Introduction & aims. Different racial groups show variations in femoral morphometry. Femoral anteroposterior measurement and mediolateral measurement are key variables in designing femoral implant for TKR. Their aspect ratio determines the shape and mediolateral sizing for the proper patellofemoral tracking and uniform stress distribution over the resected distal femoral surface. Method. We reviewed the current literature in December 2013 in common medical databases including the Cochrane Library, PubMed and Medline. Keywords included combinations of: Anthropometry, Knee, Arthroplasty, Femur, Morphometry, Geometry. We selected papers including femoral morphometric data collected from populations of different ethnic origins. Papers covered populations in the USA, China, Germany, Thailand, Korea, India, Japan and Malaysia. Results. We have analysed femoral morphometry variables among different ethnic groups from the available data. Gross size of the resected femur can be defined in terms of antero-posterior (AP) and medio-lateral (ML) dimensions, an in the aspect ratio of femoral medio-lateral to femoral antero-posterior dimensions (fML/fAP). The Korean population showed the least value of fAP among all the groups, followed by Thai, Japanese, Indian, Malaysian and Chinese showing the increasing order among the sub-groups of Asian Population. American population shows the next higher fAP measurements from Asian population. German follows, and Arab quantify the largest value of this femoral anthropometric variable. fML varies by huge difference among male and female data in all populations. Thai, Indian, Malaysian, Arab, Japanese, Korean, German, Chinese and American; this sequence is the increasing order of fML. More trapezoid-shaped and narrower ML, this variation in female group leads to over-hang the implant for a given fAP. Generally, the aspect ratios are measured higher in these smaller female knees, and lower in larger male knees. Conclusions. Anthropometric data measuring distal femoral segment in different ethnic groups shows that the Asian population requires custom-fit implant design based on the morphological data. It would be more appropriate to introduce several medio-lateral options in sizing the implant for given antero-posterior dimensions

Introduction. Surgeons fixing scaphoid fractures need to be familiar with its morphological variations and their implications on safe screw placement during fixation of these fractures. Literature has limited data in this regard. The purpose of this CT-based study was to investigate scaphoid morphometry and to analyse the safe trajectories of screw placement in scaphoid. Methods. We measured the coronal and Sagittal widths of scaphoid in CT-scans of 60 patients using CT based data from 50 live subjects with intact scaphoid. Safe placements for screws with diameters of 1.7mm, 2.4mm, 3.5mm and 4mm were studied using trajectories with additional 2mm safety corridor. Results. The mean width of proximal segment in coronal and sagittal plane were 6.39mm (4.5–8.7) and 11.44mm (8.4–14.1) respectively. For the waist region, the mean coronal, sagittal width were 8.03mm (6.3–10.2mm) and 9.02mm (7–11.4mm) respectively. For distal segment, the mean coronal and sagittal width were 10.58mm (8.2–14.6mm) and the 9.59mm (7.3–11.9mm) respectively. The coronal and sagittal widths were significantly different from each other in all three zones. All scaphoid were capable of safely containing single 4mm screw and two parallel 1.7mm screws. Conclusion. Our study shows that there is considerable variation in scaphoid morphometry. Among the parameters, the waist region measurements show the least variation. The screw lengths do not always correlate to the overall longitudinal extent of scaphoid and can be planned preoperatively using CT-scans. Surgeons treating these fractures should opt for a CT-based analysis regarding the screw direction and length and need to be familiar with the variations in scaphoid morphometry

Osteoporosis accounts for a leading cause of degenerative skeletal disease in the elderly. Osteoblast dysfunction is a prominent feature of age-induced bone loss. While microRNAs regulate osteogenic cell behavior and bone mineral acquisition, however, their function to osteoblast senescence during age-mediated osteoporosis remains elusive. This study aims to utilize osteoblast-specific microRNA-29a (miR-29a) transgenic mice to characterize its role in bone cell aging and bone mass. Young (3 months old) and aged (9 months old) transgenic mice overexpressing miR-29a (miR-29aTg) driven by osteocalcin promoter and wild-type (WT) mice were bred for study. Bone mineral density, trabecular morphometry, and biomechanical properties were quantified using μCT imaging, material testing system and histomorphometry. Aged osteoblasts and senescence markers were probed using immunofluorescence, flow cytometry for apoptotic maker annexin V, and RT-PCR. Significantly decreased bone mineral density, sparse trabecular morphometry (trabecular volume, thickness, and number), and poor biomechanical properties (maximum force and breaking force) along with low miR-29a expression occurred in aged WT mice. Aging significantly upregulated the expression of senescence markers p16INK4a, p21Waf/Cip1, and p53 in osteoporotic bone in WT mice. Of note, the severity of bone mass and biomechanical strength loss, as well as bone cell senescence, was remarkably compromised in aged miR-29aTg mice. In vitro, knocking down miR-29a accelerated senescent (β-galactosidase activity and senescence markers) and apoptotic reactions (capsas3 activation and TUNEL staining), but reduced mineralized matrix accumulation in osteoblasts. Forced miR-29a expression attenuated inflammatory cytokine-induced aging process and retained osteogenic differentiation capacity. Mechanistically, miR-29a dragged osteoblast senescence through targeting 3′-untranslated region of anti-aging regulator FoxO3 to upregulate that of expression as evident from luciferase activity assessment. Low miR-29a signaling speeds up aging-induced osteoblast dysfunction and osteoporosis development. Gain of miR-29a function interrupts osteoblast senescence and shields bone tissue from age-induced osteoporosis. The robust analysis sheds light to the protective actions of miR-29a to skeletal metabolism and conveys a perspective of miR-29a signaling enhancement beneficial for aged skeletons

