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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In five straight-stemmed, proximally porous-coated femoral components that were retrieved at revision arthroplasty from patients who had radiographic and clinical evidence of loosening, there was growth of bone into the porous coating. The components had been inserted during a primary arthroplasty in one woman and four men. The patients ranged in age from thirty-seven to sixty-seven years. Three patients were heavy, and all five were active. All patients had had an excellent early result from the initial arthroplasty; at the one-year follow-up, the mean Harris hip score had been 91 points. Pain in the hip developed in all of the patients, between one and three years after the index procedure. Initial radiographs had revealed excellent position and fixation of the prosthetic components, but the components then subsided between one and three and one-half years after the index procedure. All of the femoral components were found to be grossly loose at the revision operation. Nevertheless, all of the prosthetic components demonstrated growth of bone into 4 to 44 per cent (mean, 24 per cent) of the pore spaces available for ingrowth. Woven bone and fracture callus were found in the curettings from the proximal part of the femur. The findings in these five patients suggest that late failure of uncemented porous-surfaced femoral components can occur despite the presence of extensive ingrowth of bone. These failures may be the result of fatigue fractures of the trabeculae of the osseous ingrowth into the porous surfaces. Caution is warranted in the liberal use of these prosthetic components in heavy, active patients.
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PMID:Ingrowth of bone in failed fixation of porous-coated femoral components. 152

Peripheral nerve injury occasionally results from long bone fractures, but bony entrapment of a peripheral nerve occurs infrequently. Bony entrapment of a peripheral nerve is usually associated with upper extremity fractures. In a 34-year-old man bony entrapment of the superficial peroneal nerve occurred in a healed midshaft fibular fracture. The patient complained of progressive pain over the distribution of the superficial peroneal nerve after sustaining a closed displaced tibial and fibular fracture that healed in nonanatomic alignment. Exploration revealed bony entrapment of the superficial peroneal nerve in the fracture callus, with reactive neuroma formation. Excision of the neuroma resulted in complete relief of the symptoms. Persistent pain over the distal anterolateral leg and dorsal foot following a fibular and tibial fracture is usually derived from a compartment syndrome. If this has been ruled out, the differential diagnosis should include bony entrapment of the superficial peroneal nerve.
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PMID:Bony entrapment of the superficial peroneal nerve. 670 80

Stress fractures of the femoral diaphysis in young children are rare. Pain and an antalgic gait are the most common features. There is usually no history of either trauma or a recent increase in physical activities. Initial radiographs may be normal. Technetium bone scanning is the most sensitive method of early diagnosis, but may not be diagnostic. Computed tomography and magnetic resonance imaging are useful in early confirmation of the diagnosis. Serial radiographs will show maturation of the periosteal new bone with evidence of repair. Biopsy should be avoided, except in cases of obvious neoplasm shown by computed tomography or magnetic resonance imaging, or in cases with progressive cortical destruction shown on serial radiographs, because fracture callus may be difficult to distinguish from osteosarcoma. Treatment consists of protected weight bearing and activity restriction until resolution of symptoms and radiographic evidence of healing.
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PMID:Stress fractures of the femoral diaphysis in young children. A report of 2 cases. 764 34

Stress fractures of the axial and appendicular skeleton typically present as localized pain that develops without a history of specific acute injury. The differential diagnosis includes primary or metastatic neoplasms, infections, musculoskeletal soft tissue injuries, nerve compression syndromes and joint diseases. Plain radiographs may demonstrate changes consistent with fracture, including a fracture line or fracture callus. In many cases, however, initial radiographs are normal or nondiagnostic. This occurs most frequently in three situations: (1) when radiographs are obtained soon after the onset of symptoms, before the appearance of a fracture line or new bone formation; (2) in patients with osteopenia, in whom detection of a fracture line and new bone formation is difficult, and (3) when the fracture involves areas of the skeleton that are difficult to study with plain films (including the spine and pelvis). When the plain films are normal, other tests such as bone scans, computed tomography or magnetic resonance imaging usually demonstrate the fracture.
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PMID:Stress and insufficiency fractures. 922 73

Fluoroscopy monitors intra-articular distal radial fracture reduction and stabilisation. The reduction is guided by traction, ligamentotaxis and manipulation, and when necessary, completed by minimally invasive percutaneous or limited open instrumentation. Kirschner wires effectively splint the reduction until fracture callus is visualised on X-ray. An occasional mini plate is required to buttress a displaced volar medial lunate facet (die punch) fragment into position. First, major metaphyseal articular fragments are approximated to restore the articular surface. Smaller fragments follow their larger counterparts into position or may be ignored (the "Rule of the Majority" or "Vassal Rule"). The repaired metaphysis is then aligned with and stabilised to the diaphysis. Cancellous bone may be inserted through small targeted incisions when defects and areas of comminution are present. The wrist is splinted in a functional (slightly extended) position for three to four weeks in uncomplicated cases. Digital elevation and rehabilitation are emphasised during the early stages of fracture healing. After callus appears on X-ray, progressive wrist rehabilitation is initiated and the patients are weaned from their splints. Minimally invasive surgical intervention, good pain control and early rehabilitation maximise functional recovery and minimise morbidity, medical costs and lost work time.
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PMID:Percutaneous and limited open reduction of intra-articular distal radial fractures. 1130 1

