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PubMed1995

Zinc decrease and bone metabolism in the femoral-metaphyseal tissues of rats with skeletal unloading.

Whether the decrease of zinc content in the femoral-metaphyseal tissues of rats with skeletal unloading is involved in the alteration of bone metabolism was investigated. Skeletal unloading was designed using the model of hindlimb suspension in rats. Animals were fed for 4 days with the unloading. The metaphyseal zinc content were significantly decreased by the unloading. Zinc accumulation in the metaphyseal tissues by a single oral administration of zinc sulfate (20 mg Zn/100 g body weight) was partially depressed by the unloading, although serum zinc concentration was higher than that in normal rats, suggesting an impaired movement of zinc from serum into bone tissues by the unloading. Skeletal unloading caused a significant decrease of alkaline phosphatase activity and deoxyribonucleic acid (DNA) content in the metaphyseal tissues. These decreases were completely restored by addition of zinc sulfate (10(-4) M) or beta-alanyl-L-histidinato zinc (AHZ; 10(-5) M) in a culture medium with the metaphyseal tissues in vitro. The effects of zinc compounds were abolished by the presence of cycloheximide (10(-8) M), suggesting that the zinc effect is based on a newly synthesized protein. Dipicolinate (10(-4) and 10(-5) M), a potent zinc-chelating agent, caused an appreciable decrease of zinc content and alkaline phosphatase activity in the metaphyseal tissues. This decrease was restored by zinc supplement. The present results suggest that the skeletal unloading-induced decrease of zinc content in the femoral-metaphyseal tissues plays a role in the deterioration of bone metabolism in the unloaded rats.

Alkaline Phosphatase↗
PubMed1997

Zinc stimulates protein synthesis in the femoral-metaphyseal tissues of normal and skeletally unloaded rats.

The effect of zinc on protein synthesis in the femoral-metaphyseal tissues of normal and skeletally unloaded rats was investigated. Skeletal unloading was designed using the model of hindlimb suspension in rats. Animals were fed for 2 or 4 days during the unloading. [3H]Leucine was added to the reaction mixture containing the 5500 g supernatant fraction of the homogenate prepared from the femoral-metaphyseal tissues. In vitro protein synthesis was significantly decreased in the bone tissues from the rats which had undergone unloading for 2 or 4 days. When the metaphyseal tissues were cultured for 24 h in the presence of zinc sulfate (10(-5) M) or beta-alanyl-L-histidinato zinc (AHZ, 10(-5) M), zinc compounds clearly stimulated protein synthesis in the metaphyseal tissues from the 4-day unloaded rats. The zinc effect was also seen in the metaphyseal tissues from normal rats. The addition of zinc sulfate (10(-5) M) or AHZ (10(-7) to 10(-5) M) into the reaction mixture containing the 5500 g supernatant fraction of metaphyseal homogenate from normal or unloaded rats produced a significant increase in protein synthesis. This increase was clearly inhibited in the presence of cycloheximide (10(-7) M). The present result demonstrates that protein synthesis is impaired in the femoral-metaphyseal tissues of rats with skeletal unloading, and that this impairment is clearly restored by zinc supplementation.

Animals↗
PubMed1986

The metaphyseal lesion in abused infants: a radiologic-histopathologic study.

