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Legg‐Calvé‐Perthes disease (LCPD) is a childhood hip disorder characterized by ischemic injury to the epiphysis of the femoral head, but changes to the metaphysis have also been implicated in its pathogenesis. Quantitative magnetic resonance imaging (MRI) relaxation time mapping techniques are potentially useful to detect injury in LCPD, but studies to date have focused on the epiphysis. The purpose of this study was to assess whether T2, T1ρ, adiabatic T1ρ, and adiabatic T2ρ relaxation times can detect early metaphyseal changes in an LCPD piglet model. Complete epiphyseal ischemia of one femoral head was surgically induced and confirmed using contrast‐enhanced MRI in n = 10 6‐week‐old piglets; the contralateral side was unoperated. The bilateral hips were imaged 1 week after surgery in vivo at 3T MRI using relaxation time mapping and contrast‐enhanced MRI. Relaxation times and thicknesses of the metaphyseal primary and secondary spongiosa were measured and compared between the ischemic and contralateral‐control femoral heads using paired t‐tests. In the ischemic femoral heads, T2 relaxation times were significantly increased in the primary spongiosa (6.7 ± 9.8 ms, p = 0.029), and T2, T1ρ, adiabatic T1ρ, and adiabatic T2ρ relaxation times were significantly decreased in the secondary spongiosa (respectively: −13.3 ± 9.3 ms, p = 0.013; −32 ± 23 ms, p < 0.001; −43 ± 41 ms, p = 0.009; and −39 ± 13 ms, p < 0.001). The secondary spongiosa thickness was also significantly decreased in the ischemic femoral heads (p < 0.001). In conclusion, T2, T1ρ, adiabatic T1ρ, and adiabatic T2ρ relaxation time mapping techniques can detect early changes in the metaphysis following ischemic injury to the epiphysis of the femoral head in a piglet model of LCPD. [ABSTRACT FROM AUTHOR]

Aims: To investigate the risk factors for unsuccessful radial head reduction (RHR) in children with chronic Monteggia fractures (CMFs) treated surgically. Methods: A total of 209 children (mean age 6.84 years (SD 2.87)), who underwent surgical treatment for CMFs between March 2015 and March 2023 at six institutions, were retrospectively reviewed. Assessed risk factors included age, sex, laterality, dislocation direction and distance, preoperative proximal radial metaphysis width, time from injury to surgery, reduction method, annular ligament reconstruction, radiocapitellar joint fixation, ulnar osteotomy, site of ulnar osteotomy, preoperative and postoperative ulnar angulation, ulnar fixation method, progressive ulnar distraction, and postoperative cast immobilization. Independent-samples t-test, chi-squared test, and logistic regression analysis were used to identify the risk factors associated with unsuccessful RHR. Results: Redislocation occurred during surgery in 48 patients (23%), and during follow-up in 44 (21.1%). The mean follow-up of patients with successful RHR was 13.25 months (6 to 78). According to the univariable analysis, time from injury to surgery (p = 0.002) and preoperative dislocation distance (p = 0.042) were identified as potential risk factors for unsuccessful RHR. However, only time from injury to surgery (p = 0.007) was confirmed as a risk factor by logistic regression analysis. Receiver operating characteristic curve analysis and chi-squared test confirmed that a time from injury to surgery greater than 1.75 months increased the rate of unsuccessful RHR above the cutoff (p = 0.002). Conclusion: Time from injury to surgery is the primary independent risk factor for unsuccessful RHR in surgically treated children with CMFs, particularly in those with a time from injury to surgery of more than 1.75 months. No other factors were found to influence the incidence of unsuccessful RHR. Surgical reduction of paediatric CMFs should be performed within the first two months of injury whenever possible. Cite this article: Bone Jt Open 2024;5(7):581–591.

Slipped Upper Femoral Epiphysis (SUFE) is the most common hip abnormality in adolescents, leading to significant morbidity if not properly treated. It is classified as a Salter-Harris type I injury, resulting from a fall that affects the physis of both hips and can cause unstable alignment between the epiphysis and metaphysis. They typically present with a decreased range of motion, hip discomfort and limping. Hereby, the author presents the case of 12-year-old adolescent female with a sequential history of hip pain one after the other after a fall one month back. On physical examination, full internal rotation was lacking and flexion and abduction ability were limited. X-ray and Magnetic Resonance Imaging (MRI) of both hip joints were taken, which revealed widened epiphysis of bilateral femurs with slippage of bilateral femoral epiphysis onto metaphysis, suggestive of bilateral SUFE. Later the patient underwent bilateral prophylactic in-situ fixation with screws to prevent further slippage and long-term complications.

