The Brush Foundation studies on human growth and development, begun in 1931 and terminated in 1942, have been intensively reviewed and studied by Dr Greulich and Miss Pyle in the formulation of this Radiographic Atlas of Skeletal Development of the Hand and Wrist Serial radiographs of from 2 to 20 hand-films made at successive examinations of each of 1000 boys and girls made up the radiographic material Standards were selected that were judged to be the most representative of the central tendency or anatomic mode of each chronologic age group from birth through 18 years

Radiographic Atlas of Skeletal Development of the Hand and Wrist

ContextKnee osteoarthritis (OA) is a leading cause of disability in older persons.
Few risk factors for disease progression or functional decline have been identified.
Hip-knee-ankle alignment influences load distribution at the knee; varus and
valgus alignment increase medial and lateral load, respectively.ObjectiveTo test the hypotheses that (1) varus alignment increases risk of medial
knee OA progression during the subsequent 18 months, (2) valgus alignment
increases risk of subsequent lateral knee OA progression, (3) greater severity
of malalignment is associated with greater subsequent loss of joint space,
and (4) greater burden of malalignment is associated with greater subsequent
decline in physical function.Design and SettingProspective longitudinal cohort study conducted March 1997 to March
2000 at an academic medical center in Chicago, Ill.ParticipantsA total of 237 persons recruited from the community with primary knee
OA, defined by presence of definite tibiofemoral osteophytes and at least
some difficulty with knee-requiring activity; 230 (97%) completed the study.Main Outcome MeasuresProgression of OA, defined as a 1-grade increase in severity of joint
space narrowing on semiflexed, fluoroscopically confirmed knee radiographs;
change in narrowest joint space width; and change in physical function between
baseline and 18 months, compared by knee alignment at baseline.ResultsVarus alignment at baseline was associated with a 4-fold increase in
the odds of medial progression, adjusting for age, sex, and body mass index
(adjusted odds ratio [OR], 4.09; 95% confidence interval [CI], 2.20-7.62).
Valgus alignment at baseline was associated with a nearly 5-fold increase
in the odds of lateral progression (adjusted OR, 4.89; 95% CI, 2.13-11.20).
Severity of varus correlated with greater medial joint space loss during the
subsequent 18 months (R = 0.52; 95% CI, 0.40-0.62
in dominant knees), and severity of valgus correlated with greater subsequent
lateral joint space loss (R = 0.35; 95% CI, 0.21-0.47
in dominant knees). Having alignment of more than 5° (in either direction)
in both knees at baseline was associated with significantly greater functional
deterioration during the 18 months than having alignment of 5° or less
in both knees, after adjusting for age, sex, body mass index, and pain.ConclusionThis is, to our knowledge, the first demonstration that in primary knee
OA varus alignment increases risk of medial OA progression, that valgus alignment
increases risk of lateral OA progression, that burden of malalignment predicts
decline in physical function, and that these effects can be detected after
as little as 18 months of observation.

/pdf/the-role-of-knee-alignment-in-disease-progression-and-2wtke3c7b3.pdf

The Role of Knee Alignment in Disease Progression and Functional Decline in Knee Osteoarthritis

La rupture de la ceinture pelvienne est un traumatisme grave. La necessite d'une fixation des fractures pelviennes depend de nombreux facteurs. On precise ici, en fonction du type de fracture, les indications de la fixation externe et de la fixation interne

Pelvic ring fractures: should they be fixed?

Mesenchymal progenitor cells provide a source of cells for the repair of musculoskeletal tissue. However, in vitro models are needed to study the mechanisms of differentiation of progenitor cells. This study demonstrated the successful induction of in vitro chondrogenesis with human bone-marrow-derived osteochondral progenitor cells in a reliable and reproducible culture system. Human bone marrow was removed and fractionated, and adherent cell cultures were established. The cells were then passaged into an aggregate culture system in a serum-free medium. Initially, the cell aggregates contained type-I collagen and neither type-II nor type-X collagen was detected. Type-II collagen was typically detected in the matrix by the fifth day, with the immunoreactivity localized in the region of metachromatic staining. By the fourteenth day, type-II and type-X collagen were detected throughout the cell aggregates, except for an outer region of flattened, perichondrial-like cells in a matrix rich in type-I collagen. Aggrecan and link protein were detected in extracts of the cell aggregates, providing evidence that large aggregating proteoglycans of the type found in cartilaginous tissues had been synthesized by the newly differentiating chondrocytic cells; the small proteoglycans, biglycan and decorin, were also detected in extracts. Immunohistochemical staining with antibodies specific for chondroitin 4-sulfate and keratan sulfate demonstrated a uniform distribution of proteoglycans throughout the extracellular matrix of the cell aggregates. When the bone-marrow-derived cell preparations were passaged in monolayer culture as many as twenty times, with cells allowed to grow to confluence at each passage, the chondrogenic potential of the cells was maintained after each passage. CLINICAL RELEVANCE: Chondrogenesis of progenitor cells is the foundation for the in vivo repair of fractures and damaged articular cartilage. In vitro chondrogenesis of human bone-marrow-derived osteochondral progenitor cells should provide a useful model for studying this cellular differentiation. Furthermore, the maintenance of chondrogenic potential after greater than a billion-fold expansion provides evidence for the clinical utility of these cells in the repair of bone and cartilage.

The Chondrogenic Potential of Human Bone-Marrow-Derived Mesenchymal Progenitor Cells*

http://homeopathy1.gr/wp-content/uploads/2014/08/Neural-mechanism-underlying-acupuncture-analgesia.ZhaoZQ-2008.pdf

Neural mechanism underlying acupuncture analgesia.

