Objectives: This study was aimed to investigate the effect of Bojungikgitang-gagambang (BJIG) on longitudinal bone growth in rats. Methods: The BJIG treated group (300 mg/kg) and the control group (vehicle) were administered orally twice daily for 4 days. To investigate the effects of BJIG we measured body weight gain. The bone growth effect was analyzed by measuring between fluorescent lines marked with tetracycline, which plays the role of fluorescent dye on the surface of the tibia. Tetracycline was intraperitoneally injected. The height of growth plates in the epiphyseal plate was measured. The expression of bone morphogenetic protein-2 (BMP-2) and insuline-like growth factor-1 (IGF-1) was investigated by immunohistochemistry. Results: BJIG caused a significant acceleration of longitudinal bone growth of $349.7{\pm}15.9{\mu}m/day$ compared to control ($319.8{\pm}21.4{\mu}m/day$). The height of overall growth plate was not significantly more compared to the control, but the size of cells in the proliferative zone and hypertrophic zone were. In the immunohistochemistry, BMP-2 and IGF-1 were expressed markedly in the proliferative or hypertrophic zone, respectively. Conclusions: BJIG stimulated the chondrocyte hypertrophy and chondrogenesis in the growth plate and directly increased the longitudinal tibia length of rats.
Purpose: Prior to closure of the epiphysis of the distal phalanx, fracture usually occurs through the growth plate, Salter-Harris type I or II, or through the juxtaepiphyseal region 1 to 2 mm distal to the growth plate. The terminal tendon of extensor inserts into the epiphysis only, while insertion site of the flexor digitorum profundus spans both the epiphysis and metaphysis. Because of the difference between these tendon insertions, this injury mimics a mallet deformity. But, this type of injury does not involve a tear or avulsion of the extensor, unlike mallet finger of adults. Seymour was the first to describe this type of injury in children and called after his name, Seymour's fracture. This fracture is prone to infection or remain the residual deformity unless adequate treatment. Methods: We report a case of Seymour's fracture. A 9-year-old boy presented a laceration of the nail matrix, with the nail lies degloved from the nail fold on the right middle finger gotten from an impact against a door. An X-ray examination showed the fracture line lying 1 mm distal to the growth plate. The injury was treated with debridement and the fracture was reduced by applying hyperextension force. Under the C-arm, a single 0.7 mm K-wire was used to immobilize the distal interphalangeal joint. Intravenous antibiotics were applied for 5 days after surgery. Results: The K-wire was removed in the 3rd week. No infection or significant deformity was found until follow-up of 12 months. Conclusions: Seymour's fracture may be at first classically mallet deformity by its appearance. But it is anatomically different and more problematic injury. If it isn't corrected at the time of injury, derangement of the extensor mechanism, and growth deformity of the distal phalanx may occur. The fracture site should be debrided, removed of any interposed soft tissue, and the patient should be given appropriate antibiotics. Reduction should be maintained by K-wire fixation. We experienced no infection or premature epiphyseal closure.
Free or pedicled vascularized fibular grafts (VFG) are useful for the reconstruction of large skeletal defects, particularly in cases of scarred or avascular beds, or in patients with combined bone and soft tissue defects. Compared to non-VFG, VEG, which contains living osteocytes and osteoblasts, maintains its own viability and serves as good osteoconductive and osteoinductive graft. Due to its many structural and biological advantages, the free fibular osteo- or osteocutaneous graft is considered the most suitable autograft for the reconstruction of long bone defects in the injured extremity. The traditional indication of VFG is the long bone and soft tissue defect, which cannot be reconstructed using a conventional operative method. Recently, the indications have been widely expanded not only for defects of midtibia, humerus, forearm, distal femur, and proximal tibia, but also for the arthrodesis of shoulder and knee joints. Because of its potential to allow further bone growth, free fibular epiphyseal transfer can be used for the hip or for distal radius defects caused by the radical resection of a tumor. The basic anatomy and surgical techniques for harvesting the VFG are well known; however, the condition of the recipient site is different in each case. Therefore, careful preoperative surgical planning should be customized in every patient. In this review, recently expanded surgical indications of VFG and surgical tips based on the author's experiences in the issues of fixation method, one or two staged reconstruction, size mismatching, overcoming the stress fracture, and arthrodesis of shoulder and knee joint using VFG are discussed with the review of literature.
