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BACKGROUND: Inflammation is a major driver of heterotopic ossification (HO), a condition of abnormal bone growth in a site that is not normally mineralized. PURPOSE OF REVIEW: This review will examine recent findings on the roles of inflammation and the immune system in fibrodysplasia ossificans progressiva (FOP). FOP is a genetic condition of aggressive and progressive HO formation. We also examine how inflammation may be a valuable target for the treatment of HO. Rationale/Recent findings: Multiple lines of evidence indicate a key role for the immune system in driving FOP pathogenesis. Critical cell types include macrophages, mast cells, and adaptive immune cells, working through hypoxia signaling pathways, stem cell differentiation signaling pathways, vascular regulatory pathways, and inflammatory cytokines. In addition, recent clinical reports suggest a potential role for immune modulators in the management of FOP. FUTURE PERSPECTIVES: The central role of inflammatory mediators in HO suggests that the immune system may be a common target for blocking HO in both FOP and non-genetic forms of HO. Future research focusing on the identification of novel inflammatory targets will help support the testing of potential therapies for FOP and other related conditions.

The osteohistology of Andrias spp. is a pivotal analogue for large fossil non-amniotes (e.g., Temnospondyli), and the endangered status of this taxon underlines the importance of gathering information on its growth. We here present the first osteohistological study by petrographic thin sections of an ontogenetic series of humeri and femora of eight individuals of varying sizes (28.5–104 cm) and ages (2.5–32 years) of Andrias japonicus from the Hiroshima City Asa Zoological Park, Japan. In addition, two individuals of A. cf. davidianus of unknown age but of different size (62 cm and 94 cm) were studied. All samples of Andrias spp. show a primary avascular periosteal cortex made of parallel-fibred tissue around the ossification center in the petrographic thin sections. Mainly in small individuals, the fibers forming this tissue are very coarse and loosely organized. With increasing size and age, the coarse tissue is irregularly intermixed and later replaced with finer and better organized fibers. This histologic change is accompanied by a change from diffuse annuli in the inner cortex to distinct lines of arrested growth (LAGs) in the outer cortex. We interpret these changes in tissue and the appearance of distinct growth marks as indicating the onset of active reproduction. The lack of primary vascularization around the ossification center in our Andrias spp. sample is striking and contradicts other observations. Vascularity may be prone to plasticity and further studies are necessary. We hypothesize that the large osteocyte lacunae and the dense networks of canaliculi observed in our sample may have nourished the tissue instead of primary vascular canals. We measured the size of osteocyte lacunae of Andrias spp. in comparison to other Lissamphibia, and found them to be significantly larger throughout ontogeny. The periosteal cortex contains a high amount of thick Sharpey's fibers all around the midshaft cross sections. The two samples of Andrias cf. davidianus show tissue and growth mark distribution similar to that observed in A. japonicus. However, the large individual of A. cf. davidianus differed in its extremely osteosclerotic condition and the retention of a small layer of calcified cartilage in the endosteal region of the femur. It remains unclear whether these differences are related to plasticity, taxonomy, sex, exogenous factors, or attributable to a regenerated but fully regrown leg. Although the present study is based on zoo-kept and not wild, animals, it yields important insights into osteohistological plasticity and growth patterns in giant salamanders. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Methods Results Conclusions Current surgical strategies for thoracic ossification of the ligamentum flavum (TOLF) are denounced by thoracic kyphosis, loss of spinal motion range, etc. A new surgical technique, laminoplasty and in‐site regrafting (LPIR), was modified to address the problems. This study aimed to report the safety and feasibility of LPIR for TOLF treatment.This retrospective study reported the outcome of eight consecutive patients (3 males and 5 females, mean age 52.87 years) with TOLF who underwent LPIR surgery from January 2019 to March 2024. Pre‐ and post‐operative data including x‐ray, computerized tomography (CT), magnetic resonance imaging (MRI), the modified Japanese Orthopedic Association score (mJOA), the visual analog scale (VAS), and complications were collected to evaluate the outcome.All surgeries were performed successfully, significantly alleviating symptoms postoperatively. During an average follow‐up period of 28.63 months, the VAS score reduced from 4.50 ± 1.00 pre‐operatively to 1.63 ± 0.48 on the third post‐operative day and further reduced to 0.50 ± 0.70 during the last follow‐up. The mJOA score increased from 3.63 ± 0.70 pre‐operatively to 6.13 ± 0.78 on the third postoperative day and further increased to 8.88 ± 1.27 during the last follow‐up. No severe complications were observed.LPIR exhibited significant safety and feasibility for treating TOLF, offering a novel strategy for managing this problem. [ABSTRACT FROM AUTHOR]

Interleukin‐4 (IL‐4)/IL‐4 receptor alpha (IL‐4Rα) signalling pathways play important roles in the complex process of bone formation and bone remodelling. However, whether IL‐4/IL‐4Rα participates in skeletogenesis during embryonic development is not completely understood. We used the anti‐IL‐4Rα monoclonal antibody (anti‐IL‐4Rα mAb) as a powerful investigational tool to evaluate the potential roles of IL‐4/IL‐4Rα in the chondrogenic differentiation of rat bone marrow mesenchymal stem cells (BMSCs) in vitro. Simultaneously, we explored the effect of IL‐4/IL‐4Rα on bone ossification during rat embryo‐fetal development. In this study, we found that, compared to the control group, IL‐4 can significantly promote the chondrogenic differentiation of BMSCs. Furthermore, following exposure to anti‐IL‐4Rα mAb in pregnant rats, unexpected phenomena were observed in fetal bone development, including non‐ossification of the fetal sternum, an incomplete ossification centre in long bones and a reduced number of ossification points in digit (toe) bones. To further investigate the underlying mechanism of the phenotype, we studied the rat sternum as the target organ, starting from different time points of sternum development in the embryonic stage. The results indicated that the retardation mainly occurred in the middle and late stages of embryonic development. This retardation was characterized by the inhibition of the differentiation process of mesenchymal stem cells into chondrocytes, resulting in reduced angiogenesis near the ossification centre, failure of osteoblasts to invade the centre of the cartilage body with the blood vessels and delayed formation of the primary ossification centre (POC). Overall, our study demonstrated the significant function of IL‐4/IL‐4Rα in chondrogenic differentiation of BMSCs and bone ossification during embryo‐fetal development. [ABSTRACT FROM AUTHOR]

When developing, the mandible presents great plasticity and contains condensed mesenchymal cells that develops into Meckel's cartilage, of which the anterior part forms the mandibular symphysis. Mandible human development studies focus on investigating whether the beginning of mandibular fusion in fetal period is related to symphysis ossification and the tensions imposed on it, considering that tongue movements, mouth opening, and closing can be seen in fetuses. This research analyses tissue modifications during human mandibular symphysis growth using light and scanning electron microscopy to relate them to its functional structure. The study sample consisted of 12 human fetuses distributed into two groups: Group I (GI) of 10–14 weeks old and Group II (GII) of 20–24 weeks old. Fragments of mandibular symphysis were removed en bloc together with the surrounding tissues to preserve the relation with adjacent structures. Decalcified specimens were prepared in semi‐serial coronal sections 5‐μm‐thick and stained with hematoxylin and eosin, Masson՚s trichrome, Verhoeff, and Sirius red for histological analysis with light microscopy. Collagen fibers Type I or III and elastic fibers were quantified by volume fraction (Vv). Coronal sections of the GI and GII symphyseal region were submitted to scanning electron microscopy. Comparison between groups used independent t‐test. Our study presents the different endochondral ossification stages in the anterior part of Meckel's cartilage in GI. Both groups showed abundantly vascularized mesenchymal tissue with intense cellular activity forming the mandibular symphysis, such as a source of new osteoblasts adjacent to the newly deposited bone matrix. Scanning electron microscopy analysis revealed an invasion of the bony trabecula in the transverse direction from the hemimandible, rectilinear in GI and sinuous in GII due to interdigitating bone process, promoting its ossification. In collagen Vv analysis was verified a prevalence of type I in GII and type III in GI, indicating a proportional relation between maturation and tissue arrangement. Functionally, the collagen and elastic fibers in the mandibular symphysis were arranged in a pantographic network, and the fibrillar interconnectivity clearly contributes to resilience capacity and efficiency of the force transfer. This study inferred the functional significance of the knowledge about the tissue composition of mandibular symphysis, and the importance of this tissue for surrounding structures. The mesenchymal tissue of mandibular symphysis participates in bone growth process, revealing an adaptation mechanism of mandibular symphysis in the fetal period investigated. [ABSTRACT FROM AUTHOR]

