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Pelvic osteotomy for axial rotation of the acetabular segment in dogs with hip dysplasia.

Pelvic osteotomy has provided normal function and activity to dogs with hip dysplasia. Physical and radiographic examination and palpation under anesthesia permit evaluation of the degenerative process and provide the specific amount of axial rotation of the pelvis necessary for each dog. The technique consists of an osteotomy of the pubis, ischium, and ilium to reestablish acetabular support of the femoral head.

Animals↗

A new technique for obtaining iliac bone grafts.

A new method for obtaining corticocancellous bone grafts for use in orthognathic and facial reconstructive surgery is presented. By raising an osteoperiosteal flap from the crest of the ilium and removing a medial corticocancellous bone block, graft site morbidity is minimized, the patient's return to ambulatory status is hastened, and an excellent graft is procured.

Adolescent↗

A comparative study of osseointegration of titanium implants in autogenous and freeze-dried bone grafts.

PURPOSE: This study was undertaken to compare the rate and degree of osseointegration of dental implants when placed into either autogenous corticocancellous chip or freeze-dried corticocancellous chip bone grafts. MATERIALS AND METHODS: The canine ilium was used as the model site. Thirty experimental and 15 control implants were placed in 15 dogs: autogenous versus freeze-dried corticocancellous chip bone grafts around the exposed implant surfaces. In addition to the placement of control implants, the apical portion of the grafted implants acted as their own control. The implants were harvested at 1, 2, and 3 months. The evaluation of the integration process was performed by means of light microscopy, microradiography, and histomorphometry. RESULTS: Using this model, the results indicate that at 1 month there was no statistical difference in the degree of osseointegration in the two bone grafts. At 2 months, there was a statistically greater degree of osseointegration noted in the autogenous corticocancellous chip sites than in the freeze-dried bone grafts. At 3 months, the degree of osseointegration in the two groups was 70% and 33%, respectively. At 3 months, there was virtually 100% integration with trabecular bone at the control implant sites. CONCLUSION: The results indicate that at 2 months postoperatively implants placed in an autogenous bone chip graft osseointegrate to a significantly greater degree than implants placed in a freeze-dried bone chip graft, and this difference remains at 3 months.

Animals↗

Experimental transplantation of vascularized autologous and allogenic bone grafts for mandibular defects. Anatomical, immunological and surgical basis for vascularized bone transfer in the Göttingen minipig.

The Göttingen minipig serves as a suitable animal model for studying microsurgically reanastomosed iliac crest grafts for reconstruction of bone defects of the mandible. Because of the vascularization pattern of the hip bones of the Göttingen minipig, the cranioventral region of the ilium is especially suitable as a donor site. The separate vascularization of this area allows the excision of a bone block with sufficient volume, mechanical strength and a reliable vascular pedicle. The high degree of immunological variability of the minipigs demonstrated by isoelectric focusing and subsequent immunoblotting of lymphocyte membrane proteins offers possibilities for allogenic transplantation models. The surgical technique of harvesting and transplantation of the bone graft is described in detail.

Animals↗

Clinostatic syndrome in Waldenström macroglobulinemia.

We report a case of Waldenström macroglobulinemia revealed by clinostatic syndrome in an 81-year-old woman. A lytic lesion was found in the ilium and acetabulum. There was no evidence of transformation to high-grade lymphoma. Radiation therapy ensured complete resolution of the clinostatic syndrome within 1 month of treatment completion.

Acetabulum↗

Constant mineralization density distribution in cancellous human bone.