Fine structure of the distal femoral epiphysis of growing mouse was studied by electron microscopy. The first morphological evidence of developing secondary center of ossification in the distal femoral epiphysis was found at newborn mouse. Ossification center was in the form of multiple foci of calcification and its cells were represented by remnant of degenerated cells within large lacunae that were separated by mineralized cartilaginous septa. Endochondral ossification beneath the articular cartilage proceeded in a less orderly manner than metaphyseal endochondral ossification. Columns of hypertrophied chondrocytes were not distinctly parallel to intercellular mineralized septa in all direction. Hypertrophied chondrocytes in the inner zone of the epiphseal center of ossification showed disintegrated. Resorption of mineralized cartilaginous septa was undertaken by perivascular cells and multinucleated chondroclasts. Resorption of the calcified cartilage was restricted to the region of ruffled border of the chondroclast. Growth along the metaphyseal side of the epiphyseal center of ossification was different from that along the articular surface. As the secondary center expanded toward the metaphyseal side, many vascular buds penetrated unmineralized cartilaginous septa and invaded viable chondrocytes. Many hypertrophied chondrocytes bodering the metaphyseal side of bone center remained viable after they became embedded in mineralized cartilaginous septa. This result suggested that the hypertrophied.
Objective: In this study effects of three types of beddings on broiler leg health and bone biomechanics were evaluated. Methods: A total of 504 male chicks (Ross 308) were randomly placed on three beddings (4 replicates/group; 42 birds/pen), zeolite-added litter (ZL), plastic-grid flooring (PF), and wood shavings (WS). On day 42, chickens were weighed, slaughtered, and samples (bone, muscle, and drumstick) were collected. Bones were subjected to leg health tests, morphometric measurements, biomechanical testing, and ash analysis. Results: Broilers in PF and WS groups showed higher live weight than the ZL group (p<0.001), and the incidence of tibial dyschondroplasia (TD) and varus valgus deformity due to distal bending was significantly higher in PF (p<0.001). Multinomial logistic regression showed that bedding has a significant (p = 0.038) contribution toward the development of TD. Tibial strength (p = 0.040), drumstick width (p = 0.001), and total femur and epiphyseal ash contents (p = 0.044, 0.016) were higher in the ZL group. Chicken live weight was correlated with tibial length and weight (r = 0.762, 0.725). Conclusion: Flooring and the type of bedding material directly affect broiler bone length, strength and leg health. Plastic bedding improves the slaughter weight of chickens on the expense of leg deformities, and zeolite litter improves leg health and bone strength.
In almost all biologic systems, mechanically induced electric charge separation is a fundamental phenomenon. Since the hypothesis was established that the generation of electric potentials in bone by mechanical stress including muscular force might control the activity in bone by mechanical stress including muscular force might control the activity of osseous cells and their biopolymeric byproduct, the concept of electrically mediate growth mechanism, which involves biological growth and bone remodeling by any means, in living systems has been applied clinically and experimentally to orthopedic fracture repair, the regulation of orthodontic tooth movement, epiphyseal cartilage regeneration, etc. On the other hand, recent numerous research data available show apparently that the mandibular condyle has the characteristics of growth center as well as growth site. In addition, there exists a considerable difference of opinion as to the role of external pterygoid muscle in condylar growth. In view of these evidences, this. experiment was performed to investigate the effect of the galavic current on the growth of the mandible and condyle for elucidating the nature of condylar growth. The bimetallic device was composed of silver and platinum electrode connected with resistor (3.9 Mohm), which was expected to produce galvanic current of 23.6 nA according to the galvanic principle. The 25 Sprague-Dawley rats were divided into two group, 2 week group comprising 8 animals exposed to satanic current for 2 weeks and 3 control animals not exposed for 2 weeks, 4 week group comprising 10 animals in experimental group and 4 animals in control group applied for 4 weeks respectively. The experimental rats were subjected to application of the galvanic current invasively to codylar head surface and the control groups with sham electrode. On the basis of anatomic and histologic data from the mandibular condyle of experimental and control group, the following results were obtained. 1. After 2 weeks, there was no increase of mandibular size in experimental group over that of the control group. 2. After 4 weeks, the size of the condylar head was larger in experimental group than that of the control. 3. In 2 week group, the thickness of the mitotic compartment and hypertrophic chondroblastic layer was increased in experimental group. 4. In 4 week group, the number and the size of the hypertrophic chondroblasts were increased significantly on experimental group over that of the control group. 5. The application of the satanic current caused an increase in chondrocytic hypertrophy and intercellular matrix in both groups.