This study aimed to systematically review and compare the efficacy and safety of anterior cervical controllable antedisplacement and fusion (ACAF) versus anterior cervical corpectomy and fusion (ACCF) in treating ossification of the cervical posterior longitudinal ligament (OPLL), focusing on surgery-related indicators and postoperative outcomes. This review was conducted and reported in accordance with the Cochrane Handbook for Systematic Reviews of Interventions guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting standards. The methodological quality of this systematic review was assessed using the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) checklist. A detailed search strategy was implemented to retrieve literature from electronic databases, including PubMed, EMBASE, and the Cochrane Library, followed by quality assessment and data extraction for eligible studies. A total of 5 studies involving 366 participants were included. ACAF was associated with significantly fewer complications (OR = 0.25, 95% CI [0.12, 0.51], p = 0.000), including a lower incidence of cerebrospinal fluid (CSF) leakage (OR = 0.20, 95% CI [0.08, 0.52], p = 0.000). ACAF also showed better outcomes in postoperative neck disability index (NDI) scores (SMD = -0.48, 95% CI [-0.81, -0.15], p = 0.020), C2-C7 angle (SMD = 1.29, 95% CI [0.56, 2.03], p = 0.000), spinal canal area (SCA) (SMD = 0.93, 95% CI [0.56, 1.29], p = 0.000), and diameter of the spinal cord (DSC) (SMD = 0.38, 95% CI [0.11, 0.66], p = 0.010). Additionally, ACAF improved The Japanese Orthopedic Association (JOA) scores (SMD = 0.29, 95% CI [0.01, 0.57], p = 0.040) but required longer operation time (SMD = 1.08, 95% CI [0.01, 2.15], p = 0.049). No significant differences were found in blood loss (SMD = 0.23, 95% CI [-0.34, 0.79], p = 0.431), hospital stay (SMD = 0.65, 95% CI [-1.46, 2.76], p = 0.547), and improvement rate (IR) (SMD = 0.38, 95% CI [-0.10, 0.86], p = 0.118). The current meta-analysis indicated that ACAF surgery can effectively reduce the incidence of complications, significantly increase the spinal canal area and improve the spatial conditions of the spinal cord compared to those associated with ACCF surgery. This is more advantageous for the postoperative neurological recovery of patients. Nonetheless, it is crucial to approach these findings with a degree of caution. [ABSTRACT FROM AUTHOR]

Nanhsiungchelys (Testudines: Nanhsiungchelyidae) has been established in the 1960s, but its plastral morphology is not well understood. Here, we report an anterior lobe of the plastron of Nanhsiungchelys from the Upper Cretaceous of Ganzhou Basin, China. The plastron of the new specimen bears a V-shaped notch anteriorly which is absent or unknown in other Nanhsiungchelyidae. Besides, we also further describe the plastron of the holotype of Nanhsiungchelys yangi. These two specimens reveal that the plastron of Nanhsiungchelys spp. is partly hollow, and may have additional ossifications of the epiplastra. All of these suggest an unusual plastral morphology and evolution of Nanhsiungchelys. [ABSTRACT FROM AUTHOR]

Objective: To investigate the anatomical indexes and anatomical positional indexes of the atlantoaxial synchondroses in normal Chinese Han children aged 1–6 years, and to analyze the changing law of the atlantoaxial cartilage union with the growth and development of age and its influence on the atlantoaxial ossification in children. Methods: A retrospective collection of CT imaging of 160 cases of normal cervical spine in children aged 1 to 6 years old was conducted. The cases were divided into six age groups, with each group representing a one-year age range. Measure the morphological anatomical indicators and anatomical positional indicators of the atlantoaxial synchondroses. Record and statistically analyze the measurements of each indicator. Results: Measurements were taken on various parameters of the atlantoaxial synchondroses. TD, SD, height, area, and perimeter all gradually decreased among the groups. Distance between bilateral atlantal anterolateral synchondroses increased gradually from Group A to Group F, while the angle formed along the long axis in the cross-section showed a decreasing trend. Distance between the axoid dentolateral synchondroses and between the neurocentral synchondroses increased gradually from Group A to Group F, with the angle value in the cross-section showing a gradual decrease, and distance from the odontoid apex increasing from Group A to Group F. Conclusions: The atlantoaxial synchondroses gradually decrease in size with age, and ossification levels increase with age, with faster ossification occurring during a 1–2 years-old period. The anterolateral synchondroses, dentolateral synchondroses, and neurocentral synchondroses all gradually ossify towards the lateral direction with increasing age. [ABSTRACT FROM AUTHOR]

OBJECTIVE To describe the development and maturation of equine proximal sesamoid bones (PSBs) in fetuses and young horses using radiography, microcomputed (micro)-CT, and histology. METHODS A descriptive study. Forelimb PSBs from 12 equids ranging in age from 105 days of gestation to 540 days postgestation were evaluated. Radiography was used for preliminary assessment of metacarpophalangeal joint and PSB mineralization, and micro-CT imaging was performed to assess mineralized PSBs. Tissue volume, bone volume fraction, height, width, depth, trabecular thickness, and anisotropy were quantified from midplanar micro-CT sections in 3 dimensions. Midsagittal PSB histologic sections stained with H&E and Safranin O/Fast Green were used to determine the ratio of ossification center to cartilage template size and to describe the formation and development of the cartilage template, ossification center, spherical growth plate, articular cartilage, and entheses. RESULTS Mineralization of equine PSBs is associated with cartilage canals and a spherical growth plate that undergoes endochondral ossification during the late gestation to early postgestational period. The apical, flexor, basilar, and articular ossification fronts demonstrate morphologic variability. Structural organization of the articular cartilage and entheses occurs concurrently with the development of an underlying plate of compact bone. At 540 days postgestation, the fibrocartilaginous entheses of the flexor cortex of the PSB had yet to mature. CONCLUSIONS Equine PSBs mineralize predominantly by endochondral ossification during the late gestation to early postgestational period. Mineralization precedes maturation of the articular cartilage and fibrocartilaginous entheses. CLINICAL RELEVANCE The postgestational maturation of the PSB and its surrounding tissues may predispose young horses to developing lesions at these sites, such as apical avulsion fractures, warranting further investigation. [ABSTRACT FROM AUTHOR]

Objectives: The study of puberty is a well‐established area of bioarcheological research, which greatly enhances our understanding of adolescence and growth in the past. Since the publications of Shapland and Lewis' works, which have become "standards" for estimating puberty in skeletal material, no additional osteological indicators of puberty have been proposed. Nevertheless, clinical practice constantly develops skeletal maturation markers that could be useful in bioarcheology. This study aims to assess the applicability and reliability of novel puberty indicators as a complementary tool to estimate puberty in skeletal remains. Materials and Methods: Four new maturation markers including spheno‐occipital synchondrosis, humeral head ossification, calcaneal apophysis ossification, and mandibular premolar mineralization were selected and applied to a sample of 85 adolescents from pre‐Roman southern Italy (Pontecagnano, 7th–4th BCE). Results: Despite some limits in adapting the original clinical methods to osteoarcheological material, the use of these novel skeletal indicators had moderate to excellent scoring repeatability and an overall high agreement with the puberty and menarche status previously estimated with standard methods. These results encourage us to apply these markers in bioarcheology. In some cases, minor adaptations of the original scoring systems are suggested to enhance reliability. Discussion: Including the proposed indicators in routine puberty data collection allows us to refine puberty estimation and improve the ability to identify key growth milestones in poorly preserved skeletons. Further application to osteological collections with diverse chronology and geographical differences is needed to assess how and to what extent the newly proposed maturation markers perform. [ABSTRACT FROM AUTHOR]

Background: The xiphoid process (XP) in animals such as sheep and rats are well known to have cartilage called xiphoidal cartilage (XC). In humans, the cartilage in the xiphoid process is considered an anatomical variant and is not well understood. The aim of this study was to investigate the morphology of the XP. Methods: A total of twenty embalmed European descendant cadaveric sterna (aged 52 to 98 years) were used. Transilluminated XPs and midsagittal sections of XPs were used to examine the bone and cartilage. Subsequently, a sagittally-sectioned XP was harvested for histology and stained with Masson's trichrome. The results of the transillumination and histological examinations were compared qualitatively. Results: The dark area visible in transilluminated XPs was consistent with the bony part in the midsagittal XP sections, which contained bone marrow; the bright area was consistent with the cartilage part in the midsagittal XP sections. This was all demonstrated histologically. Most of the XPs (85%) had some portion of cartilage. The XP was classified into four types based on its proportions of bone and cartilage: Type I, no ossification (< 1/3 ossification) 45%; Type II, minor ossification (1/3 − 1/2 ossification) 20%; Type III, major ossification (1/2–2/3 ossification) 20%; Type IV, complete ossification (> 2/3 ossification) 15%. Most of the XPs (85%) had bone and cartilage, which could have been overlooked in studies using skeletons or CT. Conclusion: Previous studies probably underestimated or overestimated the size of the XP. The XC needs to be considered as normal anatomy. [ABSTRACT FROM AUTHOR]

