The role of the periosteum in the growth of long bones. An experimental study in the rabbit
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Hemicircumferential division of the periosteum was performed on the upper tibia of the rabbit. Division of the medial side regularly caused a valgus angulation, but other injuries about the upper tibia had no effect. The cause of deformity after periosteal damage is discussed.Keywords:
Periosteum
Rabbit (cipher)
Valgus deformity
Distal tibia
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The blood supply of the periosteum of the human tibia was investigated by anatomical dissection of 12 lower extremities which were filled with injection mass. By division of the tibia into 4 segments (proximal and distal fifths; proximal and distal diaphysis) a general supplying system of the periosteum was found. The proximal fifth of the tibial periosteum is nourished by branches of the arteriae recurrentes tibiales anterior et posterior and the aa. inferiores medialis et lateralis genus. At the proximal diaphysis (next three tenths of the tibia) periosteal branches arise from the aa. tibialis anterior and posterior, whereas the distal diaphysis is nourished exclusively by semicircular vessels of the a. tibialis anterior which twine around the bone and merge with each other at the facies medialis. Concerning the periosteal blood supply of the distal fifth of the tibia, two different types were found. In two thirds of the cases the lateral side was nourished by branches of the a. tibialis anterior, which are supported by vessels from the a. fibularis. In one third the latter branch was absent so that the rami periostales arising from the a. tibialis anterior nourished the lateral aspect of the distal tibia alone. The dorsal region was supplied in all cases by rami of the a. fibularis and a. tibialis posterior. On the medial side the periosteal nourishment is ensured only by anastomosis. Branches of the a. tibialis anterior supply the facies lateralis and facies posterior where it is supported by vessels of the a. tibialis posterior and in a minor region of rami of the a. fibularis (distal) and a. poplitea (proximal). Both the facies lateralis and facies posterior are nourished by direct branches which arise from the main arteries of the lower leg, whereas the facies medialis is supplied only by capillary anastomosis. The a. tibialis anterior is the artery of great importance concerning the arterial supply of the periosteum and the outer aspect of the cortex of the tibia. The autonomous region of this vessel is the periosteum of the distal diaphysis. It is known that this region has the highest incidence of congenital and acquired pseudarthrosis. Therefore an osteo- or corticotomy should be avoided in the distal diaphysis.
Periosteum
Diaphysis
Blood supply
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The formation of cartilage is described in the repair of the fractured fibula of the guinea pig. Cartilage and bone developed from a common blastema and transitions occurred between them. No convincing evidence was found that cartilage was ever directly transformed into bone. In some guinea pigs, whether with the fibula fractured or not, the tibia and fibula came into contact near the distal end, and the apposed periostea fused and chondrified. Later the cartilage was resorbed from below and replaced by bone. Thus, the tibia and fibula were united by a bony connection near their distal ends. In the chondrification of the periostea, the fibrous layer was involved as well as the cambial layer. In some specimens the periostea chondrified without fusing, making a structure resembling a nearthrosis. In the normal development of the rat, the tibia and fibula become fused near their distal ends within a few days after birth. The fusion process begins in the periostea, which unite. The cambial layers then chondrify, and the chondrification process spreads through the fused fibrous layers so that the two bones are united by a cartilaginous pad. This pad is later replaced by bone from below so that a bony union is established. In the embryo chick, metatarsals 2, 3, and 4 are at first separate cartilages. Periosteal bone develops around each cartilage and at first there is no connection between the three bones. Later, bony trabeculae form on the anterior and posterior aspects, connecting pairs of adjacent bones, close beneath the common fibrous periosteum. The fusion thus occurs without the formation of cartilage. In the frog, the tibia and fibula, and the radius and ulna, become fused during metamorphosis. No cartilage is formed during the fusion, the two bones becoming enclosed in a common sheath of periosteal bone which develops beneath the common fibrous periosteal layer. In a discussion of the induction of cartilage formation it is concluded: (1) That presumptive cartilage cells of the embryo chondrify independently of mechanical stimulation, the determining agent being presumably humoral: (2) That cells which do not normally chondrify, but which belong to the skeletal group, form cartilage if they are subjected to certain mechanical conditions, and that these conditions include pressure and shear; (3) That cells of the non-skeletal connective tissue group can form cartilage only if they undergo an induction, presumably by a humoral agent, and that no further mechanical stimulation seems then to be required.
