Factors affecting the rate and pattern of the first costal cartilage ossification.

In the present study, the extent of costochondral ossification of the first rib was determined from 78 chest roentgenograms of 13 healthy male soldiers subjected to a periodic follow-up. Roentgenography was performed at a mean interval of 2.9 years over a 15-year period. Mean subject age was 24 years at the commencement of the study and 37 years at its termination. Our results show that ossification of the first costal cartilage may start early in adult life and progress at individual rates. The ossification process proceeded from the costal toward the sternal end of the cartilage in an anteromedial direction. The morphological age-related changes ranged from the formation of small osseous islands in the cartilage to a complete ossification between the first rib and the sternum. The main conclusion of the study is that the degree of ossification of the first costal cartilage as an indicator of age does not provide the precision necessary for anthropological or forensic studies.

Decrease in bone levels of 1,25-dihydroxyvitamin D in women with subcapital fracture of the femur.

In a previous study we were able to show that in women over the age of 45 the level of 1,25-dihydroxyvitamin D (1,25(OH)2D) in bone, but not in serum, is significantly reduced when compared with younger women. In the present study we measured the concentration of 1,25(OH)2D in sera and bones of 19 female patients with subcapital fractures of the femur, mean age 78 +/- 2 years. We were able to show that serum levels of 1,25(OH)2D were within the normal range, while bone levels were markedly reduced compared to levels in femoral bone obtained from young female cadavers or to the previously reported levels in non-osteoporotic elderly women. Thus, reduced levels of 1,25(OH)2D in bones of elderly women may lead, together with other factors, to subcapital fractures.

Management of pyogenic vertebral osteomyelitis with spinal cord compression in the elderly.

Five elderly and debilitated patients presented with compressive myelopathy due to pyogenic spondylitis. All had undergone surgery which consisted of eradication of the infected tissue via an anterior approach followed by primary bone graft. Supplementary antibiotic treatment was determined by intraoperative bacteriological culture. This aggressive approach, disregarding the patients' advanced age and poor general medical state, resulted in total resolution of the neurological deficit and the patients' return to their preoperative everyday activity.

Parosteal lipoma of the proximal radius: a report of five cases.

Parosteal lipoma of the proximal radius is a benign, slow-growing tumor. It may cause compression of either the posterior interosseous or the superficial branch of the radial nerve. Surgical excision usually leads to complete recovery. Five cases of parosteal lipoma of the proximal radius are presented. X-ray films demonstrated a radiolucent mass in contact with the radius. Two patients had signs of posterior interosseous nerve compression, and two showed signs of superficial radial nerve compression. In one case the lipoma surrounded an exostosis arising from the proximal radius. The tumors were excised in four patients. The three patients with neurologic involvement recovered fully. One patient refused surgery, and posterior interosseous nerve paralysis developed.

Decrease in bone level of 1,25-dihydroxyvitamin D in women over 45 years old.

The most active metabolite of vitamin D is 1,25-dihydroxyvitamin D [1,25(OH)2D]. Its level in the bone may play a role in the pathogenesis of metabolic bone diseases such as osteoporosis. To assess this, and to see whether there is correlation between serum and bone levels, we studied serum and bone samples taken from 43 patients (18 men and 25 women) undergoing different orthopedic procedures. Patients were studied according to sex and age groups (less than 45 years, 46-60 years, greater than 61 years). Serum level of 1,25(OH)2D was found to be 29.7 +/- 2.61 pg/ml (mean +/- SEM) for women, 32.2 +/- 3.86 pg/ml for men, and 30.7 +/- 2.18 pg/ml for the group as a whole. No significant statistical differences were found among age subgroups in either sex or between sexes. Bone level of 1,25(OH)2D was found to be 31.5 +/- 4.46 pg/g for women, 26.5 +/- 3.06 pg/g for men, and 29.4 +/- 2.81 pg/g for the entire group. No significant statistical difference was found between the age subgroups for men. However, the level of 1,25(OH)2D was found to be higher in the group of younger women (less than 45 years) compared with the older women (46-60 years and greater than 61 years) (P less than 0.005).

Does the anteroposterior diameter of the bony spinal canal reflect its size? An anatomical study.

Nine anatomical parameters that may have a relation to the spinal canal size were directly measured in each of 594 cervical and lumbar vertebrae from young adult cadaver skeletons. The anteroposterior diameter of the spinal canal was the only parameter which could be statistically correlated with its cross-sectional area (P less than 0.05), and hence justifies the accepted practice of its use as an indicator of bony spinal canal size.

Migratory multiple bone involvement in a patient with systemic mastocytosis.

A young patient with severe generalized osteopenia and multiple compressed vertebral fractures caused by systemic mastocytosis is presented. Extensive clinical, laboratory, and pathologic examination showed the involvement of the skeleton alone. Follow-up bone scintigraphy with Tc-99m MDP during a period of 6 years demonstrated migratory multiple axial lesions. These results suggest that Tc-99m MDP imaging is an accurate detection of the activity of the disease.

Osteoporosis as the sole presentation of bone marrow mastocytosis.

Three (young) adults with severe generalized osteopenia and vertebral compression fractures were studied. Extensive clinical and laboratory investigations were not contributory. Undecalcified bone biopsies demonstrated multiple mast cell granulomas in the marrow in two patients and numerous mast cells diffusely distributed throughout the bone marrow in the third patient. Mast cells may serve as a pathogenic agent in osteoporosis. Therefore, we conclude that isolated skeletal mastocytosis without clinical evidence of mast cell mediator release should be sought in the evaluation of a patient with unexplained severe bone loss.