The question of what the ancient life cycle of tetrapods was like forms a key component in understanding the origin of land vertebrates. The existence of distinct larval forms, as exemplified by many lissamphibians, and their transformation into adults is an important aspect in this field. The temnospondyls, the largest clade of Palaeozoic–Mesozoic non‐amniote tetrapods, covered a wide ecomorphological range from fully aquatic to terrestrial taxa. In various species, rich ontogenetic data have accumulated over the past 130 years, permitting the study of early phases of temnospondyl development. In temnospondyls, eight ontogenetic phases have been identified in which the skeleton formed. In branchiosaurids and the eryopiform Sclerocephalus, large parts of the ossification sequence are now known. Most taxa in which small specimens are preserved had aquatic larvae with external gills that superficially resemble larval salamanders. In the edopoids, dvinosaurs, and eryopiforms, the larvae developed slowly, with incompletely ossified axial and appendicular skeletons, but possessed a fast‐developing dermal skull with strong teeth. Irrespective of adult terrestriality or a fully aquatic life, there was no drastic transformation during later ontogeny, but a slow and steady acquisition of adult features. In dissorophoids, the limbs developed at a much faster pace, whereas skull formation was slowed down, especially in the amphibamiforms, and culminating in the neotenic Branchiosauridae. In the zatracheid Acanthostomatops, slow but profound transformation led to a fully terrestrial adult. The basal dissorophoid Stegops retained rapid development of dermal skull bones and established a fully dentigerous, strongly ossified palate early. In Micromelerpeton, formation of the last skull bones was slightly delayed and metamorphosis remained a long and steady phase of morphological transformations. In amphibamiforms, metamorphosis became more drastic, with an increasing number of events packed into a short phase of ontogeny. This is exemplified by Apateon, Platyrhinops, and Amphibamus in which this condensation was maximised. We distinguish three different types of metamorphosis (morphological, ecological and drastic) that evolved cumulatively in early tetrapods and within temnospondyls. [ABSTRACT FROM AUTHOR]

Objective: The present study aims at studying the ossification of thyroid cartilage and to compare it with age of the individual. Methods: The study was conducted in 300 samples of thyroid cartilage collected during autopsy in the department of Forensic medicine in a tertiary care hospital. Each thyroid cartilage is divided in to thirteen anatomical area and ossification in each defined area was studied through gross and cut section features and classified as ossified and not ossified areas. The samples were grouped in to seven groups of age and ossification features were compared between the age groups. Results: On analysing the ossification pattern of thyroid cartilage in thirteen defined anatomical areas and comparing it with the age, a peculiar sequence of ossification was noted, and it was also observed that frequency of ossification increases significantly with increasing age groups. Conclusion: Ossification of thyroid cartilage helps in establishing the age of individual and it can be categorised to an age group of ten years. [ABSTRACT FROM AUTHOR]

Introduction Materials and Methods Results Conclusion Foot‐related lameness is common in Standardbred and Thoroughbred racehorses. Magnetic resonance imaging (MRI) provides information on both the soft tissue and osseous structures of the distal extremity. The aim of this study was to determine whether abnormalities identified on distal limb MRI differed between these two racehorse populations.The records of Standardbred and Thoroughbred racehorse distal extremity MRI examinations conducted at Camden Equine Centre and Ballarat Veterinary Practice between 2013 and 2023 were retrieved. Horses were included if pain causing lameness had been localised to the foot using perineural or intra‐articular analgesia. MRI abnormalities of the structures within the distal extremity were recorded and comparisons made between the two groups.There was a significant difference in the rate of occurrence of certain MRI abnormalities between the Thoroughbred and Standardbred racehorse populations, including distal phalangeal fractures, proximal phalangeal short tau inversion recovery (STIR) hyperintensity (distal aspect), the presence and severity of ungular cartilage ossification, abnormalities of the navicular bone distal border synovial invaginations/vascular channels and navicular bone distal border fragments. The presence of distal extremity STIR hyperintensity and fractures was significantly higher in Standardbred compared to Thoroughbred racehorses when these findings were grouped and considered in combination.There were many similarities in the distal extremity MRI abnormalities identified in lame Australian Standardbred and Thoroughbred racehorses. However, distal phalangeal fractures, ungular cartilage ossification and distal extremity STIR hyperintensity were identified in significantly more in Standardbred than Thoroughbred racehorses. [ABSTRACT FROM AUTHOR]

Diffuse Idiopathic Skeletal Hyperostosis (DISH) and Ossification of the Posterior Longitudinal Ligament (OPLL) are common disorders characterized by the ossification of spinal ligaments. The cause for this ossification is currently unknown but a genetic contribution has been hypothesized. Over the last decade, many studies on the genetics of ectopic calcification disorders have been performed, mainly on OPLL. Most of these studies were based on linkage analysis and case control association studies. Animal models have provided some clues but so far, the involvement of the identified genes has not been confirmed in human cases. In the last few years, many common variants in several genes have been associated with OPLL. However, these associations have not been at definitive levels of significance and evidence of functional significance is generally modest. The current evidence suggests a multifactorial aetiopathogenesis for DISH and OPLL with a subset of cases showing a stronger genetic component. [ABSTRACT FROM AUTHOR]

The tibial tuberosity has a superficial patellar tendon‐embedded portion and a deep uncalcified cartilage portion. Suppressed calcification of the tibial tuberosity leads to Osgood–Schlatter disease. The tibial tuberosity calcifies with age; load reduction degrades the cartilage matrix and promotes calcification, suggesting that reduced mechanical stimulation of the tibial tuberosity promotes calcification. However, this is yet to be clarified. Therefore, in this study, we aimed to investigate the effects of mechanical stimulation reduction on the tibial tuberosity tissue structure and calcification mechanism. Specifically, we examined the effect of load reduction on tibial tuberosity calcification in 20 male 7‐week‐old Wistar rats classified into two groups: hind‐limb suspension (HS, n = 10) and control (CO, n = 10). We observed superficial and deep tibial tuberosities in both groups. The tibial tuberosity in the HS group had narrower areas of deep portions than did those in the CO group (p = 0.000539), and immature bone tissue and cartilage tissue were observed in the HS group. Enpp1 expression did not significantly differ between the groups (p = 0.804). In contrast, Alpl (p = 0.001) and Mmp3 (p = 0.006) expression increased whereas Timp3 expression decreased (p = 0.002) in the HS group. Thus, these results showed a maturing of bone ossification, and this gene expression trend was similar to that observed in a murine join instability model of osteoarthritis with articular cartilage calcification and ossification. The HS tibial tuberosity also showed immature bone tissue. In conclusion, reduced mechanical stimulation caused tibial tuberosity calcification and pathological changes. These findings highlight the importance of optimal exercise to avoid premature pathological structural changes in bones and joints. [ABSTRACT FROM AUTHOR]

Background: We evaluated the clinical, functional, and quality of life (QoL) outcomes of surgical treatment of thoracic ossification of the posterior longitudinal ligament (T-OPLL). Methods: We retrospectively evaluated 51 patients followed for ‡10 years after posterior decompression and corrective fusion surgery for T-OPLL. The data collected included demographics, comorbidities, and pre- and postoperative symptoms. The Japanese Orthopaedic Association (JOA) score, numerical rating scale (NRS) for back and leg pain, and EuroQol-5 Dimension-5 Level (EQ-5D-5L) were used to assess neurological function, pain, and QoL. Imaging evaluations were conducted to assess changes in kyphotic angles and ossification progression. Results: A significant improvementwas observed in the JOA score frompreoperatively (3.7) to 2 years postoperatively (7.9) (p < 0.05); the score remained stable thereafter. The mean EQ-5D-5L score improved from 0.53 preoperatively to 0.68 at 10 years postoperatively (p < 0.001). NRS scores for back and leg pain decreased from 5.4 to 3.5 and 4.0 to 3.0, respectively, from preoperatively to 10 years (p < 0.001 for both). Radiographic outcomes showed changes in kyphotic angles and ossification areas, with no significant progression after 2 years. Fourteen (27.5%) of the patients experienced postoperative complications. Of these, 8 (15.7%) required reoperation, 6 (11.8%) in the perioperative period and 2 (3.9%) later. Four (7.8%) of the patients underwent additional surgeries for conditions including lumbar spinal canal stenosis and cervical OPLL. Nonetheless, physical function in all cases with postoperative complications or additional surgery remained stable over the decade. Conclusions: Surgical treatment of T-OPLL is effective in improving neurological function, QoL, and pain management over an extended period. The long-term outcomes of T-OPLL surgery revealed that, although cervical and lumbar spinal lesions led to reoperations, they did not affect QoL, and relative improvement was maintained even after 10 years. [ABSTRACT FROM AUTHOR]