In this case report, we present a case of non-ossifying fibroma in the mandible of an eleven-year-old girl who reported to the Oral and Maxillo-Facial Surgery Department with facial asymmetry and painless swelling on palpation over the lower right mandibular region. In this paper, we review the radiographic features, clinical presentation, and histopathological features of non-ossifying fibromas. Non-ossifying fibromas present with a unique extra-gnathic appearance in the skull. It is usually asymptomatic and has diverse histological features. Co-related histological, radiological, and clinical features differentiate it from other odontogenic and non-odontogenic tumors and cysts of the oral cavity. Ortho-pantogram revealed a well-demarcated, expansile radiolucency with pronounced sclerotic borders with striations reaching the anterior and superior regions and thus slowly approaching a multilocular stage. The treatment plan comprised of excisional resection with curettage under general anesthesia. After excisional biopsy of the lesion, the specimen was sent for histopathological evaluation in neutrally buffered 10 % formalin solution, which confirmed it to be a Non-Ossifying Fibroma. Prior to surgery, informed consent and written permission to collaborate with a case report encompassing her findings were obtained from the patients’ guardians. Confidentiality of patient has been taken care of before documenting the report. A meticulous literature review of previous case reports on non-ossifying fibromas revealed typical behaviors and characteristics of this lesion.

The bone defect, characterized by the undesired loss of bone material, can arise from postinfection cavities, lesion therapy, or fractures, presenting a complex and challenging healing process. This condition is influenced by various contributing factors. Long bones are categorized into three segments (epiphysis, metaphysis, and diaphysis) under the Universal Long Bone Defect Classification. This study aimed to determine differences in the healing process of bone defects based on the position of the defect. Conducted on 60 male Wistar rats (12 weeks old, weighing 250-300 mg), the experiment includes two groups: Group A (30 animals with metaphyseal defects) and Group B (30 animals with diaphyseal defects). Each group was divided into smaller subgroups, each consisting of 6 animals, based on designated observation days: H0, 5, 10, 17, and 25. This arrangement led to the formation of ten groups in total. The assessment involves osteogenesis markers and defect area measurement from radiographs, revealing higher values for osteoblasts and osteoclasts in Group B, except for Group A chondrocytes which exhibit higher values. Additionally, the lesion area in Group B is smaller. Statistical analysis confirms these differences, leading to the conclusion that bone defects in the diaphyseal area exhibit faster healing compared to the epiphyseal or metaphyseal regions. [ABSTRACT FROM AUTHOR]

Chondroblastoma is a rare, benign neoplasm usually located in the epiphyses and apophyses of the long bones in the immature skeleton. Radiologically, these tumors have a classic appearance of a lytic lesion with chondroid matrix surrounded by a thin sclerotic rim. Here, we describe the case of a 5-year-old male who presented with a chondroblastoma unusually located exclusively in the metaphyseal region, which led to an elusive diagnosis. The presence of tumors outlying the traditional location or epidemiological spectrum, along with the potential for histopathological misdiagnosis, can pose a diagnostic and therapeutic challenge for the treating team.

We discuss several variants of the metaphyseal and diaphyseal bone surfaces that may be misleading in clinical practice. They include metaphyseal stripes, spiculated metaphyseal cortex, cortical desmoid, laminated lateral supracondylar ridge, cortical vascular canals, variations in shape or lucency of normal tuberosities, cortical thickening of normal ridges, and well-organized undulated hyperostosis at the proximal phalanges. [ABSTRACT FROM AUTHOR]

Stress fractures are rare, occurring in 1.5/100,000 high school athletes. High impact, repetitive loading participation in woman's sports, and being a white athlete have been identified as risk factors for stress fractures. Mostly treated conservatively, they are more common in the tibia (33%). Stress fractures requiring surgery, which are extremely rare, have been reported in the scaphoid, fifth metatarsal, and neck of femur. Herein, a 16-year-old adolescent patient with obesity presented with atypical knee pain after prolonged exercise. Advanced imaging revealed a stress fracture of the left tibia with a Salter–Harris type V fracture and varus deformity of the knee. We initially managed the fatigue fracture conservatively, followed by surgical correction of the varus deformity in the knee joint. The patient made a satisfactory recovery with equal limb length and no evidence of claudication. This is the first case of a proximal tibial metaphyseal stress fracture requiring surgery. The clinical manifestations of proximal tibial metaphyseal stress fractures and potential treatment strategies and the use of magnetic resonance for tibial stress fractures have been discussed. Understanding the location of unusual stress fractures can improve early diagnostic efficiency and reduce complication rates, healthcare costs, and recovery time.