The triplane fracture has been described as a fracture of the distal tibial epiphysis occurring across three planes-sagittal, transverse and coronal. The characteristic pattern of fusion of distal tibial epiphysis explains the special configuration of the fragments in the triplane fracture. According to Dias-Tachdjian classification, triplane fracture is classified two part fracture, three part fracture, four part fracture and two part fracture with extension to the medial malleolus. Among four types, two part triplane fracture with extension to the medial malleolus is a relatively rare injury and generally is not treated by closed reduction. Such fractures should have an anatomic reduction and adequate fixation to restore the joint congruity and obtain an anatomic reduction of the growth plate to prevent a future growth deformity. This is usually best accomplished with an open reduction and screw fixation or k-wire fixation. We experienced two part triplane fracture with extension to medial malleolus and check the CT to define the extent of the injury completely. And then we underwent open reduction and screw fixation for the fracture. As a result, we present four cases of two part triplane fracture with extension with review of related literatures.
"Rickets" is the term applied to impaired mineralization at epiphyseal growth plate, resulting in deformity and impaired linear growth of long bones. Rickets may arise as a result of vitamin D deficiency or abnormality in metabolism. Vitamin D-dependent rickets(VDDR) is rare autosomal recessive disorder in which affected individuals have clinical features of vitamin D deficiency. In 1961, Prader first described this disorder including severe clinical features of rickets, such as hypophosphatemia, hypocalcemia, muscle weakness and seizure. Two distinctive hereditary defects, type I VDDR and type II VDDR have been recognized in vitamin D metabolism. Type I VDDR may be due to congenital defects of renal 1 ${\alpha}$-hydroxylase, the enzyme responsible for conversion of $25(OH)D_3$. These patients have low to detectable $1,25(OH)_2D_3$ in presence of normal to raised $25(OH)D_3$. In type II VDDR, renal production of $1,25(OH)_2D_3$ is intact but $1,25(OH)_2D_3$ is not used effectively and target organ resistant to $1,25(OH)_2D_3$ is respectively derived from the abnormality in the vitamin D receptor. We report a case of a 25 month-old girl with typical clinical features of VDDR type I rickets, hypocalcemia, increased alkaline phosphatase and secondary hyperparathyroidism.
In order to investigate the relationship between the menarche and the bone maturity of growing girls, the author interviewed about the date of menarche of 70 girls and assessed their bone maturity by hand-wrist radiographs. The results and conclusion were as iollows ; 1. The mean menarcheal age was $12.04{\pm}0.82$ year. 2. There was significant correlation between the time interval after menarche and the ossification stage. 3. The skeletal maturation level at menarche was stage SMI 7 and SMI 8. 4. There was statistically different among the time intervals after menarche according to the ossification stage. 5. The epiphyseal union of radius began about 2 years after menarche. According to this study, the probability of clinical use can be accepted in some range. In another words, skeletal age can be predicted by just interviewing the date and time interval of menarche without hand-wrist radiograph, also, with this information, the level of maxillofacial growth can be assessed.
Among many maturation indicators of growing patients, menarche and skeletal maturity are useful to assess growth and development, and the changes of the first and third finger are relatively important in hand-wrist X-rays. The objective of this study was to evaluate the relationship between menarche and the changes of the phalanx of the first and third finger and compare skeletal maturation among different malocclusion types. The sample used in this study was 29 Class 1,27 Class II and 27 Class III females whose hand-wrist X-rays had been taken with 6 month interval before the appearance of ulnar sesamoid ossification till the phalanges of the fingers were almost fused. The results were as follows. 1. There was no skeletal maturity difference among malocclusion types. 2. There was no difference in the mean chronologic age of menarche among different malocclusion types and that was $12.30\pm0.98$ years. 3. The ulnar sesamoid was observed at $10.35\pm1.01$ years, and on distal phalanx of the first finger, epiphyseal capping appeared at $11.26\pm1.04$ years and fusion at $13.12\pm1.06$ years. The epiphyseal capping on middle phalanx of the third finger was observed at $11.57\pm1.02$ years and fusion at $13.72\pm1.04$ years. 4. The timing of menarche occurred around the same time as the fusion process of distal phalanx of the first finger(p<0.001, r=0.82) and the initiation of fusion of middle phalanx of the third finger(p<0.001, r=0.78). Therefore, we can give the aid when we evaluate the growth and development of growing females seeing the changes at phalanx of the first and third finger.
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