Investigation of factors related to the occurrence of osteochondral lesions of the talus by 3D bone morphology of the ankle.

AIMS: The aims of this study were to evaluate the morphology of the ankle in patients with an osteochondral lesion of the talus using 3D CT, and to investigate factors that predispose to this condition. PATIENTS AND METHODS: The study involved 19 patients (19 ankles) who underwent surgery for a medial osteochondral lesion (OLT group) and a control group of 19 healthy patients (19 ankles) without ankle pathology. The mean age was significantly lower in the OLT group than in the control group (27.0 vs 38.9 years; p = 0.02). There were 13 men and six women in each group. 3D CT models of the ankle were made based on Digital Imaging and Communications in Medicine (DICOM) data. The medial malleolar articular and tibial plafond surface, and the medial and lateral surface area of the trochlea of the talus were defined. The tibial axis-medial malleolus (TMM) angle, the medial malleolar surface area and volume (MMA and MMV) and the anterior opening angle of the talus were measured. RESULTS: The mean TMM angle was significantly larger in the OLT group (34.2°, sd 4.4°) than in the control group (29.2°, sd 4.8°; p = 0.002). The mean MMA and MMV were significantly smaller in the OLT group than in the control group (219.8 mm2, sd 42.4) vs (280.5 mm2, sd 38.2), and (2119.9 mm3, sd 562.5) vs (2646.4 mm3, sd 631.4; p < 0.01 and p = 0.01, respectively). The mean anterior opening angle of the talus was significantly larger in the OLT group than in the control group (15.4°, sd 3.9°) vs (10.2°, sd 3.6°; p < 0.001). CONCLUSION: 3D CT measurements showed that, in patients with a medial osteochondral lesion of the talus, the medial malleolus opens distally, the MMA and MMV are small, and the anterior opening angle of the talus is large. This suggests that abnormal morphology of the ankle predisposes to the development of osteochondral lesions of the talus. Cite this article: Bone Joint J 2018;100-B:1487-90.

Three-dimensional corrective osteotomy for treatment of cubitus varus after supracondylar fracture of the humerus in children.

Cubitus varus deformity after supracondylar fracture of the humerus in children generally includes deformities of varus, hyperextension, and internal rotation. Presently almost all corrective osteotomies for treatment of cubitus varus deformity have been limited to correction of only the varus or of the varus and hyperextension deformity. Electromyographic study and stick picture motion analysis have revealed unphysiological joint motion and muscle activity around the joint in elbows with cubitus varus, hyperextension, and internal rotation deformity. On this basis we have successfully attempted simultaneous correction of all three deformities. The end results in 41 elbows have been satisfactory. In conclusion, we recommend simultaneous correction of the three elements of cubitus varus deformity to restore anatomic alignment of the elbow joint.

Contractile responses to electrical field stimulation and ATP in guinea-pig urinary bladder.

1. The responses of guinea-pig urinary bladder smooth muscle to intramuscular nerve stimulation were investigated by isometric tension recording. 2. The nerve mediated contractions, evoked by field stimulation with a stimulus of 0.5 msec duration, a frequency of 15 Hz and a voltage of 50 V, were inhibited by atropine (10(-6) M) and alpha, beta-MeATP (10(-4) M) to about 80% and 20%, respectively, of control. 3. Simultaneous application of atropine (10(-6) M) and alpha, beta-MeATP (10(-4) M) abolished the contraction evoked by selective nerve stimulation. 4. Terodiline (10(-4) M), one of Ca2+ antagonists, inhibited the contraction evoked by both nerve selective stimulation and exogenously applied ATP. 5. Based on these results we suggested that in guinea-pig urinary bladder, ATP was a predominant excitatory transmitter and the nerve-mediated contraction and exogenous ATP were mainly dependent upon Ca2+ influx.