Periosteum
Bridge (graph theory)
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We reviewed the cases of seven children with post-traumatic tibia valga in order to determine whether spontaneous improvement of this deformity occurs with growth. The children were between eleven months and six years and four months old at the time of injury and were followed for an average of thirty-nine months after the fracture. The valgus deformity appeared to progress during the period of fracture-healing as well as after union of the fracture, as determined clinically and radiographically. The angulation progressed most rapidly during the first year after the injury, and then continued at a slower rate for as long as seventeen months. Overgrowth of the tibia by as much as 1.7 centimeters accompanied the angular deformity. Adequate clinical correction then occurred spontaneously in six of the seven patients. Because this spontaneous improvement of the deformity usually occurred with growth, we recommend a conservative approach to the management of both the acute fracture and the subsequent valgus deformity.
Valgus deformity
Distal tibia
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Valgus deformity
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The mode of action of the periosteum in the growth of the long bones was investigated by comparing the activity of the growth plate after hemicircumferential and longitudinal periosteal incisions. Twenty-eight rabbits were divided into three groups. A longitudinal periosteum incision was made on the medial upper tibia in rabbits of Group A, and a hemicircumferential periosteum incision was made in Group B. An incision of the skin and superficial tissue only, similar to the skin incision of Groups A and B, was performed on rabbits in Group C. Certain differences in the development of the right tibia compared to the control side were observed in rabbits of Group B: (1) valgus deformity, 5 degrees-10 degrees; (2) overgrowth, 1-2 mm; (3) an S-shaped tibia deformity. The dynamics of the deformity support the mechanical theory because the direction of periosteum division was an important factor in the appearance of growth disturbances.
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The cause and mechanisms of the migration of tendons and ligaments were studied in young rabbits. Three techniques were used: (1) Marking of insertions, the neighbouring periosteum and the diaphysis with metallic markers. (2) Marking of insertion sites by tetracycline as an indicator of osteogenesis. (3) Histological examination. The insertions used in the study were of three different characters: (1) Insertions subject to muscular traction (patellar ligament, quadratus femoris muscle, tibialis anterior muscle). (2) The distal insertions of the medial collateral ligament of the knee, stretched by the activity of the proximal epiphyseal cartilage of the tibia. (3) The proximal and distal insertions of the anterior annular ligament of the tibia, inserted solely in bone and periosteum. The cause of migration is the growth of periosteum dragging the insertions during its stretching, caused itself by the activity of the epiphyseal plates. The local mechanism governing migration while ensuring a continuous connexion with the bone is not the same in all sites. It depends upon the character of the bony surface at the insertion and of the function of the insertion zone, which can be osteogenic, resorptive or both. A plexus of precollagenous fibres is present at all resorptive insertion sites, and at some of the osteogenic sites.
Periosteum
Medial collateral ligament
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Thirty-six tibiae from 11 female and 7 male cadavers were dissected. Anatomical and histological examinations of the plantar flexor muscle origins at the posteromedial border of the tibia were performed. Many individual variations in the type and size of muscle origin were observed. Muscle fibers and/or connective tissue in different proportions attached the muscle to the periosteum or directly to the cortical bone. The length of the attachments varied greatly and there was a considerable overlap of the muscles in some individuals. The attachments of the flexor digitorum longus overlapped the tibialis posterior and the flexor digitorum longus muscle was overlapped by the soleus muscle. In two cases the soleus muscle did not attach to the tibia at all. Our findings may shed some light on the question as to why some athletes sustain posteromedial tibial stress fractures and others develop shin splits or other posteromedial injuries from similar precipitating activity.
Periosteum
Plantar flexion
Flexor Digitorum Longus
Flexor muscles
Muscle belly
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Hemicircumferential division of the periosteum was performed on the upper tibia of the rabbit. Division of the medial side regularly caused a valgus angulation, but other injuries about the upper tibia had no effect. The cause of deformity after periosteal damage is discussed.
Periosteum
Rabbit (cipher)
Valgus deformity
Distal tibia
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Citations (55)
Clinical, experimental and histopathological studies were done on sixteen patients and four rabbits. Clinical material includes sixteen patients with bowlegs deformity, their ages ranged between 2 - 7 years and experimental material includes four rabbits each of them 5 weeks of age. Hemicircumferential periosteal release was done on rabbits (only one leg and the other leg is a control one) after ten weeks histopathological study to the proximal tibia was done on the operated and the non operated sides also hemicircumferential periosteal release was done on the patients at the proximal tibia on the medial side.growth changes occur in the tibia of the experimental animals and histopthological changes were observed at the growth plate adjacent to the divided periosteum and the clinical results on the patients were encouraging and correction of bowlegs occur within 6 - 8 months after operation.
Periosteum
Distal tibia
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