The metaphyseal lesions in abused infants have highly distinctive radiologic characteristics. The so-called "bucket-handle" and "corner" fractures often form the basis for the diagnosis of abuse. However, despite the great familiarity with the radiologic appearances, no systematic histopathologic study of the metaphyseal lesions in abused infants has been carried out. An in-depth study of pre- and postmortem radiologic features combined with histologic analyses of the metaphyses from a group of four abused infants provides new insights into the nature of these peculiar lesions. The basic histologic alteration is a subepiphyseal planar series of microfractures through the most immature portion of metaphyseal bone. This fracture results in the isolation of a mineralized disc or portion of a disc that is identifiable radiographically. Depending upon the size of the injury, the degree of involvement of the periphery of the bone, and the radiographic projection, a bucket-handle lesion, corner fracture, or metaphyseal lucency will result. In some cases, the radiographs may be normal even though there is significant histologic alteration. Although cartilaginous injuries may play a role in infant abuse, none of the specimens examined in this study evidenced injury through the germinal layers of cartilage. On the basis of the findings described here, it is recommended that postmortem analysis of all radiographically suspicious metaphyses be carried out in cases of suspected infant homicide. If there are other clinical or pathologic indications to support abuse, a strong argument can be made for removal of radiologically normal but high-risk metaphyses. Instituting these procedures will require closer cooperation between the radiologist and the medical examiner, but the potential for reducing the number of infant homicides demands this enlightened approach.

Autopsy↗
PubMed2004

Metaphyseal chondrodysplasia with cone-shaped epiphyses: a specific form involving the lower limbs.

Three unrelated patients affected by a characteristic metaphyseal chondrodysplasia with cup-shaped metaphyses of the knees are described. Lower femoral and upper tibial cone-shaped epiphyses were embedded in the metaphyses. Main clinical features are short stature, shortening of the lower limbs, limitation of knee extension, and normal hands length. Radiographs of skull, spine, and hands showed no abnormality. This particular appearance of the knees has been seldom described in acquired disease such as repeated injuries, meningococcemia, scurvy, and hypervitaminosis A. Metaphyseal dysplasias with these distinctive radiological findings of the knees are uncommon. Differential diagnosis includes trichoscyphodysplasia and acroscyphodysplasia among others. Two other cases reported by Kozlowski showed the most similarities to our three cases and defined a new form of metaphyseal dysplasia with specific lower limbs involvement and cup-shaped metaphyses.

Body Height↗
PubMed2002

Osteosclerotic metaphyseal dysplasia: a skeletal dysplasia that may mimic lead poisoning in a child with hypotonia and seizures.

We report the case of a 23-month-old male with hypotonia, developmental delay, and complex seizures. Radiographs revealed profound sclerosis of the metaphyses and epiphyses of the long and short bones in the extremities, with a unique pattern of distribution. Sclerosis also involved the anterior ribs, iliac crests, talus, and calcaneus. The skull and vertebral bodies appeared unaffected. Blood lead levels were normal. We believe that this constellation of clinical and radiographic abnormalities closely resembles osteosclerotic metaphyseal dysplasia (OMD) due to an autosomal recessive defect. Characteristic skeletal findings were instrumental in determining the diagnosis. OMD is a very rare sclerosing bone disorder, first described in 1993. The syndrome is characterized clinically by developmental delay of a progressive nature, hypotonia, elevated alkaline phosphatase, and late-onset spastic paraplegia. We encountered a young child with these neurologic symptoms who displayed sclerotic metaphyseal changes on hand radiographs obtained to determine the bone age. Lead poisoning, a known cause of metaphyseal sclerosis, was initially suspected. Careful analysis of the metaphyseal bone changes helped to distinguish this bone dysplasia from lead poisoning and other causes of metaphyseal sclerosis.

Abnormalities, Multiple↗
PubMed2001

Metaphyseal fractures mimicking abuse during treatment for clubfoot.

