The periphysis and its effect on the metaphysis: I. Definition and normal radiographic pattern

The zone of Ranvier and the ring of LaCroix, together with the membranous bone bark they produce, are termed the periphysis in order to emphasize their normal effect (the metaphyseal collar) on the metaphysis of the infant and young child. In the first 7 years of life, the normal collar at the wrist is 1–3 mm wide. The step-off between the metaphyseal collar and the curvilinear metaphysis, at the margin of the periphysis, should not be mistaken for abuse fracture. The periphyseal bone bark may be radiologically visible at the edge of the physis at the distal ulna in 9% of infants and should not be mistaken for fracture or rickets.     

Effect of grape seed proanthocyanidins extract on alteration of mechanical properties of metaphysis tibia bone in rats fed a low-calcium diet

The effects of grape seed proanthocyanidins extract (GSPE, 3 mg in 100 g of high-calcium diet with a calcium content of 1697 mg/100 g) on rat metaphysis tibia formation following feeding of a low-calcium diet (30% of calcium in the standard diet) were investigated by examining bone density, mineral content, geometric and bone strength. Five-week old male Wistar rats (n = 40) were randomly divided into a control (Co) group, a low-calcium diet (LC) group, a low-calcium diet • high-calcium diet (LCH) group, and a lowcalcium diet • high-calcium diet with supplementary GSPE (LCHG) group. The metaphysis tibia bones were analyzed using three-dimensional peripheral quantitative computed tomography (pQCT), while whole tibia bones were tested for mechanical resistance using a material testing machine. We found no significant differences in body weight among the 4 groups. All bone parameters in the LC group were significantly lower than these in the Co group (P < 0.01). Furthermore, trabecular bone density (TrBD), trabecular bone mineral content (TrBMC), cross-sectional moment of inertia to the reference axis y (yCSMI), and stress-strain index to the reference axis x (xSSI) in the LCHG group were significantly higher than those in the LCH group (P < 0.05; P < 0.01; P < 0.05; P < 0.05, respectively), while stiffness in the LCHG and LCH groups were significantly higher than that in the LC group (P < 0.01). We concluded that a mixture of high-calcium and GSPE in the diet has a more beneficial effect on bone formation for the treatment of metaphysis tibia bone debility in rats than does a high-calcium diet alone.     

后正中入路干骺端锁定加压钢板治疗肱骨干下段骨折的可行性

目的 探讨后正中入路干骺端锁定加压钢板治疗肱骨干下段骨折的临床效果.方法 选取2010年3月至2013年7月在我院采用干骺端锁定加压钢板治疗肱骨干下段骨折的患者96例,采用随机数表法将患者分为观察组和对照组,各48例,观察组患者采用从后正中入路干骺端锁定加压钢板治疗,对照组患者采用从前外侧入路干骺端锁定加压钢板治疗.观察并比较两组患者的临床愈合时间、肘关节功能评分和并发症评估情况.结果 两组患者均获得了较好的临床愈合,观察组的愈合时间为(8.25±1.59)d,明显短于对照组的(14.84±3.28)d,两组比较差异具有统计学意义(P<0.05);根据肘关节的评分功能,观察组优良率为87.5%(42/48),明显高于对照组的77.1%(37/48),两组比较差异有统计学意义(P<0.05);观察组患者术后出现并发症9例,其中骨折延迟愈合5例,桡神经麻痹2例,前臂外侧皮神经麻痹和切口感染各1例,对照组患者术后出现并发症25例,其中骨折延迟愈合13例,桡神经麻痹5例,前臂外侧皮神经麻痹4例,切口感染3例,两组患者的并发症发生率比较差异有统计学意义(P<0.05).结论 利用后正中入路干骺端锁定加压钢板治疗肱骨干下段骨折可以减少愈合时间,减小并发症的发生,同时可改善肘关节功能和提高肘关节恢复能力,值得在临床上推广.     

Metaphyseal factors promote calcium incorporation in physeal chondrocyte cultures

Our hypothesis is that physiological mineralization within the mammalian growth plate is a consequence of communication between cartilage chondrocytes and cells within metaphyseal bone. To test this hypothesis, chondrocytes were isolated from the proliferative region of the fetal ovine physis and co-cultured with cells or conditioned medium from cells characteristic of those in metaphyseal bone. The mineralization potential of chondrocytes alone and in the presence of other cells or conditioned medium was determined by ⁴⁵calcium incorporation. Co-culture of chondrocytes with a crude cell isolate from metaphyseal bone resulted in a stimulation of ⁴⁵calcium incorporation of 93% above that observed in the individual cell populations alone. Conditioned medium from metaphyseal bone cultures also stimulated ⁴⁵calcium incorporation. This response to conditioned medium was dose-dependent and stable to 90°C. Vascular endothelial cells and conditioned medium from chondrocyte and osteoblast cultures did not stimulate ⁴⁵calcium incorporation by physeal chondrocytes. Thus, cells found in the metaphyseal bone produce a soluble factor, which promote calcium incorporation by physeal chondrocytes. The source of this factor is not chondrocytic, osteoblastic, or endothelial in origin. Received: March 27, 2000 / Accepted: June 5, 2000     

