1/24. Histopathology of a well-functioning hydroxyapatite-coated femoral prosthesis after 52 months.A fully hydroxyapatite-coated femoral implant was retrieved during autopsy. This component, provided with a bipolar femoral head, had been inserted for a displaced fracture of the femoral neck 52 months before. osseointegration of the implant was evident, without any formation of fibrous tissue :39.9% of the perimeter of the prosthesis at the level of its proximal third was interfaced with bone (62.8% at the mid-third and 65.2% at the distal third). Remodeling of bone had ensued. Deposition of bone was most prominent in the calcar zone, along the medial and lateral aspects and around the tip. Proximally, cortical porosity was found to be increased by 73%, whereas medullary bone porosity was increased by a factor of 2. Cell-mediated resorption of the coating was systematically present in these bone remodeling areas. The average thickness of the coating was respectively 10.8, 50.2 and 151.2 microns in the proximal, mid- and distal thirds of the implant. Formation of new bone was often coupled with resorption. No debris from the coating was found in the joint tissues or in the articulating surface of the polyethylene insert. These overall histopathological features support mechanical stability of the implant and active remodelling of bone along with focal removal of HA coating associated with osteoclastic activity. No side effects from coating degradation could be demonstrated.- - - - - - - - - - ranking = 1keywords = activity (Clic here for more details about this article) |
2/24. Growth factors in distraction osteogenesis. Immuno-histological pattern of TGF-beta1 and IGF-I in human callus induced by distraction osteogenesis.Although growth factors have been demonstrated during bone healing, their presence has not yet been confirmed in callus distraction. Therefore, in 3 patients we searched for cytokines during callus distraction. Bone biopsies were immuno-histochemically stained for TGF-beta1, IGF-I, TGF-beta type II receptor, IGF receptor, and proliferating cell nuclear antigen (PCNA). Histologically we found immature woven bone in the middle of the callus zone and increasing calcification and lamellar bone in the re-modelling zone. osteoblasts and fibroblast-like cells in the middle zone, and osteoblasts in all zones stained for TGF-beta and its receptor. The number of positive staining cells related to proliferous activity as assessed both by PCNA, and by bone density in radiographs. IGF-I could be detected everywhere. In conclusion, growth factors are present in bone formation and in areas of re-modelling during callotasis. Their relation to proliferous activity and radiographic density supports their involvement in osteogenesis.- - - - - - - - - - ranking = 2keywords = activity (Clic here for more details about this article) |
3/24. femur fracture in infants: a possible accidental etiology.femoral fractures in nonambulating infants are generally felt to be attributable to abuse in the absence of significant trauma or underlying organic pathology. The investigation of such fractures includes a report to appropriate social service and law enforcement agencies, and legal involvement. This paper describes 2 nonambulatory infants who sustained identical oblique distal femoral metaphyseal fractures extending through the growth plate after playing in an infant stationary activity center called an Exersaucer. It is possible that the twisting motion provided by the Exersaucer (Evenflo, Picqua, OH) might be consistent with the generation of forces necessary to cause these fractures.- - - - - - - - - - ranking = 1keywords = activity (Clic here for more details about this article) |
4/24. Rapid osteolysis after revision hip arthroplasty in Paget's disease.Rapid bone turnover in Paget's disease has been of concern to many surgeons performing hip arthroplasties. We present the case of a 71-year-old man with Paget's disease affecting the proximal femur. He had undergone total hip arthroplasty 14 years before. He sustained a fracture at the tip of the femoral component, which was managed with revision total hip arthroplasty. His postoperative course was complicated by rapid and profound osteolysis of the femur distal to the fracture site, secondary to disease activity. This case highlights the need for awareness of Paget's disease activity and this potential complication.- - - - - - - - - - ranking = 2keywords = activity (Clic here for more details about this article) |
5/24. Mid-trimester fracture of femur in a normal fetus.We report a case of an intrauterine fracture of the femur detected at routine mid-trimester sonography in an otherwise normal fetus. There was no associated maternal trauma. At birth, callus formation was palpable and confirmed by radiography. Absence of further fractures despite normal childhood activity and other features precluded a diagnosis of skeletal dysplasia. Although such an event is extremely rare, the possibility of an intrauterine origin should be considered in the differential diagnosis of battered baby syndrome presenting with a single fracture.- - - - - - - - - - ranking = 1keywords = activity (Clic here for more details about this article) |
6/24. Three different stages of bone stress reactions of long bones in one patient: case report and review of the literature.INTRODUCTION: The similar clinical and radiological early course of stress fractures and bone tumors can lead to diagnostic misinterpretation. MATERIALS AND methods: A patient is presented who was admitted to our clinic with the diagnosis of similar bone tumors in the distal femur and the proximal tibia. We found an additional localization with high bone turnover in the contralateral proximal tibia; including this lesion, the patient presented with three different types of stress reaction of bone. The final diagnostic decision-making was based on MRI and bone scintigraphy as well as the consideration of localization, age of occurrence, and behavior of malignant bone diseases. Therefore, bone biopsy was not performed. RESULTS: After 8 weeks of partial weight-bearing, the symptoms disappeared, and the patient could return to normal activity.- - - - - - - - - - ranking = 1keywords = activity (Clic here for more details about this article) |
