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At least 379 records · Page 21Linked to original sources
PubMed2005

Traumatic fracture-dislocation of C5 on C6 through a previously solid multilevel anterior cervical discectomy and fusion: a case report and review of the literature.

BACKGROUND CONTEXT: Due to the underlying pathology and altered biomechanics, traumatic cervical fractures have been reported in patients with ankylosing spondylitis (AS), diffuse idiopathic skeletal hyperostosis (DISH), ossification of the posterior longitudinal ligament (OPLL), and combination of DISH and OPLL. However, incidence of a fracture-dislocation through a solid multilevel anterior cervical discectomy and fusion (ACDF) construct with no associated underlying pathology of AS, DISH, or OPLL but severe osteopenia has not, to the best knowledge of the authors, been reported in the medical literature. PURPOSE: To report the development of an unstable cervical spine fracture that occurred through a previous multilevel anterior cervical fusion and the challenges associated with the diagnosis and surgical management of these uncommon lesions. STUDY DESIGN/SETTING: A case report and review of the literature. METHODS: A case report entailing the clinical history, operative management, and postoperative course of a 72-year-old male patient with no known AS, DISH, or OPLL who suffered a cervical spine fracture-dislocation, secondary to a motor vehicle accident, through a previous solid three-level ACDF that was performed 20 years earlier. RESULTS: The patient underwent emergent reduction and realignment of the cervical fracture-dislocation, eventual posterior spinal fusion and stabilization with rigid segmental internal fixation, and application of external halo immobilization. At recent follow-up, he has radiographic evidence of fusion and maintenance of sagittal alignment without loss of reduction. CONCLUSIONS: Multilevel cervical fusion constructs are susceptible to traumatic injuries. Many of the same challenges in the management of the previously fused ACDF patient, who sustains a fracture-dislocation, are similar to those found in the patient with mass-inflammatory conditions or metabolic disorders, such as AS, DISH, or OPLL. In many cases, this includes severe osteopenia, long unstable fusion segments, and difficulties associated with prolonged halo vest immobilization. As a result, preoperative surgical planning should take into consideration the difficulties in achieving fracture reduction, decompression, and proper stabilization.

Accidents, Traffic↗
PubMed2006

The function of proprioceptors in bone organization: a possible explanation for neurogenic heterotopic ossification in patients with neurological damage.

Neurogenic heterotopic ossification is characterized by the formation of extra osseous bone in soft tissue surrounding peripheral joints in neurological patients. It occurs in 25% of spinal cord injury patients, and in 20% of these the pathologic process is severe enough to cause limitations in joint motion. Vascular and metabolic changes resulting from autonomic nervous system impairment may play a role in the etiology of heterotopic ossification. Repetitive vigorous passive manipulation of the joint to preserve range of motion, in the presence of reduced defense mechanisms, may also traumatize soft tissue, thereby initiating the pathological process. Nerve terminals within ligaments and capsules that allow for proprioception have a determinant role in triggering on and off muscle contraction, permitting acceleration and deceleration during gait. The Sarah Network of Rehabilitation Hospitals has treated over 20,000 patients with spinal cord and brain injury in the past 20 years. Based on the observation of heterotopic ossification development in some of these patients, and its tendency to relapse, this present article speculates whether, after an interruption in the neural pathways: (1) altered proprioception can forge a different relationship between tissues; and (2) chaotic new bone formation can occur. We postulate that heterotopic ossification in patients with injury to the central nervous system (CNS) may be related to a dysfunction of proprioception. With interruption of the neural tract of a given limb, ligaments lose control and coordination of their proprioceptive function and begin to react to direct stimulus in an independent, isolated and haphazard way. Free of CNS control and directly stimulated by such independent signals, mesenchymal osteoprogenitor cells located in soft tissues begin to occasion tissue maturation and differentiation into bone: heterotopic bone.

Bone and Bones↗
PubMed1990

A suitable culture medium for ossification of embryonic chick femur in organ culture.

