also for both cancellous and cortical bones, the Young's modulus increases consistently with increase in densities.

Background: Autologous periosteal grafting is used as treatment for articular cartilage defect. Objective: To study the effect of bone morphogenetic protein (BMP) on articular cartilage regeneration following periosteal grafting. Methods: 16 healthy 15 week-old New Zealand white rabbits of both sexes (32 knees) were randomly divided into experimental group (group A) and control group (group B). A4.0 mmdiameter full-thickness articular cartilage defect was created in the femoral intercondylar fossa in all rabbits. Following this, a4.0 mmdiameter section of the periosteum was harvested from the anteromedial part of the upper tibial bone. In group A (eight rabbits, 16 knees), the cartilage defect was covered with periosteum, into which 20 μg BMP and 20% Pluronic were injected. In group B (eight rabbits, 16 knees), the cartilage defect was covered with periosteum, into which the same dosage of 0.9% NS (Normal saline) and 20% Pluronic were injected. All rabbits were sacrificed at 4, 8, and 12 weeks postoperatively, the cartilage defect areas were examined macroscopically and microscopically, and the morphology of the chondrocytes and collagen fibers were examined by scanning electron microscopy. Results: The filling of the defects with regenerated tissue was observed in both the group. The most notable improvement was that the cartilage regeneration in group A was obviously superior to that in group B, with the total histological score in group A significantly higher. Conclusion: BMP is an effective factor that could promote regeneration of articular cartilage and lead to successful cartilaginous resurfacing following periosteal grafting

Background Fast bowling in cricket is an important skill that imparts mechanical loads on limbs. The differential loading patterns involved in bowling affect the peripheral limb bone status. Objective To evaluate bone properties using quantitative ultrasound densitometry (QUS), among fast cricket bowlers in comparison with nonathletes. A secondary objective was designed to find correlation between QUS parameters and bonespecific physical activity questionnaire (BPAQ). Methodology A total of 80 subject, 40 fast cricket bowlers of both gender (20 male and 20 female) and 40 nonathletes (20 male and 20 female) were included in our study and all are aged between 20 and 25 years. Bone speed of sound (SOS) was measured bilaterally at the distal radius and the mid tibia using Sunlight OmnisenseTM device. Results There was a significant difference between dominant side and nondominant side radial SOS (p < 0.05) and tibial SOS (p < 0.05) in cricket bowlers favoring dominant radial bone SOS and nondominant tibial bone SOS which was not found in nonathletes. Significant difference in dominant radial bone SOS values (p < 0.05) and nondominant tibial bone SOS (p < 0.05) values existed between cricket bowlers and controls. Positive correlation was found between tibial SOS and past BPAQ in all subjects. Conclusion QUS parameters were significantly higher in young cricket bowlers with greater values observed in the dominant arm and leading foot, thus reflecting the osteogenic effect that occurs due to the nature of the game. Further BPAQ is significantly correlated with lower limb bone properties as measured by QUS at mid shaft tibia. How to cite this article Shenoy S, Parthasarathy S, Sandhu JS. Quantitative Ultrasound Densitometry in University Level Cricket Fast Bowlers and Nonathletes. J Postgrad Med Edu Res 2013;47(2):83-89.

