Florid reactive periostitis ossificans of the humerus: Case report and differential diagnosis of periosteal lesions of long bones

A case of florid reactive periostitis ossificans(RPO) arising in a long bone is presented. This is a rare bone proliferation with a pronounced periosteal reaction. Less than 100 cases have been described in the literature with far fewer outside the bones of the hand, feet, fingers, and toes. Although the etiology is unknown, a relationship to preceding trauma is suggested. The imaging and histologic features show an overlap with other bone lesions including bizarre parosteal osteochondromatous proliferation, subungual exostosis, and malignant surface tumors of bone and cartilage which include, periosteal and parosteal osteosarcoma. It is important to recognize the clinical presentation and diagnostic features of RPO as a benign entity so that it is not mistaken for a more aggressive neoplasm. We present a case of a right distal humeral lesion that on histopathological review revealed florid RPO. This diagnosis was not suspected on imaging studies, but was made on open biopsy of the mass. The patient remains disease free, years postoperatively. In addition to presenting this unique case report, we review the pertinent literature, and offer a differential diagnosis and treatment strategy for its management.

Voriconazole-Induced Periostitis &Enthesopathy in Solid Organ Transplant Patients: Case Reports

Background: Voriconazole is frequently used to treat fungal infections in solid organ transplant patients. Recently, there have been reports suggesting that prolonged voriconazole therapy may lead to periostitis. Aim: Here we present two cases of voriconazole-induced periostitis in solid organ transplant patients. Case Presentation: Voriconazole was given to two transplant patients-one with a liver transplant and the second with a heart transplant, to treat their fungal infections. Both developed voriconazole-induced toxicity. While undergoing voriconazole therapy, they had incapacitating bone pain. The liver transplant patient had to be taken off voriconazole, and the heart transplant patient succumbed to non-voriconazole related causes. Conclusions: Voriconazole therapy in two solid organ transplant patients resulted in periostitis. We provide potential etiologies underlying voriconazole-induced periostitis, including fluoride toxicity, abnormalities in the pulmonary vascular bed leading to the production of downstream inflammatory mediators, and abnormal pharmacokinetics of hepatic drug metabolism. In addition to monitoring blood voriconazole trough levels, we suggest careful assessment for musculoskeletal pain in patients undergoing voriconazole treatment for two months or more, particularly if their daily dosages of voriconazole exceed 500 mg per day. Appropriate workup should include measurement of alkaline phosphatase and fluoride levels, voriconazole trough and bone scan. Overall, early recognition of voriconazole-induced musculoskeletal toxicity is important for better morbidity outcomes.

Voriconazole-associated periostitis:Pathophysiology,risk factors,clinical manifestations,diagnosis,and management

Voriconazole use has been associated with osteoarticular pain and periostitis,likely due to high fluoride content in the drug formulation.This phenomenon has been described primarily with high dosage or prolonged course of voriconazole therapy in immunocompromised and transplant patient populations.Patients typically present with diffuse bony pains associated with elevated serum alkaline phosphatase and plasma fluoride levels in conjunction with radiographic findings suggestive of periostitis.We provide a comprehensive review of the literature to highlight salient characteristics commonly associated with voriconazole-induced periostitis.

Early Prevention of Exercise-induced Tibia Periostitis for Long-Distance Runners in China＇ s Regular Universities

Exercise-induced tibia periostitis is one of the most common sports injuries in the sports training of athletics in regular institutions of higher learning. It often occurs. When it is serious, periosteal proliferation would occur, It will result in fatigue fi^cture sometimes. This is relevant to tibialis anterior muscle restrained contraction in the events in the sports process. If measures are not adopted, early prevention should be strengthened. This would not only affect seriously the sports achievement of long-distance runners, but also affects their future ordinary lives. Through analysis and summaries, the main reasons for the occurrence of tibia periostitis for long-distance runners are shown. From the perspectives of reasonably arranging the exercise load, strengthening the field management and strengthening the self-protection and so on, the prevention of tibia periostitis for long-distance runners has been explored. It also helps the long-distance runners to train scientifically, which can effectively avoid and lessen the occurrence of tibia periostitis and the adverse effect it brings.