To establish a culture medium which allows ossification in organ culture, 9-day-old embryonic chick femurs were cultured in variously supplemented BGJb-HW2 media. Changes of Ca and Pi concentrations in the BGJb-HW2 medium or the 10% addition of chick embryo extract (CEE) did not induce ossification. Furthermore, combinations of the 10% CEE with a high Ca x Pi product or with 5 mM beta-glycerophosphate (beta-GP) or with 10% horse serum plus a high Ca x Pi product often caused pathological abnormalities in the periosteum. On the other hand, BGJb-HW2 medium supplemented with 5 mM beta-GP induced development of ossification. The Ca content of femurs and the diaphysial hydroxyproline content were markedly increased. Histological observation showed a formation of a thick and active periosteum, numerous osteoblastic cells, a sufficient amount of osteoid tissue and well developed calcified trabeculae without any pathological changes. Thus, the organ culture system using this medium was considered to be an appropriate one for studies on osteogenesis in vitro.

Animals↗
PubMed1993

[Periprosthetic ossifications of the hip: role of the duration of postoperative indomethacin therapy in the prevention of ossifications and role of screwed acetabulum in the occurrence of ossification].

After showing, as many others did, in an article published in 1987, that indomethacin administered immediately after surgery and for about 3 weeks at a dose of 75 mg/day effectively protected THA against heterotopic ossification, the authors have searched whether treatment duration could be reduced, and to investigate the existence of risk factors other than those classically known. They studied the prevalence of heterotopic ossification in two groups of THA with known risks of ossification, one with one-week prophylaxis, the other with two-week prophylaxis using Indomethacin. The results obtained were compared with a third group of THA performed during the same period, which presented no known risk of ossification and were not treated with indomethacin, and with the THAs of the initial study, where indomethacin had been administered for 3 weeks. Occurrence of heterotopic ossification was equally prevented by an 8-day course and by a longer one. No etiological, radiological or pathological risk factor other than those described in 1987 were fund (with all due caution given to hips re-operated on that had not ossified the first time): in contrast, the type or acetabular cup appears to have some influence on the occurrence of HO: uncemented prosthesis clearly favours ossification.

Acetabulum↗
PubMedDate not supplied

Ossification sequence of occipital bone and vertebrae in human fetuses.

The aim of this radiographic study of human fetuses was to examine the pattern and sequence of ossification in the occipital bone and the spinal vertebrae. Together with previous studies of ossification of the human fetal basal cranium, this study can serve as a reference for normalcy in future studies of fetuses with neural tube defects and associated pathological development of the axial skeleton. Thirty-nine normal fetuses aborted between 9 and 14 weeks of gestation were examined. Based on the appearance of ossification centers in the bones under study, the fetuses could be grouped in four well-defined developmental stages, which were named occipito-spinal stages I-IV (OS I-IV). The OS stage was closely related to gestational age, crown-rump length, foot length, and degree of ossification in the hands and feet.

Embryonic and Fetal Development↗
PubMed1990

[Endometrial ossification. Apropos of 5 recent cases].

Five cases of ossification of the endometrium that have been seen in the course of five years are reported. Special attention is paid to a case that occurred in the post-partum period. Several different hypotheses as to the aetiology of the pathology of this condition are discussed yet again; the only one that seems likely to be possible is that these ossifications start as metaplasias. The clinical, paraclinical and therapeutic angles are also dealt with.

Adult↗
PubMed2006

Overview of the ossified stylohyoid ligament based in more than 1200 forensic autopsies.

The human stylohyoid chain presents considerable anatomic variability. In a personal series of 1215 forensic autopsies, eleven cases of complete ossification of the stylohyoid ligament have been revealed. Nine cases were bilateral and two cases were unilateral ossifications. A fractured ossified stylohyoid ligament was found in one case. The embryology and clinical significance of this condition has been mentioned briefly.

Adult↗
PubMed1996

Articulated radial head replacement and elbow release for post head-injury heterotopic ossification.