BACKGROUND: Metaphyseal injuries resembling the classic metaphyseal lesion (CML) of abuse may occur as the result of serial casting during treatment of clubfoot deformity. Mentioned in the orthopedic literature in 1972, this iatrogenic fracture has not been described in the radiologic literature nor has the similarity to injuries occurring with abuse been previously recognized. OBJECTIVE: To describe the mechanism and radiographic appearance of metaphyseal injury observed during serial casting of clubfoot. Note similarities to the CML of abuse. MATERIALS AND METHODS: Eight children ranging in age from 1 to 4 months underwent casting for clubfoot. Five orthopedic surgeons from three different institutions performed the casting. Two patients had spina bifida and one, arthrogryposis. A complete skeletal survey was performed on one child who was abused; there was no suspicion of abuse in the remaining seven. RESULTS: All children manifest injury with periosteal new bone. One child had clear evidence of abuse with 24 rib fractures. X-rays of lower extremities in short leg casts revealed bilateral tibial metaphyseal fractures. Four other children had metaphyseal fractures resembling the CML of abuse, and three developed an area of sclerosis within the metaphysis. CONCLUSION: In the setting of serial casting for equinovarus deformity, metaphyseal injury even the CML of abuse may be noted. Since inflicted injuries are almost always unobserved and explanations rarely offered, the fact that the CML occurs as a result of orthopedic maniuplation may offer some further insight concerning the pathogenesis of this well-described abuse injury.

Casts, Surgical↗
PubMed1993

Canine distemper virus transcripts detected in the bone cells of dogs with metaphyseal osteopathy.

Using the technique of in situ hybridisation, we have recently extended our observations that canine distemper virus (CDV) is present in the bone cells of patients with Paget's disease, and have shown that CDV is also detectable in the bone cells of dogs that are naturally infected with the virus. Since hybridisation was localised to bone cells within the metaphyses of the affected dogs, we investigated the possibility that CDV might be involved in the canine metaphyseal bone disorder, metaphyseal osteopathy. Bone samples from three cases of metaphyseal osteopathy were examined for the presence of the CDV nucleocapsid (CDV-N) gene and the measles virus nucleocapsid (MV-N) gene, using 35S-labelled sense and antisense riboprobes. As with our previous findings in Paget's disease of bone, only the antisense probe was found to hybridize to the osteoblasts and osteoclasts within the affected metaphyses. No hybridisation was seen with the CDV-N sense and MV-N probes in any of the samples tested. Bone samples were also taken from one of the cases to check for the presence of the CDV-N gene using the polymerase chain reaction (PCR). Our findings with in situ hybridisation were confirmed by PCR and subsequent Southern blotting and probing with a 32P-labelled cDNA probe. The detection of CDV RNA within the bone cells of dogs with metaphyseal osteopathy suggests that this virus may be a cause of the disease and provides further, indirect evidence that CDV might be responsible for the bony abnormalities seen in Paget's disease of bone.

Animals↗
PubMedDate not supplied

Classification of metaphyseal change with magnetic resonance imaging in Legg-Calvé-Perthes disease.

Seventy-eight patients (85 affected hips and 71 unaffected hips) with Legg-Calvé-Perthes disease were included in this study to evaluate the metaphyseal change in radiographs and magnetic resonance imaging (MRI) and to define the type of the metaphyseal cyst according to presence or absence of the epiphyseal involvement. The content of the metaphyseal cyst was evaluated by using T1,T2, proton, and gadolinium-enhanced T1-weighted MRI scans. Among 85 hips, there were no changes in 32 hips, marrow edema in 13 hips, false cyst with epiphyseal involvement in 28 hips, and true cyst without epiphyseal involvement in 12 hips. Granulation tissue was found in the false cysts and water-rich fibrotic tissue was found in the true cysts based on the MRI scans. The metaphyseal change in MRI scans was shown in 71% of groups 3 and 4 and in 35% of groups 1 and 2 according to the Catterall classification, and 52% of group A, 56% of group B, and 86% of group C according to the Herring classification. Of the 30 hips at the avascular stage, 33% showed metaphyseal cyst in MRI scans. Of the 53 hips at the fragmentation stage, 60% showed the metaphyseal cyst.

Adolescent↗
PubMed2005

Cyclical intravenous pamidronate treatment affects metaphyseal modeling in growing patients with osteogenesis imperfecta.

