Fracture of the Bone Inducing Its Necrosis as the End Point in the Evolution of Untreated Neuroarthropathy

We describe here the case of a female patient with type I diabetes who developed active Charcot neuroarthropathy in the foot. Due to therapeutic noncompliance, talus necrosis was discovered 2 years after the presentation of neuroarthropathy. The impact of untreated neuroarthropathy on the bone is commonly described as fracture and joint dislocation, but we describe the complete disappearance of the bony structure and its necrosis associated with active neuroarthropathy in a patient who refused offloading.

Determination of Most Reliable Bony Structure For Ageing of Carassius carassius (Linnaeus, 1758) Inhabiting In Duhok River (Iraq)

In this study, it was aimed to make a comparative age determination in the population of Carassius carassius (Linnaeus, 1758) living in Duhok River. For this purpose, 71 fish samples (57 male and 14 female) were obtained. The bony structures vertebrae, scales, otoliths and operculum used in the age determination. The age groups determined for each bony structure. The number and percentage distributions of individuals in these groups were expressed with tables. The comparison of age matching between bony structures was expressed by figures. The most reliable bony structures were found as vertebrae, otolith, scales and operculum respectively. The highest consistency was observed in the vertebrae (70.42%). The ages changed between I and IX age in Carassius carassius in this study.

Atypical Presentation of Frontoethmoidal Encephaloceles in a Child - A Case Report

Encephalocele is a form of neural tube defect affecting many children, more common in the occipital regions. The frontoethmoidal encephaloceles (FEE) are rare and the aetiology is unclear since it varies genetically and is linked to multiple reasons. The child with FEE mainly presents with swelling over the bridge of the nose or inner canthus of an eye since birth, with varying degrees of hypertelorism. Here we report a child who has facial asymmetry with FEE. Encephalocele is a defect in the calvarium that causes the cranial contents to protrude outside the natural limits of the skull. It can have meninges (meningocele), brain matter and meninges (meningoencephalocele), or communication with the ventricles. Suwanwela and Suwanwela defined encephaloceles based on the location and form of skull defect as occipital encephaloceles, cranial vault encephaloceles, frontoethmoidal encephaloceles, and basal encephaloceles. The internal skull defect in frontoethmoidal encephalocele (FEE) is in the midline, but the external skull defect may vary in the facial bony structure. 1–3 It is also classified into three subtypes: nasofrontal (NF), naso-ethmoidal (NE), and naso-orbital (NO). These swellings are classified as sessile or pedunculated, and their palpability ranges from robust and rigid to soft and cystic. We present a case of an infant with frontoethmoidal encephaloceles as well as a facial deformity.

P0869EXOGENOUS OSTEOGENIC FACTOR 1 ADMINISTRATION ATTENUATED VASCULAR CALCIFICATION AND IMPROVED BONE DISORDERS IN CHRONIC UREMIC RATS

Background and Aims Hyperphosphatemia and secondary hyperparathyroidism are frequent complications in chronic kidney disease (CKD) which both contribute to increased morbidity and mortality in CKD. Osteogenic factor-1 (OP-1) is an important member of BMPs subfamily and its effects on CKD-associated mineral and bone disorders (MBD) is controversial. The study examined whether exogenous OP-1 administration can modulate disturbed CKD-MBD in adenine-induced chronic uremic rats Method Chronic renal failure was induced in adult male SD rats by feeding adenine-containing diet. After adenine diet feeding 3 weeks, animals were injected with OP-1 (5μg/kg/day) intraperitoneally for 2 weeks. The serum and urine phosphorus levels and associated mineral parameters, including fibroblast growth factor 23(FGF-23), DKK-1 and sclerostin were measured. Vascular calcification was assessed by immunohistochemistry staining on aortic tissue. Bony structure was evaluated by microCT (Bruker-microCT, Kontich, Belgium). Results A significant decrease of body weight and deteriorated renal function was observed in adenine and OP-1 treatment groups during study period and serum creatinine levels were similar (5.23 ±1.1 mg/dL vs. 5.4 ±1.2 mg/dL, p>0.05). Animals in OP-1 group had lower serum phosphorous (18.7±5.1 vs. 29.0±9.6 mg/dL, p<0.05) and intact parathyroid hormone levels (2906.1±1206.9 vs. 4669.7±2505.9 pg/dL, p<0.05) compared to adenine group. Decreased urine phosphorous excretion was noted in both groups without significant difference. Levels of serum FGF-23, sclerostin and DKK-1 were significantly lower in OP-1 treatment group (all p< 0.05). OP-1 administration diminished the staining of RUNX2 (59.1±3% of adenine-treated group), alkaline-phosphatase (49.4±5.7%), β-caterin (39.3±1.8%), BMP2 (43.2%±6.7%), and BMP7 (51.9±10%, all p <0.05). MicroCT revealed that bone mineral density was increased by OP-1 treatment (0.46±0.1 vs.0.39±0.06 g/cm3). Total volume was increased but bone volume was not changed. OP-1 administration did not affect trabecular thickness and trabecular number. Conclusion Our data indicated administration of exogenous OP-1 improved hyperparathyroidism and attenuated vascular calcification. OP-1 treatment was also associated with beneficial effects on bony structure in animals with renal failure.