Biochemical and biomechanical properties of avian callus after local administration of dihydroxylated vitamin D metabolites.

In vitamin D-fed chicks 1,25-dihydroxyvitamin D3 and 24,25-dihydroxyvitamin D3 were implanted into experimentally-produced fractures of the mid-tibia. The mechanical and biochemical properties of the tibia were evaluated for two weeks, including torsion tests, measurement of alkaline phosphatase activity, 45Ca incorporation, and Ca2+ content. Both dihydroxylated metabolites of vitamin D3 had a direct effect on endochondral bone formation. 24,25(OH)2D3 strengthened the callus, and raised alkaline phosphate activity in the first seven days after fracture. 1,25(OH)2D3 decreased the strength of the callus concomitant with a reduction in 45Ca incorporation. It is suggested that local application of 24,25(OH)2D3 into fractures may accelerate healing and prevent non-union.

Medial discoid meniscus with cyst formation in a child.

A medial discoid meniscus with cystic formation was found in a 9-year-old girl. The cyst was located in the anterolateral part of the meniscus, mechanically blocking knee extension. The presenting symptom was knee flexion contracture. Total meniscectomy was followed by full recovery.

Villous lipomatous proliferation of the synovial membrane (lipoma arborescens).

The cases of five patients (7 knees) who had villous lipomatous proliferation of the synovial tissue (lipoma arborescens) are reported. The longest duration of symptoms was thirty years. Six of the seven knees were treated by synovectomy. The length of follow-up ranged from two to eleven years, and six knees were followed for five years or more. The patients who were treated by synovectomy had complete healing of the synovial lesion, but the osteoarthritis tended to progress, especially in patients who had long-standing symptoms. Because of the clinical, macroscopic, and microscopic features of this rare disease, we suggest discarding the name lipoma arborescens, which implies that the lesion is a neoplasm, and using the more descriptive term of villous lipomatous proliferation of the synovial membrane.

Bridging large defects in bone by demineralized bone matrix in the form of a powder. A radiographic, histological, and radioisotope-uptake study in rats.

Demineralized bone powder was used as an osteoinductive substance to bridge very large defects (more than 50 per cent of the total length of the bone) in one radius of each of thirty-three rats. An identical defect was produced in the contralateral radius of each animal for use as a control. The defect on the control side was left unbridged or was bridged by large chips of autologous bone or an autologous inlay graft. All rats showed formation of new bone throughout the length of the radial defect only on the side in which the demineralized bone powder had been implanted. The control side, in which an autologous graft in the form of chips or inlay had been implanted, showed resorption of the graft. The maximum rate of formation of bone occurred fifteen to twenty-one days after implantation of the demineralized bone powder. At thirty-five days, the experimental defect was fully bridged, forming solid bone, in 71 per cent of the rats, and the remaining 29 per cent showed bridging of 95.8 per cent of the length of the defect, with union on one side. Analysis of the sequential radiographs, technetium-99m scans, and histological findings showed that the formation of bone and bridging of the defect were superior on the side in which the demineralized bone powder had been implanted compared with the side in which pieces of autologous bone or an autologous inlay graft had been used.(ABSTRACT TRUNCATED AT 250 WORDS)

Levels of active metabolites of vitamin D3 in the callus of fracture repair in chicks.

The levels of the active metabolites of vitamin D were measured in the callus and in the epiphyseal growth plate of chicks given radioactive cholecalciferol during fracture healing. Those levels were correlated with the histological findings. Three groups of chicks were studied: a control group with no fracture, chicks with fractures fixed by Kirschner wire, and chicks with unfixed fractures. A significant increase in the levels of the active metabolites was found in the callus during the first few days after fracture. The levels of 25-hydroxycholecalciferol [25(OH)D3] and of 24,25-dihydroxycholecalciferol [24,25(OH)2D3] were higher when there was no fixation, while those of 1,25-dihydroxycholecalciferol [1,25(OH)2D3] were higher after fixation. The concentrations of these metabolites in the proximal epiphysis of the tibia were similar to those found in the callus. Based on these findings it is suggested that the active metabolites of vitamin D are directly involved in the process of fracture repair.

Closed percutaneous drilling for osteochondritis dissecans of the talus. A report of two cases.

Two cases of osteochondritis dissecans of the talar dome treated by closed percutaneous drilling are presented to illustrate a procedure for high-risk patients. The operation is performed with the aid of an image intensifier. The ostoechondral fragment is percutaneously drilled to avoid open operation and osteotomizing the medial malleolus.

Surgery for early stage osteochondritis dissecans of the knee in young adults: a preliminary report.

Results are reported of surgical treatment and a 7-year follow up of a group of seven young adults (average age, 17.9 years) suffering from early-stage osteochondritis dissecans (OCD) of the medial femoral condyle. A randomly selected group of patients was treated surgically by drilling and shaving the OCD lesion. Results of radiological examination demonstrated healing of the lesion within 4 to 7 months in all cases. Subjective and objective evaluation indicated that patients complained of pain, limitation of mobility and activity for 20.3 months prior to surgery, but were symptom-free 3.2 months following surgery and remained so for the 7 years of follow up. The role of early surgery for the early stage of the disease is discussed.