Introduction: Primary objective was to investigate the prevalence of ossification of the posterior longitudinal ligament (OPLL) in a mixed demographic region, especially in the Pacific Island population. Secondary objective was to investigate the prevalence of diabetes mellitus and cervical diffuse skeletal hyperostosis (DISH) in patients with and without OPLL. Methods: Using the local picture archiving and communication system (PACS), cervical spine computed tomography (CT) examinations over a 2‐month period were retrospectively assessed for the presence of OPLL. Basic demographic data were recorded—gender, age, ethnicity, presence of cervical DISH and the presence or absence of diabetes mellitus. Results: A total of 1692 CT examinations were included in the study. The distribution of the ethnic groups was 57.3% European, 12.09% Pacific peoples, 11.9% Māori, 11.53% Asian, 0.95% Middle Eastern/Latin American/African and 6.3% not specified. Overall, 47 cases of OPPL were identified (2.78%). The prevalence of OPPL in the Pacific ethnic groups was significantly higher than the European ethnic group 8.4% versus 0.6%, P < 0.05. The prevalence of OPLL was also significantly higher in the Asian (6.9%) and Māori (3.6%) than in the European ethnic group, P < 0.05. A significantly higher proportion of the patients with OPLL had underlying diabetes 20/47 (42.6%) compared with the study population 196/1692 (11.6%), P < 0.05. Seven cases of OPPL (14.9%) had associated cervical DISH, which was significantly higher compared with the study group (23/1692), P < 0.05. Using the Japanese Ministry of Health and Welfare classification system4, segmental type was the most common (34/47, 72.3%), followed by mixed (14.9%) and continuous types (12.8%). Conclusion: The prevalence of OPLL is significantly higher among the Pacific populations in Auckland. There is also increased prevalence in the Asian and Māori populations. [ABSTRACT FROM AUTHOR]

Objective: The anterior controllable antedisplacement and fusion (ACAF) technique is a new procedure for the treatment of cervical ossification of the posterior longitudinal ligament (OPLL) that requires management of the disc adjacent to the ossification. This study describes a novel technique to reduce the number of fixed segments, namely, the "Klotski technique." The efficacy of ACAF using the Klotski technique was compared with that of anterior cervical corpectomy and fusion (ACCF) in the treatment of OPLL with en bloc type dural ossification (DO). Methods: The clinical data of 25 patients with severe OPLL and en bloc type DO who were treated by the ACAF Klotski technique or ACCF at our hospital from January 2020 to January 2022 were retrospectively analyzed. In the Klotski technique, the number of segments fused within the OPLL is limited. The antedisplacement space was designed according to the shape of the vertebrae-OPLL-DO complex (VODC). Then, the entire VODC was antedisplaced as in Klotski. Neurological function and image examination were assessed preoperatively and postoperatively. Complications associated with surgery were recorded. Results: Patients were followed up for 24–36 months. There were 11 patients who were treated with ACAF and 14 patients who were treated with ACCF. At 2 weeks after surgery, the incidence of neurological deterioration was 21.4% (3 of 14) in the ACCF group and 9.1% (1 of 11) in the ACAF group. The incidence of intraoperative cerebrospinal fluid leakage (CFL) was 35.7% (5 of 14) in the ACCF group and 9.1% (1 of 11) in the ACAF group. The postoperative follow-up JOA scores of the patients in both groups were significantly better than their preoperative JOA scores (p<0.05). Conclusion: The Klotski technique for ACAF is a good option for the treatment of patients with en bloc type OPLL-DO, as it limits the number of fused segments, has a low incidence of CFL and neurologic deficits and is associated with good neurological recovery. [ABSTRACT FROM AUTHOR]

Introduction: Systemic osteogenesis has been speculated to be involved in the pathogenesis of ossification of the posterior longitudinal ligament (OPLL). Our purpose was to compare the radiologic prevalence and severity of heterotopic ossification in foot tendons of Japanese patients with OPLL and to determine their association with systemic heterotopic ossification. Materials and methods: Clinical and radiographic data of 114 patients with OPLL were collected from 2020 to 2022. Control data were extracted from a medical database of 362 patients with ankle radiographs. Achilles and plantar tendon ossification were classified as grades 0–4, and the presence of osteophytes at five sites in the foot/ankle joint was assessed by radiography. Factors associated with the presence and severity of each ossification were evaluated by multivariable logistic regression and linear regression analysis. Results: The prevalence of Achilles and plantar tendon ossification (grade ≥ 2) was 4.0–5.5 times higher in patients with OPLL (40–56%) than in the controls (10–11%). The presence of Achilles tendon ossification was associated with OPLL, age, and coexisting plantar tendon ossification, and was most strongly associated with OPLL (standardized regression coefficient, 0.79; 95% confidence interval, 1.34–2.38). The severity of Achilles and plantar tendon ossification was associated with the severity of ossification of the entire spinal ligament. Conclusions: The strong association of foot tendon ossification with OPLL suggests that patients with OPLL have a systemic osteogenesis background. These findings will provide a basis for exploring new treatment strategies for OPLL, including control of metabolic abnormalities. [ABSTRACT FROM AUTHOR]

Colloid goiter is the most common type of non-neoplastic thyroid condition. They may present with secondary degenerative changes like hyalinization, cystic changes, hemorrhages, fibrosis with rarely presenting with calcification and eventual ossification. Herein we present a case of colloid goiter with fibro-osseous metaplasia in a 55 year male patient who underwent total thyroidectomy due to the clinical suspicion of malignancy. [ABSTRACT FROM AUTHOR]

Flat head syndrome (FHS) sometimes occurs when a baby maintains the same head position during the first several months of life, causing a skull deformity. FHS usually improves with time and natural growth, although some show aggravation against conservative treatment. We reviewed pathologically proved early closure of skull suture that may be seen secondary to FHS. The clinical and radiologic findings of the patients who showed progressive skull deformity resembling FHS were retrospectively reviewed. All the patients underwent surgical treatment and pathologic specimens were obtained. The detected patients included two 5-month-old infants and one 1-year-old child. The former were conservatively treated without any obvious premature suture closure on computed tomography (CT), and later developed progressive tower-like skull deformities. The infants were diagnosed with possible premature fusion of lambda site and underwent removal around lambda depression (LD). The latter showed evident sagittal suture closure on CT with digital markings, and was diagnosed with increased intracranial pressure and underwent cranioplasty of posterior expansion. Histopathologic specimens obtained from the patients' resected sutures showed irregularly narrowed suture structure with ossification and fibrous tissue proliferation within them, supporting the diagnosis of premature closure of the sagittal sutures. Their postoperative courses were uneventful, and their skull deformities subsequently improved. Conservative therapy-resistant progressive occipital skull deformity with LD may be a sign of early suture closure, even if CT does not show obvious suture closure. The findings are helpful for early diagnosis and might lead to minimal invasive surgery if needed. [ABSTRACT FROM AUTHOR]

Background: Ossification of the posterior longitudinal ligament (OPLL) is a prevalent condition in orthopedics. While death-associated protein kinase 2 (DAPK2) is known to play roles in cellular apoptosis and autophagy, its specific contributions to the advancement of OPLL are not well understood. Methods: Ligament fibroblasts were harvested from patients diagnosed with OPLL. Techniques such as real-time reverse transcriptase-polymerase chain reaction (RT-qPCR) and Western blot analysis were employed to assess DAPK2 levels in both ligament tissues and cultured fibroblasts. The extent of osteogenic differentiation in these cells was evaluated using an alizarin red S (ARS) staining. Additionally, the expression of ossification markers and autophagy markers was quantified. The autophagic activity was further analyzed through LC3 immunofluorescence and transmission electron microscopy (TEM). An in vivo heterotopic bone formation assay was conducted in mice to assess the role of DAPK2 in ossification. Results: Elevated DAPK2 expression was confirmed in both OPLL patient tissues and derived fibroblasts, in contrast to non-OPLL controls. Silencing of DAPK2 significantly curtailed osteogenic differentiation and autophagy in these fibroblasts, evidenced by decreased levels of LC3 , and Beclin1 , and reduced autophagosome formation. Additionally, DAPK2 was found to inhibit the mechanistic target of the rapamycin complex 1 (mTORC1) complex's activity. In vivo studies demonstrated that DAPK2 facilitates ossification, and this effect could be counteracted by the mTORC1 inhibitor rapamycin. Conclusion: DAPK2 enhances autophagy and osteogenic processes in OPLL through modulation of the mTORC1 pathway. [ABSTRACT FROM AUTHOR]

