Differences in pathways contributing to thyroid hormone effects on postnatal cartilage calcification versus secondary ossification center development

The proximal and distal femur epiphysis of mice are both weight bearing structures derived from chondrocytes but differ in development. Mineralization at the distal epiphysis occurs in an osteoblast rich secondary ossification center (SOC), while the chondrocytes of the proximal femur head (FH) in particular, are directly mineralized. Thyroid hormone (TH) plays important roles in distal knee SOC formation, but whether TH also affects proximal FH development remains unexplored. Here, we found that TH controls chondrocyte maturation and mineralization at the FH in vivo through studies in Thyroid stimulating hormone receptor (Tshr -/-) hypothyroid mice by X-ray, histology, transcriptional profiling, and immunofluorescence staining. Both in vivo, and in vitro studies conducted in ATDC5 chondrocyte progenitors concur that TH regulates expression of genes that modulate mineralization (Bsp, Ocn, Dmp1, Opn, and Alp). Our work also delineates differences in prominent transcription factor regulation of genes involved in the different mechanisms leading to proximal FH cartilage calcification and endochondral ossification at the distal femur. The information on the molecular pathways contributing to postnatal cartilage calcification can provide insights on therapeutic strategies to treat pathological calcification that occurs in soft tissues such as aorta, kidney, and articular cartilage.

SIS therapy in the treatment of distal radius epiphyseal fracture (Case report)

Introduction. Fractures of the distal radius epiphysis are the most common fractures of the upper limb, present both in the general population active following major trauma and in the elderly population in minimal trauma due to osteoporosis. Among the adjuvant therapies for orthopedic treatment of distal radius epiphyseal fracture we can list Super Inductive System (SIS), a therapy based on the interaction between the electric field and the human body with the improvement of the healing process by acting on the pathophysiological stages of bone callus. Material and method. A clinical case study was performed on a 28-year-old patient, hospitalized and treated in the neurosurgery department of the Constanta County and Emergency Hospital for a polytrauma by road accident (passenger) with amyelotic cervical vertebral trauma, thoracic trauma and trauma to the right upper limb, subsequently performing 12 SIS therapy sessions at the Balneal and Rehabilitation Sanatorium of Techirghiol. CT examination of the cervical spine reveals fractures of C4 vertebra (the blade and pedicle) and C5 vertebra (vertebral body, lamina and pedicle). Right forearm radiography reveals fracture of the right radial styloid. After conservative treatment of the cervical injury and orthopedic treatment of the upper limb injury, the clinical evolution is favorable, allowing the patient to be discharged and allowed to do 12 sessions of SIS therapy, 3 times a week, within 4 weeks. The subsequent clinical and paraclinical evolution was favorable for the outpatient orthopedic ambulatory reevaluation performed at 5 weeks. Results and discussions. Due to the type of fracture of the radial distal epiphysis (linear fracture without displacement), absence of comorbidities and young age, led to the indication of orthopedic treatment with immobilization in the antebrachio-palmarcast, which allowed subsequent physiotherapy. Keywords: radial fracture, callus, polytrauma, cervical spine, lamina, Super Inductive System,

An experimental study on the effects of the cortical thickness and bone density on initial mechanical anchorage of different Straumann® implant designs

Background The aim of the current study was to comparatively assess the primary stability of different Straumann® implant designs (BLX, Straumann Tapered Effect, Bone Level Tapered, and Standard Plus) via resonance frequency analysis by using an implant insertion model in freshly slaughtered bovine ribs with and without cortical bone. Tapered Effect (4.1 × 10 mm), Bone Level Tapered (4.1 × 10 mm), Standard Plus (4.1 × 10 mm), and BLX (4.0 × 10 mm) implants were inserted into the distal epiphysis on the longitudinal axis of the freshly slaughtered bovine ribs. As a control, implants with the same sizes were inserted into the proximal diaphysis. The stability of the implants was examined with resonance frequency analysis. Results BLX and Tapered Effect implants showed higher implant stability quotient values in both study and control groups. All implant systems showed a significant decrease of mechanical anchorage in the study group. BLX and Bone Level Tapered designs had a significantly lower loss of mechanical anchorage in the lack of cortical bone. Conclusion Both Tapered Effect and BLX designs could ensure sufficient initial stability; however, BLX implants could be an appropriate option in the lack of cortical bone and poor bone quality at the implant recipient site. Clinical relevance BLX is a novel implant system, which could be especially beneficial in the presence of spongious bone type at posterior maxillae.