UNLABELLED: This analysis of 50 growing patients with osteogenesis imperfecta revealed that 2-4 years of pamidronate treatment lead to abnormalities in the shape of the distal femoral metaphyses. INTRODUCTION: Cyclical intravenous pamidronate therapy is of clinical benefit in children and adolescents with moderate to severe osteogenesis imperfecta (OI) but might interfere with the shaping of long bone metaphyses during growth. MATERIALS AND METHODS: We evaluated the distal femur in 50 growing children with moderate to severe OI (mean age, 6.7 +/- 3.4 years; 26 girls) who had received 2-4 years of pamidronate therapy (annual dose, 9 mg/kg body weight). The mediolateral width of the distal femoral growth plate and of the metaphysis, as well as the ratio between these two measures (called metaphyseal index), were determined on lower limb radiographs. RESULTS: Compared with untreated OI patients who were matched for OI type and age, pamidronate-treated patients had similar growth plate width but wider metaphyses, resulting in a 26% higher metaphyseal index (p < 0.001). Apart from the effect on bone shape, each pamidronate cycle induces a transverse line in metaphyses that are adjacent to active growth plates. Analyses of these transverse lines revealed that they persist for an average time of approximately 4 years, with a range from 2 to 8 years. CONCLUSIONS: Pamidronate interferes with the process of periosteal resorption that is normally responsible for shaping the distal femoral metaphysis. Pamidronate-induced transverse lines disappear with time, supporting the view that these lines represent horizontal trabeculae that undergo remodeling. There is no evidence at present that these treatment induced morphological changes have any clinical implications.

Bone Density Conservation Agents↗
PubMed1982

Physiological bowing and tibia vara. The metaphyseal-diaphyseal angle in the measurement of bowleg deformities.

The metaphyseal-diaphyseal angle is the angle created by the intersection of a line through the transverse plane of the proximal tibial metaphysis with a line perpendicular to the long axis of the tibial diaphysis. This angle represents the degree of deformity of the proximal end of the tibia in a patient with clinical bowleg deformity and permits early differentiation between infantile tibia vara and physiological bowleg, before the appearance of the radiographic changes of tibia vara. In twenty-nine of thirty affected extremities with an initial metaphyseal-diaphyseal angle of more than 11.0 degrees, radiographic changes of tibia vara later developed. However, only three of fifty-eight extremities with a metaphyseal-diapyseal angle of 11.0 degrees or less had any of the diagnostic changes. In addition, the ratio of the metaphyseal-diaphyseal angle (proximal tibial metaphyseal deformity) to the tibiofemoral angle (deformity of the entire extremity) showed that approximately 60 per cent of the deformity in tibia vara originates in the proximal metaphysis, whereas only 20 per cent of the deformity in physiological bowing originates there. The metaphyseal-diaphyseal angle allows accurate early diagnosis of bowleg deformity, as well as accurate assessment of its progression.

Bone Diseases, Developmental↗
PubMed1994

Experimental healing of distraction osteogenesis comparing metaphyseal with diaphyseal sites.

Distraction osteogenesis was performed on 32 adult dogs to compare bone healing at metaphyseal and diaphyseal sites. Sixteen dogs underwent proximal metaphyseal corticotomy and 16 dogs underwent middiaphyseal corticotomy of the left tibiae for gradual lengthening. Each major group was then divided into four subgroups of four dogs each on the basis of zero-, seven-, 14- and 21-day latency periods. The standard radiograph, quantitative computer tomography density, and bone-healing index were used to evaluate new bone formation and consolidation. A distraction rate of 1 mm per day for four weeks created an average elongation of 23.9 +/- 3.7 mm in the metaphyseal groups and 23.8 +/- 2.0 mm in the diaphyseal groups, excluding nine premature consolidations. In the 16 metaphyseal lengthenings, there were six premature consolidations (37.5%): four with a 21-day latency, two with a 14-day latency, and one nonunion (6.2%). In the 16 diaphyseal lengthenings, three fused prematurely (18.7%), two with a 21-day latency and one incomplete corticotomy with a seven-day latency. Three lengthenings of the diaphyseal group resulted in nonunion (18.7%). All animals, metaphyseal and diaphyseal, successfully bridged the distraction gap after a zero-day latency. The bone-healing index showed that new bone consolidation was best with a zero-day latency in metaphyseal (22 +/- 7.6 days/cm) and diaphyseal lengthening (26.5 +/- 6.5 days/cm). Comparing the minimum quantitative computer tomography density ratio of the experimental side with the contralateral side indicated a significant difference at the end of distraction (p = 0.001), at fixator removal (p = 0.001), and when the dogs were killed (p = 0.04).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMedDate not supplied