The degree of mineralization of bone matrix is an important factor in determining the mechanical competence of bone. The remodeling and modeling activities of bone cells together with the time course of mineralization of newly formed bone matrix generate a characteristic bone mineralization density distribution (BMDD). In this study we investigated the biological variance of the BMDD at the micrometer level, applying a quantitative backscattered electron imaging (qBEI) method. We used the mean calcium concentration (Ca(Mean)), the most frequent calcium concentration (Ca(Peak)), and full width at half maximum (Ca(Width)) to characterize the BMDD. In none of the BMDD parameters were statistically significant differences found due to ethnicity (15 African-American vs. 27 Caucasian premenopausal women), skeletal site variance (20 ilium, 24 vertebral body, 13 patella, 13 femoral neck, and 13 femoral head), age (25 to 95 years), or gender. Additionally, the interindividual variance of Ca(Mean) and Ca(Peak), irrespective of biological factors, was found to be remarkably small (SD < 2.1% of means). However, there are significant changes in the BMDD in the case of bone diseases (e.g., osteomalacia) or following clinical treatment (e.g., alendronate). From the lack of intraindividual changes among different skeletal sites we conclude that diagnostic transiliac biopsies can be used to determine the BMDD variables of cancellous bone for the entire skeleton of the patient. In order to quantify deviations from normal mineralization, a reference BMDD for adult humans was calculated using bone samples from 52 individuals. Because we find the BMDD to be essentially constant in healthy adult humans, qBEI provides a sensitive means to detect even small changes in mineralization due to bone disease or therapeutic intervention.

Adult↗

The androgenic anabolic steroid nandrolone decanoate prevents osteopenia and inhibits bone turnover in ovariectomized cynomolgus monkeys.

We examined the effects of nandrolone decanoate (25 mg im every 3 weeks) on bone mass, serum biomarkers, and bone histomorphometric endpoints in 52 female cynomolgus macaques randomized into four treatment groups: (1) sham-ovariectomized (sham); (2) ovariectomized + placebo for 2 years (ovx); (3) ovx + nandrolone decanoate for 2 years (Nan); and (4) ovx + nandrolone decanoate beginning 1 year after ovx (dNan). Serum alkaline phosphatase (ALP), osteocalcin, and tartrate-resistant acid phosphatase (TRAP) were assayed every 3 months, and X-ray densitometry of the lumbar spine was done every 6 months. Fluorochrome-labeled iliac biopsies collected at baseline and 1 year, and lumbar vertebrae and midshaft femur collected at 2 years, were evaluated histomorphometrically. Body weight increased over 50% with administration of nandrolone. After 2 years, ovx animals had lower spinal BMC and BMD than all other groups. Ovx animals also had higher bone turnover rates than all other groups, as indicated by higher levels of the serum and urine biomarkers, and by at least twofold higher label-based bone formation rates in the femur diaphysis and in both cancellous and cortical bone of the ilium and vertebral bodies. Nandrolone-treated animals had similar serum estradiol levels as the sham animals, presumably due to conversion of endogenous or exogenous androgens. The effects of nandrolone on bone in this experiment are consistent with estradiol action and may be attributable to the increased serum estradiol. Despite >50% higher body weight, nandrolone-treated, ovariectomized animals did not have higher bone mass than sham animals.

Absorptiometry, Photon↗

Iliac crest donor site morbidity following open and closed methods of bone harvest for alveolar cleft osteoplasty.

Donor site morbidity after bone harvesting still remains a crucial problem in alveolar cleft osteoplasty. This study focuses on ilium donor site morbidity comparing two different techniques. A series of 52 consecutive patients was divided in half. All had anterior iliac crest bone grafts. In the study group the harvesting was performed with a closed osteotomy using a cylindrical Shepard osteotome. The control group underwent the traditional open osteotomy. In the open osteotomy group the short-term morbidity at the donor site was slightly greater than in the closed harvesting group. The low short-term morbidity in the closed harvesting group was reflected in the analgesic consumption which was three times higher in the open osteotomy group (p < 0.008). The most striking difference occurred in the appearance of the mature scar: a length of 24.2 mm (mean) in the closed harvesting group against 60.3 mm in the open osteotomy group (p < 0.0001), and a width of 4.9 mm (mean) versus 7.7 mm, respectively (p < 0.003). The long-term morbidity was negligible in both groups. Based on these findings we suggest that bone harvesting from the anterior iliac crest remains the preferred method, provided that closed harvesting is undertaken.

Adolescent↗

[Hyperostosis triangularis ilii -- a sacro-iliac stress phenomenon Part. 2 (Incidence, prognosis, pathogenesis, aetiology, tracer studies, differential diagnosis) (author's transl)].

