Local arthroscopic bone grafting of a juxta-articular glenoid bone cyst

This report describes a rare, juxta-articular bone cyst of the posterior glenoid that developed after a fracture of the glenoid in a 38-year-old male. The patient had persistent pain, popping and stiffness of his right shoulder for 3 years, and failed to improve after a nonoperative rehabilitation program. At arthroscopy, the senior author transported an autogenous bone graft from the bare area of the humeral head to fill the glenoid cyst arthroscopically. At second-look arthroscopy approximately 1 year after the index procedure, the bone graft had consolidated within the original cystic defect and the surface was covered with fibrocartilage. The graft harvest site posteriorly on the humeral head had healed with a small amount of scar tissue at the articular margin. Comfortable motion and function were restored.     

Posttransplant bone disease: evidence for a high bone resorption state

Loss of bone is a significant problem after renal transplant. Although bone loss in the first post transplant year has been well documented, conflicting data exist concerning bone loss after this time. It is equally unclear whether bone loss in long-term renal transplant recipients correlates with bone turnover as it does in postmenapausal osteoporosis. To examine these issues, we conducted a cross-sectional study to define the prevalence of osteoporosis in long-term (> 1 year) renal transplant recipients with preserved renal function (mean creatinine clearance 73 +/- 23 ml/min). Bone mineral density (BMD) was measured at the hip, spine and wrist by DEXA in 69 patients. Markers for bone formation (serum osteocalcin) and bone resorption [urinary levels of pyridinoline (PYD) and deoxypyridinoline (DPD)] were also measured as well as parameters of calcium metabolism. Correlations were made between these parameters and BMD at the various sites. The mean age of the patients was 45 +/- 11 years. Eighty eight percent of patients were on cyclosporine (12% on tacrolimus) and all but 2 were on prednisone [mean dose 9 +/- 2 mg/day)]. Osteoporosis (BMD more than 2.5 SD below peak adult BMD) at the spine or hip was diagnosed in 44% of patients and osteopenia was present in an additional 44%. Elevated levels of intact parathyroid hormone (i PTH) were observed in 81% of patients. Elevated urinary levels of PYD or DPD were present in 73% of patients and 38% had elevated serum levels of osteocalcin. Levels of calcium, and of 25(OH) and 1,25(OH)2 vitamin D were normal. In a stepwise multiple regression model that included osteocalcin, PYD, DPD, intact PTH, age, years posttransplant, duration of dialysis, cumulative prednisone dose, smoking, and diabetes: urinary PYD was the strongest predictor of bone mass. These results demonstrate that osteoporosis is common in long-term renal transplant recipients. The data also suggest that elevated rates of bone resorption contribute importantly to this process.     

Reconstruction of a phalangeal bone using a vascularised metacarpal bone graft nourished by a dorsal metacarpal artery

SUMMARY: We report on a patient with an infected nonunion of the left little-finger phalanges following a gunshot injury. The defect was treated by transplanting a partial fifth metacarpus, vascularised by the fourth dorsal metacarpal vessels. Bone union was obtained 6 months after surgery and no signs of infection were found at the site of the nonunion. Although the range of the interphalangeal joints of the finger was limited, the patient was satisfied because the preserved little finger had a metacarpophalangeal (MP) joint with unrestricted motion.     

Serum bone GLA-protein is not a sensitive marker of bone turnover in Paget's disease of bone

Summary Serum bone Gla-protein (sBGP) was measured in 32 patients with untreated Paget's disease of bone. Despite clinical and biological symptoms of active disease in all patients, sBGP was normal in 13/32 patients (41%). There was a striking discrepancy between the moderate increase of sBGP above normal values (11.4±4.5 vs 6.0±2.1 ng/ml) and the marked increase of both serum alkaline phosphatase (sAP) and urinary hydroxyproline (uOHP). sBGP was weakly correlated with sAP (r=0.50, p<0.01), uOHP (r=0.48, p<0.01) and with the extension of the disease (r=0.48, p<0.01), We conclude that sBGP is not a sensitive marker of bone turnover in patients with Paget's disease of bone, and should be interpreted with caution in this condition.     

Large aneurysmal bone cyst of iliac bone in a female child: a case report

Background  

Symptomatic aneurysmal bone cysts in pediatric age group with an expansile lesion in ilium is a rare occurrence.     