Background: Radiographic evaluations are commonly used to determine calcaneal ossification staging throughout pediatric development. Sonographic imaging may offer a less expensive, noninvasive, clinically feasible option for calcaneal developmental assessments. Here, we assessed (1) inter-rater agreement of radiographic and sonographic calcaneal ossification staging of children and adolescent patients with Sever's disease and (2) agreement between radiographic and sonographic calcaneal ossification staging scores., Hypothesis: There would be substantial agreement of radiographic and sonographic calcaneal ossification staging across raters, and between imaging measures., Study Design: Retrospective cohort study., Level of Evidence: Level 3., Methods: Adolescent patients (<18 years of age) with physician-diagnosed Sever's disease who had complete calcaneal sonographic and radiographic imaging available on a retrospective chart review were included. Three independent reviewers with advanced training in musculoskeletal ultrasound each separately assessed radiographic and sonographic imaging data and assigned calcaneal calcification stages (0-5) to blinded images based on established criteria. Fleiss' Kappa analyses were used to determine inter-rater staging agreement for both imaging approaches. Cohen's Kappa analyses were used to determine the agreement between radiographic and sonographic staging. Absolute agreement, and relative agreement within each stage were assessed for both analyses., Results: Data from 19 patients (13 female, 6 male; 12.2 ± 2.3 years) were included. Absolute inter-rater agreement for radiographic and sonographic calcaneal ossification staging was comparable across the 3 raters (radiographs, κ = 0.692, z = 9.02; P < .01; sonographs, κ = 0.713, z = 7.95; P < .01), and perfect relative agreement (κ = 1.0, z = 10.6; P < .01). Consensus scores for radiographic and sonographic staging had moderate (κ = 0.535, z = 4.2; P < .01, and perfect relative (100% relative agreement, z = 6.22; P < .01) agreement., Conclusion: Sonographic evaluations of calcaneal ossification staging was comparable across assessors, and similar to radiographic staging., Clinical Relevance: Clinicians may consider incorporating ultrasound imaging for calcaneal ossification staging for young patients., Competing Interests: The authors report no potential conflicts of interest in the development and publication of this article.

Aims: The main objective of this study is to analyze the penetration of bone cement in four different full cementation techniques of the tibial tray. Methods: In order to determine the best tibial tray cementation technique, we applied cement to 40 cryopreserved donor tibiae by four different techniques: 1) double-layer cementation of the tibial component and tibial bone with bone restrictor; 2) metallic cementation of the tibial component without bone restrictor; 3) bone cementation of the tibia with bone restrictor; and 4) superficial bone cementation of the tibia and metallic keel cementation of the tibial component without bone restrictor. We performed CT exams of all 40 subjects, and measured cement layer thickness at both levels of the resected surface of the epiphysis and the endomedular metaphyseal level. Results: At the epiphyseal level, Technique 2 gave the greatest depth compared to the other investigated techniques. At the endomedular metaphyseal level, Technique 1 showed greater cement penetration than the other techniques. Conclusion: The best metaphyseal cementation technique of the tibial component is bone cementation with cement restrictor. Additionally, if full tibial component cementation is to be done, the cement volume used should be about 40 g of cement, and not the usual 20 g.

Skeletal stem and progenitor cells (SSPCs) constitute a reservoir of boneforming cells necessary for bone development, modeling and remodeling, as well as for fracture healing. Recent advances in tools to identify and isolate SSPCs have revealed that cells with multipotent properties are present not only in neonatal bone, but also in adult bone marrow and periosteum. The long bone metaphysis and endosteum have been proposed as an additional SSPC niche, although in vitro approaches to study their cellular and molecular characteristics are still limited. Here, we describe a comprehensive procedure to isolate and culture SSPCs derived from the metaphysis and endosteum of young-adult mice. Based on flow cytometry analysis of known SSPC markers, we found the presence of putative multipotent SSPCs, similar to neonatal bone tissue. In vitro, metaphyseal/endosteal SSPCs possess selfrenewing capacity, and their multipotency is underscored by the ability to differentiate into the osteogenic and adipogenic lineage, while chondrogenic potential is limited. Expansion of metaphyseal/endosteal SSPCs under low oxygen conditions increases their proliferation capacity, while progenitor properties are maintained, likely reflecting their hypoxic niche in vivo. Collectively, we propose a validated isolation and culture protocol to study metaphyseal/endosteal SSPC biology in vitro. [ABSTRACT FROM AUTHOR]