Magnetic resonance evaluation of "metaphyseal" changes in Legg-Calvé-Perthes disease.

Twenty involved hips in 16 patients with Legg-Calvé-Perthes disease (LCP) were studied with both plain radiographs and magnetic resonance imaging (MRI) scans to better evaluate the existence of "metaphyseal" changes. Thirty-four sets of radiographs and MRI scans were reviewed in a blinded fashion and compared for the presence and location of these changes. Of 23 hips with plain radiographic metaphyseal changes, 11 showed no such changes on MRI scans (48%). Twelve hips did show MRI changes located in the anterior metaphysis. One hip studied three times had a discrete cystic change located in the central metaphysis. Of 11 hips with no plain radiographic changes in the metaphysis, five showed metaphyseal changes on MRI. Metaphyseal changes in LCP remain poorly understood. Even with use of MRI, fine distinction between physis and metaphysis still proved difficult. It appears that most metaphyseal changes are physeal and epiphyseal irregularities. A few hips have truly metaphyseal lesions. The significance of these "cysts" is unclear.

Child↗
PubMedDate not supplied

Spondylo-metaphyseal dysplasia corner fracture type (a cautionary tale).

Spondylo-metaphyseal dysplasia Sutcliffe type is a rare disease characterised by oval vertebral bodies, coxa vara and metaphyseal irregularities. It was named spondylo-metaphyseal dysplasia corner fracture type by Langer et al. as corner fractures are a constant feature later in life. We report 3 further cases of spondylo-metaphyseal dysplasia Sutcliffe type; one without coxa vara and 2 bone dysplasias with distinctive radiographic features--different from spondylo-metaphyseal dysplasia Sutcliffe type, for diagnosis. Both of the latter showed corner fractures. Corner fractures are a characteristic but not diagnostic feature of spondylo-metaphyseal dysplasia Sutcliffe type.

Adolescent↗
PubMed1993

Metaphysics, rationality and science.

The debate over the metaphysical elements of Palmer's theories, and in chiropractic generally, has been a long and frequently bitter one. This article attempts to show the illogicality of both sides of the debate by reviewing the role of metaphysics in science and the discussions of metaphysics in philosophy. Within philosophy, metaphysics have been viewed, at least by those who do not object to them outright, as heuristic devices, which, although they cannot be subjected to either confirmation or refutation (that is, we cannot know if they are true or false), can be subjected to rational criticism. Furthermore, the article suggests that a critical confrontation with Palmer's metaphysical constructs should begin with a critique of vitalism, the philosophical source of these constructs (innate and universal intelligence).

Chiropractic↗
PubMed2006

Metaphyseal dysplasia of Braun-Tinschert type: report of a Japanese girl.

We report on a 7-year-old Japanese girl with metaphyseal dysplasia (MD) of Braun-Tinschert type, a recently recognized, autosomal dominant sclerosing bone dysplasia. All individuals with the disorder from four families in the literature originated from a small town in Bohemia or its vicinity. The occurrence of the disorder in a Japanese girl indicates that it is not restricted to Germans. The radiographic hallmarks of the disorder include metaphyseal undermodeling (Erlenmeyer-flask deformity); osteosclerosis of the chondroosseous junctions, metaphyseal cortices, and epiphyseal margins; and exostosis-like bone excrescences at the metaphyseal-diaphyseal junctions. In the girl we described, the latter two findings were conspicuous at age 4 years, but became less prominent with increasing age. The metaphyseal trabeculae were somewhat coarse. The humeri exhibited varus deformity, and the ulnae and fibulae mild bowing. The mean bone mineral density of the lumbar spine was lower than that of age-matched controls. The patient exhibited premature loss of primary teeth, likely to be a sign of increased periodontal bone resorption. Markers of bone formation and resorption were both increased, an indication of a high rate of bone turnover.