This is a case report of the release of an elbow ankylosed by post-head-injury heterotopic ossification. An extensive bony resection and soft-tissue release was required. At surgery a pathological, osteoporotic fracture of the radial head was found that could not be preserved and thus was removed. In its place an articulated "floating radial head prosthesis" was used that allowed immediate rehabilitation and avoided the need for temporary joint distraction or stabilization. The initial excellent function achieved has been maintained, at a > 3-year follow-up and without the complications experienced with silicone radial head prostheses.

Adult↗
PubMed2000

Pathology of bone lesions associated with congenital pseudarthrosis of the leg.

Congenital pseudarthrosis of the leg remains one of the most controversial pediatric entities in terms of etiopathogenesis, pathology, treatment, and prognosis. The authors reviewed the pathologic material of 24 patients with congenital pseudarthrosis of the leg along with clinical and radiographic data. The tibia was affected in 22 patients; in two patients the disease was limited to the fibula. Fifteen patients were male and nine were female. Age at surgery ranged from 1 to 26 years. Nineteen patients were classified as having dysplastic type, one cystic, and four mixed. Clinical evidence of neurofibromatosis type I (NF-I) was found in 17 patients. The main histopathologic change observed was the growth of a highly cellular, fibromatosis-like tissue. In the dysplastic type, such tissue was associated with the periosteum. In the cystic type, a closely similar tissue occupied the lytic area. In case classified as of mixed type, the coexistence of endosteal/medullary and periosteal involvement by the fibromatosis-like tissue was observed. In the cystic lesion, evidence of de novo bone formation within the lesional tissue was obvious. Overall, the histologic features of the cystic lesion were similar to those of osteofibrous dysplasia. In the dysplastic type, the proliferation of the fibrovascular tissue was associated with active osteoclastic resorption of the cortex, which remodeled into a trabecular rather than a compact type of structure. Histologic comparison of the pathologic samples of patients with and without NF-I revealed no significant differences. The pseudarthrosis gap was continuous with periosteal soft tissues and filled by fibrous tissue, fibrocartilage, and hyaline cartilage with features of enchondral ossification. The authors suggest that the clinical diversity of congenital pseudarthrosis of the leg results from the diverse location of a single pathologic process--namely the growth of an abnormal, fibromatosis-like tissue either within the periosteum or within the endosteal/marrow tissues. It is tempting to suggest that such an "osteofibromatosis" represent a skeletal expression of neurofibromatosis, either within the fully expressed syndrome (patients with known neurofibromatosis) or as isolated lesion (patients with unknown/cryptic neurofibromatosis).

Adolescent↗
PubMed1996

Manifestation of multifocal heterotopic ossifications with unusual locations as a complication after severe burn injury.

Heterotopic bone formation is a well-known but rare complication after burns and other traumatic injuries. Pathology, aetiology, progression and management remain controversial. Joint immobilization in concert with an altered metabolism and aggressive physical therapy are suspected to be the cause of heterotopic bone formation. The most frequent sites of manifestation are major joints and large muscle groups. The formation of disseminated large ossifications in soft-tissue and juxta-articular bone bridges of small joints is barely mentioned in the literature. A case of most unusual, massive heterotopic bone formation as a complication after severe burn is presented. In this patient serious complications after the severe burn injury primarily attracted clinical attention, so that diagnostic measures were delayed. Four months later after successful weaning from ventilation, the patient could describe his sites of pain. The therapeutic options were limited because of extensive and unusual localizations. This case emphasizes the necessity of an early and specific radiological diagnosis in long-term ventilated patients to avoid this serious complication.

Burns↗
PubMed2006

Adam Politzer (1835-1920) and the description of otosclerosis.

In 1893, Adam Politzer was the first to describe otosclerosis as a specific disease fixating the stapes. The aim of this study is to follow Politzer's research to understand how he finally explained the mechanism responsible for the fixation of the stapes. Politzer conducted his preliminary research from 1862 to 1893. From the concept of a dry catarrh of the middle ear, the fixation of the stapes became progressively associated with a specific ossification in and around the footplate. Politzer presented his first results in 1893. He completed his research by concluding in 1901 that otosclerosis had become an independent disease and should have the right to its own chapter in otologic books. He selected the word otosclerosis to describe this new pathologic entity.

