Anterior Cruciate Ligament ; pathology ; Anterior Cruciate Ligament Injuries ; Biomechanical Phenomena ; Foreign Bodies ; Humans ; Knee Joint ; pathology ; Tibia

PURPOSE: There have been a few reports of bizarre parosteal osteochondromatous proliferation (BPOP) in Korea to date. The purpose of this study was to investigate the etiology, diagnosis, treatment, and prognosis of BPOP and to report the clinical outcomes from a single institution. MATERIALS AND METHODS: Between 1999 and 2016, six patients who were diagnosed and treated operatively at Yeungnam University Medical Center were reviewed retrospectively. The analysis was performed using medical records, simple radiographs, magnetic resonance imaging (MRI), and pathology results, based on clinical and oncological results. All patients underwent surgical treatment for complete resection. We also analyzed one patient who was initially diagnosed with BPOP, showing different clinical features during the follow-up period. RESULTS: The age of patients ranged from 17 to 60 years. All patients did not show a history of trauma. All patients showed localized edema on the tumor lesion, and three patients also showed tenderness. The tumor lesions were distributed to the femur, tibia, and humerus. All patients underwent marginal resection or wide resection. The mean follow-up period was 50.3 months. There was a malignant change in one patient, but no recurrence or metastasis. CONCLUSION: In this study, there was no difference in the incidence of BPOP in accordance with sex. Moreover, there was no significant relationship between trauma and onset of BPOP. Unlike previous reports, no recurrence occurred after complete resection. If BPOP is diagnosed, it is necessary to consider the possibility of malignant change and distinguish it from other malignant tumors.
Academic Medical Centers ; Diagnosis ; Edema ; Femur ; Follow-Up Studies ; Humans ; Humerus ; Incidence ; Korea ; Magnetic Resonance Imaging ; Medical Records ; Neoplasm Metastasis ; Pathology ; Prognosis ; Recurrence ; Retrospective Studies ; Tibia

OBJECTIVETo explore a new method for finite element modeling to achieve material property assignment based on in situ CT gray value in simulated osteotomies for deformities.

METHODSA CT scan dataset of the lower limb of a patient with extorsion deformity was obtained for three-dimensional reconstruction using Mimics software and preparing a solid model. In the CAD software, the parameters for osteotomy simulation were defined including the navigation axis, rotation angle and reference plane. The tibia model was imported to the FEA pre-processing software for meshing procedure and then exported to Mimics. All the segments of the tibia meshed model were assigned uneven material properties based on the relationship between CT gray values and material properties in the Mimics software. Finally, all the segments of the tibia model, reference axis and reference plane were assembled in the pre-processing software to form a full finite element model of a corrected tibia, which was submitted to resolver for biomechanical analysis.

RESULTSThe tibia model established using our modeling method had inhomogeneous material properties based on CT gray values, and was available for finite element analysis for the simulation of osteotomy.

CONCLUSIONSThe proposed finite element modeling method, which retains the accuracy of the material property assignment based on CT gray value, can solve the reposition problem commonly seen in modeling via the routine method of property assignment and provides an efficient, flexible and accurate computational biomechanical analysis method for orthopedic surgery.

Finite Element Analysis ; Humans ; Models, Anatomic ; Osteotomy ; Software ; Tibia ; pathology ; Tomography, X-Ray Computed

OBJECTIVETo evaluate the effects a lithium chloride-doped calcium phosphate cement (Li/CPC) on promoting tibial defect repair in rats.

METHODSTwenty 6-month-old female SD rats randomized into Li/CPC (n=10) and CPC control (n=10) groups. Surgery was performed to create bone defects at the bilateral tibia, which were filled with either of the cement. Five rats from each group were sacrificed at 1 and 2 months after the surgery for micro-CT examination and HE staining of the tibia.

RESULTSMicro-CT showed better repair of bone defects in Li/CPC group, which had a significantly higher new bone volume fraction (BV/TV) and a lower trabecular separation/spacing (Tb.Sp) than the control group (P<0.05). HE staining showed an earlier appearance of fiber and osteoid callus in Li/CPC group than CPC control group. The number and quality of bone healing was significantly higher in Li/CPC group than in CPC group.

CONCLUSIONLi/CPC possessed better osteoinductivity and can significantly promote bone defect repair in rats.