Difficulties that occur during limb lengthening were subclassified into problems, obstacles, and complications. Problems represented difficulties that required no operative intervention to resolve, while obstacles represented difficulties that required an operative intervention. All intraoperative i

Problems, obstacles, and complications of limb lengthening by the Ilizarov technique.

Deformity planning for frontal and sagittal plane corrective osteotomies.

Normal lower limb alignment and joint orientation.- Malalignment and malorientation in the frontal plane.- Radiographic assessment of lower limb deformities.- Frontal plane mechanical and anatomic axis planning.- Osteotomy concepts.- Sagittal plane deformities.- Oblique plane deformities.- Translation and angulation-translation deformities.- Rotation and angulation-rotation deformities.- Length considerations.- Hardware and osteotomy considerations.- Six-Axis deformity analysis and correction.- Consequences of malalignment.- Malalignment due to ligamentous laxity of the knee.- Knee joint line deformity sources of malalignment.- Realignment for mono-compartment osteoarthritis of the knee.- Sagittal plane knee considerations.- Ankle and foot considerations.- Hip joint considerations.- Growth plate considerations.- Gait considerations.- Dynamic deformities and lever arm considerations.- TKR and total hip replacement.

Principles of Deformity Correction

Twenty-five patients aged 19-62 years were treated for tibial nonunions (22 atrophic, three hypertrophic) with bone loss (1-23 cm, mean 6.2 cm) by the Ilizarov technique and fixator. Thirteen had chronic osteomyelitis, 19 had a limb-length discrepancy (2-11 cm), 12 had a bony defect (1-16 cm), and 13 had a deformity. Six had a bone defect with no shortening, 13 had shortening with no defect, and six had both a bone defect and shortening. Nonunion, bone defects, limb shortening, and deformity can all be addressed simultaneously with the Ilizarov apparatus. Bone defects were closed from within without bone grafts by the Ilizarov bone transport technique of sliding a bone fragment internally, producing distraction osteogenesis behind it until the defect is bridged (internal lengthening). Length was reestablished by distraction of a percutaneous corticotomy or through compression and subsequent distraction of the pseudarthrosis site (external lengthening). Distraction osteogenesis resulting from both processes obviated the need for a bone graft in every case. Deformity was corrected by means of hinges on the apparatus. Infection was treated by radical resection of the necrotic bone and internal lengthening to regenerate the excised bone. Union was achieved in all cases. The mean time to union was 13.6 months, but it was only 10.6 months if the time taken for unsuccessful compression-distraction of the nonunion is eliminated from the calculation. The bone results were excellent in 18 cases, good in five, and fair in two based on union in all cases, persistent infection in three, deformity in four, and limb shortening in one. The functional results were excellent in 16 cases, good in seven, fair in one, and poor in one based on return to work and daily activities in all cases, limp in four cases, equinus deformity in five cases, dystrophy in four cases, pain in four cases, and voluntary amputation for neurogenic pain in one case.

Ilizarov treatment of tibial nonunions with bone loss.

Twenty-nine patients (thirty-two femora) had femoral lengthening over an intramedullary nail, with the nail and the external fixator applied concomitantly at the time of the femoral osteotomy. After gradual distraction at a rate of one millimeter per day, the nail was locked and the fixator was removed. The mean age was twenty-six years (range, ten to fifty-three years), and the mean amount of lengthening was 5.8 centimeters (range, two to thirteen centimeters). For comparison, thirty-one patients (thirty-two limbs) who had had standard Ilizarov femoral lengthening were matched with the group that had had lengthening over an intramedullary nail; the matching was performed on the basis of the amount of lengthening, the age of the patient, the etiology of the indication for lengthening, and the level of difficulty of the procedure. Lengthening over an intramedullary nail reduced the average duration of external fixation by almost one-half. The radiographic consolidation index (the number of months needed for radiographic consolidation for each centimeter of lengthening) for the limbs that had had lengthening over an intramedullary nail was reduced significantly (p < 0.001) compared with that for the matched-case group. The range of motion of the knee returned to normal a mean of 2.2 times faster in the group that had had lengthening over an intramedullary nail. There were six refractures of the distraction bone in the matched-case group. In the group that had had lengthening over an intramedullary nail, one nail and one proximal locking screw failed. The over-all rate of complications was 1.4 per cent in the group that had had lengthening over an intramedullary nail compared with 1.9 per cent in the matched-case group. With the numbers of patients available for study, we could not detect a significant difference between the groups with respect to the operative time (p = 0.124); however, the cost of treatment and the estimated blood loss were higher in the group that had had lengthening over an intramedullary nail. On the basis of clinical and radiographic criteria, there were twenty-three excellent, seven good, and two fair results in the group that had had lengthening over an intramedullary nail compared with twenty-six excellent, four good, and two fair results in the matched-case group (p = 0.37). The advantages of lengthening over an intramedullary nail include a decrease in the duration of external fixation, protection against refracture, and earlier rehabilitation.

Dror Paley

Papers

Problems, obstacles, and complications of limb lengthening by the Ilizarov technique.

Deformity planning for frontal and sagittal plane corrective osteotomies.

Principles of Deformity Correction

Ilizarov treatment of tibial nonunions with bone loss.

Femoral Lengthening Over an Intramedullary Nail. A Matched-Case Comparison With Ilizarov Femoral Lengthening