Abnormalities, Multiple↗
PubMed1997

Local physeal widening on MR imaging: an incidental finding suggesting prior metaphyseal insult.

OBJECTIVE: To offer a descriptive review which characterizes and evaluates the significance of local physeal widening, (cartilaginous signal extending from the physis into the adjacent metaphysis), identified on magnetic resonance (MR) imaging. MATERIALS AND METHODS: MR images (recollected from exams performed between 1988 and 1995) of 31 metaphyses in 22 children where we recognized local physeal widening were examined retrospectively. These areas of physeal widening were evaluated for morphology, depth, location, signal intensity, and the coexistence of epiphyseal alterations. The characteristics of the signal abnormalities were correlated with the duration and type of any identifiable insult to the adjacent metaphysis, and with the development of growth disturbance. RESULTS: Twenty-six metaphyses had identifiable insults (19 single event and 7 sustained or repetitive). The widened physes were of focal tongue (n = 15), broad band (n = 10), or mixed (n = 6) morphology. Most (n = 27) areas of widening were isointense with the physeal cartilage on all sequences. Subsequent growth disturbance was more likely when the metaphyseal insult was a single event rather than sustained or repetitive (P = 0.023), with focal tongues (P = 0.029), and with centrally located lesions (P = 0.030). In five cases, the adjacent epiphysis showed signal abnormalities; all developed growth disturbance. Histologic examinations available in two limbs confirmed that the MR findings represented extensions of hypertrophic physeal chondrocytes into the metaphysis. CONCLUSION: Incidentally observed local physeal widening in a growing bone may represent the imprint of a previous or ongoing interference with endochondral ossification from a prior metaphyseal insult, rather than a primary metaphyseal disorder. Single event insults, physeal widening of focal tongue morphology, central distribution in the metaphysis, and concomitant epiphyseal signal abnormalities on MR imaging are significant predictors of subsequent growth disturbance.

Adolescent↗
PubMed2004

Effects of FGF-2 on metaphyseal fracture repair in rabbit tibiae.

Fibroblast growth factor-2 (FGF-2) has been found to have stimulatory effects on fracture repair at diaphysis, while its effect on metaphyseal fracture repair, where spongiosal bone is dominant, has not been studied. This study was conducted to investigate the effect of FGF-2 on metaphyseal fracture healing in a rabbit proximal tibial metaphyseal model. The proximal tibial metaphysis of 6-month-old Japanese white rabbits was osteotomized bilaterally. Then 400 microg of FGF-2, mixed with gelatin hydrogel, and gelatin hydrogel alone (the control) were injected to each osteotomy site of the rabbit proximal tibiae, and the osteotomies were fixed with staples. One and 2 weeks after surgery, the osteoid area in the repairing spongiosal bone at the fracture site was significantly larger in the FGF-2 group than in the control group ( P < 0.05). On immunohistochemistry, proliferating-cell nuclear antigen-positive cells had a tendency to show greater numbers in the FGF-2 group. After 4 and 8 weeks, values for bone mineral density and the cancellous bone area in the healing region of the fracture site were significantly larger in the FGF-2 group ( P < 0.05). These data suggest that local application of FGF-2 may have an accelerating effect on the repair of metaphyseal fractures. Exogenous recombinant human rhFGF-2 may have potential clinical applications in metaphyseal fracture treatment.

Animals↗
PubMed2000

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 degrees 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.

Animals↗