The response to loading of human articular cartilage as assessed by magnetic resonance imaging (MRI) remains to be defined in relation to histology and biomechanics. Therefore, an MRI-compatible whole-knee joint loading device for the functional in situ assessment of cartilage was developed and validated in this study. A formalin-fixed human knee was scanned by computed tomography in its native configuration and digitally processed to create femoral and tibial bone models. The bone models were covered by artificial femoral and tibial articular cartilage layers in their native configuration using cartilage-mimicking polyvinyl siloxane. A standardized defect of 8 mm diameter was created within the artificial cartilage layer at the central medial femoral condyle, into which native cartilage samples of similar dimensions were placed. After describing its design and specifications, the comprehensive validation of the device was performed using a hydraulic force gauge and digital electronic pressure-sensitive sensors. Displacement-controlled quasi-static uniaxial loading to 2.5 mm $$(\delta _{2.5})$$ and 5.0 mm $$(\delta _{5.0})$$ of the mobile tibia versus the immobile femur resulted in forces of $$141 \pm 8$$ N $$(\delta _{2.5})$$ and $$906 \pm 38$$ N $$(\delta _{5.0})$$ (on the entire joint) and local pressures of $$0.680 \pm 0.088$$ MPa $$(\delta _{2.5})$$ and $$1.050 \pm 0.100$$ MPa $$(\delta _{5.0})$$ (at the site of the cartilage sample). Upon confirming the MRI compatibility of the set-up, the response to loading of macroscopically intact human articular cartilage samples ( $$n=5$$ ) was assessed on a clinical 3.0-T MR imaging system using clinical standard proton-density turbo-spin echo sequences and T2-weighted multi-spin echo sequences. Serial imaging was performed at the unloaded state $$(\delta _{0})$$ and at consecutive loading positions (i.e. at $$\delta _{2.5}$$ and $$\delta _{5.0})$$ . Biomechanical unconfined compression testing (Young’s modulus) and histological assessment (Mankin score) served as the standards of reference. All samples were histologically intact (Mankin score, $$1.8 \pm 1.3$$ ) and biomechanically reasonably homogeneous (Young’s modulus, $$0.42 \pm 0.14$$ MPa). They could be visualized in their entirety by MRI and significant decreases in sample height [ $$\delta _{0}$$ : $$2.86 \pm 0.25$$ mm; $$\delta _{2.5}$$ : $$2.56 \pm 0.25$$ mm; $$\delta _{5.0}$$ : $$2.02 \pm 0.16$$ mm; $$p

Purpose: Ultraviolet (UV)-mediated photofunctionalization technology is intended to enhance the osseointegration capability of titanium implants. There are concerns about orthodontic anchor screws loosening under immediate loading protocols in adolescent orthodontic treatment. The purpose of this in vivo study was to evaluate the effects of photofunctionalization on the intrabony stability of orthodontic titanium anchor screws and bone-anchor screw contact under immediate loading in growing rats. Materials and Methods: Custom-made titanium anchor screws (1.4 mm in diameter and 4.0 mm in length) with or without photofunctionalization pretreatment were placed on the proximal epiphysis of the tibial bone in 6-week-old male Sprague-Dawley rats and were loaded immediately after placement. After 2 weeks of loading, the stability of the anchor screws was evaluated using a Periotest device, and the bone-anchor screw contact ratio (BSC) was assessed by a histomorphometric analysis using field-emission scanning electron microscopy. Results: In the unloaded group, Periotest values (PTVs) were ~25 for UV-untreated screws and 13 for UVtreated screws (P < .01), while in the immediate-loading group, PTVs were 28 for UV-untreated screws and 16 for UV-treated screws (P < .05). Significantly less screw mobility was observed in both UV-treated groups regardless of the loading protocol. The BSC was increased ~1.8 fold for UV-treated screws, compared with UV-untreated screws, regardless of the loading protocol. Conclusion: Photofunctionalization enhanced the intrabony stability of orthodontic anchor screws under immediate loading in growing rats by increasing boneanchor screw contact.

Low-intensity whole-body vibration (LIWBV) may stimulate bone healing, but the involvement of vascular ingrowth, which is essential for bone regeneration, has not been well examined. We thus investigated the LIWBV effect on vascularization during early-stage bone healing. Mice aged 13 weeks were subjected to cortical drilling on tibial bone. Two days after surgery (day 0), mice were exposed daily to sine-wave LIWBV at 30 Hz and 0.1 g peak-to-peak acceleration for 20 min/day (Vib) or were sham-treated (sham). Following vascular casting with a zirconium-based contrast agent on days 6, 9, or 12 and sacrifice, vascular and bone images were obtained by K-edge subtraction micro-CT using synchrotron lights. Bone regeneration advanced more in the Vib group from days 9 to 12. The vascular volume fraction decreased from days 6 to 9 in both groups; however, from days 9 to 12, it was increased in shams, while it stabilized in the Vib group. The vascular volume fraction tended to be or was smaller in the Vib group on days 6 and 12. The vessel number density was higher on day 9 but lower on day 12 in the Vib group. These results suggest that the LIWBV-promoted bone repair is associated with the modulation of vascularization, but additional studies are needed to determine the causality of this association.

