The effect of prenatal exposure to 1800 MHz electromagnetic field on calcineurin and bone development in rats

PURPOSE: To investigated the effects of exposure to an 1800 MHz electromagnetic field (EMF) on bone development during the prenatal period in rats. METHODS: Pregnant rats in the experimental group were exposed to radiation for six, 12, and 24 hours daily for 20 days. No radiation was given to the pregnant rats in the control group. We distributed the newborn rats into four groups according to prenatal EMF exposure as follows: Group 1 was not exposed to EMF; groups 2, 3, and 4 were exposed to EMF for six, 12, and 24 hours a day, respectively. The rats were evaluated at the end of the 60th day following birth. RESULTS: Increasing the duration of EMF exposure during the prenatal period resulted in a significant reduction of resting cartilage levels and a significant increase in the number of apoptotic chondrocytes and myocytes. There was also a reduction in calcineurin activities in both bone and muscle tissues. We observed that the development of the femur, tibia, and ulna were negatively affected, especially with a daily EMF exposure of 24 hours. CONCLUSION: Bone and muscle tissue development was negatively affected due to prenatal exposure to 1800 MHz radiofrequency electromagnetic field.

Subchondral Insufficiency Fracture of the Femoral Head in Elderly People

We evaluated the clinical course of subchondral insufficiency fracture of the femoral head (SIFFH) and its characteristic findings with special regard to joint space narrowing (JSN). Thirty-one cases of SIFFH of mean age 68.9 yr initially underwent limited weight-bearing conservative treatment. During the follow-up period, the patients with intractable pain underwent total hip arthroplasty (THA). For radiographic evaluation, lateral center-edge angle, JSN and femoral head collapse (FHC) were documented, and the extent of FHC was classified as mild (4 mm). The progression or new development of FHC more than 2 mm was evaluated on sequential plain radiographs. The relationship between radiographic parameters and clinical outcomes were evaluated. THAs were performed in 15 cases (48.4%). There was no significant correlation between clinical outcomes and the extent of initial FHC. However, a significantly larger proportion of patients that underwent THA showed JSN and FHC progression compared to the symptom improvement group. The risk factor significantly associated with failed conservative treatment was JSN (P=0.038; OR, 11.8; 95% CI, 1.15-122.26). Clinical results of conservative treatment for SIFFH in elderly patients are relatively poor. The patients with JSN are at higher risk of failed conservative treatment.

Silicon Dioxide Particles Deposited in Vessels and Cartilage of the Femoral Head

Silicosis had been considered for decades as an illness with manifestations of lung fibrosis due to inhalation of overconcentrated SiO2 dust. To the best of our knowledge, studies have yet to report SiO2 deposits in any other tissues and organs. In the present case, while performing bilateral artificial total hip arthroplasty for one patient, we found that the articular cartilage of the bilateral femoral head was black. Therefore, specimens thereof were sent for pathological examination. Pathological examination (immunohistochemistry) and polarized light microscopy revealed the presence of considerable brown, acicular, rhombic, and crumb-like crystals. The crystals were mainly composed of SiO2. SiO2 could deposit in vessels and femoral head cartilage via blood circulation.

Evaluación de las variaciones del ángulo de torsión del fémur en fémures aislados de individuos brasileños / Evaluation of changes of femoral torsion angle in brazilian individuals isolated femur

En corte axial del fémur, generalmente la orientación del eje del cuello femoral se ubica en diferente plano del eje de los cóndilos. La formación angular que el eje del cuello hace, en relación a la de los cóndilos, es conocida como ángulo de torsión femoral. Los autores realizaron mediciones de los ángulos de torsión (o antetorsión) en 56 fémures humanos adultos, de ambos sexos, siendo 26 derechos y 30 izquierdos. La literatura investigada presenta varios valores que varían de 8 a 25. Los valores obtenidos en las mediciones buscaron determinar el valor del ángulo de torsión en ese material y compararlo con los datos de la literatura. También se determinaron los valores que, permitieran conocer si el miembro inferior tenía rotación lateral o medial patológicas. Los valores obtenidos de los ángulos en las mediciones variaron entre 0 y 35. En el lado derecho, el promedio del ángulo de torsión fue de 20,8 y el del lado izquierdo de 14,86, lo que indica una mayor tendencia del lado derecho a tener anteversión.

