Evaluation of Experimental Proximal Femoral Physeal Fractures Repaired with Two Cortical Screws Placed from the Articular Surface

1994 ◽  
Vol 07 (04) ◽  
pp. 140-147 ◽  
Author(s):  
R. M. McLaughlin ◽  
J. K. Roush ◽  
D. M. Tillson
Keyword(s):  
Articular Cartilage ◽  
Femoral Neck ◽  
Articular Surface ◽  
Weight Bearing ◽  
Histological Evidence ◽  
Fine Detail ◽  
Osteocyte Death ◽  
Physeal Closure ◽  
Gross Examination ◽  
Physeal Fractures

SummaryProximal femoral physeal fractures were surgically created unilaterally in twelve immature dogs and repaired using two cortical screws placed in lag fashion from the articular surface into the femoral neck. Four dogs were euthanatized at two, four and eight weeks after surgery and evaluated by gross examination, fine detail radiography, fine detail angiography and histology. Mild to severe injury to the articular cartilage of the acetabulum was observed in all operated joints. Narrowing of the femoral neck was evident on fine detail radiographs and was most severe at week four. Metaphyseal vessels crossed the physis and revascularized the epiphysis with greater than 90% of the epiphysis being revascularized by eight weeks. Operated femora showed histological evidence of physeal disruption and premature physeal closure. Osteocyte death in the epiphysis was evident histologically with viable osteocytes following revascularization and proceeding from distal to proximal through the epiphysis over eight weeks.The healing of proximal fe-moral physeal fractures repaired with two, 2.0 mm cortical screws placed from the articular surface was evaluated by gross evaluation, fine detail radio-graphs and angiographs, and histological examination. Fracture healing and restoration of blood supply was adequate for weight bearing. This technique is acceptable for use in clinical patients.

scholarly journals Anatomy of the Intermetatarsal Facets of the Fourth and Fifth Metatarsals

2021 ◽  
Vol 6 (1) ◽  
pp. 247301142097570
Author(s):  
Mossub Qatu ◽  
George Borrelli ◽  
Christopher Traynor ◽  
Joseph Weistroffer ◽  
James Jastifer
Keyword(s):  
Articular Cartilage ◽  
Digital Imaging ◽  
Articular Surface ◽  
Implant Design ◽  
Joint Surface ◽  
Fracture Classification ◽  
Articular Damage ◽  
Metatarsal Fracture ◽  
Metatarsal Fractures ◽  
The Mean

Background: The intermetatarsal joint between the fourth and fifth metatarsals (4-5 IM) is important in defining fifth metatarsal fractures. The purpose of the current study was to quantify this joint in order to determine the mean cartilage area, the percentage of the articulation that is cartilage, and to give the clinician data to help understand the joint anatomy as it relates to fifth metatarsal fracture classification. Methods: Twenty cadaver 4-5 IM joints were dissected. Digital images were taken and the articular cartilage was quantified by calibrated digital imaging software. Results: For the lateral fourth proximal intermetatarsal articulation, the mean area of articulation was 188 ± 49 mm2, with 49% of the area composed of articular cartilage. The shape of the articular cartilage had 3 variations: triangular, oval, and square. A triangular variant was the most common (80%, 16 of 20 specimens). For the medial fifth proximal intermetatarsal articulation, the mean area of articulation was 143 ± 30 mm2, with 48% of the joint surface being composed of articular cartilage. The shape of the articular surface was oval or triangular. An oval variant was the most common (75%, 15 of 20 specimens). Conclusion: This study supports the notion that the 4-5 IM joint is not completely articular and has both fibrous and cartilaginous components. Clinical Relevance: The clinical significance of this study is that it quantifies the articular surface area and shape. This information may be useful in understanding fifth metatarsal fracture extension into the articular surface and to inform implant design and also help guide surgeons intraoperatively in order to minimize articular damage.

A Review of the Collagen Orientation in the Articular Cartilage

Cartilage ◽  
2021 ◽  
pp. 194760352098877
Author(s):  
Roy D. Bloebaum ◽  
Andrew S. Wilson ◽  
William N. Martin
Keyword(s):  
Surface Layer ◽  
Articular Cartilage ◽  
Fiber Orientation ◽  
Collagen Fiber ◽  
Articular Surface ◽  
Imaging Techniques ◽  
Collagen Fibers ◽  
Deep Zone ◽  
Collagen Fiber Orientation ◽  
Critical Point Drying