Osteoporosis is an age related disorder manifested by skeletal fractures. This has been recognized as an important health issue mainly in women. Low bone mineral density is the major cause for osteoporosis. Detection and prediction of osteoporosis is a major challenge. Detection of osteoporosis helps in determining the density of the bone and also in the prevention of osteoporotic fractures in the high risk populations. In this study an easy first line method has been proposed to detect and predict osteoporosis. Impulse response test was carried out on the tibial bone for the detection of osteoporosis with the help of LabVIEW. The vibrations which were generated by the periodic impact of surgical hammer were captured by the accelerometer. The recorded analog signal was examined in frequency domain. The natural frequency of the vibration was significantly decreased in osteoporosis subjects which in turn indicate the loss in mechanical strength of the bone and bone mineral density. Prediction of osteoporosis was performed using a decision making system such as ANN in Matlab where factors other than bone mineral density was considered.

Low magnitude bone-loading sports may benefit bone structure and strength in the exercised limbs. This study compared peripheral quantitative computed tomography measures of radial and tibial diaphyseal strength (strength-strain index, SSI), structure (total area (ToA) and cortical area (CoA), density (CoD) and thickness (CT), and circumferences), muscle cross-sectional area (MCSA) and strength (one-repetition maximum, 1-RM) in male endurance athletes taking part in (i) non-weight-bearing and non-impact sports: swimmers (SWIM, n = 13) and road cyclists (RC, n = 10), (ii) non-weight-bearing, impact sport: mountain bikers (MB, n = 10), (iii) weight bearing and impact sport: runners (RUN, n = 9). All athlete groups were also compared to sedentary controls (CON, n = 10). Arm MCSA, 1-RM and radial bone size and strength tended to be greater in SWIM than CON and/or RC (ToA, %difference ± 95%CI, SWIM-CON: 14.6% ± 12.7%; SWIM-RC: 12.9% ± 10.7%) but not different to MB and RUN. RUN had bigger tibial CoA than CON, SWIM and RC (CoA, RUN-CON: 12.1% ± 10.7%; RUN-SWIM: 10.9% ± 9.4%; RUN-RC: 15.8% ± 9.5%) without marked changes in tibial strength indices, lower-limb MCSA or 1-RM. Both MB and RC failed to display any difference in tibial indices, lower-limb MCSA and 1-RM compared to CON. In swimmers, the bone structure and strength of the primary exercised limbs, the arms, is greater than controls and road cyclists. Conversely, although runners experience impact and weight-bearing loading, tibial structure is greater without a substantial difference in tibial strength compared to controls and non-impact sports. Failure to observe a difference in tibial indices in MB and RC compared to controls is unexpected.

Long-bone defects are one of the most challenging problems associated with limb reconstruction following high-energy extremity trauma. Without reconstitution of structural integrity, amputation is the likely result. The current orthopaedic literature on segmental bone loss is limited to case reports, case series, and observational studies, making it difficult to establish sound conclusions on the basis of the levels of evidence provided. Ten-year data from a fracture registry indicated that 0.4% of all fractures that were treated at a Level-I orthopaedic trauma unit were associated with bone loss1. Data from the same registry also indicated that the most common site of bone loss was the tibia (68%), followed by the femur (22%), with the remaining fractures occurring evenly at different sites. An additional retrospective review of tibial bone defects …