Ear, Inner↗
PubMedDate not supplied

Heterotopic ossification: a review of symptoms and treatment.

Heterotopic ossification (HO) is the abnormal development of bone tissue within soft tissue. Its etiology and pathology are uncertain. This condition is often seen near one or more joints in people who have sustained traumatic injuries of varying types. Symptoms include localized swelling, pain, increase in temperature, and loss of the joint's range of motion at the affected site. Further testing generally reveals an increase in serum alkaline phosphatase, a positive three-phase bone scan, and the identification of bone formation on radiographs. A review of the literature reveals that common treatment options include range-of-motion exercises to maintain joint function, pharmacologic intervention, possible irradiation of the site, and surgical removal of ankylosing bone. The rehabilitation nurse must be aware of this medical complication to participate in its identification and treatment, as well as to be effective in counseling and educating patients and their families.

Humans↗
PubMed1993

[Sonographic findings in the hip of newborn infants after pregnancy and labor from breech position].

In the period between October 1990 and July 1992 58 newborn were ultrasonographically examined because of intrauterine breech presentation and therefore higher pressure on the fetal hips. These children were compared with other 66 children who had neither risk factors nor family disposition. We noted significant differences in the distribution of hip dislocation types (by Graf) between both groups. There was a normal distribution among the control group. Children in breech presentation, whether twin or single pregnancy, showed the following: (1) shift of the fine distribution to type Ia, (2) increase of type IIa, classified as pathological not before the 3rd month of life (type IIb, persistence of delay of ossification), (3) two hip dislocations type IIg, (4) one hip dislocation type IIIa. We recommend to perform ultrasound screening after delivery in all children who have had an intrauterine breech presentation, so that treatment can be started as soon as possible.

Breech Presentation↗
PubMed1999

Collagenase 3 is a target of Cbfa1, a transcription factor of the runt gene family involved in bone formation.

Collagenase 3 (MMP-13) is a recently identified member of the matrix metalloproteinase (MMP) gene family that is expressed at high levels in diverse human carcinomas and in articular cartilage from arthritic patients. In addition to its expression in pathological conditions, collagenase 3 has been detected in osteoblasts and hypertrophic chondrocytes during fetal ossification. In this work, we have evaluated the possibility that Cbfa1 (core binding factor 1), a transcription factor playing a major role in the expression of osteoblastic specific genes, is involved in the expression of collagenase 3 during bone formation. We have functionally characterized a Cbfa motif present in the promoter region of collagenase 3 gene and demonstrated, by cotransfection experiments and gel mobility shift assays, that this element is involved in the inducibility of the collagenase 3 promoter by Cbfa1 in osteoblastic and chondrocytic cells. Furthermore, overexpression of Cbfa1 in osteoblastic cells unable to produce collagenase 3 leads to the expression of this gene after stimulation with transforming growth factor beta. Finally, we show that mutant mice deficient in Cbfa1, lacking mature osteoblasts but containing hypertrophic chondrocytes which are also a major source of collagenase 3, do not express this protease during fetal development. These results provide in vivo evidence that collagenase 3 is a target of the transcriptional activator Cbfa1 in these cells. On the basis of these transcriptional regulation studies, together with the potent proteolytic activity of collagenase 3 on diverse collagenous and noncollagenous bone and cartilage components, we proposed that this enzyme may play a key role in the process of bone formation and remodeling.

3T3 Cells↗
PubMedDate not supplied

Myositis (fasciitis) ossificans in an infant.

Myositis (fasciitis) ossificans developed following minor trauma to the soft tissues of the posterior aspect of the right knee of a 5-month-old female infant. The clinical and pathological features of myositis ossificans are reviewed and the differential diagnosis of soft tissue ossification in early childhood is discussed.

Female↗