Serum bone Gla protein as a marker of bone turnover in acromegaly

Summary Serum bone Gla protein, a sensitive and specific marker of bone turnover, was measured in 35 acromegalic patients (14 untreated, 8 clinically active, and 13 cured) and 21 controls. We also examined 10 acromegalic patients before and after transsphenoidal surgery. Untreated and clinically active acromegalic patients had significantly higher serum bone Gla protein concentrations than the control subjects. Other nonspecific biochemical markers of bone metabolism, such as urinary hydroxyproline and urinary calcium, were also present in significantly greater amounts in active acromegalic patients. After treatment, a significant decrease in levels was observed, with return to control levels. In acromegalic patients, positive correlations were found among serum bone Gla protein and serum growth hormone and serum insulin-like growth factor I levels, as well as among levels of insulin-like growth factor I and serum phosphorus, serum alkaline phosphatase, and urinary hydroxyproline. These results suggest that serum bone Gla protein is a sensitive marker of the action of growth hormone in bone metabolism in acromegaly, a role that is probably mediated by insulin-like growth factor I.     

Bridging large bone defects with a xenograft composited with autologous bone marrow

Summary We have investigated the role of defatted, decalcified xenogenic bone implants composited by impregnation with fresh autologous marrow in bridging large cortical defects. Diaphyseal cortical implants were obtained from orthopaedic operations on humans and from guinea pigs and prepared by treatment with acetone, 0.6 M HCl and ethanol. The composited graft was used to bridge a 3 cm defect in the diaphysis of the ulna of rabbits. Periodic investigations were made clinically, radiographically and histologically and by tetracycline, fluorescence studies up to 20 weeks. Abundant new bone formation was observed in 85.7% of composited human xeno-autografts and in 83.3% of composited guinea pig xeno-autografts. New bone formation was seen in 13.3% of noncomposited xeno-implants. No appreciable antigenicity was observed either clinically or histologically in the grafts. The high degree of success obtained justifies further studies on implants composited by fresh autologous marrow and offers hope for the enhancement of new bone formation clinically, particularly in reconstructive operations for significant skeletal defects. We feel that the osteo-inductive potential of autologous marrow was responsible for the healing of the defects aided by the better internal milieu provided by defatted decalcified xeno implant.

---

Résumé Les auteurs ont étudié le rôle, dans le remplacement de pertes de substance corticales étendues, d'implants osseux hétérogènes, dégraissés et décalcifiés, et rendus composites par imprégnation à l'aide de moelle autogène fraîche. Les greffons corticaux diaphysaires ont été obtenus au cours d'interventions orthopédiques chez l'homme et sur des cobayes. Ils sont ensuite lavés successivement à l'acétone, à l'acide chlorhydrique et à l'alcool éthylique. La greffe composite est alors utilisée pour ponter une perte de substance de 3 cm, au niveau de la diaphyse cubitale du lapin. Des examens périodiques, cliniques, radiographiques et histologiques, ont été pratiqués jusqu'à la 20 semaine, ainsi que l'étude de la fluorescence par la tétracycline. Une abondante formation d'os nouveau a été observée dans 85,7% des greffes composites d'origine humaine et dans 83,3% des greffes composites de cobaye. Une néoformation osseuse n'a été constatée que dans 13,3% des greffes hétérogènes non composites. Ni cliniquement ni histologiquement, il n'est apparu de réaction antigénique au niveau des greffons. Le nombre élevé de succès obtenus justifie des études complémentaires et perment d'espérer l'accroissement de la néoformation osseuse, notamment dans les opérations reconstructrices pour pertes de substance étendues. Les auteurs estiment que le potentiel inducteur de la moelle est l'agent de la consolidation du matériau idéal que constitue la greffe hétérogène, dégraissée et décalcifiée.

     

骨斑点症合并“骨中骨”1例

<正>患者男,45岁,身高153cm,因"外伤摄胸片发现骨骼异常"入院,既往无骨、关节相关临床症状。X线检查:胸腰椎各椎体内均见相似比例小椎体,后缘与大椎体共线,上下缘与大椎体上下缘平行,小椎体终板致密骨厚度稍大于大椎体(图1A);双肱骨头内见与关节弧度一致的粗大致密带,见大小不等斑点及条纹状致密骨影;双肩胛骨见点条状致密骨影;双膝关节股侧与胫侧内见与骨端形态相似、轮廓清楚、具有内外髁及髁间棘的小骨端,其下缘止于骨骺线痕,小骨端内可见斑点影,左侧见边缘硬化的小囊样透明区,其下缘邻近骨干见纵横交错略模糊     

Inter-trabecular bone formation: a specific mechanism for healing of cancellous bone

Background and purpose — Studies of fracture healing have mainly dealt with shaft fractures, both experimentally and clinically. In contrast, most patients have metaphyseal fractures. There is an increasing awareness that metaphyseal fractures heal partly through mechanisms specific to cancellous bone. Several new models for the study of cancellous bone healing have recently been presented. This review summarizes our current knowledge of cancellous fracture healing.