In axial section of the fêmur, typically the axis direction of the femoral neck is located in different plane of the axis of the condoyle. The angle that the axis of the neck makes, when compared to the condoyle, is known as angle of femoral torsion. The authors carried out measurements of torsion angles or anteversion femurs in 56 human adults of both sexes, bein 26 right and 30 left. The literature shows several values ranging from 8-25 degrees. The values obtained in measurements seek to determine the value of the torsion angle in this material and compare with literature data. Also we determine values that, in tum, determine, from which, if the leg will feature lateral rotation, medial rotation or pathological. The values obtained in measurements of the angles between zero and thirty-five degrees. On the obtained in measurements of the angles zero and thirty-five degrees. On the right side, the average torsion angle was 20.8 and the left side of 14.86, indication a greater tendency to have the right anteversion.

Artroscopia do quadril na epifisiólise grave / Hip arthroscopy in severe epiphysiolisis

Apresenta-se o caso de um indivíduo de 12 anos de idade, do sexo masculino, com diagnóstico de epifisiólise femoral proximal grau III em sua forma crônica agudizada, associada à limitação funcional grave e restrição importante do arco de movimento do quadril. O paciente foi submetido à osteotomia de ressecção de uma cunha trapezoide do colo femoral tipo Dunn por via artroscópica, seguido da redução e fixação percutânea com parafuso de 6,5mm. Houve melhora significativa do quadro clínico logo no primeiro pós-operatório, o que permitiu a reabilitação precoce. Os autores apresentam uma breve revisão de literatura e propõem esta técnica como um método adjuvante viável no tratamento da epifisiólise femoral proximal grave, encorajando o desenvolvimento de estudos sobre o tema.

We present a case report of a 12-year-old boy diagnosed with slipped capital femoral epiphysis grade III, with an acute-on-chronic presentation, associated with severe functional impairment and significant reduction in hip range of motion. The patient underwent a Dunn-type trapezoidal wedge femoral neck subtraction osteotomy by hip arthroscopy, followed by closed reduction and fixation with a 6.5mm percutaneous screw. There was significant improvement of the clinical picture on the first postoperative day, allowing for early rehabilitation. After a brief review of the literature, the authors propose this novel surgical technique as a viable method to treat severe slipped capital femoral epiphysis, encouraging the development of new studies on the subject.

Apoptosis in the Osteonecrosis of the Femoral Head

BACKGROUND: Osteonecrosis of the femoral head is classified into idiopathic and secondary forms. A number of etiological factors in the development of osteonecrosis have been suggested but the biological mechanisms are still unclear. Recently, some reports suggested that the apoptosis is closely related to osteonecrosis of the femoral head. Therefore, this study examined the expression of apoptosis in osteonecrosis of the femoral head. METHODS: Of the patients diagnosed preoperatively with osteonecrosis and underwent total hip replacement arthroplasty between August 2004 and July 2005, 58 patients (58 hips) were available for this study. Their diagnoses were confirmed by the postoperative pathology findings. Tissue samples of the femoral head sections were terminal deoxynucleotydyl transferase mediated dUTP nick-end labeling (TUNEL) stained using an in situ cell death detection POD kit. The number of total and TUNEL-positive osteocytes, and the average ratio of TUNEL-positive cells were calculated and analyzed according to the cause. RESULTS: Osteonecrosis was steroid-induced in 8 cases (13.8%), alcohol-induced in 29 cases (50%), post-traumatic in 6 cases (10.3%) and idiopathic in 15 cases (25.9%). The percentage of TUNEL-positive osteocytes was high in patients with steroid- and alcohol-induced osteonecrosis of the femoral head but low in patients with post-traumatic and idiopathic osteonecrosis. The difference in the percentage of TUNEL-positive osteocytes between these groups was significant (p < 0.05). CONCLUSIONS: Apoptosis might play an important role in the pathogenesis of osteonecrosis of the femoral head induced by steroid and alcohol. These findings highlight a need for further research into the role of apoptosis in the development of osteonecrosis of the femoral head.

