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Two children 7 and 14 years old respectively, presented with reflex neurovascular dystrophy. The salient feature of the disease consisted of osteolytic lesions of distal tibial and fibulal metaphyses. To out knowledge these were not previously reported. Complete recovery spontaneously occurred in a few weeks or months. Thus they do not require any treatment, which might be harmful.
The article reports on 4 patients with rare modeling defects of the long bones. These defects are metaphyseal dysplasia, craniometaphyseal dysplasia, frontometaphyseal dysplasia, and osteodysplasty (osteodysplasty of Melnick and Needles). The differential diagnostic criteria are shown in a table to allow diagnosis already in children. This appears important in respect of the therapy to be employed (corrective surgery) and for prognosis, as well as for giving patients proper genetic and vocational advice.
The question whether giant cell tumours (GCT) of tubular bones originate in the metaphysis or epiphysis, was investigated by studying 233 GCT registered in the files of the Netherlands Committee on Bone Tumours. In 6 cases the GCT was found to be located in the metaphysis exclusively, no case with a purely epiphyseal localization was found. The result of this study favours the metaphyseal origin of GCT. An unusual case is discussed.
Chronic recurrent osteomyelitis is a recognized clinicopathological entity with typical radiographic findings in the metaphyses of the long bones. Epiphyseal lesions usually are small and may easily be overlooked. Bone scintigraphy is helpful in identifying multiple lesions whether symptomatic or not. The diagnosis is one of exclusion without pathognomonic findings. Recognition of the condition is important to avoid treatment with antibiotics and repeated operations.
A case of patient with flexor digitorum profundus tenodesis at the site of metaphyseal fracture of the radius is presented. The open fracture occurred when the patient was 11 years old and was treated elsewhere with plaster of paris. Progressive flexion contracture of the middle, ring and little finger was treated surgically 7 years later. Full extension and good hand function has been achieved.
Fibrous metaphyseal defects (FMD) are tumor-like bone lesions according to the WHO classification of 1994. They are found in children and adolescents. FMD occur at characteristic points in the circumference of long bones. Depending on age, the distance to the epiphyseal line varies. The longitudinal axis of FMDs in the direction of the epiphysis meets a tendon or ligamentous structure inserting at the growth plate line. This tendon, which inserts at the perichondrium of the epiphyseal cartilage and the surrounding periosteum, seems to have a causal relationship in the pathogenesis of FMDs. In 152 specimens obtained from the autopsy of long tubular bones with open epiphyseal growth plates, the tendons and ligamentous structures inserting into the perichondrium of the epiphyseal plate cartilage were examined. Within the site of two tendon-inserting areas (Ranvier's node), the pathomorphological picture revealed that the normal medullary tissue is displaced by fibroblastic tissue. In addition to the etiopathogenesis of FMD's the radiological, clinical and histological features and the prognosis are discussed.
The experimental results in effect of limb lengthening using metaphyseal osteotomy at proximal tibia on epiphyseal growth plate in 28 young sheep were reported. Radiographic, microscopic and electronmicroscopic findings showed that lengthening of 7.5% the growth plate resulted in narrowing in varying degrees in one third of the sheep with a lengthening rate of 0.25 mm every six hours. Narrowing of epiphyseal growth plate was seen in half of sheep with lengthening of 10% and in all sheep with lengthening of 12.5% and 15%. Degeneration and necrosis of chondrocytes happened in one sheep of lengthening of 15%. Thickening of growth plate was seen in all sheep of the control group. Our conclusion from this series of experimental studies was that depression caused by compression stress effect in limb lengthening of less than 7.5% on epiphyseal growth plate is minimal.
Necrosis of fatty bone marrow is an unusual complication of several pancreatic disorders. We describe a patient with polyarthritis, sterile subcutaneous abscess and osteolysis arising during the course of alcoholic chronic pancreatitis. MR images of one knee showed multiple foci of abnormal signal intensity within the marrow of the distal femur and proximal tibia, consistent with intraosseous fat necrosis. CT scans showed significant changes in the cancellous bone in these areas compatible with metaphyseal osteonecrosis.