Purpose: (1) To determine the prevalence, magnitude and distribution pattern of acetabular rim ossification in patients with femoroacetabular impingement syndrome (FAIS) and (2) to determine the association between acetabular rim ossification and rotational abnormalities of the hip. Methods: Patients underwent hip arthroscopic surgery for FAIS at our institute between January 2021 and May 2022 were retrospectively reviewed. Patients were included if preoperative computed tomography (CT) images of the operated hip and ipsilateral distal femur were available for the measurement of femoral and acetabular anteversion. The presence and size of acetabular rim ossification were evaluated on coronal CT sections for the superior half of the acetabulum on each clockface location. The associations between acetabular rim ossification and radiographic parameters of hip rotational morphology were examined. Results: A total of 214 hips were included. Acetabular rim ossification was found in 167 hips (78%) and the most common locations were 10 and 11 o'clock. Patients presenting with acetabular rim ossification had a mean size of 4.6 ± 1.6 mm. It was the largest at 9 o'clock position (4.9 ± 2.2 mm), with a decreasing trend in size from posterior to anterior. Logistics regression analysis found age was associated with the occurrence of posterior ossification (p = 0.002). Linear regression analysis found age (p = 0.049) and male sex (p < 0.001) were significantly correlated with the size of ossification. Patients with increased cranial combined anteversion had larger posterior ossification than patients with normal and decreased cranial combined anteversion (4.2 ± 2.9 vs. 3.1 ± 2.5 mm, p = 0.016; 4.2 ± 2.9 vs. 2.5 ± 2.4 mm, p = 0.005). Conclusion: Increased combined anteversion is associated with greater posterior acetabular rim ossification. The presence and size of acetabular rim ossification are positively associated with older age and male sex. Level of Evidence: Level III. [ABSTRACT FROM AUTHOR]

Purpose: The triticeal cartilage, situated within the lateral thyrohyoid membrane, remains elusive in function yet crucial in clinical contexts. Composed of hyaline cartilage, it is prone to ossification, potentially leading to diagnostic challenges such as misidentification with atherosclerosis or fractures. Methods: This study, aiming to establish its prevalence and highlight clinical relevance, conducted a systematic review across several electronic databases such as Medline, PUBMED, Scopus, Google Scholar, Web of Science, SpringerLink and Sciencedirect using keywords "triticeal cartilage", "triticeous cartilage" or "cartilago triticea". An assurance tool for anatomical investigations was used to assess the quality of the methodology (AQUA). A random effects model was utilized to determine the pooled prevalence. Results: The true prevalence of triticeal cartilage was found to be variable, with an overall pooled proportion of 43% while crude prevalence were 50.6%. Its crude prevalence was notably higher in women compared to men, in contrary true prevalence was higher in men, posing sex-related disparities. It was mostly seen bilaterally. When the morphologic characteristics of the cartilage were evaluated, classification differences were observed in terms of shape, with a mean length of 5.48 mm, a mean width of 3.04 mm and a mean weight of 62.32 mg. The vertebral level at which the TC was located was mostly C4. The degree of calcification of the cartilage was most commonly mild. Conclusion: In conclusion, triticeal cartilage holds significant clinical importance, necessitating vigilance during diagnostic evaluations and surgical approaches. Further studies are imperative to elucidate its function comprehensively and refine diagnostic strategies, ensuring optimal patient care in neck-related pathologies. [ABSTRACT FROM AUTHOR]

Axial Spondyloarthritis (axSpA) is a chronic, inflammatory, immune-mediated rheumatic disease that comprises two subsets, non-radiographic and radiographic axSpA, and belongs to a heterogeneous group of spondyloarthritides (SpA). Over the years, the concept of SpA has evolved significantly, as reflected in the existing classification criteria. Considerable progress has been made in understanding the genetic and immunological basis of axSpA, in studying the processes of chronic inflammation and pathological new bone formation, which are pathognomonic for the disease. As a result, new medication therapies were developed, which bring more effective ways for disease control. This review presents a brief overview of the literature related to these aspects of disease after summarising the available information on the topic that we considered relevant. Specifically, it delves into recent research illuminating the primary pathological processes of enthesitis and associated osteitis in the context of inflammation in axSpA. The exploration extends to discussion of inflammatory pathways, with a particular focus on Th1/Th17-mediated immunity and molecular signaling pathways of syndesmophyte formation. Additionally, the review sheds light on the pivotal role of cytokine dysregulation, highlighting the significance of the IL-23/17 axis and TNF-α in this intricate network of immune responses which is decisive for therapeutic approaches in the disease. [ABSTRACT FROM AUTHOR]

PURPOSE OF THE STUDY Os vesalianum pedis (OVP) is a rare accessory bone of the foot located at the base of the fifth metatarsal bone. It is usually asymptomatic and incidentally seen on radiographs. When symptomatic, it manifests itself with lateral foot pain. OVP, which can become symptomatic as a result of traumatic injuries, can also be confused with fracture. The aim of this study is to determine the prevalence and morphometric characteristics of OVP in the Turkish population. MATERIAL AND METHODS Radiographic images of 5268 individuals aged 16 years and older (mean 39.65±17.21) who completed ossification of the fifth metatarsal bone were evaluated for OVP. Of the cases included in the study, 44.8% were female and 55.2% were male. The general and sex-based prevalence of OVP was calculated, and morphometric measurements were done. RESULTS OVP prevalence in the Turkish population was found to be 0.15% regardless of sex. OVP prevalence was calculated to be 0.24% in men and 0.04% in women. CONCLUSIONS Anatomy, radiology, orthopedics and emergency medicine physicians are frequently encountered with foot disorders in clinical and educational practices. It is important to keep in mind the rare presence of OVP (0.15%), in the preliminary diagnosis. [ABSTRACT FROM AUTHOR]

Background: Hypertrophy ligamentum flavum is a prevalent chronic spinal condition that affects middle‐aged and older adults. However, the molecular pathways behind this disease are not well comprehended. Objective: The objective of this work is to implement bioinformatics techniques in order to identify crucial biological markers and immune infiltration that are linked to hypertrophy ligamentum flavum. Further, the study aims to experimentally confirm the molecular mechanisms that underlie the hypertrophy ligamentum flavum. Methods: The corresponding gene expression profiles (GSE113212) were selected from a comprehensive gene expression database. The gene dataset for hypertrophy ligamentum flavum was acquired from GeneCards. A network of interactions between proteins was created, and an analysis of functional enrichment was conducted using the Kyoto Encyclopedia of Genes and Genomes (KEGG) and Gene Ontology (GO) databases. An study of hub genes was performed to evaluate the infiltration of immune cells in patient samples compared to tissues from the control group. Finally, samples of the ligamentum flavum were taken with the purpose of validating the expression of important genes in a clinical setting. Results: Overall, 27 hub genes that were differently expressed were found through molecular biology. The hub genes were found to be enriched in immune response, chemokine‐mediated signaling pathways, inflammation, ossification, and fibrosis processes, as demonstrated by GO and KEGG studies. The main signaling pathways involved include the TNF signaling pathway, cytokine–cytokine receptor interaction, and TGF‐β signaling pathway. An examination of immunocell infiltration showed notable disparities in B cells (naïve and memory) and activated T cells (CD4 memory) between patients with hypertrophic ligamentum flavum and the control group of healthy individuals. The in vitro validation revealed markedly elevated levels of ossification and fibrosis‐related components in the hypertrophy ligamentum flavum group, as compared to the normal group. Conclusion: The TGF‐β signaling pathway, TNF signaling pathway, and related hub genes play crucial roles in the progression of ligamentum flavum hypertrophic. Our study may guide future research on fibrosis of the ligamentum flavum. [ABSTRACT FROM AUTHOR]