The anterior iliac margin adjacent to the sacro-iliac joint contains a physiological zone of hyperostosis. Its shape is that of a triangular pyramid. Because of its small size, it is radiological invisible, but is nevertheless an indication of the presence of normal stresses passing from the mass of the trunk to the lower extremities. If for any reason, such as is described in this paper, the stresses on the hyperostosis zone are increased, the latter becomes enlarged, while still keeping its shape. It then appears on the radiograph as hyperostosis triangularis ilii. In approximately 50% of cases there is a simultaneous but variable sacral hyperostosis. Observations on 40 patients, together with two autopsies and radionucleide investigations suggest that hyperostosis triangularis ilii represents a potentially reversible bone reaction of the physiological hyperostosis of the anterior iliac margin. The clinical differential diagnosis raised by the radiological finding of a "triangular ilium hyperostosis" is discussed.

Adult↗

[Computed tomographic control of the conventional x-ray findings in space-occupying lesions of the bony pelvis].

The CT and conventional radiological findings in 30 patients with space-occupying lesions of the pelvic bones were compared. 73% of the tumours diagnosed by CT were shown by conventional means and in 71% their extent was correctly estimated. Lesions at the ilio-sacral junction are not demonstrated as well by conventional methods as those near the hip joint. The lesions most frequently missed by conventional radiography lie in the dorsal part of the ilium and in the lateral mass of the sacrum.

Adolescent↗

[Adult degenerative and senile degenerative hyperostosis triangularis ilii (author's transl)].

A randomized study of 2000 patients (1000 males, 1000 females) revealed two forms of the triangular hyperostosis of the ilium in female patients. The hyperostosis triangularis ilii, HTI, is also known as osteitis condensans. One form of HTI concerning women under the age of 50 is called the adult generative HTI, the other beyond the age of 50 senile degenerative HTI. These two forms are not evident in male patients. The 3.05% incidence of HTI in adults appeared to be higher than presumed till now. The sex incidence male/female of 1:1.6 diverges considerably from preceding investigations. Histomorphological studies of two autopsies of cases of senile degenerative HTI revealed no signs of inflammation. Statistical correlations of HTI with other chronic diseases of the pelvis and hip could doubtlessly and generally be established only for osteoarthrosis of the sacro-iliac joints in females beyond the age of 50 and in males as a matter of principle.

Adult↗

Plutonium-239 deposition in the skeleton of the mouse.

Using the technique of neutron-induced autoradiography, together with computer-based methods of data reduction, the distribution of intravenously injected plutonium-239 in the skeleton of the female CBA mouse, 24 hours after injection, has been investigated. With these techniques, it is possible to measure the localization of 239Pu on the endosteal and periosteal surfaces of the bone to an accuracy of approximately +/- 2 x 5 micrometer. Results are reported for the distribution of 239Pu in the third lumbar vertebra, a central caudal vertebra, the right ilium and the right femur. Radiochemical analyses of the 239Pu in other comparable bones of the skeleton are also reported.

Animals↗

Melanotic schwannoma. Clinicopathologic, immunohistochemical, and ultrastructural features of a rare primary bone tumor.

The authors report a 35-year-old woman who presented with a lytic and blastic tumor of the ilium with soft tissue extension. The resected tumor showed light microscopic and ultrastructural features characteristic of a melanotic schwannoma. An unusual histologic finding was the presence of laminated concretions resembling psammoma bodies. Immunohistochemical stains for S-100, HMB-45, and vimentin were strongly positive. The patient is free of disease 18 months after complete surgical excision.

Adult↗

The iliac crest cartilaginous cap.

Bone and cartilage grafts can be procured from the ilium either separately or as composite chondroosseous grafts when sufficient cartilage is present. The thickness and anatomy of this iliac cartilaginous cap was analyzed in relationship to age in 50 individuals. Histology was that of normal hyaline cartilage. The cartilage alone was more pliable with little memory when compared with auricular or septal cartilage. The cartilage/bone junction was very strong. Cartilage thickness ran from close to 1 cm at age 5 to a diminished zero at age 25.