It has been previously shown that Low-Magnitude High-Frequency Vibration (LMHFV) is able to enhance ovariectomy-induced osteoporotic fracture healing in rats. Fracture healing begins with the inflammatory stage, and all subsequent stages are regulated by the infiltration of immune cells such as macrophages and the release of inflammatory cytokines including tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6) and interleukin-10 (IL-10). Therefore, the aim of this study was to investigate the effect of LMFHV treatment on the inflammatory response in osteoporotic fracture healing. In this study, ovariectomy-induced osteoporotic and sham-operated closed-femoral fracture SD-rats were randomized into three groups: sham control (SHAM), ovariectomized control (OVX-C) or ovariectomized vibration (OVX-V) (n=36, n=6 per group per time point). LMHFV (35Hz, 0.3g) was given 20 min/day and 5 days/week to OVX-V group. SHAM operation and ovariectomy were performed at 6-month and closed femoral fracture was performed at 9-month. Callus morphometry was determined by callus width from weekly radiography. Local expressions of inducible nitric oxide synthase (iNOS) (macrophage M1 marker), CD206 (macrophage M2 marker), TNF-α, IL-6 and IL-10 were detected by immunohistochemistry and quantified by colour threshold in ImageJ, assessed at weeks 1 and 2 post-fracture. Significant difference between groups was considered at p≤0.05 by one-way ANOVA. Callus formation was higher in OVX-V than that of OVX-C as shown by callus width at weeks 1 and 2 (p=0.054 and 0.028, respectively). Immunohistochemistry results showed that CD206 positive signal and the M2/M1 ratio which indicates the progression of macrophage polarization were significantly higher in OVX-V rats (p=0.053 and 0.049, respectively) when compared to OVX-C at week 1. Area fraction of TNF-α positive signal was significantly higher in SHAM and OVX-V rats at week 1 (p=0.01 and 0.033, respectively). IL-6 signal was also significantly higher in SHAM and OVX-V groups at week 1 (p=0.004 and 0.029, respectively). IL-10 expression was significantly lower in SHAM and OVX-V groups at week 1 (p=0.013 and 0.05, respectively). Here we have shown that LMHFV treatment promoted the shift from pro-inflammatory stage towards anti-inflammatory stage earlier. It has been reported that the polarization of pro-inflammatory macrophages M1 to anti-inflammatory macrophages M2 was indicative of the endochondral ossification process in the long bone fracture model. Besides, we found that LMHFV treatment enhanced pro-inflammatory markers of TNF-α and IL-6 and suppressed anti-inflammatory marker of IL-10 at week 1, showing that inflammatory response was enhanced at week 1 post-fracture. These inflammatory cytokines involved in fracture healing were shown to coordinate different fracture healing processes such as mesenchymal stem cell recruitment and angiogenesis. Our previous study has demonstrated that ovariectomized rats exhibit lower levels of inflammatory response after fracture creation. Therefore, we report that LMHFV treatment can modulate macrophage polarization from M1 to M2 at an earlier time-point and partly restore the impaired inflammatory response in OVX bones at the early stage of fracture healing that may lead to accelerated healing of osteoporotic fracture as shown by promoted callus formation

We report the case of a 12-year-old boy with flexion loss in the left elbow caused by deficient of the concavity corresponding to the coronoid fossa in the distal humerus. The range of motion (ROM) was 15°/100°, and pain was induced by passive terminal flexion. Plain radiographs revealed complete epiphyseal closure, and computed tomography (CT) revealed a flat anterior surface of the distal humerus; the coronoid fossa was absent. Then, the bony morphometric contour was surgically recreated using a navigation system and a three-dimensional elbow joint model. A three-dimensional model of the elbow joint was made preoperatively and the model comprising the distal humerus was milled so that elbow flexion flexion of more than 140° could be achieved against the proximal ulna and radius. Navigation-assisted surgery (contouring arthroplasty) was performed using CT data from this milled three-dimensional model. Subsequently, an intraoperative passive elbow flexion of 135° was obtained. However, active elbow flexion was still inadequate one year after operation, and a triceps lengthening procedure was performed. At the final follow-up one year after triceps lengthening, a considerable improvement in flexion was observed with a ROM of −12°/125°. Plain radiographs revealed no signs of degenerative change, and CT revealed the formation of the radial and coronoid fossae on the anterior surface of the distal humerus. Navigation-assisted surgery for deformity of the distal humerus based on a contoured three-dimensional model is extremely effective as it facilitates evaluation of the bony morphometry of the distal humerus. It is particularly useful as an indicator for milling the actual bone when a model of the mirror image of the unaffected side cannot be applied to the affected side as observed in our case