Bone sialoprotein (BSP) and osteopontin (OPN) are two phosphorylated and highly glycosylated cell-binding proteins in bone. Both proteins bind to hydroxylapatite. The cell binding is mediated via an Arg-Gly-Asp (RGD) sequence and previous work indicates that both proteins can bind to the vitronectin receptor (alpha v beta 3). The present work shows that a prevailing localization of BSP in metaphyseal bone of the young rat is at the interface between calcified cartilage and bone. Thus BSP shows a conspicuous enrichment in the osteoid laid down by the invading osteoblasts immediately next to the calcified cartilage. Furthermore, the most prominent amount of BSP mRNA was detected in cells at the epiphyseal/metaphyseal border. As opposed to OPN, no prominent accumulation of BSP immunoreactivity was observed at bone surfaces that face cells. Also the synthesis OPN was most pronounced at sites very different from those of BSP. Thus, the most prominent amount of OPN mRNA was observed in cells close to the metaphyseal/diaphyseal border, where osteoclastic bone resorption is particularly active. Indeed, message was often found in cells surrounding osteoclasts without any detectable message. The distinctly different patterns of synthesis and expression of the two proteins indicate different roles in bone turnover at this stage of development. Thus, it appears that BSP has a specific role during the initial phases of bone formation at the cartilage/bone interface. On the other hand, the pattern of OPN synthesis and expression support and extend our previous data showing OPN particularly enriched at attachment sites of osteoclasts resorbing bone.
A key event in bone resorption is the attachment of osteoclasts to the bone matrix. The process apparently involves integrin plasma membrane receptors for extracellular matrix proteins. In the present study the distribution of some integrin subunits among different osteoclastic and osteoblastic domains was determined using immunocytochemistry on rat metaphyseal bone. Ultrathin cryosections were incubated with polyclonal antibodies against the alpha v beta 3 integrin and against the individual integrin subunits, alpha v, beta 1, beta 3, and beta 5. Bound antibodies were detected with 10-nm colloidal gold coated with protein A. The results show that alpha v- and beta 3-subunits are enriched at the osteoclast plasma membrane facing the bone matrix, i.e., the clear zone. Furthermore, beta 1- and beta 5-subunits were somewhat enriched at the osteoblast plasma membrane facing the bone surface. The present observations corroborate and extend our previous data indicating that the alpha v beta 3 integrin mediates tight attachment of the osteoclast to the bone matrix. Moreover, a role for integrins in the attachment and interactions of the osteoblast is suggested.
Type X collagen is a homotrimeric, short-chain, nonfibrillar extracellular-matrix component that is specifically and transiently synthesized by hypertrophic chondrocytes at the sites of endochondral ossification. The precise function of type X collagen is not known, but its specific pattern of expression suggests that mutations within the encoding gene (COL10A1) that alter the structure or synthesis of the protein may cause heritable forms of chondrodysplasia. We used the PCR and the SSCP techniques to analyze the coding and upstream promoter regions of the COL10A1 gene in a number of individuals with forms of chondrodysplasia. Using this approach, we identified two individuals with metaphyseal chondrodysplasia type Schmid (MCDS) with SSCP changes in the region of the gene encoding the carboxyl-terminal domain. Sequence analysis demonstrated that the individuals were heterozygous for two unique single-base-pair transitions that led to the substitution of the highly conserved amino acid residue tyrosine at position 598 by aspartic acid in one person and of leucine at position 614 by proline in the other. The substitution at residue 598 segregated with the phenotype in a family of eight (five affected and three unaffected) related persons. The substitution at residue 614 occurred in a sporadically affected individual but not in her unaffected mother and brother. Additional members of this family were not available for further study. These results suggest that certain amino acid substitutions within the carboxyl-terminal domain of the chains of the type X collagen molecule cause MCDS. These amino acid substitutions are likely to alter either chain recognition or assembly of the type X collagen molecule, thereby depleting the amount of normal type X collagen deposited in the extracellular matrix, with consequent aberrations in bone growth and development.