Several studies describe the development of the chondrocranium of vertebrates. The details in these studies vary a lot, which makes it hard to compare developmental patterns and identify evolutionary trends. Therefore, we aim to close this gap for anurans, which is the largest order of amphibians. We present here a detailed description of the chondrocranium morphology and development of Smilisca phaeota, the New Granada cross-banded tree frog. The anatomy was described for the larvae at or older than Gossner stage 31 and before ossification starts. Following this, we describe the development of the chondrocranium from Gossner stages 19–26. Early in Gossner stage 19 no precursors of any cartilages are visible, while later in that stage the mesodermal Anlage of Meckel's cartilage was observed. In the subsequent stages more and more mesodermal anlagen become identifiable, followed by chondrification, and final differentiation of the cartilage elements. We used serial sections to study all the developmental stages and additionally utilized cleared and stained specimens and CT scan data. The latter were also used for the 3D reconstruction of the chondrocranium. We previously studied several species and compared these developmental patterns with S. phaeota, revealing potentially characteristic patterns significant for Lalagobatrachia, a clade that includes over 7000 frog species. These include (1) the suprarostral alae develop before the suprarostral corpus, (2) the infrarostral cartilage chondrifies late, after the chondrification of ceratobranchial 1, and (3) the ceratohyal body is the first element to show chondrocytes and to chondrify. However, with only six species studied so far, our data only provide a basis for future studies and developing hypotheses about the ancestral developmental pattern in anurans. [ABSTRACT FROM AUTHOR]

This study aims to answer the question: Which are superior—conventional or short femoral stems?. An Optymis stem was used as a short-femoral stem, and an Accolade II stem was used as a conventional-femoral stem. There were 95 patients in the short femoral stem group (Group 1) and 90 in the conventional stem group (Group 2). The SF-36 Life Quality Score, thigh pain, and the Harris Hip Score were used to evaluate the patients' clinical outcomes. Pre-operative, immediate post-operative, and final follow-up x-rays were used for radiological evaluation. Stem varus/valgus alignment, hip offset changing, acetabular anteversion/inclination changing, femoral migration, acetabular migration, periarticular ossification, and osteointegration evaluation were assessed for both groups. The mean follow-up time was 5.5 years for Group 1 and 5.2 years for Group 2. No significant difference existed between the two groups in terms of clinical scores (Harris Hip Score, SF-36). Thigh pain was significantly higher in Group 2 (p = 0.0001). As for radiological parameters, Group 1 exhibited more varus position-related results. In terms of angular stability, Group 1 was found to be more unstable than Group 2 (p = 0.0001). The power to reconstruct femoral offset was superior in Group 1. Periarticular ossification was more frequent in Group 2. Femoral osteointegration was denser proximally in Group 1 and distally in Group 2. When mid-term radiological and clinical results of both femoral stems are evaluated, they have no superiority over each other. [ABSTRACT FROM AUTHOR]

Several risk factors of ossification of the posterior longitudinal ligament (OPLL) have been established, including diabetes and obesity. However, the relationship between hyperlipidemia (HLD) and OPLL is incompletely understood. PearlDiver was queried to identify adults with (+) and without (−) HLD, diabetes, and obesity. Comparative analyses were performed on demographics, comorbidities, and OPLL rates before and after matching for age, sex, and comorbidities. Stepwise logistic regression modeling assessing the relationship between HLD and OPLL with the addition of predictor variables was also performed. In total, 31,677 cervical OPLL patients, as well as 170,467 HLD+ and 118,665 HLD–, 168,985 Diabetes+ and 137,966 Diabetes–, and 150,363 Obesity+ and 142,553 Obesity– patients, were examined. Mean age ranged 43.44–59.46 years, 54.94–63.12% were females, and mean Charlson Comorbidity Index ranged from 0.06 from 1.53, all higher in those with the comorbidity. Before matching, OPLL rates were higher in those with HLD (HLD+ = 0.05% vs. HLD– = 0.03%, P = 0.005), diabetes (Diabetes+ = 0.06% vs. Diabetes– = 0.02%, P < 0.001), and obesity (Obesity+ = 0.05% vs. Obesity– = 0.02%, P = 0.001). However, after matching by age, sex, and Charlson Comorbidity Index, the associations between the studied comorbidities and OPLL were attenuated (all P > 0.05). Stepwise regression modeling revealed an association between HLD and cervical OPLL that was most impacted by the addition of age (OR=1.95, R2 = 0.029 to OR=1.38, R2 = 0.075) and obesity (OR=1.21, R2 = 0.086 to OR=1.07, R2 = 0.111) into the model. Cervical OPLL rates were higher in patients with HLD even after accounting for demographics and comorbidities. HLD may be an independent risk factor for OPLL development. [ABSTRACT FROM AUTHOR]

Purpose: Ossification of the mamillo-accessory ligament (MAL) results in the formation of a mamillo-accessory foramen (MAF), which is associated with aging. The MAL tethers the medial branches of the lumbar dorsal rami to the lumbar vertebrae. A MAL ossified at the lumbar vertebrae can cause low back pain by compressing the medial branch of a dorsal ramus. Age ranges related to ossification of the MAL have not been reported in previous studies. The objective of the present study was to determine the prevalence of ossification of the MAL in the lumbar column and its relationship to aging, and to measure the newly formed MAF at each level of the lumbar vertebrae. Methods: This study examined 935 dried lumbar vertebrae from 187 donors at Khon Kaen University, Thailand, consisting of 93 females and 94 males. The research focused on ossification patterns of the MAL, categorizing them into three patterns. Results: We found that over 50% of ossified MAL occurred in the 30–45-year-old range and the frequency increased with age. The prevalence of ossified lumbar MAL was 72.73%, especially in L5 on the left side in females (76.92%). The width of the MAF did not differ significantly between the sexes, but it was greater on the left side (2.46 ± 1.08; n = 76) than the right (2.05 ± 0.95; n = 72) (p = 0.016). Conclusion: Ossification of the MAL into the MAF progresses with age, leading to low back pain from nerve compression. Physicians should be aware of the MAF during anesthesia block to treat low back pain. [ABSTRACT FROM AUTHOR]

The pediatric hip undergoes significant changes from infancy through adolescence. Proper maturation is crucial for the development of a stable and functional hip joint. Imaging interpretation of the pediatric hip requires distinguishing normal variants and maturation patterns from pathology. We review femoral ossification centers, variants, and conditions that affect the proximal femur, such as Legg-Calvé-Perthes disease; the acetabulum, such as developmental hip dysplasia; the acetabular labrum, such as femoroacetabular impingement; and synovial pathology in children through adolescence. Understanding the spectrum of hip conditions and using advanced imaging techniques are essential for the accurate diagnosis and effective management of pediatric hip disorders. [ABSTRACT FROM AUTHOR]

Alignment, longitudinal growth, and function of the musculoskeletal unit of the pediatric hand is complex due to the combination of open growth plates, ossification variations, and their relationship with finger tendinous and ligamentous attachments. This review presents the basics of normal development, acquired and congenital variations, and traumatic conditions of the pediatric hand from the perspective of the pediatric musculoskeletal radiologist and hand surgeon. This multimodality imaging article focuses on non-oncologic and non-rheumatologic conditions of the pediatric hand, inclusive of fingers, thumb, and metacarpal bones. [ABSTRACT FROM AUTHOR]

The development of the pelvis follows a predictable pattern of ossification that involves the maturation of bone, synchondroses, and apophyses. These growth centers appear and close at distinct times during skeletal maturity and give rise to structural changes in the pelvis that can be distinctively appreciated on various imaging modalities. Accurate interpretation of radiologic images requires knowledge of skeletal development because the varying appearance of the maturing pediatric pelvis may be mistaken for pathology. In addition, many normal features within the pelvis can be erroneously perceived as injury. This article incorporates a multimodality review of normal pelvic maturation, a discussion of developmental variants, and a description of common injuries unique to the pediatric pelvis. [ABSTRACT FROM AUTHOR]

Pediatric foot development throughout childhood and adolescence can present a diagnostic dilemma for radiologists because imaging appearances may be confused with pathology. Understanding pediatric foot development and anatomical variants, such as accessory ossification centers, is essential to interpret musculoskeletal imaging in children correctly, particularly because many of these variants are incidental but others can be symptomatic. We first briefly review foot embryology. After describing common accessory ossification centers of the foot, we explain the different patterns of foot maturation with attention to irregular ossification and bone marrow development. Common pediatric foot variants and pathology are described, such as tarsal coalitions and fifth metatarsal base fractures. We also discuss pediatric foot alignment and various childhood foot alignment deformities. [ABSTRACT FROM AUTHOR]