Observation on Therapeutic Effect of Oblique Puncture plus Plucking Manual Technique for Fatigue Periostitis of Tibia

Purpose： To observe the clinical effect of oblique puncture plus plucking manual technique for fatigue periositis of tibia. Methods： 60 cases of the patients with fatigue periostitisof tibia were randomly divided into the treatment group of 30 cases treated by oblique puncture plus plucking manual technique, and the control group of 30 cases treated by ultra short wave. Results： The curative rate was 60.0% in the treatment group and 20.0% in the control group, and the total effective rate was 93.3% and 70.0% respectively. The therapeutic effect was better in the treatment group than in the control group （P〈0.05）. Conclusion： Oblique puncture plus plucking manual technique has a better therapeutic effect for fatigue periostitis of tibia.

MicroRNA-584-5p/RUNX family transcription factor 2 axis mediates hypoxia-induced osteogenic differentiation of periosteal stem cells

BACKGROUND The hypoxic environment during bone healing is important in regulating the differentiation of periosteal stem cells(PSCs)into osteoblasts or chondrocytes;however,the underlying mechanisms remain unclear.AIM To determine the effect of hypoxia on PSCs,and the expression of microRNA-584-5p(miR-584-5p)and RUNX family transcription factor 2(RUNX2)in PSCs was modulated to explore the impact of the miR-584-5p/RUNX2 axis on hypoxiainduced osteogenic differentiation of PSCs.METHODS In this study,we isolated primary mouse PSCs and stimulated them with hypoxia,and the characteristics and functional genes related to PSC osteogenic differentiation were assessed.Constructs expressing miR-584-5p and RUNX2 were established to determine PSC osteogenic differentiation.RESULTS Hypoxic stimulation induced PSC osteogenic differentiation and significantly increased calcified nodules,intracellular calcium ion levels,and alkaline phosphatase(ALP)activity in PSCs.Osteogenic differentiation-related factors such as RUNX2,bone morphogenetic protein 2,hypoxia-inducible factor 1-alpha,and ALP were upregulated;in contrast,miR-584-5p was downregulated in these cells.Furthermore,upregulation of miR-584-5p significantly inhibited RUNX2 expression and hypoxia-induced PSC osteogenic differentiation.RUNX2 was the target gene of miR-584-5p,antagonizing miR-584-5p inhibition in hypoxia-induced PSC osteogenic differentiation.CONCLUSION Our study showed that the interaction of miR-584-5p and RUNX2 could mediate PSC osteogenic differentiation induced by hypoxia.

Multiple Bone Involvement in Secondary Syphilis: Case Report

Syphilitic periostitis is not a common manifestation of bone involvement in congenital and acquired late syphilis, and it’s rarely seen in secondary syphilis. Syphilis should be considered as a differential diagnosis in patient with deep bony pain that worsens at night. We report a case of secondary syphilis presented with multiple bony swelling of both tibiae (sabre-like) and other long bones.

Differential involvement of Wnt signaling in Bmp regulation of cancellous versus periosteal bone growth

Bone morphogenetic proteins （Bmp） are well-known to induce bone formation following chondrogenesis, but the direct role of Bmp signaling in the osteoblast lineage is not completely understood. We have recently shown that deletion of the receptor Bmprla in the osteoblast lineage with Dmpl-Cre reduces osteoblast activity in general but stimulates proliferation of preosteoblasts specifically in the cancellous bone region, resulting in diminished periosteal bone growth juxtaposed with excessive cancellous bone formation. Because expression of sclerostin （SOST）, a secreted Wnt antagonist, is notably reduced in the Bmprla- deficient osteocytes, we have genetically tested the hypothesis that increased Wnt signaling might mediate the increase in cancellous bone formation in response to Bmprla deletion. Forced expression of human SOST from a Dmpl promoter fragment partially rescues preosteoblast hyperproliferation and cancellous bone overgrowth in the Bmprla mutant mice, demonstrating functional interaction between Bmp and Wnt signaling in the cancellous bone compat^a-tent. To test whether increased Wnt signaling can compensate for the defect in periosteal growth caused by Bmprla deletion, we have generated compound mutants harboring a hyperactive mutation （A214V） in the Wnt receptor Lrp5. However, the mutant Lrp5 does not restore periosteal bone growth in the Bmprla-deficient mice. Thus, Bmp signaling restricts cancellous bone accrual partly through induction of SOST that limits preosteoblast proliferation, but promotes periosteal bone growth apparently independently of Wnt activation.