Skeletal stem and progenitor cells (SSPCs) constitute a reservoir of bone-forming cells necessary for bone development, modeling and remodeling, as well as for fracture healing. Recent advances in tools to identify and isolate SSPCs have revealed that cells with multipotent properties are present not only in neonatal bone, but also in adult bone marrow and periosteum. The long bone metaphysis and endosteum have been proposed as an additional SSPC niche, although in vitro approaches to study their cellular and molecular characteristics are still limited. Here, we describe a comprehensive procedure to isolate and culture SSPCs derived from the metaphysis and endosteum of young-adult mice. Based on flow cytometry analysis of known SSPC markers, we found the presence of putative multipotent SSPCs, similar to neonatal bone tissue. In vitro, metaphyseal/endosteal SSPCs possess self-renewing capacity, and their multipotency is underscored by the ability to differentiate into the osteogenic and adipogenic lineage, while chondrogenic potential is limited. Expansion of metaphyseal/endosteal SSPCs under low oxygen conditions increases their proliferation capacity, while progenitor properties are maintained, likely reflecting their hypoxic niche in vivo. Collectively, we propose a validated isolation and culture protocol to study metaphyseal/endosteal SSPC biology in vitro.

Osteonecrosis of the metaphysis is often rare as it is a highly vascular region. Here we report an unusual case of non-traumatic osteonecrosis of the humerus predominantly involving the metaphysis in a post covid elderly female. The patient had a pathological fracture of humerus during the postoperative period of intertrochanteric femur fracture surgery. She was evaluated for the causes of pathological fracture and the fracture was managed with hemi replacement of the shoulder because of the extensive bone loss. The pathology here could only be explained as some sequelae of hyper inflammatory state associated with COVID-19 infection. The possible differentials are also discussed here. This case report will help clinicians to consider COVID-19 infection as a cause for nontraumatic osteonecrosis among other reported causes of osteonecrosis. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Redisplacement following fracture reduction is a known sequela during the casting period in children treated for distal radius fracture. Kirschner wire pinning can be alternatively used to maintain the reduction during fracture healing. This study was conducted to compare the outcomes at skeletal maturity of distal radius fractures in children treated with a cast alone or together with a Kirschner wire transfixation. Materials and Methods: This was a retrospective study involving 57 children with metaphyseal and physeal fractures of the distal radius. There were 30 patients with metaphyseal fractures, 19 were casted, and 11 were wire transfixed. There were 27 patients with physeal fractures, 19 were treated with a cast alone, and the remaining eight underwent pinning with Kirschner wires. All were evaluated clinically, and radiologically, and their overall outcome assessed according to the scoring system, at or after skeletal maturity, at the mean follow-up of 6.5 years (3.0 to 9.0 years). RESULTS: In the metaphysis group, patients treated with wire fixation had a restriction in wrist palmar flexion (p=0.04) compared with patients treated with a cast. There was no radiological difference between cast and wire fixation in the metaphysis group. In the physis group, restriction of motion was found in both dorsiflexion (p=0.04) and palmar flexion (p=0.01) in patients treated with wire fixation. There was a statistically significant difference in radial inclination (p=0.01) and dorsal tilt (p=0.03) between cast and wire fixation in physis group with a more increased radial inclination in wire fixation and a more dorsal tilt in patients treated with a cast. All patients were pain-free except one (5.3%) in the physis group who had only mild pain. Overall outcomes at skeletal maturity were excellent and good in all patients. Grip strength showed no statistical difference in all groups. Complications of wire fixation included radial physeal arrests, pin site infection and numbness. CONCLUSION: Cast and wire fixation showed excellent and good outcomes at skeletal maturity in children with previous distal radius fracture involving both metaphysis and physis. We would recommend that children who are still having at least two years of growth remaining be treated with a cast alone following a reduction unless there is a persistent unacceptable reduction warranting a wire fixation. The site of the fracture and the type of treatment have no influence on the grip strength at skeletal maturity.