Prognostic Value of Modified Lateral Pillar Classification in Legg-Calve-Perthes Disease

BACKGROUND: To evaluate the usefulness of the modified lateral pillar classification as a prognostic factor in Legg-Calve-Perthes disease (LCPD). METHODS: Thirty nine patients diagnosed with lateral pillar C in LCPD from May, 1977, to October, 2001 were reviewed, and their skeletal maturity was followed. The mean follow up duration was 12 years and 7 months (4 years, 6 months to 24 years, 9 months). Lateral pillar C classification was divided into C1 (50-75% collapse of the lateral pillar) and C2 (> 75%). All radiological and clinical prognostic factors were evaluated. The final results were evaluated according to the Stulberg classification. RESULTS: Twenty one and 18 of the affected hips were in groups C1 and C2, respectively. According to the Stulberg classification, the final results of group C1 were better than those of C2 (p = 0.002). Patients with more head-at-risk signs had significantly poorer outcomes. CONCLUSIONS: The modified lateral pillar classification has significant value for predicting the prognosis of LCPD.

Osteonecrosis en fracturas del cuello del femur / Osteonecrosis in femoral neck fractures

Introducción: La osteonecrosis de la cabeza femoral, posterior a una fractura del cuello del fémur, se produce por la lesión vascular que ocurre en el momento de la lesión. La posibilidad de osteonecrosis suele ser un factor condicionante cuando se tiene que optar por un tratamiento, por lo tanto es frecuente que se presente la disyuntiva de preservar o no la cabeza femoral. El objetivo de este trabajo es comunicar el índice de osteonecrosis ocurrido luego del tratamiento con osteosíntesis a cielo cerrado. Materiales y métodos: Entre 1989 y 2005, se trataron mediante osteosíntesis a cielo cerrado con clavos de Leoncio Fernández 38 fracturas del cuello del fémur en 26 pacientes mujeres y 12 varones. La cirugía se realizó dentro de las primeras 24 horas de ocurrida la lesión. Veintiséis eran fracturas desplazadas (Garden III y IV) y 12, sin desplazamiento (Garden I y II). Resultados: Sólo 5 caderas de las 38 (13 por ciento) desarrollaron osteonecrosis. De las 26 fracturas con desplazamiento, 4 presentaron osteonecrosis (15 por ciento) y de las 12 sin desplazamiento, la presentó una sola (8 por ciento). Todas las fracturas consolidaron entre los 45 y los 90 días. Conclusiones: Las fracturas del cuello del fémur tratadas mediante osteosíntesis en forma temprana tienen un bajo índice de osteonecrosis. La técnica quirúrgica y el tipo de osteosíntesis utilizados pueden determinar el resultado final. Los bajos índices de osteonecrosis nos alientan, en muchas fracturas del cuello del fémur, a utilizar osteosíntesis en lugar de un reemplazo protésico

Prevención de la deformidad de la cabeza femoral con necrosis isquémica en cerdos inmaduros, utilizando ácido ibandrónico y factores de crecimiento / Prevention of deformity of the femoral head in immature pigs by using ibandromic acid and growing factors to induce ischemic necrosis

La enfermedad de perthes en niños presenta como un desafío de tratamiento aún en la actualdad. A pesar de enumerarse varias causas todavía, evitar el colapso de la cabeza femoral es el paradigma que genera múltiples investigaciones. La base de este trabajo de investigación fue provocar en forma mecánica la necrosis avascular de la cabeza femoral y mediante el uso de ácido ibandrónico y concentrado plaquetario demostrar sus beneficios en esta patología.

Evaluation of total hip replacement.