7/24. Four-year review of burns as an etiologic factor in the development of long bone fractures in pediatric patients.Reduced bone density has been documented in children after burns. This loss of bone may place children at heightened risk for fractures. The medical records of all acutely injured patients with burns in excess of 40% TBSA burn admitted to our institution between January 1, 1997, through December 31, 2000, were reviewed for fracture incidence. patients with fractures sustained during the course of initial trauma were not included in the review. One hundred four records were reviewed. These patients had a mean age of 6.7 /- 0.51 years, (range, 0.2 to 18.0) and a mean %TBSA burn of 59.9 /- 1.60 (range, 40 to 98) with a mean full-thickness %burn of 51.7 /- 2.16 (range, 0 to 95). Fifteen long bone fractures were documented in six patients during the review time frame. All fractures were initially suspected by physical therapy personnel upon regularly scheduled therapy sessions and subsequently verified by x-ray. All fractures identified by this review occurred in children less than 3 years of age. Most fractures were noted during the rehabilitation phase of injury (range, 73 to 283 days after burn) once wounds were more than 95% healed, except for one child, who sustained multiple fractures during the acute recovery phase at a referring hospital. A 5.8% incidence of fractures was noted in patients with burns in excess of 40% (6 of 104 admissions). The etiology of the fractures is unknown, although the hormonal milieu postburn, depressed vitamin d status, inadequate protein intake, and decreased weight-bearing activity are potential contributory factors. In addition, infants and toddlers tend to provide more resistance to therapy because of an inherent lack of cognition. This may account for the increased breaks in this population.- - - - - - - - - - ranking = 1keywords = activity (Clic here for more details about this article) |
8/24. Delayed treatment of a malreduced distal femoral epiphyseal plate fracture.Fractures of the epiphyseal plate are considered rare when compared with the more prevalent injuries found in competitive sports, but the complications associated with this type of trauma are a major concern. The factors affecting the success or failure of healing include the severity of injury, patient age, and the type and expedience of treatment. This case study examines the clinical presentation and treatment of a 15-yr-old high school football player who sustained a displaced, distal femoral epiphyseal Salter II fracture. Primary treatment consisted of nonmanipulative, nonweight bearing knee immobilization. The treatment resulted in malunion, pain, decreased range of motion and physical deformity; therefore, the patient sought a second opinion. On physical exam, the displacement and rotational deformity of the fracture site were unacceptable. The fracture was treated 20 days post-injury via open reduction with internal fixation. On follow-up, the athlete demonstrated radiographic healing, normal physical exam, and no significant leg length discrepancy or deformity. The athlete successfully returned to full competitive sport activity.- - - - - - - - - - ranking = 1keywords = activity (Clic here for more details about this article) |
9/24. Periprosthetic fracture of the femur after total hip arthroplasty occurring in winter activities: report of two cases.periprosthetic fractures are uncommon after total hip replacement surgery and are most often associated with loosening or osteolysis. In a review of Mayo Clinic records, the cumulative incidence of femoral fractures after primary uncemented prostheses was only 0.4% (4). No periprosthetic fracture associated with sports participation has been previously reported in the literature. When advising patients about return to sports and recreational activities after total hip replacement, concerns fall into two main categories: 1) wear of the bearing surface(s) and secondary ramifications such as early failure or osteolysis, and 2) dislocation or fracture of the prosthesis or periprosthetic bone. The former concerns have been previously examined (5), but the latter have not been reported to date. These case reports describe a complication that may occur in total hip arthroplasty in those patients who return to winter sports and recreational activities. Although at intermediate follow-up there does not appear to have been irreversible damage for these patients, it is imperative to warn patients that activities that place the patient at risk of trauma may compromise the longevity of the artificial joint. This information can be used in helping patients understand the risks associated with athletic activity after total hip arthroplasty, which is a major goal of current recommendations for advising patients after this type of surgery.- - - - - - - - - - ranking = 1keywords = activity (Clic here for more details about this article) |
10/24. Identification and management of 2 femoral shaft stress injuries.STUDY DESIGN: Resident's case problem. BACKGROUND: Although femoral shaft stress fractures in the general population are rare, they are more common among endurance athletes and military recruits. Such individuals presenting with a complaint of hip, thigh, or knee pain should raise suspicion for femoral shaft stress injury. A united states Military Academy cadet presented to West Point's Physical Therapy-sports medicine clinic with a complaint of thigh pain related to training with the local marathon team. A second cadet presented to the same clinic during Cadet Basic Training with a complaint of vague but increasing hip, thigh, and knee pain. diagnosis: Both cadets were suspected of having femoral stress injuries, based on clinical exams, and both diagnoses were confirmed with diagnostic imaging. The 2 cadets were both treated conservatively with progressive rehabilitation once healing was confirmed with radiographs. They both responded favorably to conservative management and returned to full athletic activity at approximately 12 weeks. DISCUSSION: Symptoms from a femoral shaft stress fracture can be vague and mimic those of other etiologies. Providers should consider a broad differential diagnosis, to include femoral shaft stress fracture, when treating endurance athletes and military recruits with anterior hip, thigh, or knee pain. Proper imaging confirms the diagnosis and sequential radiographs assist in rehabilitation planning.- - - - - - - - - - ranking = 1keywords = activity (Clic here for more details about this article) |
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