Bone Transplantation↗

Decreased gallium uptake in acute hematogenous osteomyelitis.

Decreased radiopharmaceutical uptake was noted on both bone and gallium scans in the case of acute hematogenous osteomyelitis of the right ilium (acetabular roof). This combination of findings is probably rare. The mechanism of decreased gallium uptake is unknown, but may be related to decreased blood flow.

Acetabulum↗

Bilateral posterior pelvic resection osteotomies in patients with exstrophy of the bladder.

This paper describes a modification of bilateral posterior iliac osteotomies for bladder exstrophy, in which a strip of ilium is resected subperiosteally lateral to the sacroiliac joints, allowing easier anterior closure with less breakdown compared with traditional osteotomies. Thirty-one children underwent repair of bladder exstrophy between 1974 and 1994. Orthopaedic procedures included: closed reduction and cast application in the newborn period (four patients), classic bilateral posterior iliac osteotomies (12 patients), and bilateral posterior resection osteotomies (15 patients). Dehiscence occurred after one closed reduction, five classic osteotomies, and one resection osteotomy. Urinary continence was obtained in four patients who underwent closed reduction, nine patients who underwent classic posterior osteotomies, and nine patients who underwent posterior resection osteotomies.

Bladder Exstrophy↗

Treatment of femoral head necrosis with vascularized iliac crest transplants.

The development of microsurgical methods has allowed for the use of vascularized bone transplants in the treatment of femoral head necrosis, particularly for Stages II, III, and IV according to the Association Internationale de Recherche sur la Circulation Osseuse classification system. Eighty patients with avascular necrosis of the femoral head were treated with vascular pedicled iliac crest transplant, perfused by the circumflexed ilium profunda artery between 1988 and 1996. On average, the postoperative followup was 5 years. Evaluation was based on the Harris hip score, and clinical and radiologic examination. Clinical results according to the Harris hip score were good or excellent in 86.6% of the patients. Radiologic appearance during the followup remained stable in 56.1% of the patients according to the classification system of the Association Internationale de Recherche sur la Circulation Osseuse. These findings are compatible with the findings of other studies in which vascularized bone transplants were used and approximately 50% of the patients with Stages II, III, and IV, according to the classification of the Association Internationale de Recherche sur la Circulation Osseuse had an unchanged stage of disease 5 to 6 years after the procedure.

Adult↗

Combined posterior pelvis and lumbar spine resection for sarcoma.

The oncologic outcome in the treatment of pelvic sarcomas is not comparable with that in the extremity. Particular problems arise when the tumor involves the posterior pelvis and the sacrum or even the lower lumbar spine. Because of the difficulty in achieving local control and the major functional deficits after extensive surgery, some authors suggest conservative, nonsurgical treatment for these patients. The purpose of the current study was to analyze the oncologic outcome of patients who were treated for a pelvic sarcoma necessitating resection of the ilium, part of the sacrum and part of the lower spine, which is defined as extended hemipelvectomy. Between 1979 and 1999, 11 males and seven females with a mean age of 34.5 years (range, 14-67 years) had an extended hemipelvectomy for a sarcoma of the posterior pelvis. The tumors included seven osteogenic sarcomas, six chondrosarcomas, and five fibrosarcomas: 13 were classified as high-grade lesions. The mean size of the tumor was 11 x 9 x 6 cm. In 11 patients, a hemivertebrectomy of L5 and in seven patients of L4 combined with L5 was done to achieve an adequate margin. In four patients, the resection was followed by reconstruction with a vascularized fibula or autograft. At a mean followup of 56 months (range, 3-220 months), 12 of 18 patients were alive and without disease. Six patients died; four of these patients had metastasis to the lung at presentation. The two remaining patients died of complications of adjuvant treatment. The authors conclude from this small series of patients that an aggressive surgical resection for localized, nonmetastatic, high-grade sarcomas of the posterior pelvis may be justified to provide local control and improve survival.

Adolescent↗