Pediatric wrist injuries pose unique diagnostic challenges due to distinct bone characteristics in children and their diverse injury patterns. The dynamic development of the wrist, marked by changes in bone age and emerging ossification centers, is crucial to evaluate growth and identify potential pathologies. The skeletal composition, rich in cartilage, renders bones relatively weaker yet more elastic, impacting their susceptibility to fracture. Forearm fractures display diverse patterns influenced by torsional forces. Scaphoid fractures, less common in children, differ from those in adults. Conditions like Madelung's deformity and ulnar variance are more common wrist disorders in the pediatric population. In addition, the scarcity and nonspecificity of symptoms in those with tendon injuries and triangular fibrocartilage complex lesions can be diagnostically challenging. This article reviews pediatric wrist injuries, emphasizing ossification patterns, common fracture types, and developmental variants. Grasping these complexities in pediatric wrist development and associated pathologies is essential for precise diagnosis and treatment. [ABSTRACT FROM AUTHOR]

"Cysts of the ligamentum flavum (cysts‐LF)" is the term for non‐neoplastic cystic lesion involving LF. The aim of the present study was to elucidate the histopathological characteristics and pathogenesis of "cysts‐LF". Herein, we defined cysts‐LF as spinal cysts containing degenerative LF components. From archival cases, we investigated 18 symptomatic cysts‐LF surgically removed from 18 patients (13 males and five females; median age 68.5 years [range, 42–86 years]). The elastic fibers of LF components in the wall were separated and/or torn, and cyst walls were accompanied by chondroid metaplasia (17 cases), myxoid changes (13 cases), ossification (11 cases), amyloid deposits (14 cases), hemosiderosis (six cases), granular/smudgy calcification (four cases), synovial cell linings (three cases), and severe inflammatory infiltrates (one case). These histologic features of our cysts‐LF were shared by previously reported "cysts‐LF." Fourteen cysts‐LF demonstrated vascular stenosis/occlusion, and eight showed thick hyalinized vessels, suggesting local circulatory insufficiency. Eight cases (44%) exhibited lipomembranous fat necrosis, accompanied by hyalinized vascular changes (p = 0.003). Ischemic conditions were observed in nearly half of the present cysts‐LF, and may be one of the main contributing factors for the formation of cysts‐LF, via degeneration and cystic changes in the LF. [ABSTRACT FROM AUTHOR]

Selective laser melting (SLM) is a contemporary manufacturing method that offers numerous advantages for producing various components. This research focuses on the examination of a dental implant sample fabricated using the SLM method. The investigation encompasses multiple aspects, including hardness, dimensional accuracy, strength, and surface properties. The results demonstrate that the hardness of the SLM sample is comparable to that of machined samples, establishing it as a viable alternative to traditional production methods. Dimensional tests reveal that the SLM sample adheres to the required acceptance limits for critical dimensions. The strength of the sample, with a value of 700 MPa, proves to be acceptable for medical applications. The presence of surface porosity and holes in the SLM sample highlights its potential for enhanced bone ossification. However, challenges associated with thread construction in the SLM process require further attention. Overall, this research showcases the promising aspects of the SLM method for dental implant production, while also identifying areas for future investigation and improvement. [ABSTRACT FROM AUTHOR]

Objective: The objective was to determine the effects of older age on hearing preservation after cochlear implantation (CI), and whether steroids improve hearing preservation in older animals. We hypothesized greater hearing preservation would be observed in (1) young animals compared to older animals and (2) older animals receiving steroids compared to no steroids. The secondary objective was to assess levels of fibrosis utilizing optical coherence tomography (OCT). Study Design: Experimental Animal Study. Setting: Laboratory. Methods: Three groups of guinea pigs: young (YCI; 8.5 ± 0.5 weeks; n = 10), old (OCI; 19.1 ± 1.0 months; n = 9) and old + steroids (OCI+S; 19.1 ± 1.0 months; n = 9) underwent CI. The OCI+S group received a steroid taper over 7 days starting 2 days before surgery to 4 days after. Auditory brainstem response (ABR) measurements were performed preoperatively and postoperatively. OCT imaging was performed to assess cochleae for extent of fibrotic tissue growth in the scala tympani. Results: The YCI group had significantly better hearing preservation as measured by smaller increases in ABR thresholds [mean shift: 2.79 ± 0.66] compared to the OCI group [mean shift = 12.44 ± 5.6]. The OCI+S group had significantly better hearing preservation [2.66 ± 1.50] compared to the OCI group. No significant differences was seen in fibrosis across groups. Conclusions: Young animals and older animals that received steroids had better hearing after CI than older animals not given steroids, but hearing preservation was not correlated with the level of fibrosis assessed using OCT. This work is the first to investigate differences in hearing preservation by age in an animal model, and supports the protective effects of steroids on hearing preservation in older individuals. [ABSTRACT FROM AUTHOR]

Aims: Surgical approaches to cervical ossification of the posterior longitudinal ligament (OPLL) remain controversial. The purpose of the present study was to analyze and compare the long-term neurological recovery following anterior decompression with fusion (ADF) and posterior laminectomy and fusion with bone graft and internal fixation (PLF) based on > ten-year follow-up outcomes in a single centre. Methods: Included in this retrospective cohort study were 48 patients (12 females; mean age 55.79 years (SD 8.94)) who were diagnosed with cervical OPLL, received treatment in our centre, and were followed up for 10.22 to 15.25 years. Of them, 24 patients (six females; mean age 52.88 years (SD 8.79)) received ADF, and the other 24 patients (five females; mean age 56.25 years (SD 9.44)) received PLF. Clinical data including age, sex, and the OPLL canal-occupying ratio were analyzed and compared. The primary outcome was Japanese Orthopaedic Association (JOA) score, and the secondary outcome was visual analogue scale neck pain. Results: Compared with the baseline, neurological function improved significantly after surgery in all patients of both groups (p < 0.001). The JOA recovery rate in the ADF group was significantly higher than that in the PLF group (p < 0.001). There was no significant difference in postoperative cervical pain between the two groups (p = 0.387). The operating time was longer and intraoperative blood loss was greater in the PLF group than the ADF group. More complications were observed in the ADF group than in the PLF group, although the difference was not statistically significant. Conclusion: Long-term neurological function improved significantly after surgery in both groups, with the improvement more pronounced in the ADF group. There was no significant difference in postoperative neck pain between the two groups. The operating time was shorter and intraoperative blood loss was lower in the ADF group; however, the incidence of perioperative complications was higher. Cite this article: Bone Jt Open 2024;5(9):768–775.

BACKGROUND: Ossification of the ligamentum flavum was previously considered to be rare in the population. As research has progressed, its incidence rate is increasing gradually, which has aroused the interest of a large number of researchers. OBJECTIVE: To visualize and analyze the research results on ossification of the ligamentum flavum from the Web of Science Core Collection since 1999 using bibliometric methods, and to review the research history of ossification of the ligamentum flavum, highlighting important literature, summarizing research hotspots, and providing ideas for researchers to find research directions. METHODS: Using the Web of Science Core Collection as the data source, relevant papers on ossification of the ligamentum flavum were searched and screened. VOSviewer 1.6.19 and CiteSpace 6.2.R6 were used to conduct the visual analysis of annual publication volume, research countries, institutions, citations, journals, authors, and keywords. RESULTS AND CONCLUSION: (1) A total of 347 papers were included. Since 1999, the number of published papers has increased in a spiral pattern. China’s research started later than Japan’s, but the number of publications has come up later, with Peking University being the institution with the most publications, and Prof. Chen Zhongqiang from Peking University being the scholar with the most publications. (2) Five of the 10 most frequently cited publications were related to the surgical treatment of the disease. (3) Excluding keywords directly related to the research topic and synthetically analyzing frequencies and betweenness centralities of key words, terms such as “thoracic myelopathy,” “dural ossification,” “minimally invasive surgery,” and “ossification of the posterior longitudinal ligament” occupied a central position in this field. (4) Keywords clustering analysis showed that clinical manifestations and surgical treatment of ossification of the ligamentum flavum accounted for a large proportion of study. (5) The timeline and burst analysis of keywords revealed that “minimally invasive surgery” appeared as a keyword around 2015, with the highest burst strength and the latest burst start time, and began to receive extensive attention from researchers in 2019. The burst of the keyword “dural ossification” has not yet ended. (6) Surgical treatment for ossification of the ligamentum flavum has been at the forefront of research. Development and research of minimally invasive surgery and research on dural ossification secondary to ossification of the ligamentum flavum are both current research hotspots and possible future research trends. [ABSTRACT FROM AUTHOR]