Division of the growing long bone into individual basic parts, that is, diaphysis, metaphysis, physes and epiphyses, has become generally accepted and used. However, the origin of these terms is almost unknown. Therefore, we have analyzed the literature in order to identify their sources. The terms epiphysis and apophysis have been used since the time of Hippokrates, although with different meanings. During the time of Galen, the term apophysis was used to describe all types of bone processes, and epiphyses denoted articular ends. The term diaphysis denoting the middle cylindrical part of the long bone was used for the first time by Heister in 1717. The first to use the term metaphysis was Theodor Kocher in his books on gunshot wounds and on bone inflammation of 1895. On the basis of Kocher's study, Lexer published a radiological study of the vascular supply to bones in which he defined metaphyseal blood vessels as a separate group supplying a particular part of the long bone. The epiphyseal growth plate had no particular name from the time of its first description in 1836. During the second half of 19th century, this structure acquired different names. The term "physis" was therefore introduced in 1964 by the American radiologist Rubin in order to label the growth structure between metaphysis and epiphysis clearly. One year later, the term physis also appeared in the radiological literature, and during the following decades it spread in the orthopedic literature., (© 2024 The Authors. Clinical Anatomy published by Wiley Periodicals LLC on behalf of American Association of Clinical Anatomists and British Association of Clinical Anatomists.)

Fibrous dysplasia is a rare condition in which bone is replaced by fibroosseous tissue. It is a benign condition, divided into monostotic and polyostotic fibrous dysplasia, which accounts for about 5-7% of all benign bone tumours. Here, authors reported a case of a 38-year-old male that presented with left hip pain since 15 days and had a history of trauma. X-ray pelvis and Magnetic Resonance Imaging (MRI) showed shepherd’s crook deformity in the left proximal femur with pathological femur neck fracture. It was managed with valgus osteotomy for deformity correction and fracture fixation using long proximal femur nail and cannulated cancellous screws. At one and half year follow-up, the patient showed good hip and knee range of motion with no complications

We are passing through an age that is under the control of quantity, even in poetry. In fact, many aesthetically unsuccessful writings are published under the title of verses or poems. In such a context, the works of a discreet poet like Eugen D. Popin, who lives with his deepest self in the Logos, come to put poetry back on its natural path. The present research therefore has as its starting point the poetry of the mentioned author. In addition to reviewing the reception of E. D. Popin's works, we highlight the poetic pillars on which he built his discourse, a special one, for the poet has been serving poetry for almost four decades without ever giving up to its aesthetic and ethical value. [ABSTRACT FROM AUTHOR]

Despite the high incidence of metaphyseal bone fractures in patients, the mechanisms underlying the healing processes are poorly understood due to the lack of suitable experimental animal models. Hence, the present study was conducted to establish and characterise a clinically relevant large-animal model for metaphyseal bone healing. Six female adult Merino sheep underwent full wedge-shaped osteotomy at the distal left femur metaphysis. The osteotomy was stabilised internally with a customised anatomical locking titanium plate that allowed immediate post-operative full-weight bearing. Bone healing was evaluated at 12 weeks post-fracture relative to the untouched right femur. Histological and quantitative micro-computed tomography results revealed an increased mineralised bone mass with a rich bone microarchitecture. New trabeculae healed by direct intramembranous ossification, without callus and cartilaginous tissue formation. Stiffness at the cortical and trabecular regions was comparable in both groups. Functional morphological analysis of the osteocyte lacunae revealed regularly arranged spherically shaped lacunae along with the canalicular network. Bone surface biochemical analysis using time-of-flight secondary-ion mass spectrometry showed high and homogeneously distributed levels of calcium and collagenous components. Ultrastructure imaging of the new trabeculae revealed a characteristic parallel arrangement of the collagen fibrils, evenly mineralised by the dense mineral substance. The specialised bone cells were also characterised by their unique structural features. Bone remodelling in the fractured femur was evident in the higher expression levels of prominent bone formation and resorption genes. In conclusion, the novel metaphyseal fracture model is beneficial for studying healing and treatment options for the enhancement of metaphyseal bone defects.