Osteoid osteoma is a benign bone forming neoplasm that is characterized by its small size (less than 2 cm), self-limited growth, and the tendency to cause extensive reactive changes in the adjacent tissue. The lesion classically presents with severe pain at night that is dramatically relieved by NSAIDs. The tumor has been shown to express very high levels of prostaglandins, particularly PGE2 and PGI2. The high local levels of these prostaglandins are presumed to be the cause of the intense pain seen in patients with this lesion. One generally accepted form of treatment is the prolonged use of NSAIDs. Since the cyclooxygenases are thought to be the source of these prostaglandins, and the central target of NSAIDs, we evaluated the expression of cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2) in osteoid osteoma tissues from patients following surgery. In the 12 specimens examined we found that the tumor osteoblasts had strong immunohistochemical staining for COX-2, while the staining in the surrounding host osteoblasts in the reactive bone was scant. Significant COX-1 staining was also detected in both tumor and host osteoblasts. For comparison we examined the COX expression in human fracture callus, fibrous dysplasia, osteoblastoma, osteofibrous dysplasia, and myositis ossificans. With the exception of fracture callus, very limited amounts of COX-2 could be detected in these tissues. Taken together, we conclude that the increased production of prostaglandins by osteoid osteomas implicates that COX-2 is one of the mediators of this condition. These findings suggest that the newly selective COX-2 inhibitors could be used to more safely treat osteoid osteomas.
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PMID:COX-1 and COX-2 expression in osteoid osteomas. 1600 74

The objective of the present study was to conduct a corresponding histological analysis of 162 macroscopically assessed keel bones (1: severe, 2: moderate, 3: slight, 4: no deformity). Four layer lines were used and hens were kept in furnished cages, small group systems (both allowing more activities due to the provision of perches) and an aviary system, which fully conformed to the EU standards. Investigations were carried out in the 3rd, 6th, 9th and 12th laying month of two experimental trials. In 97.9% of grade 4 keel bones, no histological deviations were found, whereas in keel bones manifesting deformities of grade 1 and 2, the predominant histological observation was the incidence of fracture callus material (FCM) and new bone in the form of woven bone. FCM was also detected in 50.9% of grade 3 keel bones, whereas in 40.7%, only s-shaped deviations of keel bones were found, which were related to extended pressure loading while perching activities rather than short-duration trauma. Histological analysis showed that keel bones of grade 1 and 2 were mainly attributed to traumatic origin and therefore associated with pain experience in layers. Grade 3 keel bones manifested either FCM as a result of trauma or adaptational deformities without any evidence of a preceding fracture in response to mechanical pressure loading and were most likely not associated with pain. Therefore, histological analysis was found to be a mandatory tool when evaluating grade 3 keel bones with respect to layers'welfare. Furthermore, this analysis corroborates the findings that in aviary systems deformities of keel bones are predominantly caused by painful fractures.
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PMID:Keel bone condition in laying hens: a histological evaluation of macroscopically assessed keel bones. 1841 25

Nonsteroidal antiinflammatory drugs (NSAIDs) are used to reduce inflammatory response and pain. These drugs have been reported to impair bone metabolism. Parecoxib, a specific COX-2 inhibitor, exerts an inhibitory effect on the mineralization of fracture callus after a tibial fracture in rats. Decreased bone mineral density (BMD) at a fracture site may indicate impairment of early healing, casting doubt on the safety of using COX-2 inhibitors during the early treatment of diaphyseal fractures. Forty-two female Wistar rats were randomly allocated to three groups. They were given parecoxib, indomethacin, or saline intraperitoneally for 7 days after being subjected to a closed tibial fracture stabilized with an intramedullary nail. Two and 3 weeks after surgery, the bone density at the fracture site was measured using dual energy xray absorptiometry (DEXA). Three weeks after the operation the rats were euthanized and the healing fractures were mechanically tested in three-point cantilever bending. Parecoxib decreased BMD at the fracture site for 3 weeks after fracture, indomethacin for 2 weeks. Both parecoxib and indomethacin reduced the ultimate bending moment and the bending stiffness of the healing fractures after 3 weeks. These results suggest COX inhibitors should be avoided in the early phase after fractures.
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PMID:Parecoxib and indomethacin delay early fracture healing: a study in rats. 1931 14

A 73-year-old female suffered from right hip pain without any history of antecedent trauma. The initial radiograph showed a slight narrowing of the joint space in the right hip. The patient was treated by non-weight bearing for 5 weeks. Radiographs obtained 3 months after the onset of pain showed the progression of both the joint-space narrowing and subchondral collapse at the superior portion. T1-weighted MR (magnetic resonance) images obtained 3 months after the onset revealed an irregular-shaped low-intensity area just beneath the articular cartilage as well as a low-intensity band, which was concave to the articular surface. A total hip replacement was performed. A histopathological examination revealed fracture callus and granulation tissue in the subchondral area. This subchondral fractured area was surrounded by vascular rich granulation tissue and fibrous tissue, which corresponded to the concave-shaped low-intensity band observed on the T1-weighted image.
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PMID:A histopathological evaluation of a concave-shaped low-intensity band on T1-weighted MR images in a subchondral insufficiency fracture of the femoral head. 1958 36

Osteogenesis imperfecta is one of the most commonly recognized inheritable disorders of the connective tissue leading to bone fragility. Usually it is associated to a genetic mutation inducing a reduction in collagen quality and entity production. It involves either modification in dentin formation or multiple bone fractures. The authors reviewed the clinical aspects of these disorders, focusing on oral and orthopaedic concerns, especially related to the histological features of the fracture callus, with respect to new trends in pharmacological and surgical treatments of bone fractures. Surgical treatment varies, according to the age of the patient. In children, surgical orthopaedic procedures include multiple osteotomies and the use of telescopic rods. Medical therapy has always to be associated to surgery and is designed to reduce the incidence of fractures, to increase growth velocity and to ally pain in order to improve mobility and independence. Bisphosphonates (BP) are considered potent inhibitors of bone resorption decreasing the osteoclast population and its activity and bone turn over.
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PMID:Orthopaedic and dental abnormalities in osteogenesis imperfecta: a review of the literature. 2202 55


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