This prospective study was made to asses the results of total hip replacement done primarily at Dhaka Medical College Hospital by the surgical team from its orthopaedic department. Eight patients were selected randomly from April/2005 to December/2005. Six patients were male and two females. Age of the patients was ranging from 22 to 67 years with average of 37.4+/-5.12 (mean+/-SE) years. Majority of the patients (75%) were diagnosed as Aseptic necrosis of femoral head with secondary osteoarthritis. The femoral head was replaced by metallic component with C-stem and the acetabular cup made up of Ultra-High density Polyethylene. Both the components were cemented (methylmethacrylate) by hand-packing. The patients were followed-up for 7.75+/-6.1 months (mean+/-SE) ranging from 4 months to 1 year. The results were evaluated on the basis of Harris Hip Score(2). 75 % had good to excellent and 12.5% had fair results. One patient complicated with dislocation and ultimately had poor result. The quality of life in seven patients (87.5%) improved much for which they were grateful.

Enfermedad de Perthes: revisión bibliográfica / Perthes' disease: bibliographic review

La enfermedad de Perthes es una patologia osteoarticular que afecta a la población infantil, sus secelas alteran el desarrollo dela cabeza del fémur y la relación de ésta cone l acetábulo será anormal, lo que predispone a una degeneración del cartílago articular, dando como resultado una artrosis prematura; por lo tanto los ovimientos del abducción, educción y rotación de la cadera estarán restringidos, produceindo una limitación funcional con claudicación en la march que, en mucos casos, acarrea trastornos psicológicos en losniños. Eisten diferentes tipos de tratamiento ortopédicos y quirúrgicos, que en ningún caso restauran completamente la anatomía y la función de la articulación de la cadera. Esto conduce a realizar una revisión de todos los tratamientos ortopédicos y quirúrgicos que se efectuán. Así miso, se revisa las nuevas propuestas etiológicas, los exámenes complemtarios y el pronóstico a que éstos conducen. El proposito de este estudio es que los especialistas que tratan a niños con enfermedad de Perthes conozcan todas las opciones que existen en la actualidad para tratar esta enfermedad, a fin de disminuir las secuelas y las consecencias que conlleva.

Free vascularized fibula graft for a cystic femoral head and neck lesion in the West Indies

A case is presented of an 18-year-old athlete with fibrous dysplasia of the femoral neck and head. The approach was by joint plastic and orthopaedic teams, which minimized operating time and allowed the option of vascular bone grafting. The lesion was curetted through a greater trochanteric window and the defect reconstructed with a free vascularized fibula graft with excellent result. Weight bearing was achieved in six months and there was minimal donor site morbidity. We believe the free vascularized fibula graft to be a reconstructive option, in difficult orthopaedic problems, facilitated by microsurgery and there is immense benefit of a joint effort between the orthopaedic and plastic surgical teams

HIP reconstruction in children with loss of the femoral head secondary to infection

A prospective study was performed at the Department of the Orthopedic Surgery, Assiut University Hospital, Assiut, Egypt during the period between 1994 and 1996. The age of the patients at the time of surgery ranged between 2.5 and 7 years, with an average of 4 years and 8 months. Clinical and radiological measurements of limb length were performed preoperatively, postoperatively and at follow up for all patients. Colonna hip arthroplasty procedure for non-united femoral-neck fractures has been reported, in which the greater trochanter is placed in the acetabulum and the abductor muscles of the hip are transferred distally on the femoral shaft to improve their function. A modified Colonna procedure has been used for the treatment of pathological dislocation of the hip secondary to pyogenic infection in five children. The modification made in the procedure is its combination with proximal femoral varus osteotomy that is fixed by plate and screws. All patients had full hip extension. No patient had adduction, abduction or flexion contracture of the affected hip at the final follow up. However, compared with the preoperative range of motion, all operated hips decreased the range of motion at a different degree. The average gain in the limb length was 46% of the original discrepancy. Gait was initially improved in all patients. However, in all patients the limp has persisted, for some degree

Slipped capital femoral epiphysis in Ramathibodi Hospital.