The mammalian skull base ossifies from chondral elements into successive bones described as the basicranial stem or axis. The axis includes the basioccipital, basisphenoid, presphenoid, and mesethmoid bones. Accurately tracing the ontogenetic origin of this area is essential, as endochondral development plays a crucial role in understanding the homology of these axial bones. This area contributes to building the ethmo-sphenoidal area and contains phylogenetic signal. In our study, we examined the ontogeny of the neurocranial base and allied bones (i.e., alisphenoid and orbitosphenoid) in representatives of two living armadillo clades: Dasypus hybridus (n = 18) (Dasypodidae), Chaetophractus vellerosus (n = 9) and Chaetophractus villosus (n = 11) (Chlamyphoridae). The presphenoid is not ossified in D. hybridus, C. villosus, or C. vellerosus; moreover, there is no clear evidence that this bone forms a separate ossification in other cingulates. In addition, there is evidence for the existence of postnatal mesethmoid ossification in armadillos. There are different ontogenetic trajectories in armadillos, precocial for Dasypus and altricial for Chaetophractus. The presence of the mesethmoid is likely a plesiomorphic condition for Placentalia. [ABSTRACT FROM AUTHOR]

In forensic age estimation, CT imaging of the clavicles is used to determine an age over completed 21 years. If ossification of the medial clavicular epiphysis is complete, young men are assumed to be over 21 years of age. The aim of this study is to check the statistical parameters (specificity, predictive probability) for the characteristic "completed ossification of the medial clavicles". 285 male patients who, for various reasons, received a chest CT at the Medical Center of the University of Freiburg between 1st December 2019 and 6th December 2022 were screened for the study, of whom 203 patients were included in the study. The stage of clavicular ossification was classified as stage 1 – 5 according to Schmeling. While 70 out of 71 patients under 21 years of age were correctly estimated to be under 21 years of age, there was one patient whose ossification on one side was classified as stage 4 and who would therefore have been estimated to be over 21 years of age. If only subjects whose ossification stage was the same on both sides are included, the specificity of the test method is 100% and the positive predictive probability is 100%. If patients for whom only one side is stage 4 are also included, the specificity is 98.6%. Thus, only the complete and symmetrical ossification of both clavicles (stage 4 according to the Schmeling classification) in a standardised thin-layer CT can be classified as a reliable indicator of an age over 21 years in young men. In the case of asymmetric ossification of the medial clavicles (stage 4 is not reached on one side), false positive evaluations and the incorrect assumption of an age over 21 years can occur. [ABSTRACT FROM AUTHOR]

Ossifying fibromyxoid tumor (OFMT) is a rare mesenchymal tumor of uncertain histogenesis with intermediate malignant potential presenting commonly in the fifth to sixth decade in the proximal limb and limb girdle. A 65-year-old male patient presented with a slow-growing gluteal mass. Wide local excision performed showed a well-defined tumor in the subcutaneous plane with a partially hard outer shell. Microscopy showed a moderately cellular tumor having cords and nests of round to ovoid cells with moderate cytoplasm and bland nuclei embedded in a myxo-hyaline matrix. An incomplete peripheral rim of ossification was seen. Pleomorphism/high cellularity was not seen. Mitosis was

Abstract Background This study evaluated the osseointegration potential of functionalised high-performance oxide ceramics (HPOC) in isolation or coated with BMP-2 or RGD peptides in 36 New Zeeland female rabbits using micro-computed tomography (micro CT). The primary outcomes of interest were to assess the amount of ossification evaluating the improvement in the bone volume/ total volume (BV/TV) ratio and trabecular thickness at 6 and 12 weeks. The second outcome of interest was to investigate possible differences in osteointegration between the functionalised silanised HPOC in isolation or coated with Bone Morphogenetic Protein 2 (BMP-2) or RGD peptides. Methods 36 adult female New Zealand white rabbits with a minimum weight of three kg were used. One-third of HPOCs were functionalised with silicon suboxide (SiOx), a third with BMP-2 (sHPOC-BMP2), and another third with RGD (sHPOC-RGD). All samples were scanned with a high-resolution micro CT (U-CTHR, MILabs B.V., Houten, The Netherlands) with a reconstructed voxel resolution of 10 µm. MicroCT scans were reconstructed in three planes and processed using Imalytics Preclinical version 2.1 (Gremse-IT GmbH, Aachen, Germany) software. The total volume (TV), bone volume (BV) and ratio BV/TV were calculated within the coating area. Results BV/TV increased significantly from 6 to 12 weeks in all HPOCs: silanised (P = 0.01), BMP-2 (P

Background. Open reconstructive plastic surgeries are the most radical method of treating patients with elbow contractures caused by ossification. However, these surgeries pose a serious problem due to the large number of unsatisfactory results. The aim of the study is a comparative assessment of the effectiveness between standard techniques and 3D visualization technologies in the surgical treatment of patients with elbow contractures caused by ossification. Methods. Using random number generation, all patients (n = 71) were randomized into two groups. The first group included 34 patients with elbow contractures caused by ossification that underwent surgical intervention using 3D technologies to assess the ossification process. The second group enrolled 37 patients with a similar nosology that underwent standard examination and surgical treatment. The results were evaluated intraoperatively and 180 days after the surgery. The data were obtained from primary medical records and further survey. Results. The application of new planning technology and tactics for onstructive plastic surgeries made it possible to reduce the surgery time by 1.2 times (p0.05), reduce blood loss by 1.3 times (p0.05) and increase the relative number of patients with sufficient movement volume by 10.6% (p0.05). The assessment of various performance parameters (range of motion, pain syndrome, quality of life etc.) showed that after 6 months in the main group, the relative number of patients with problems related to the operated joint was significantly lower than in the control group: 20.5% vs 84.7% (p0.05). Conclusions. The data obtained indicate that the use of the new technique for planning and performing reconstructive plastic surgery in patients with elbow contractures caused by ossification contributes to a less invasive intervention and achievement of better intraoperative and medium-term treatment results.

Abstract Background Cardiac myxomas are the most common type of primary cardiac tumors in adults, but they can have variable features that make them difficult to diagnose. We report two cases of atrial myxoma with calcification or ossification, which are rare pathological subgroups of myxoma. Case presentation A 47-year-old woman and a 35-year-old man presented to our hospital with different symptoms. Both patients had a history of chronic diseases. Transthoracic and transesophageal echocardiography revealed a mass in the left or right atrium, respectively, with strong echogenicity and echogenic shadows. The masses were suspected to be malignant tumors with calcification or ossification. Contrast transthoracic echocardiography(cTEE) showed low blood supply within the lesions. The patients underwent surgical resection of the atrial mass, and the pathology confirmed myxoma with partial ossification or massive calcification. Conclusion We report two rare cases of atrial myxoma with calcification or ossification and analyze their ultrasonographic features. Transthoracic echocardiography and cTEE can provide valuable information for the diagnosis and management of such mass. However, distinguishing calcification and ossification in myxoma from calcification in malignant tumors is challenging. More studies are needed to understand the pathogenesis and imaging characteristics of these myxoma variants.

Ossification of the sacrotuberous ligament is a rare occurrence in soft tissue, with only 15 cases reported in the past few decades. We reported two cases of bilateral ossification in sacrotuberous ligaments and provided a concise review of the literature on this pathology. Clinical data, radiographic outcomes, and diagnostic and treatment details were obtained. This study aimed to summarize this disease's characteristics and investigate its pathogenesis through a review of literature from the last thirty years. This condition is often incidentally confirmed in elderly males via imagiological examination or gross anatomy and presents a low morbidity rate. Its pathogenesis may be related to stress concentration, excessive intake of element ions, injury repair, and improper operative technique. The majority of patients may not exhibit any clinical symptoms or signs and typically do not require medical interventions. It may be complicated with pudendal nerve entrapment syndrome. The long‐term effects of surgical resection and the most effective treatment approach remain areas for further research.

Introduction: Epibulbar choristoma is a benign congenital lesion containing histologically normal-appearing tissue in an abnormal ectopic location. An epibulbar choristoma is classified as either epibulbar dermoid, dermolipoma, or complex choristoma based on histological examination. The case presented was a presumed epibulbar dermolipoma with no signs of ossification on imaging, examination, or intraoperatively until the specimen was examined histologically, clarifying the lesion as an epibulbar complex choristoma. Reassuringly, the presence of bone in such lesions should not change management. Case Presentation: A mother noticed a small fleshy mass on her 9-year-old daughter’s superotemporal bulbar conjunctiva. The suspected epibulbar dermolipoma was confirmed with MRI and initially managed conservatively. Two years later, she was referred for apparent growth and cosmetic concerns, and she underwent surgical debulking. Conclusion: We present this case for its unusual presentation and histological findings. Orbital surgeons should be aware of the possibility of ossification of epibulbar choristomas and avoid confusion with alternative diagnoses. Clarification of the latest classification system for epibulbar choristomas is provided.