Proximal fibular physeal stress injury: a known entity in an unusual location.

In the skeletally immature patient, physeal stress injury is a common diagnosis in repetitive stress injury; in this case, we present an atypical location of physeal stress injury of the bilateral proximal fibulae. There are multiple well-documented diagnoses of physeal stress injury involving the shoulder, elbow, wrist and tibia, often considered when patients present with the typical history of intensive sports training and pain exacerbated by repetitive movements. However, isolated proximal fibular physeal stress injury is either unusual or under-recognized and underreported. Although less common, proximal fibular physeal stress injury should be among the diagnostic considerations in active adolescents complaining of lower extremity pain as failure to identify this entity can lead to delayed care and preventable potential long-term musculoskeletal effects.

Orthopaedic aspects of neurofibromatosis: update.

PURPOSE OF REVIEW: Neurofibromatosis type I (NF-1), affecting 1: 3000 people, is one of the most common disorders of the nervous system, and most pediatricians will care for a patient with this condition. It is imperative that careful attention be paid to screening for scoliosis and tibial dysplasia. Prompt referral to an orthopaedist at the time of diagnosis, as well as neurologist, ophthalmologist, and dermatologist, will provide a global spectrum of care for the individual. Patient care between surgical procedures will be inevitable, with 70% of patients with NF-1 undergoing hospitalization or surgery. RECENT FINDINGS: This review provides a description of diagnosis, presurgical evaluation, and advances in understanding tibial dysplasia, scoliosis and malignant peripheral nerve sheath tumors. New pharmaceutical treatments such as lovastatin have improved bone healing in vivo and induced apoptosis in vitro. Multiple pharmaceuticals have shown neurofibroma arrest in vitro and are in phase II clinical trials. SUMMARY: As animal models improve and clinical trials proceed, there is momentum toward eliminating the musculoskeletal morbidity associated with NF-1.

Effects of single versus combinatorial treatment strategies on beta II-tubulin gene expression in axotomized hamster rubrospinal motoneurons.

PURPOSE: betaII-tubulin, a regeneration-associated gene, is upregulated in injured peripheral neurons, but significantly less so in injured central neurons. Using a hamster dorsal spinal cord injury (SCI), the ability of single versus combinatorial treatment strategies to alter betaII-tubulin mRNA expression in rubrospinal motoneurons (RSMN) was examined. We have shown that systemic testosterone propionate (TP) treatment in combination with peripheral nerve grafting into a SCI site produces a peripheral-like pattern of betaII-tubulin mRNA expression in injured RSMN. In the present study, selected single- and combinatorial-therapy strategies were tested for their ability to promote a sustained upregulation of betaII-tubulin mRNA levels in injured RSMN. METHODS: Single treatments of olfactory ensheathing cells (OEC), brain-derived neurotrophic factor (BDNF), or Schwann cells (SC) vs combinatorial treatments (SC+TP, OEC+TP, and OEC+BDNF) were administered to hamsters following a dorsal SCI. Quantitative in situ hybridization in conjunction with a betaII-tubulin cDNA probe was accomplished. RESULTS: All of the single-therapy treatments tested were able to prevent the downregulation of betaII-tubulin mRNA that occurred a week after injury alone, but only BDNF maintained high levels of betaII-tubulin mRNA. In contrast, all combinatorial treatments tested maintained the upregulation of betaII-tubulin mRNA expression in injured RSMN 1 week post-SCI. CONCLUSIONS: Targeting both intrinsic and extrinsic components of CNS injury can re-program elements of the molecular response of injured central motoneurons.

Use of a cell line to investigate olfactory ensheathing cell-enhanced axonal regeneration.

Olfactory ensheathing cells (OECs), a unique type of macroglia required for normal olfactory axonal regeneration throughout the lifetime of an individual, have been shown to have regeneration-enhancing properties when used to treat various neuronal injuries. Availability of OECs is a hurdle facing future clinical use of the cells for spinal cord injury (SCI) therapy. The number of OECs that can realistically be harvested from each animal is limited, and ensuring a pure cell population is difficult. We have begun to characterize a nonsyngeneic strain of OECs, i.e., from a homogenous OEC clonal cell line (nOECs). The purpose of this study was to determine whether nOECs have the same properties and provide the same functional recovery after SCI, as primary cultures of OECs. The results indicate that nOECs survive in vivo, produce growth-promoting proteins, and possess regeneration-promoting capabilities. Spinal cord injured rats that were treated with nOECs performed significantly better on functional tests than injured control animals beginning at 5 weeks after operation. In summary, evidence of nOEC regeneration-promoting capabilities suggests that this cell line can be used as potential therapy in SCI research.