Purpose. The purpose of this study is to analysis and compare the micro-structural and mechanical properties of subchondral trabecular bone of non-osteoarthritic and osteoarthritic distal femur using a micro-images based on finite element analysis. Materials and Methods. Fifteen distal femur were harvested from the eight cadevers(5 males, 3 females; non-OA, 10, OA, 5). The subchondral trabeculae were obtained from the middle of artticular surface of distal femurs(Fig. 1). Cylinderical saw with 10 mm diameter was used to acquire trabecular bone core. Total 15 specimens were scanned using micro-CT (SkyScan-1172, SKYSCAN, Belgium) at 24.9ãŽ> of spatial resolution under 70ãŽ,'s voltage and current of 141ãŽ,. 2-D images with were established by an imaging software (TomoNT, SKYSCAN, Belgium) as shown in Fig. 2. Histomorphologic index, trabeculae thickness (Tb.Th), trabecular separation (Tb.Sp), bone volume (BV), bone volume fraction (BV/TV), structure model index(SMI) were determined by the ANT software (Table 1). Based on 2-D images, a finite element model was reconstructed (Fig. 3). Finite element analysis was done using BIONIX (CANTIBIO, Suwon, Korea). Yield stress (MPa), Stiffness was calculated with ANSYS 10.0(ANSYS, Inc) (Fig. 4). Results. The descriptive statistics of the microstructural and mechanical parameters are presented in Fig. 4. The results showed that trabecular bone of osteoarthritic distal femur had a decrease in Tb.Th, BV/TV and had an increase in Tb.Sp and SMI than non-osteoarthritic group. There was a decrease in the yield stress. Conclusion. The results of bone morphometry index and strength showed that subchondral trabeculae of osteoarthritic group was more degenerative structure and decreased strength. And, this results are contribution to understand the osteoarthritic change in bone remodeling aspect

INTRODUCTION. Appropriate, well characterized animal models remain essential for preclinical research. This study investigated a relevant animal model for cancellous bone defect healing. Three different defect diameters of fixed depth were compared in both skeletally immature and mature sheep. This ovine model allows for the placement of four confined cancellous defects per animal. METHODS. Defects were surgically created and placed in the cancellous bone of the medial distal femoral and proximal tibial epiphyses (See Figure 1). All defects were 25 mm deep, with defect diameters of 8, 11, and 14 mm selected for comparison. Defects sites were flushed with saline to remove any residual bone particulate. The skeletally immature and mature animals corresponded to 18 month old and 5 year old sheep respectively. Animals were euthanized at 4 weeks post-operatively to assess early healing. Harvested sites were graded radiographically. The percentage of new bone volume within the total defect volume (BV/TV) was quantified through histomorphometry and μ-CT bone morphometry. Separate regions of interest were constructed within the defect to assess differences in BV/TV between periosteal and deep bone healing. Defect sites were PMMA embedded, sectioned, and stained with basic fuschin and methylene blue for histological evaluation. RESULTS. The animals tolerated the surgery well, with no incidence of fractures within the four weeks. Healing of the defects progressed via endochondral ossification, with none of the defects being completely healed within the 4 week time point. Bone volume fraction (BV/TV) significantly decreased with an increasing defect diameter. Actual bone volume (BV), however, increased with defect diameter, suggesting a correlation between biological response and severity of injury. Three distinct healing regions were found to exist within the defect and along the axis of the defect, with significant differences detected in the BV/TV between adjacent regions. Histologically, the 5 year old animals appeared to have decreased osteoblast activity, and lower osteocyte density within the newly formed woven bone. On occasion, the defects were found to intersect the tibial growth plate in the 18 month old animals, with bone replacing the proliferating chondrocyte zone (See Figure 2). Additionally, the 14 mm defect was not able to be placed in the tibia of sheep due to the possibility of the defect entering the tibial intramedullary (IM) canal, and the lack of cancellous bone between the tibial plateau and IM canal. Both these issues considerably affect this model and should be avoided. CONCLUSION. The surgical placement of 11 mm diameter defects in the proximal tibial and distal femoral epiphyses of skeletally mature sheep presents a suitable large animal model to study early healing of cancellous bone defects. This refined model allows for the placement of four separate non-healing defects within a single sheep, and allows for the possibility to reduce animal numbers required to obtain information