Summary: Bone stroma contributes to the regulation of osteogenesis and hematopoiesis but also to fracture healing and disease processes. Mesenchymal stromal cells from bone (BMSCs) represent a heterogenous mixture of different subpopulations with distinct molecular and functional properties. The lineage relationship between BMSC subsets and their regulation by intrinsic and extrinsic factors are not well understood. Here, we show with mouse genetics, ex vivo cell differentiation assays, and transcriptional profiling that BMSCs from metaphysis (mpMSCs) and diaphysis (dpMSCs) are fundamentally distinct. Fate-tracking experiments and single-cell RNA sequencing indicate that bone-forming osteoblast lineage cells and dpMSCs, including leptin receptor-positive (LepR+) reticular cells in bone marrow, emerge from mpMSCs in the postnatal metaphysis. Finally, we show that BMSC fate is controlled by platelet-derived growth factor receptor β (PDGFRβ) signaling and the transcription factor Jun-B. The sum of our findings improves our understanding of BMSC development, lineage relationships, and differentiation.

The fracture repair process is known to be delayed in postmenopausal women, under estrogen-deficient status. Osteoporotic fracture mainly occurs in the metaphyseal region of the long bone; however, most studies on fracture healing have focused on the diaphyseal region. In this study, we compared the repair process between metaphysis and diaphysis of ovariectomized (OVX) and Sham mice, and analyzed the effects of short-term estrogen administration in OVX mice. Mice were divided into four experimental groups, including Sham, OVX, OVX + vehicle, and OVX + 17β-estradiol (E2). Bone apertures were formed in the tibial metaphysis and diaphysis. The samples were collected and examined by micro-computed tomography, and using histological, histochemical, and immunohistochemical analysis at different time points after the surgery. The cartilaginous callus was formed at the diaphysis site of both the groups, which was sequentially replaced by bone on the periosteum side. Medullary callus was formed in all the groups; however, the volume of the callus in OVX mice was significantly lesser (˜30%) than that in Sham mice. Furthermore, in the metaphysis, no differences were observed in the medullary callus and bone mineral density between the two groups from day 21 to 28. The diaphysis of OVX group was not completely repaired even by day 28. In both the sites of OVX mice, ALP activity and disappearance of Gr-1 positive cells were delayed compared to that of Sham. Estrogen administration improved medullary callus formation in the diaphysis, however not in the metaphysis. The effect of ovariectomy on the repair process in diaphysis was greater than that in metaphysis. Our findings clarify the differences between the metaphysis and diaphysis repair process using OVX mouse model and suggest that the estrogen sensitivities differ between the sites during the bone repair process. [ABSTRACT FROM AUTHOR]

Oligoarticular juvenile idiopathic arthritis (JIA) and tubercular arthritis in children can present in a similar way as monoarthritis. Patients with musculoskeletal tuberculosis may not have the classical constitutional symptoms. Moreover, microbiological evidence of infection may not be found in all patients. In such cases, features on imaging aid in the diagnosis. We present a case of an 8-year-old girl who had inflammation in the right knee. Investigations showed negative results for autoimmune markers. Synovial fluid examination did not reveal any evidence of tuberculosis. However, magnetic resonance imaging of the knee joint showed inflammation around the distal growth plate of the femur, away from the knee joint. The suspicion of tuberculosis was strengthened by the presence of left hilar lymphadenopathy on chest X-ray and positive result on tuberculin skin sensitivity test. The patient showed remarkable clinical and radiological recovery with antitubercular therapy. Peculiar features on imaging may help in differentiating infections from inflammatory arthritides, even in the absence of microbiological evidence of infection. [ABSTRACT FROM AUTHOR]

Objective: This study investigates bilateral asymmetry in the humerus of modern human populations with differing activity patterns to assess the relative plasticity of different bone regions in response to environmental influences, particularly the biomechanical demands of handedness. Methods: External breadths, cross‐sectional properties, and centroid sizes were used to quantify directional and absolute asymmetry of humeral diaphyseal, distal periarticular, and articular regions in six populations with differing subsistence strategies (total n = 244). Geometric section properties were measured using computed tomography at six locations along the distal humerus, while centroid sizes of the distal articular and periarticular regions, as well as eight segments of the diaphysis, were extracted from external landmark data. Bilateral asymmetries were compared between populations and sexes. Each property was also tested for correlation with bilateral asymmetry at 40% of bone length, which has been shown to correlate with handedness. Results: Asymmetry is highest in the diaphysis, but significant through all distal bone regions. Asymmetry increases in the region of the deltoid tuberosity, and progressively declines distally through the shaft and distal periarticular region. Articular asymmetry is higher than periarticular asymmetry, approaching levels seen just proximal to the olecranon fossa, and is weakly but significantly correlated with diaphyseal asymmetry. Hunter‐gatherers from Indian Knoll have significantly higher levels of asymmetry than other groups and are more sexually dimorphic, particularly in cross‐sectional properties of the diaphysis. Conclusions: Humeral dimensions throughout the diaphysis, including regions currently used in taxonomic assignments of fossil hominins, likely respond to in vivo use, including population and sex‐specific behaviors. [ABSTRACT FROM AUTHOR]