Elbow Arthrodesis—A Review

Elbow arthrodesis is an uncommonly performed operation, but it has a specific and niche place in the management of difficult elbow pathology. Many indications and contraindications have been reported, but one of the more challenging aspects of this procedure remains choosing the appropriate angle of fusion. Varying results have been reported along with speculations as to why the fusion may not have been obtained, such as lack of bony structure in the site. Common complications have also been reported most notably fractures distal to the plate. One area of future research is that of the reversibility of this procedure; going from a total elbow arthroplasty to an elbow arthrodesis has been studied well but not so for converting an arthrodesis to an arthroplasty. Elbow arthrodesis remains a valuable but niche solution for complex elbow pathologies that cannot be addressed with other commoner elbow operations.

Morphometric and Topographic Study of Foramen Ovale in Indian Skulls

Foramen ovale is an important foramen for neurosurgeons and used for percutaneous trigeminal rhizotomy in trigeminal neuralgia. The present study was undertaken to study anatomic variations in appearance, dimensions of foramen ovale and its location in relation to the zygomatic arch. The study was conducted on 50 dry human skulls of known sex, available in the museum of Anatomy Dept. in G.S.V.M. Medical College, Kanpur. The shape of foramen ovale and presence of any accessory bony structure like spur, spine, tubercle or bony plate were observed on both sides. The length and width of foramen ovale and its distance from articular tubercle and the anterior root of Zygomatic Arch was measured on both sides. The metric data was statistically analysed for bilateral symmetry and sexual dimorphism. The shape of foramen ovale was typically oval in most of the skulls (66%). In 40% sides any accessory bony structure was not seen while bony plate in 45% sides, spine in 6% and bridge like bony septa dividing the foramen into two compartments in 2% was observed. The mean length and width of foramen ovale in male skulls was 7.50+/-0.90 mm and 4.20+/-0.70 mm and 7.7+/-1.00 mm and 3.9+/-0.80 mm in the female skulls. The mean distance of foramen ovale from articular tubercle on Zygomatic arch was 32.8 +/- 2.8 mm in males and 31.1 +/- 2.4 mm in females. The mean distance from anterior root of Zygomatic arch was 21.4 +/- 1.9 mm in males and 21.6 +/- 1.7 mm in females. There was no significant difference in measurements of various metric parameters between right and left sides of foramen ovale (p>0.05) but highly significant difference was observed between male and female dimensions of all metric parameters.(p<0.001). Thus the foramen ovale does not exhibit bilateral symmetry but the sexual dimorphism is evident. The data is helpful for surgical practices.

Quantitative 3D Trajectory Measurement for Percutaneous Endoscopic Lumbar Discectomy

Background: Percutaneous endoscopic lumbar discectomy (PELD) has become an increasingly popular minimally invasive spinal surgery. Due to the technical evolution of PELD, the focus of decompression has shifted from the central nucleus to the subannular-protruded disc herniation, which allows direct neural decompression. Surgical entry into the spinal canal leads to the greater possibility of bony structure obstruction, thus the location and direction of the working channel are crucial. The existing preoperative measuring methods mainly rely on 2-dimensional (2D) x-ray images or MRI cross-sections. Because the bony structure and the trajectory are 3-dimensional (3D), the relationship between the anatomical lumbar structure and the working channel cannot be precisely evaluated. Objectives: To investigate a 3D method and quantitatively evaluate the trajectory for percutaneous endoscopic lumbar discectomy (PELD). Study Design: Technical note. Setting: Pain medicine center of a university hospital. Methods: Twenty patients suffering from L4/5 disc herniation were enrolled in this study. After reconstructing the preoperative CT images, the virtual trajectory was placed into the intervertebral foramen through gradient-changing angulations in relation to the coronal and transverse planes. The overlapping portion of the virtual trajectory and the lumbar vertebrae was evaluated. In addition, the probability of atypical structure involvement was calculated. Results: As cephalad angulation (CA) increased, the intersection volume of the L4 inferior articular process increased, while the total intersection volume, the intersection volume of the L5 superior articular process, the intersection volume of the facet joint, and the volume proportion of L5 superior articular process intersection in the facet joint all decreased. As coronal plane angulation (CPA) increased, the total intersection volume, the intersection volume of the L4 inferior articular process, and the intersection volume of the facet joint all increased, while the volume proportion of the L5 superior articular process intersection in the facet joint decreased. When CA increased to 15°-20°, there was a high probability of atypical structure involvement, whereas such a probability in the groups of CA 0° (CPA 15°, 20°, and 25°), CA 5° and CA 10° was low. Limitations: Only patients with L4/5 herniation were evaluated in this study. Conclusions: In terms of the regularity, the ideal angulation for L4/L5 PELD is CPA 5°-10° and CA 5°-10°, which can lead to a relatively low level of total damage to the bony structure, minimal damage to the facet joint, and negligible involvement of atypical structures. Key words: Lumbar disc herniation, percutaneous endoscopic lumbar discectomy (PELD), transforaminal, trajectory, 3D method, quantitative measurement, angulation, bony structure obstruction