Animals ; Bone Cements ; chemistry ; Calcium Phosphates ; chemistry ; Female ; Lithium ; chemistry ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Tibia ; pathology

BACKGROUND: Percutaneous lateral hemiepiphysiodesis of the lower extremity is a simple and excellent method to correct the angular and length problems cosmetically. However, the efficacy of percutaneous lateral hemiepiphysiodesis is not well established in the literature. The purpose of this study was to evaluate the efficacy of percutaneous lateral hemiepiphysiodesis for angular corrections in adolescent idiopathic genu varum patients with proximal tibia vara and identify the factors affecting the amount of deformity correction of the lower limb in the coronal plane. METHODS: We retrospectively reviewed 20 patients (40 lower limbs) who had percutaneous lateral hemiepiphysiodesis on the proximal lateral tibia between 1997 and 2010. Radiographic evaluations were made using (1) the hip-knee-ankle angle and (2) the length of the tibia. Furthermore, the intercondylar distance was evaluated at the level of the knee joint. Preoperative factors (gender, age, body mass index, intercondylar distance, preoperative hip-knee-ankle angle, remaining growth of tibia, and calculated correctable angle) were analyzed, as well as their correlation with the degree of the actual correction angle. RESULTS: The amount of coronal deformity of the lower limb was improved from its preoperative state. The median average of hip-knee-ankle angle improved from 8.0degrees (interquartile range [IQR], 7.0degrees to 10.0degrees) preoperatively to 3.0degrees (IQR, 2.5degrees to 4.0degrees) at the final follow-up (p < 0.001). The median percent ratio of the angular correction was 60% (IQR, 50% to 71.3%). The correlation coefficients were -0.537, 0.832, 0.791, and 0.685 for the bone age, preoperative hip-knee-ankle angle, the remaining growth of tibia, and calculated correctable angle, respectively. CONCLUSIONS: Despite the excellent cosmetic outcome of percutaneous lateral hemiepiphysiodesis on the proximal lateral tibia in adolescent idiopathic genu varum, the effect was limited in most cases. For optimum results, surgery a few months earlier is recommended, rather than at the calculated operation time.
Adolescent ; Child ; Female ; Genu Varum/diagnostic imaging/pathology/*surgery ; Humans ; Leg Bones/diagnostic imaging/pathology/surgery ; Male ; Orthopedic Procedures/*methods ; Retrospective Studies ; Tibia/diagnostic imaging/pathology/*surgery ; Treatment Outcome

OBJECTIVE: Our aim was to evaluate the cartilage cap of osteochondromas using T2 maps and to compare these values to those of normal patellar cartilage, from age and gender matched controls. MATERIALS AND METHODS: This study was approved by the Institutional Review Board and request for informed consent was waived. Eleven children (ages 5-17 years) with osteochondromas underwent MR imaging, which included T2-weighted fat suppressed and T2 relaxation time mapping (echo time = 9-99/repetition time = 1500 msec) sequences. Lesion origins were femur (n = 5), tibia (n = 3), fibula (n = 2), and scapula (n = 1). Signal intensity of the cartilage cap, thickness, mean T2 relaxation times, and T2 spatial variation (mean T2 relaxation times as a function of distance) were evaluated. Findings were compared to those of patellar cartilage from a group of age and gender matched subjects. RESULTS: The cartilage caps showed a fluid-like high T2 signal, with mean thickness of 4.8 mm. The mean value of mean T2 relaxation times of the osteochondromas was 264.0 +/- 80.4 msec (range, 151.0-366.0 msec). Mean T2 relaxation times were significantly longer than the values from patellar cartilage (39.0 msec) (p < 0.0001). These findings were observed with T2 spatial variation plots across the entire distance of the cartilage cap, with the most pronounced difference in the middle section of the cartilage. CONCLUSION: Longer T2 relaxation times of the cartilage caps of osteochondromas should be considered as normal, and likely to reflect an increased water content, different microstructure and component.
Adolescent ; Bone Neoplasms/*pathology ; Cartilage, Articular/*pathology ; Child ; Child, Preschool ; Female ; Femur ; Humans ; Magnetic Resonance Imaging/*methods ; Male ; Osteochondroma/*pathology ; Patella/*pathology ; Retrospective Studies ; Tibia