Objective There has been a debate as to the alignment of the collagen fibers. Using a hand lens, Sir William Hunter demonstrated that the collagen fibers ran perpendicular and later aspects were supported by Benninghoff. Despite these 2 historical studies, modern technology has conflicting data on the collagen alignment. Design Ten mature New Zealand rabbits were used to obtain 40 condyle specimens. The specimens were passed through ascending grades of alcohol, subjected to critical point drying (CPD), and viewed in the scanning electron microscope. Specimens revealed splits from the dehydration process. When observing the fibers exposed within the opening of the splits, parallel fibers were observed to run in a radial direction, normal to the surface of the articular cartilage, radiating from the deep zone and arcading as they approach the surface layer. After these observations, the same samples were mechanically fractured and damaged by scalpel. Results The splits in the articular surface created deep fissures, exposing parallel bundles of collagen fibers, radiating from the deep zone and arcading as they approach the surface layer. On higher magnification, individual fibers were observed to run parallel to one another, traversing radially toward the surface of the articular cartilage and arcading. Mechanical fracturing and scalpel damage induced on the same specimens with the splits showed randomly oriented fibers. Conclusion Collagen fiber orientation corroborates aspects of Hunter’s findings and compliments Benninghoff. Investigators must be aware of the limits of their processing and imaging techniques in order to interpret collagen fiber orientation in cartilage.

Traumatic physeal fractures in cats: a review of 36 cases (2010–2020)

2021 ◽  
pp. 1098612X2110058
Author(s):  
Carlos Rubinos ◽  
Richard L Meeson
Keyword(s):  
Distal Tibia ◽  
Fracture Repair ◽  
Implant Removal ◽  
Type I ◽  
Physeal Fracture ◽  
Physeal Closure ◽  
Femoral Physis ◽  
Clinical Records ◽  
Physeal Fractures

Objectives The aim of this study was to describe the demography, aetiology, location and classification of physeal fractures in cats, and to describe their management and outcomes. Methods Clinical records and radiographs of cats referred for management of physeal fractures were retrospectively reviewed. Fractures of the proximal femoral physis were excluded. Descriptive statistics were used to describe signalment, cause of injury, presence of concurrent injuries, fracture description, treatment modality, complications, follow-up, physeal closure, implant removal and outcome. Results Thirty-four cats with 36 fractures were included, of which 17 affected the distal femur, 11 the distal tibia and fibula, five the distal radius and ulna, two the proximal tibia and one the distal humerus. Salter–Harris classification was type I in 14, type II in 16, type III in two and type IV in four fractures. Thirty-four fractures were treated with primary fixation, and the most common method was crossed Kirschner wires (24/34 fractures). Complications were observed in 14 fractures, of which 12 were minor. At radiographic follow-up, physeal closure was reported in 23 fractures, of which 15 were considered premature. Implant removal was performed in three fractures. Outcome was good in 28, fair in four and poor in two fractures. Conclusions and relevance Fracture of the distal femoral physis was the most common physeal fracture seen. Cats presenting with physeal fractures may be skeletally immature or mature with delayed physeal closure. The rate of physeal closure after fracture repair was relatively high but without apparent impact. The frequency of implant removal was very low, indicating that despite having a physeal fracture repair, most cats did not require a second procedure to remove implants. Overall, internal fixation provided a good outcome in most fractures.

scholarly journals POS0277 ANABOLIC EFFECT OF LNA043, A NOVEL DISEASE-MODIFYING OSTEOARTHRITIS DRUG CANDIDATE: RESULTS FROM AN IMAGING-BASED PROOF-OF-CONCEPT TRIAL IN PATIENTS WITH FOCAL ARTICULAR CARTILAGE LESIONS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 363.2-363
Author(s):  
S. Trattnig ◽  
C. Scotti ◽  
D. Laurent ◽  
V. Juras ◽  
S. Hacker ◽  
...  
Keyword(s):  
Articular Cartilage ◽  
Weight Bearing ◽  
Cartilage Lesion ◽  
Cartilage Volume ◽  
Lesion Volume ◽  
Proof Of Concept ◽  
T2 Relaxation Time ◽  
T2 Relaxation ◽  
Cartilage Lesions ◽  
Articular Cartilage Lesions