Fractures of the distal tibia: minimally invasive plate osteosynthesis

Unstable fractures of the distal tibia that are not suitable for intramedullary nailing are commonly treated by open reduction and internal fixation and/or external fixation, or treated non-operatively. Treatment of these injuries using minimally invasive plate osteosynthesis (MIPO) techniques may minimise soft tissue injury and damage to the vascular integrity of the fracture fragments. We report the results of 20 patients treated by MIPO for closed fractures of the distal tibia. Their mean age was 38.3 years (range: 17-71 years). Fractures were classified according to the AO system, and intra-articular extensions according to Rüedi and Allg?wer. The mean time to full weight-bearing was 12 weeks (range: 8-20 weeks) and to union was 23 weeks (range: 18-29 weeks), without need for further surgery. There was one malunion, no deep infections and no failures of fixation. MIPO is an effective treatment for closed, unstable fractures of the distal tibia, avoiding the complications associated with more traditional methods of internal fixation and/or external fixation.     

Osteochondroma induced by reflection of the perichondrial ring in young rat radii

Summary In order to investigate the effects of reflection of the perichondrial ring in osteochondroma formation, the perichondrial rings of the epiphyseal growth plates in 42 young rat radii were turned to the metaphyseal periosteum by means of blunt dissection. Seven days after surgery a small nest of chondrocytes appeared on the metaphyseal-diaphyseal bone surface at the level of the tip of the reflected perichondrial ring. From the 9th to the 15th days the histological pattern of the osteochondroma was established. The osteochondroma was not connected with the hypertrophic cartilage of the growth plate. During the third and fourth weeks the osteochondroma began to regress with the disappearance of the cartilage nest. During the development of the lesion the bone grew normally and the growth plate migrated distally while the lesion remained at its initial site. The growth plate zone devoid of perichondrial ring was covered by fibrous connective tissue and no removal of the perichondrial ring occurred. These results suggest that the origin of this osteochondroma is the perichondrial ring cells whose polarity has been surgically changed.     

Short-term effects of zoledronate on the histomorphology of osteoclast in young albino rats

The present study was conducted to histomorphometrically evaluate the effects of short-term administration of zoledronate, a third generation bisphosphonate, on the metaphysis of the proximal end of tibia in twenty day old male albino rats. Zoledronate (2.8 μg/kg body weight), was daily given subcutaneously for eleven days. The animals were sacrificed; tibiae were dissected out and decalcified in EDTA. Seven micron thick, serial longitudinal paraffin sections were stained with haematoxylin and eosin and examined under a Zeiss light microscope and Image Pro-Express Analyzer. In zoledronate treated rats, a significant increase (p < 0.05) in the number of osteoclasts was observed both in the regions of primary spongiosa (zoledronate treated: 6.41 ± 0.30/mm², control: 2.90 ± 0.28/mm²) and secondary spongiosa (zoledronate treated: 49.58 ± 0.84/mm², control: 31.81 ± 2.02/mm²) along with a significant increase (p < 0.05) in the length of the metaphyseal region as compared to the control group. The number of nuclei per osteoclast and area of the osteoclast also showed a significant increase (p < 0.001; p < 0.05 respectively) following the uptake of zoledronate.The findings in the present study, suggest that the osteoclasts are the primary sites of action of zoledronate resulting in decreased osteoclastic activity, which would account for the great increase in the number and size of inactive osteoclasts resulting in marked cancellous bone formation.     

我国5省区非大骨节病病区村儿童掌指骨干骺端改变率调查

目的 研究非大骨节病病区村7~12岁儿童干骺端的改变率,为病区村判定消除大骨节病提供依据。方法 在吉林、辽宁、陕西、山西和内蒙古5个大骨节病病区省份随机调查36个非大骨节病病区村。用全数字化多功能X线摄影系统(DR)拍摄每个调查村全部7~12岁儿童右手X线片,并按照《大骨节病诊断》标准(WS/T 207-2010)诊断。结果 在调查的36个村中,只有13个村的儿童右手X线干骺端发生改变,且无骨端改变病例,以村为单位X线干骺端改变率均<3%。结论 建议判定病区村消除大骨节病的标准为7~12岁儿童干骺端改变率<3%。