Slipped capital femoral epiphysis is rare in Asiatic Indonesian-Malays. Seven cases (9 hips) of this condition in Ramathibodi Hospital including five boys (average age, 12.5 years) and two girls (average age, 13 years) were reviewed. Most of the cases (4 out of 7) were acute on chronic and mild slips. No endocrine disorder was observed in all cases. All of the patients had a body weight above the mean of the normal population, four of which were obese. For the treatment, a single screw fixation including one case with cancellous and six cases with cannulated type were used. In the follow-up of average 2.5 years, six cases had satisfactory results. Avascular necrosis occurred in one case with mild and chronic slips in which a cancellous screw was used. It is concluded that obesity is the important factor related to the etiology in this study and probably is the same in other developing countries. The effect of a cancellous screw causing avascular necrosis is still questionable.

Necrose avascular da cabeça femoral. Aspectos à ressonância magnética / Avascular necrosis of hip - MRI aspects

A osteonecrose da cabeça femoral do adulto ocorre em uma variedade de situaçöes, mas apesar da etiologia, a história natural é a mesma se näo tratada precocemente. Atualmente, a Ressonância Magnética é o método mais preciso para o diagnóstico dessa patologia em fases iniciais. Os autores fazem uma breve revisäo da literatura atual e correlacionam as fases da doença com os achados de imagem por Ressonância Magnética

Fibroma nåo ossificante. Apresentaçåo de 3 casos / Three cases of non ossifying fibroma are selected

Os autores registram três observaçÆes em pacientes portadores de fibroma nåo ossificantes. Dois pacientes acima da média da idade registrada na literatura. Discutem fatores etiológicos e argumentam em favor de lesåo vascular, aspecto condizente com as pesquisas dos autores e desfavorecendo a hipótese de setratar de lesåo tumoral

O valor da reabilitaçäo no tratamento de pacientes portadores de doença de Legg-Calvé-Perthes submetidos à osteotomia de Salter modificada / The value of rehabilitation in treatment of patients with Legg-Calvé-Perthes disease submitted to modified Salter osteotomy

No período compreendido entre janeiro de 1987 e agosto de 1990, 28 pacientes portadores de DLCP foram tratados cirurgicamente pela osteotomia de Salter modificada e acompanhadas no Setor de Fisiatria do Departamento de Ortopedia e Traumatologia da Escola Paulista de Medicina, no sentido de se verificar a influência de um tratamento fisiátrico reabilitacional sobre os resultados clínicos finais. Os pacientes foram avaliados clinicamente de modo padronizado em relaçäo aos dados mensuráveis, que chamamos de grau de disfunçäo articular (goniometria, força muscular e discrepância de membros), e àqueles observáveis (postura e marcha), denominados por nós grau de alteraçäo de postura e marcha em três ocasiöes pré-operatório, pós-operatório e avaliaçäo final. No pré-operatório foram feitos exames radiológico e artrográfico, objetivando a determinaçäo da fase da doença e do grau de comprometimento da cabeça do fêmur. Pôde-se observar uma média de idade de 6,9 anos, variando de 3 a 10 anos, com predomínio do sexo masculino (75%). No pós-operatório, todos os pacientes foram encaminhados para tratamento de reabilitaçäo. Nessa ocasiäo, de modo espontâneo, foram estabelecidos dois grupos de pacientes: os que fizeram reabilitaçäo (grupoI) e os que näo fizeram (grupo II). Na análise dos resultados, pôde-se notar que, clinicamente, todas as crianças estavam piores do ponto de vista cinético postural na avaliaçäo pós-operatória em relaçäo à avaliaçäo inicial, e que elas melhoraram por ocasiäo da avaliaçäo final, especialmente as do grupo I, que fizeram tratamento reabilitacional. O tratamento reabilitacional foi positivo nos pacientes considerados inicialmente graves e moderados, tanto para o grau de disfunçäo articular como para o grau de alteraçäo de postura e marcha. A ausência desse tratamento influenciou negativamente mesmo os pacientes iniciais leves, especialmente quanto ao grau de alteraçäo de postura e marcha, que notamos ser a disfunçäo mais persistente. Além disso, o tratamento reabilitacional favoreceu especialmente as crianças novas, notadamente as do sexo masculino

Hydatid disease of the head of the femur

A case of hydatid disease is described which presented as aseptic necrosis of the head of the femur and subsequent fragmentation of the capital epiphysis. Particular reference is made to the problems of establishing the diagnosis