Radiographic and Biochemical Evaluations of Postnatal Development of Bones of the Forelimb in Nigerian Indigenous Dogs.

Bone is a hard and resilient tissue structure that provides mechanical support for the body of an organism. This study was aimed to evaluate the radiographical and biochemical changes during postnatal bone development of forelimbs in Nigerian indigenous puppies from 2-week-old to 24-week-old. Six (6) Nigerian indigenous puppies were chemically restrained using chlorpromazine at 2 mg/kg I.M. and positioned using ropes and sandbags for mediolateral and craniocaudal views of bones of the forelimbs. At 2-week-old, radiographic evaluation of bones of the forelimbs were undertaken and continued bi-weekly up to 24-week-old. Serum samples were analysed from 4-week-old to 24-week-old at four weeks’ interval for mineral (electrolytes) using colometric method for calcium and phosphorus and flame photometry method for sodium and potassium. At 2-week-old, there was an ill-defined radiopaque secondary ossification centre at the proximal epiphysis and a small ovoid radiopaque structure at the distal epiphysis of the humerus. There was not any sign of secondary ossification centre at proximal and distal epiphyses of both radius and ulna. There was the presence of a small radiopaque (ill-defined) accessory carpal. 1st to 5th metacarpals were present together with the proximal, middle and distal phalanges of all digits except the 1st digit that has proximal and distal phalanges. From 20-week-old, fully developed carpals and bony structures were observed through 24-week-old where the commencement of fusion of apophyses of olecranon (proximal epiphysis of ulna) at the centre and acrophyses of metacarpals and phalanges. The mean values (mean ± SEM) from serum biochemistry of calcium, phosphate, sodium and potassium in mmol/L from this study were within the normal limits throughout the study. Conclusively, the complementary information from calcium, phosphate, sodium and potassium in this study showed that these elements are within the normal limit that suggests normal bone development during the study period, which stressed the importance of the knowledge on serial changes of bone development which could be useful in clinical practice.

Shelf Osteotomy for Madelung’s Deformity in Adults: A Novel Technique

Background Madelung's deformity (MD) comprises increased volar and ulnar tilt of the distal radius joint facet, secondary to an idiopathic physeal dysplasia. Such change causes radial shortening and a consequent distal ulnar prominence, along with wrist pain and loss of motion. Classic surgical techniques are problematic for adults, as they are specific for children and adolescents whose distal radial physis is still open. Description of Technique It is suggested a new treatment method for MD in skeletally mature patients: a distal radius osteotomy and joint realignment are performed through a volar approach to increase the support area of the lunate bone. The rotation and lengthening of the distal epiphysis of the radius generate support and cover to the lunate bone, with improvement of both radiocarpal and distal radioulnar joints. Patients and Methods We describe the technique in details and report the treatment of a 25-year-old female patient. Results Early clinical and radiographic outcomes are encouraging for the treatment of symptomatic patients. Conclusion There is a plethora on the literature about conflicting opinions on the best treatment options and surgical techniques are quite variable, although usually with good results. Besides, the technique here described is indicated during a specific stage of disease presentation, consisting of young adults without any wrist-degenerative changes. Having said that, it is possible to claim that MD treatment with shelf osteotomy is a concept change. Our main goal is to reconstruct the diseased segment and improve wrist stability.