Background:LNA043 is a modified, recombinant version of the human angiopoietin-like 3 (ANGPTL3) protein acting directly on cartilage-resident cells to transmit its cartilage anabolic effect. A first-in-human study previously demonstrated the favourable safety profile and the modulation of several pathways involved in cartilage homeostasis and osteoarthritis (OA)1. A previous proof-of-mechanism imaging study used high field (7 Tesla) magnetic resonance imaging (MRI) to show formation of hyaline-like tissue after a single injection of 20 mg LNA043 (unpublished data).Objectives:To evaluate non-invasively the chondro-regenerative capacity of multiple intra-articular (i.a.) injections of LNA043 in patients with articular cartilage lesions in the knee (NCT03275064).Methods:This was a randomised, double-blind, placebo (PBO)-controlled, proof-of-concept study in patients with a partial thickness cartilage lesion. In total, 58 patients (43 [20 mg LNA043]; 15 [PBO]), stratified by lesion type (condylar or patellar) were treated with 4 weekly i.a. injections. The primary endpoint was T2 relaxation time measurement as a marker of collagen fiber network, and cartilage lesion-volume was a secondary endpoint, both using 3-Tesla MRI. Assessments were performed at baseline, weeks (wks) 8, 16, 28 and 52 (the latter in 23/58 patients). While lesion-volume for the secondary endpoint was determined from manually segmented images, the cartilage volume of 21 sub-regions spanning the entire knee was also measured from 3D isotropic MR images employing an automated segmentation prototype software (MR Chondral Health 2.1 [MRCH], Siemens Healthcare)2. An exploratory analysis evaluated the treatment effect for the additive volume of the 3 subregions in the weight-bearing area of the medial femur.Results:No change in T2 relaxation time was detected between treatment and PBO groups. Manual segmentation showed continuous filling of the cartilage lesions up to wk 28 in LNA043-treated patients with femoral lesions (p=0.08, vs PBO) while no effect was detected for patients with patellar lesions. Given the limitations of measuring small, irregularly shaped lesions with manual image-analysis, the MRCH approach was used (Figure 1). In the medial femoral weight-bearing region, refilling was detected over time (Δ=123 mm3 at wk 28, N= 37, p= 0.05). No overgrowth was detected in the lateral femoral condyles without cartilage damage. The overall safety profile was favourable; only mild/moderate local reactions were reported, including a higher incidence of joint swelling (9.3% vs 0%) and arthralgia (11.6% vs 6.7%) for LNA043 vs PBO resolving spontaneously or with paracetamol/NSAIDs. No anti-drug antibodies were detected.Conclusion:Treatment with 4 weekly i.a. injections of 20 mg LNA043 resulted in regeneration of damaged cartilage in patients with femoral articular cartilage lesions. Automated measurement of cartilage volume in the femoral index region was able to detect a relevant treatment effect and was found to be more sensitive than the manual segmentation method. No sign of cartilage overgrowth was observed in healthy femoral regions. A Phase 2b study in patients with mild to moderate knee OA is in preparation.References:[1]Scotti et al. ACR Convergence 2020; Abstract #1483[2]Juras et al. Cartilage 2020; Sep 29:1-12Disclosure of Interests:Siegfried Trattnig: None declared, Celeste Scotti Shareholder of: Novartis, Employee of: Novartis, Didier Laurent Shareholder of: Novartis, Employee of: Novartis, Vladimir Juras: None declared, Scott Hacker Grant/research support from: Novartis, Brian Cole: None declared, Libor Pasa: None declared, Roman Lehovec: None declared, Pavol Szomolanyi: None declared, Esther Raithel Employee of: Siemens Healthcare GmbH, Franziska Saxer Shareholder of: Novartis, Employee of: Novartis, Jens Praestgaard Shareholder of: Novartis, Employee of: Novartis, Fabiola La Gamba Shareholder of: Novartis, Employee of: Novartis, José L. Jiménez Employee of: Novartis, David Sanchez Ramos Shareholder of: Novartis, Employee of: Novartis, Ronenn Roubenoff Shareholder of: Novartis, Employee of: Novartis, Matthias Schieker Shareholder of: Novartis, Employee of: Novartis

On the Natural Lubrication of Synovial Joints: Normal and Degenerate

1977 ◽  
Vol 99 (2) ◽  
pp. 163-172 ◽  
Author(s):  
Joseph M. Mansour ◽  
Van C. Mow
Keyword(s):  
Articular Cartilage ◽  
Solid Phase ◽  
Articular Surface ◽  
Moving Load ◽  
Frictional Resistance ◽  
Elastic Solid ◽  
Surface Load ◽  
Two Phase ◽  
Tissue Properties ◽  
Synovial Joints

Fluid flow and mass transport mechanisms associated with articular cartilage function are important biomechanical processes of normal and pathological synovial joints. A three-layer permeable, two-phase medium of an incompressible fluid and a linear elastic solid are used to model the flow and deformational behavior of articular cartilage. The frictional resistance of the relative motion of the fluid phase with respect to the solid phase is given by a linear diffusive dissipation term. The subchondral bony substrate is represented by an elastic solid. The three-layer model of articular cartilage is chosen because of the known histological, ultrastructural, and biomechanical variations of the tissue properties. The calculated flow field shows that for material properties of normal healthy articular cartilage the tissue creates a naturally lubricated surface. The movement of the interstitial fluid at the surface is circulatory in manner, being exuded in front and near the leading half of the moving surface load and imbibed behind and near the trailing half of the moving load. The flow fields of healthy tissues are capable of sustaining a film of fluid at the articular surface whereas pathological tissues cannot.