The presence of large segmental defects of the diaphyseal bone is challenging for orthopedic surgeons. Free vascularized fibular grafting (FVFG) is considered to be a reliable reconstructive procedure. Stress fractures are a common complication following this surgery, and hypertrophy is the main physiological change of the grafted fibula. The exact mechanism of hypertrophy is not completely known. To the best of our knowledge, no studies have examined the possible relationship between stress fractures and hypertrophy. We herein report three cases of patients underwent FVFG. Two of them developed stress fractures and significant hypertrophy, while the remaining patient developed neither stress fractures nor significant hypertrophy. This phenomenon indicates that a relationship may exist between stress fractures and hypertrophy of the grafted fibula, specifically, that the presence of a stress fracture may initiate the process of hypertrophy.
Adult ; Female ; Fibula ; pathology ; transplantation ; Fractures, Stress ; pathology ; Humans ; Hypertrophy ; Male ; Middle Aged ; Tibia ; surgery ; Tibial Fractures ; surgery

Adult ; Bone Neoplasms ; diagnosis ; diagnostic imaging ; pathology ; Diagnosis, Differential ; Diaphyses ; diagnostic imaging ; pathology ; Humans ; Knee Joint ; diagnostic imaging ; pathology ; Lipoma ; diagnosis ; diagnostic imaging ; pathology ; Magnetic Resonance Imaging ; Male ; Radiography ; Tibia ; diagnostic imaging ; pathology

Any medical diagnosis should take a multimodal approach, especially those involving tumour-like conditions, as entities that mimic neoplasms have overlapping features and may present detrimental outcomes if they are underdiagnosed. These case reports present diagnostic pitfalls resulting from overdependence on a single diagnostic parameter for three musculoskeletal neoplasm mimics: brown tumour (BT) that was mistaken for giant cell tumour (GCT), methicillin-resistant Staphylococcus aureus osteomyelitis mistaken for osteosarcoma and a pseudoaneurysm mistaken for a soft tissue sarcoma. Literature reviews revealed five reports of BT simulating GCT, four reports of osteomyelitis mimicking osteosarcoma and five reports of a pseudoaneurysm imitating a soft tissue sarcoma. Our findings highlight the therapeutic dilemmas that arise with musculoskeletal mimics, as well as the importance of thorough investigation to distinguish mimickers from true neoplasms.
Adult ; Aneurysm, False ; diagnosis ; Biopsy ; Bone Diseases ; diagnosis ; Bone Diseases, Metabolic ; diagnosis ; Bone Neoplasms ; diagnosis ; Cell Proliferation ; Diagnosis, Differential ; Diagnostic Errors ; prevention & control ; Female ; Giant Cell Tumors ; diagnosis ; Humans ; Hyperparathyroidism ; complications ; Leukocytosis ; diagnosis ; Male ; Methicillin-Resistant Staphylococcus aureus ; Middle Aged ; Neoplasms ; diagnosis ; microbiology ; Osteomyelitis ; diagnosis ; microbiology ; Osteosarcoma ; diagnosis ; Sarcoma ; diagnosis ; Soft Tissue Neoplasms ; diagnosis ; Tibia ; pathology

Fluorodeoxyglucose (FDG) hepatic superscan refers to the diffuse intense uptake of 18F-FDG in the liver on positron emission tomography (PET), with reduced physiological activity in the brain and heart. The common causes include lymphoma and metastasis. In this case report, we describe the imaging features of tuberculosis as a rare cause of FDG hepatic superscan. PET imaging may be the only clue to a diagnosis of hepatic tuberculosis, as other imaging modalities may demonstrate only nonspecific hepatomegaly. It is important to consider this entity in the differential diagnosis of patients presenting with FDG hepatic superscan and proceed with liver biopsy for a definitive diagnosis.
Adult ; Aged ; Biopsy ; methods ; Bone Neoplasms ; diagnosis ; pathology ; Equipment Design ; Female ; Femur ; pathology ; Fracture Fixation, Intramedullary ; Fractures, Bone ; diagnosis ; Humans ; Humerus ; pathology ; Laparoscopy ; instrumentation ; Middle Aged ; Surgical Equipment ; Tibia ; pathology