THE DEVELOPMENT OF EXTRA-ARTICULAR LIGAMENTS OF THE HIP JOINT DETERMINE ANGULAR VALUES OF THE PROXIMAL FEMUR

There are practically no data on the quantitative aspects of prenatal morphogenesis and the growth rates of the ligaments of the hip joint in humans, as well as information on the correspondence of the shape and structure of the ligaments to the bones forming the joint. The aim of the study was to reveal the features of the growth of the extra-articular ligaments of the hip joint in the prenatal period and to establish correlations between the structure of the ligaments and the structures of the proximal end of the femur. The material of the study is based on the analysis of 175 cases without pathology of the musculoskeletal system. The dimensions of the ilio-femoral, pubic-femoral, ischio-femoral ligaments and the cervico-diaphyseal angle and angle of rotation of the femoral neck in relation to the distal epiphysis of the bone were studied. As a result of the study, it was found that in the process of prenatal development with increasing age, the distance between the distal fixation points and the angle between the parts of the ilio-femoral ligament increases. Both legs have fibers that are woven into the fibrous membrane of the joint capsule. A correlation was found between the growth of morphometric parameters of the ilio-femoral ligament and the angular values ​​of the proximal femur. In contrast to the ilio-femoral ligament, the pubo-femoral and ischio-femoral ligaments show low signs of differentiation at different stages of prenatal ontogenesis. The pubo-femoral ligament becomes available for macroscopic examination from the beginning of the second half of the prenatal period. It is defined as a thickening of the medial fibrous membrane of the joint capsule, has its origin on the superior branch of the pubic bone and the iliac part of the acetabulum and is attached to the intertrochanteric line in the medial segment. The sciatic-femoral ligament is macroscopically defined as a thickening of the posterior part of the joint capsule. The ligament has a triangular shape, with a base in the region of the ischial part of the acetabulum and the ischial tubercle, its apex facing the trochanteric fossa at the antero-inner edge of the greater trochanter. It was found that the growth rate of morphometric parameters of different parts of the hip joint ligaments at different stages is not the same, which determines the change in the shape of the ligaments. The greatest transformations occur in the ilio-femoral ligament, the smallest in the pubic-femoral and sciatic-femoral ligaments. There is a correlation between the anatomical structure of the extra-articular ligaments of the hip joint and the corresponding angular values ​​of the proximal femur.

Features of total, longitudinal and transverse body sizes in men of the general group of patients with mild and severe psoriasis

Annotation. The constitutional approach is a valuable tool in the hands of practicing dermatologists, which allows an individual approach to the diagnosis and treatment of patients with psoriasis. The aim of the study was to examine the differences in total, longitudinal and transverse body sizes between healthy and/or psoriatic men depending on the severity of the disease. Anthropometric examination according to Bunak was performed for 32 men of the first mature age in patients with mild and 68 men with severe psoriasis. The PASI index was used to clinically assess the severity and area of psoriatic lesions. As a control from the data bank of the research center of National Pirogov Memorial Medical University, Vinnytsya anthropometric data of 82 practically healthy men of the same age group were selected. Statistical data processing was performed in the license package “Statistica 5.5” using non-parametric methods of evaluation of the obtained results. In patients with mild and severe psoriasis compared with healthy men found: lower values – pubic height (by 3.2 % and 5.4 %) and trochanter (by 8.2 % and 7.0 %) anthropometric points, shoulder width (by 19.6 % and 19.0 %) and the width of the distal epiphysis of the shin (by 5.2 % and 4.8 %); greater values – body weight (by 20.1 % and 17.5 %), body length (by 1.7 % in mild course), body surface area (by 10.0 % and 7.8 %), height of suprasternal (by 3.0 % and 1.5 %), acromial (by 2.3 % and 1.0 %) and finger (by 6.1 % and 4.4 %) anthropometric points, width of the distal epiphysis of the shoulder (by 6.9 % and 5.7 %), forearm (by 3.3 % in mild course) and thigh (by 10.3 % and 7.1 %), mid-thoracic diameter (by 16.5 % and 16.3 %), transverse lower thoracic diameter (by 16.5 % and 15.7 %), anterior-posterior mid-thoracic diameter (by 17.7 % and 20.2 %), interspinous (by 12.2 % and 12.1 %), intercristal (by 13.4 % and 11.7 %) and intertrochanteric (by 11.3 % and 10.4 %) distances. Differences in the studied body size in patients with varying degrees of psoriasis found. Thus, in patients with mild psoriasis, compared with patients with severe psoriasis, higher values were found for: body length (by 1.6 %); heights of suprasternal (by 1.5 %), pubic (by 2.1 %) and finger (by 1.4 %) anthropometric points; width of the distal epiphysis of the forearm (by 2.3 %). Thus, pronounced differences in total, longitudinal and transverse dimensions between healthy and patients with mild and severe psoriasis were revealed by Ukrainian men of the first mature age. Between patients with varying degrees of severity of dermatosis, most differences are found only for longitudinal body size.

Features of longitudinal and transverse body sizes in men with various forms of eczema