Conservative management of osteoarthrosis

1973 ◽  
Vol 11 (8) ◽  
pp. 29-30
Keyword(s):  
Articular Cartilage ◽  
Rheumatoid Factor ◽  
Conservative Management ◽  
Inflammatory Arthritis ◽  
Morning Stiffness ◽  
Weight Bearing ◽  
Radiological Evidence ◽  
Wear And Tear ◽  
Joint Erosions ◽  
Synovial Effusion

Osteoarthrosis (osteoarthritis) can be regarded as excessive joint wear and tear to the point where this becomes painful or produces stiffness. It is most disabling in weight-bearing joints, in which wearing away of articular cartilage is accompanied by underlying bony overgrowth and accumulation of a synovial effusion. The mechanism of the pain is uncertain: capsular strains and deep bone sensation may contribute. Diagnosis requires the exclusion of inflammatory arthritis such as rheumatoid; pointers to the latter are morning stiffness, raised ESR, positive tests for rheumatoid factor in the serum and radiological evidence of joint erosions.

Medial malleolar osteotomy for intralesional curettage and bone grafting of primary aneurysmal bone cyst of the talus

2021 ◽  
Vol 14 (5) ◽  
pp. e242452
Author(s):  
Sujit Tripathy ◽  
Paulson Varghese ◽  
Sibasish Panigrahi ◽  
Lubaib Karaniveed Puthiyapura
Keyword(s):  
Aneurysmal Bone Cyst ◽  
Cystic Lesion ◽  
Articular Surface ◽  
Weight Bearing ◽  
Bone Cyst ◽  
Lytic Lesion ◽  
Intralesional Curettage ◽  
Medial Malleolar Osteotomy ◽  
Fluid Levels

Access to the cystic lesion of the talar body without damage to the articular surface is difficult. This case report is about a 23-year-old man who had a symptomatic huge cystic lesion in the left-sided talus bone. Radiograph and CT scan showed an expansile lytic lesion within the talar body. The MRI revealed a well-defined lesion with fluid-fluid levels. The needle biopsy aspirate was haemorrhagic, and hence a diagnosis of the aneurysmal bone cyst was made. As the lesion was beneath the talar dome with an intact neck and head, a medial approach with medial malleolar osteotomy was performed. The lesion was curetted out, and the cavity was filled up with a morselised bone graft. The limb was splinted for 6 weeks, and complete weight bearing was started after 3 months. At 1-year follow-up, the lesion was found to be healed up, and the patient was pain-free with no recurrence.

Collagen fibrils are differently organized in weight-bearing and not-weight-bearing regions of pig articular cartilage

2000 ◽  
Vol 287 (5) ◽  
pp. 346-352 ◽  
Author(s):  
Santiago Gomez ◽  
Renato Toffanin ◽  
Sigrid Bernstorff ◽  
Milena Romanello ◽  
Heinz Amenitsch ◽  
...  
Keyword(s):  
Articular Cartilage ◽  
Weight Bearing ◽  
Collagen Fibrils

scholarly journals Hip dislocation following the treatment of femoral neck fracture: Case report

2010 ◽  
Vol 138 (3-4) ◽  
pp. 248-251
Author(s):  
Zoran Vukasinovic ◽  
Igor Seslija ◽  
Borislav Dulic
Keyword(s):  
Femoral Neck ◽  
Femoral Neck Fracture ◽  
Open Reduction ◽  
Weight Bearing ◽  
Young Patients ◽  
Hip Dislocation ◽  
Full Weight Bearing ◽  
Limited Range Of Motion ◽  
Femoral Head Osteonecrosis ◽  
Neck Fracture

Introduction. Femoral neck fractures are very rare in young patients and are frequently complicated by femoral head osteonecrosis and femoral neck nonunion. Case Outline. A 19-year-old girl with hip dislocation following the treatment of the femoral neck fracture is presented. The femoral neck fracture was initially treated by open reduction and three-screw fixation. After detecting the nonunion of femoral neck, valgus osteotomy was done. Secondary, iatrogenic, hip dislocation appeared. The patient had pains, and in clinical findings a shorter leg and limited range of motion in the hip - altogether 40 degrees. She was then successfully treated by open reduction, together with Chiari pelvic osteotomy and joint transfixation. Transfixation pin was removed three weeks following the operation. After that, the patient was put into the abduction device and physical therapy was started. The mentioned regimen lasted four months after the surgery, then the abduction device was removed and walking started. Full weight bearing was allowed eight months after surgery. Conclusion. As we have not found the literature data concerning the above mentioned problem, we solved it in the way that we usually do for the treatment of developmental dislocation of the hip in adolescence.

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