Resurfacing of joints by chondrocyte implants often leads to an increased subchondral bone density. To further evaluate this phenomenon, this study analyzed bone density and bone formation in three groups of 3-year-old chickens (90 animals, 30 per group): (1) implantation of chondrocytes embedded in hyaluronic acid (HA) into the tibial metaphysis; (2) implantation of delivery substance only; (3) sham-operated control group. Results were assessed biochemically, histologically, and histomorphometrically at 6 weeks and 6 months postimplantation. A 1.5-fold increase in the metaphyseal bone density was observed in the HA-implanted controls, as compared to sham-operated/normal joints. A further increase in bone density to twice the density of the sham-operated joints was achieved by implantation of chondrocytes. In bones implanted with cells, long-lasting (6 weeks) cartilage nodules were observed, which eventually underwent hypertrophy. The implanted chondrocytes were surrounded by a dense inflammatory infiltrate, which did not prevent the induction and formation of new bone. Based on these findings, it was concluded that chondrocyte implantation into bones results in an increase in local bone density due to a prolonged process of endochondral ossification. Further studies are necessary to evaluate the possible application of this implantation procedure in osteoporosis.
The potential necrotizing effects of the heat produced by the exothermic polymerization process has raised questions regarding the use of polymethylmethacrylate (PMMA) in orthopedic surgery. An experimental model was used to: (1) analyze the amplitude and distribution of heat in bone taken from autopsy specimens when large metaphyseal defects (simulating tumor excision) were filled with curing PMMA and (2) to observe any significant necrotizing temperatures. The experimental design included two experimental groups of five distal femora into which either a small- or large-bore defect was made in the lateral epicondylar region. These defects were filled with either one or two packs of PMMA cement, and temperature probes were used to record temperature elevations at the cement core, the bone-cement interface, and the surrounding 1-, 2-, 3-, and 5-mm bone intervals. To simulate physiologic temperature and fluid environment, the experiment was conducted in a 37 degrees normal saline bath. There is clinical evidence suggesting that the large amounts of PMMA used in tumor reconstructive surgery (often two packs or more) may lead to thermal necrosis of remaining tumor cells in the curetted cavity. This may explain, at least in part, the decrease in recurrence of giant-cell bone tumor after curettage and PMMA cementation.
We examined histologically 40 bones from 11 infants aged < 1 year who died with evidence of infant abuse. Twenty-three bones had fractures, and 15 of these contained conspicuous metaphyseal extensions of hypertrophied chondrocytes (EHC) which were highly associated with healing fracture sites. These data indicate that such lesions are common in fractures related to child abuse, are easily identified, and are indicative of healing fractures. The presence of this lesion has significant implications for those who assess skeletal injury in abused infants because the determination of infant abuse often relies on establishing a pattern of skeletal trauma. Quantitation of the growth rate of individual physes in this age group may eventually permit assessment of the minimum age of these skeletal injuries.
A study was done of 44 metaphyseal dissociation fractures of the proximal tibia in 42 patients (27 men and 15 women, aged 22 to 77 years; mean, 42 years). Follow-up ranged from 6 months to 4 years. There were 2 study groups: a retrospective group (group 1, 22 fractures) given a variety of treatments ranging from casts to dual plates, and a prospective group (group 2, 22 fractures) treated by combining external fixation and optional minimal internal fixation. There were 12 comminuted fractures in group 1 and 20 in group 2 (P < 0.01). All fractures eventually healed, with an average healing time in group 1 of 3.8 months, and 5.3 months in group 2. There was one delayed union in group 2. Results were graded from poor to excellent, based on pain, range-of-motion, and malunion. There were 6 poor and 4 fair results in group 1, and no poor and 3 fair results in group 2. Complications included 6 deep infections, 5 in group 1 (1 requiring a free-flap procedure); and 1 pin-tract infection resulting in septic arthritis in group 2. There were 7 gastrocnemius flaps required in group 1, and 1 in group 2. The results of this study suggest that patients treated with external fixation had better results with less infection and soft-tissue complications than those treated with conventional internal fixation.
The so-called "metaphyseal channel" and "serpiginous tract" signs are described in detail, emphasizing their value in the roentgen diagnosis and differential diagnosis of some bone lesions. The authors present two cases of osteomyelitis, one of the chronic type and the other subacute in two adult patients, to illustrate the value of the above radiologic signs. These have been previously described in the long bones of infants and children only. The serpiginous tract sign is reported, for the first time, in a flat bone.
A case of Jansen's metaphyseal dysostosis, a rare disorder of endochondral ossification, is described. This is the first case in which the severe radiographic manifestations of this disease were detected at birth. Linear growth is significantly retarded at 2 years of age. Nevertheless, because full ossification with trabeculae is anticipated, early recognition and appropriate management during the phase of active growth should minimize deformities.
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