Consideration of the aspect of adaptation, in particular morphological, is expedient with obligatory comparison of morphometric indicators in healthy and sick patients and between groups of patients with different degrees of severity of dermatosis. The aim of the study was to investigate the differences between longitudinal and transverse body sizes between healthy and/or patients with eczema men depending on the severity of the dermatosis. Patients with idiopathic (n=34) and microbial (n=38) eczema men of the first mature age underwent an anthropometric examination according to Bunak. The diagnosis of eczema was made according to the nomenclature of ICD-10. As a control from the data bank of the research center of National Pirogov Memorial Medical University, Vinnytsya anthropometric data of 82 practically healthy men of the same age group were selected. Statistical data processing was performed in the license package “Statistica 5.5” using non-parametric methods of evaluation of the obtained results. In healthy men, compared with patients, higher values were found for: the height of the pubic anthropometric point by 3.5-5.7% and the height of the acetabular anthropometric point by 4.9-7.5% compared with sick men with idiopathic mild and severe eczema and mild and severe microbial eczema and lower values for: height of the suprathoracic anthropometric point by 1.7-2.6% for idiopathic eczema of mild, severe course and microbial eczema of mild course; height of the acromial anthropometric point by 1.6-2.3% compared with men with idiopathic eczema of mild and severe course; height of the finger anthropometric point by 3.0-5.9% compared with men with idiopathic eczema of mild and severe course and microbial eczema of mild and severe course. In healthy men, compared with patients, higher values were found: mid-thoracic diameter – by 3.1-11.1%, 5.5-14.4%, transverse lower thoracic diameter – by 8.6-14.1% and anterior-posterior mid-thoracic diameter – by 10.2-16.6% and smaller values: width of shoulders by 15.3-21.1% compared with men with idiopathic eczema of mild and severe course and microbial eczema of mild and severe course. In healthy individuals, the width of the distal epiphysis of the forearm is greater by 3.14% compared with patients with idiopathic severe eczema and the width of the distal epiphysis of the crus by 3.1% compared with patients with microbial eczema of mild course; smaller - the width of the distal epiphysis of the shoulder by 3.0% compared with patients with idiopathic eczema of severe course and the width of the distal epiphysis of the thigh by 5.2-7.6% compared with patients with idiopathic eczema of mild and severe course and microbial eczema of mild course. In healthy individuals, the values of the size of the pelvis are lower: interspinous distance – by 8.3-11.6%, intercristal distance – by 8.7-12.5% and intertrochanteric distance – by 7.7-10.5% compared with sick men with idiopathic mild and severe eczema and microbial eczema of the mild and severe course. Differences in longitudinal body size in patients with different forms and severity of eczema. When comparing anthropometric indicators between sick men, the following were found: the height of pubic and acetabular anthropometric points in sick men with idiopathic eczema of mild course is higher by 1.8% and 1.7%, respectively, compared with sick men with microbial eczema of similar severity; shoulder width in patients with idiopathic eczema of mild course is 4.8% less than in patients with idiopathic eczema of severe course. Thus, men with eczema have a subpathological constitutional type, which is characterized by an elongated “cylindrical” torso, shortened lower extremities, as well as more massive distal and less massive proximal epiphyses of the upper and lower extremities.

Fresh Cadaveric Study of the Distances between the Deep Plantar Arch and the Lesser Metatarsals at Risk During Osteotomy of the Lesser Metatarsals

Category: Midfoot/Forefoot Introduction/Purpose: Osteotomy of the lesser metatarsals is useful to treat forefoot deformity. Although there is the possibility that some arteries supplying the lesser metatarsals are injured during osteotomy, there are few informations about the distances from the deep plantar arch to the lesser metatarsals. This study aimed to identify the distances from the deep plantar arch to the lesser metatarsals and to reveal how osteotomy of the lesser metatarsals might injure the deep plantar arch. Methods: Twenty fresh cadaveric feet were injected with barium through the external iliac artery, and enhanced computed tomography images were assessed. The distance between the deep plantar arch and each lesser metatarsal was measured on both axial and sagittal images. Results: The distances between the deep plantar arch and the second, third, and fourth metatarsals on the axial plane were 0.5, 2.2, and 2.8 mm, respectively. The distances from the distal epiphysis to the line passing through the deep plantar arch perpendicular to the longitudinal axis of the lesser metatarsal on the sagittal plane were 47.0, 45.7, and 46.4 mm, respectively, and those from the proximal epiphysis were 23.0, 21.0, and 18.6 mm, respectively. The deep plantar arch coursed at the level of the middle third, proximal to this third in 11/20 (55.0%), 7/20 (35.0%), and 5/16 (31.2%) feet, respectively. Conclusion: This study suggested that overpenetration into the medial-plantar direction of the second metatarsal or the proximal-plantar direction of the fourth metatarsal during the shaft or proximal osteotomy might injure the deep plantar arch easily. This study also suggested that on the plantar aspect, the shaft or proximal osteotomy about 45-47 mm proximal to the distal epiphysis of the lesser metatarsal or 18-23 mm distal to the proximal epiphysis might damage blood flow of the deep plantar arch.