Summary: A 10‐year‐old Warmblood gelding presented with a left hindlimb lameness. Diagnostic analgesia located the lameness to the stifle. Radiography showed an unusually large cyst in the distal femur. Diagnostic arthroscopy of the stifle did not reveal any significant abnormalities. An extra‐articular transcortical approach to the cyst was performed for drainage, curettage, and provision of an autologous, cancellous bone graft, gentamicin‐impregnated collagen fleeces and injectable steroid. The horse returned to a higher level of competitive dressage than prior to surgery. This report describes a large cyst in the distal femur of a horse. [ABSTRACT FROM AUTHOR]

Introduction: The Monteggia equivalent type 1b fracture, consisting of an ulnar shaft fracture and radial head dislocation, is a rare condition first described by Giovanni Battista Monteggia. The Metaizeau technique, emphasizing percutaneous intramedullary fixation to preserve bone healing and prevent growth plate damage, has gained prominence in managing these fractures., Case Report: A 10-year-old boy presented with left forearm pain, swelling, and deformity following a fall while playing football. X-rays revealed a proximal fourth ulnar fracture with dorsal and lateral angulation, along with a proximal radial metaphyseal fracture showing anterior rotation and physeal extension. This fracture pattern resembled a Monteggia fracture type III but differed in the lateral proximal radial disruption via a Salter-Harris type II fracture rather than radial epiphysis dislocation. Satisfactory reduction achieved for ulna was managed with standard nailing system but could not be achieved for radial physeal injury, which was managed with Metaizeau technique., Discussion: Type 1b Monteggia equivalents involving a Salter-Harris type 2 fracture of the proximal radius with an associated proximal ulnar fracture, adherence to Monteggia fracture reduction principles is vital. Closed reduction and internal fixation are preferred treatments, with the Metaizeau technique offering advantages such as minimal invasiveness and avoidance of implant-related complications. The Metaizeau technique is particularly beneficial for displaced radial neck fractures in children, providing stable fixation while preserving the fracture environment necessary for optimal healing., Conclusion: In cases of Monteggia fracture equivalents, most proximal radial fractures typically reduce to an acceptable level following ulnar reduction. However, proximal radial physeal fractures may require specific attention to achieve satisfactory reduction. The Metaizeau technique, commonly employed in the management of isolated radial neck fractures, can be utilized to achieve this reduction to an acceptable level., Competing Interests: The authors declare no conflict of interest., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

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Abstract Background Ollier’s disease is a non-hereditary, benign bone tumor which is usually characterized by presence of multiple radiolucent lesions (enchondromas) in the metaphysis of long bones with unilateral predominance. The disease is a rare clinical entity with 1/100000 occurrence in early childhood. Patients mostly present with multiple hard swellings and deformity of the tubular bones specially hands and feet with leg discrepancy and pathologic fractures. Case presentation We present two cases of Ollier’s disease in a 13 years old female and 8 years old boy which had no specific symptoms. The girl had multiple hard swellings and deformity in the fingers of both hands and left toes with left leg deformity and discrepancy. Her plain radiographs demonstrated multiple expansile enchondromas in the phalanges of hands, left toes and metaphyses of upper humeri as well as left leg bones. The enchondromas were also noted in the left iliac bone and anterior end of ribs. The boy had bowing deformity and shortage of left leg with multiple enchondromas in the metaphyses of left femur, left tibia and fibula as well as left iliac bone in his radiographic images. Conclusion Ollier’s disease is usually diagnosed by clinical signs and typical location of enchondromas across skeleton in conventional radiography. It usually does not need specific treatment. Well understanding of the clinical manifestation and radiographic features can prevent unnecessary application of other imaging modalities; while other diagnostic imaging modalities like MRI, ultrasound and scintigraphy can be used in complicated and painful conditions.