Methods — We performed a review of the literature after doing a systematic literature search.

Results — Cancellous bone appears to heal mainly via direct, membranous bone formation that occurs freely in the marrow, probably mostly arising from local stem cells. This mechanism appears to be specific for cancellous bone, and could be named inter-trabecular bone formation. This kind of bone formation is spatially restricted and does not extend more than a few mm outside the injured region. Usually no cartilage is seen, although external callus and cartilage formation can be induced in meta­physeal fractures by mechanical instability. Inter-trabecular bone formation seems to be less sensitive to anti-inflammatory treatment than shaft fractures.

Interpretation — The unique characteristics of inter-trabecular bone formation in metaphyseal fractures can lead to differences from shaft healing regarding the effects of age, loading, or drug treatment. This casts doubt on generalizations about fracture healing based solely on shaft fracture models.     

Systemic zoledronate precoating of a bone graft reduces bone resorption during remodeling

Background Cartilage degeneration often occurs after osteosynthesis of a devascularized intermediary fragment in a joint fracture, in mosaicplasty or in whole-joint toe-to-finger transplantation. Hypothetically, the degeneration is secondary to a collapse of the transferred subchondral bone as it remodels during high mechanical load. Bisphosphonates are used to reduce resorption of necrotic bone. We tested a systemic pretreatment before harvesting the graft in order to protect the bone and cartilage against collapse and secondary arthrosis.

Methods Rats were given one zoledronate injection and bone grafts were harvested. The grafts were frozen, thawed and placed into bone chambers, and implanted into another batch of rats. Graft resorption and new bone formation was measured by histomorphometric analysis and compared with untreated grafts.

Results In the remodeled area of the controls, the graft was almost totally resorbed and replaced by bone marrow. In the zoledronate-treated specimens, the graft remained and the graft trabeculas were lined with new bone. By histomorphometry, the total amount of bone (graft plus new bone) within the remodeled area was 16% in the zoledronate-treated grafts and 5% in the controls (p = 0.003).

Interpretation A bone graft can be pretreated with bisphosphonate and remain protected against resorption once implanted again. ▪     

Systemic zoledronate precoating of a bone graft reduces bone resorption during remodeling

Background?Cartilage degeneration often occurs after osteosynthesis of a devascularized intermediary fragment in a joint fracture, in mosaicplasty or in whole-joint toe-to-finger transplantation. Hypothetically, the degeneration is secondary to a collapse of the transferred subchondral bone as it remodels during high mechanical load. Bisphosphonates are used to reduce resorption of necrotic bone. We tested a systemic pretreatment before harvesting the graft in order to protect the bone and cartilage against collapse and secondary arthrosis.

Methods?Rats were given one zoledronate injection and bone grafts were harvested. The grafts were frozen, thawed and placed into bone chambers, and implanted into another batch of rats. Graft resorption and new bone formation was measured by histomorphometric analysis and compared with untreated grafts.

Results?In the remodeled area of the controls, the graft was almost totally resorbed and replaced by bone marrow. In the zoledronate-treated specimens, the graft remained and the graft trabeculas were lined with new bone. By histomorphometry, the total amount of bone (graft plus new bone) within the remodeled area was 16% in the zoledronate-treated grafts and 5% in the controls (p = 0.003).

Interpretation?A bone graft can be pretreated with bisphosphonate and remain protected against resorption once implanted again.??     

Reconstruction of a free bone transplant in long bone defect after distraction

The authors have studied the roentgenological changes of the bone substance in a defect making use of densitometric and planimetric methods of investigation in a study on 63 adult dogs (2 series of experiments) who had their defect of the upper part of the tibia replaced by a graft that was being removed in doses and a distraction regenerate that was being formed at the same time. It was established that the formation of the distraction regenerate lead to demineralization of the osseous graft which was favourable for an organotypic reconstruction of the freely replaced bone.