From the point of view of the social sciences, the ratio identity-antinomy is that one between Myself and the rest of the world, hypostasized by The Other. The identity is based on the knowledge, more or less profound, of an interiority that considers itself as being or not being an integrant component of the world. Through this, the world can be seen eminently familiar, friendly, or completely extraneous and consequently hostile. In this article I am trying to catch the identity/antinomy ratio from the imaginary perspective of Eliade, through the Yogi Rite of passing, widely described by the great scholar Eliade in his works Yoga. ”Essai sur les origines de la mystique indienne” (1936),”Techniques du Yoga” (1948),”Pantanjali et la Yoga” (1966). In this type of ratio only the dynamic of sacred-profane dialect it is relevant. From this perspective, the identity conservation means keeping the individual on the coordinates of routine and profane existence that “connects” the mind to the captivity of its own reflections of the world and life. The only chance of the individual is to “wake up” in order to be able to “free himself” and become Another One. What should we understand by Another One? That Ganz Andere of Rudolf Otto, starting from the old texts of Indian metaphysics: the divinity understood as a total antinomy. For the yogi, becoming Another One is the ideal that can crown his existence because this process is equal to releasing the human condition and uniting with the universal soul. As a consequence, for the yogi preserving the identity is not an option but maintaining it under the incidence of karma’s curse and giving up the weaknesses, suffering and illusions of individual self is the first step to the identification with the Another One, the true and definitive freedom. All these aspects will be analyzed mainly in the short story The secret of doctor Honigberger (1940), by Mircea Eliade, one of the best written fantastic work of the author.

One of the most frequent cartilage-capped outgrowths that develop beneath the periosteum due to cartilage ossification is osteochondroma. The second decade of life is noted as the most prevalent age of presentation. This case report looks at an uncommon osteochondroma presentation in a 20-year-old female with swelling along the right inferomedial border of the scapula. The patient presented with complaints of difficulty in daily activities and exhibited altered posture, decreased range of motion (ROM), muscle weakness, and altered shoulder function. The clinical assessment highlighted restricted shoulder and cervical ROM and muscle weakness in the trapezius, rhomboids, serratus anterior, and other surrounding muscles. Magnetic resonance imaging revealed an inferomedial bony outgrowth indicative of osteochondroma. A comprehensive physiotherapy intervention protocol for eight weeks was designed to alleviate pain, improve mobility, restore ROM, strengthen weakened muscles, correct posture, and enhance functions that were restricted. The protocol encompassed various techniques, such as muscle energy techniques (MET), proprioceptive neuromuscular facilitation (PNF), cold therapy, stretching, scapular mobilization, resistance exercises with TheraBand, postural correction exercises, ergonomic adjustments, scapular stabilization exercises, and 'J'-taping to aid in muscle activation and address rounded shoulder posture. Outcome measures for cervical and shoulder ROM and strength were measured to note the progression after rehabilitation. The case report emphasizes the importance of a tailored physiotherapy rehabilitation protocol in managing osteochondroma-related symptoms, showing the potential benefits of multifaceted interventions in alleviating pain, improving function, and boosting the quality of life for individuals with similar presentations., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Burile et al.)

Summary: Parathyroid hormone (PTH) and agents related to the manipulation of Wnt/β‐catenin signalling are two promising anabolic anti‐osteoporotic therapies that have been shown to promote the healing of bone fractures. Now, it is widely accepted that cortical bone and trabecular bone are two different compartments, and should be treated as separate compartments in pathological processes, such as fracture healing. It is currently unknown whether PTH and the activation of β‐catenin signalling would demonstrate different effects on cortical bone and trabecular bone healing. In the current study, single 0.6‐mm cortex holes were made in the femur metaphysis and diaphysis of mice, and then, PTH application and β‐catenin activation were used to observe the promoting effect on bone healing. The effects of β‐catenin and PTH signalling on fracture healing were observed by X‐ray and CT at 3, 6, and 14 days after fracture, and the levels of β‐catenin were detected by RT‐PCR assay, and the number of specific antigen‐positive cells of BRDU, OCN, RUNX2 was counted by immunohistochemical staining. While β‐catenin activation and PTH were found to demonstrate similar effects on accelerating metaphyseal bone healing, activation of β‐catenin showed a more striking effect than PTH on promoting diaphyseal bone healing. These findings might be helpful for selecting proper medication to accelerate fracture healing of different bone compartments. [ABSTRACT FROM AUTHOR]