Modified membrane fixation technique in a severe continuous horizontal bone defect:A case report

BACKGROUND Continuous severe horizontal bone defect is common in the aesthetic maxillary anterior area,and presents a major challenge in implant dentistry and requires predictable bone augmentation to increase the width of the alveolar bone.CASE SUMMARY A 24-year-old man,with a history of well-controlled IgA nephropathy,presented to the Dentistry Department of our hospital complaining of missing his right maxillary anterior teeth 1 mo ago.Severe horizontal alveolar bone defects at sites of teeth 12,13 and 14 were diagnosed.A modified guided bone regeneration surgical approach stabilizing the absorbable collagen membrane and particulate graft materials by periosteal diagonal mattress suture(PDMS)combined with four corner pins was used for this severe continuous horizontal bone defect.The outcome revealed that the newly formed alveolar ridge dimension increased from 0.72 mm to 11.55 mm horizontally 10 mo postoperatively,with no adverse events.The implant surgery was successfully performed.CONCLUSION This case highlights that PDMS combined with four corner pins is feasible to maintain the space and stabilize the graft and membranes in severe continuous horizontal bone defect.

Periosteal chondroma of the rib: A case report

BACKGROUND Periosteal chondroma is a very rare benign tumor that develops adjacent to the cortical surface of bone and beneath the periosteal membrane.Periosteal chondroma of the rib is an extremely rare entity.CASE SUMMARY The patient was a 43-year-old man who had been incidentally found to have a mediastinal mass 1 mo earlier.Plain computed tomography showed a lobulated soft tissue mass on the right side of the T4/5 vertebra that measured about 47 mm×28 mm in the transverse view and contained diffuse stippled calcification.The mass caused cortical scalloping of the right fourth rib and marginal bone sclerosis.Enhanced computed tomography showed mild enhancement of the mass.Magnetic resonance imaging showed a lobulated mass on the right side of the thoracic vertebra with long TI and T2 signals,mottling,and patchy long T1 and short T2 signals inside.The lesion had a hypointense rim.Enhanced magnetic resonance imaging showed enhancement predominantly at the periphery of the tumor.The tumor was approached through a right posterolateral thoracotomy,and parts of the fourth and fifth ribs were excised with the tumor.Postoperative pathological analysis revealed periosteal chondroma of the rib.CONCLUSION Periosteal chondroma of the rib has a low incidence and typical imaging manifestations.Understanding its imaging features is helpful to ensure a correct preoperative diagnosis.

Influence of bone morphogenetic protein on articular cartilage regeneration following periosteal grafting

Background: Autologous periosteal grafting is used as treatment for articular cartilage defect. Objective: To study the effect of bone morphogenetic protein (BMP) on articular cartilage regeneration following periosteal grafting. Methods: 16 healthy 15 week-old New Zealand white rabbits of both sexes (32 knees) were randomly divided into experimental group (group A) and control group (group B). A4.0 mmdiameter full-thickness articular cartilage defect was created in the femoral intercondylar fossa in all rabbits. Following this, a4.0 mmdiameter section of the periosteum was harvested from the anteromedial part of the upper tibial bone. In group A (eight rabbits, 16 knees), the cartilage defect was covered with periosteum, into which 20 μg BMP and 20% Pluronic were injected. In group B (eight rabbits, 16 knees), the cartilage defect was covered with periosteum, into which the same dosage of 0.9% NS (Normal saline) and 20% Pluronic were injected. All rabbits were sacrificed at 4, 8, and 12 weeks postoperatively, the cartilage defect areas were examined macroscopically and microscopically, and the morphology of the chondrocytes and collagen fibers were examined by scanning electron microscopy. Results: The filling of the defects with regenerated tissue was observed in both the group. The most notable improvement was that the cartilage regeneration in group A was obviously superior to that in group B, with the total histological score in group A significantly higher. Conclusion: BMP is an effective factor that could promote regeneration of articular cartilage and lead to successful cartilaginous resurfacing following periosteal

Periosteal pedicle graft for the treatment of gingival recession:A viable alternative to sub-epithelial connective tissue graft

Treating gingival recessions is important to satisfy the functional and aesthetic needs of the patients. Among various available techniques to treat gingival recessions, the subepithelial connective tissue graft technique is still considered to be the best despite its inherent disadvantages. The recent innovation utilising periosteum as a pedicle graft to treat gingival recession defects has drawn considerable attention and may provide a viable alternative to subepithelial connective tissue graft.

Revisiting the upper eyelid blepharoplasty advancement flap:adaptation for the repair of full-thickness upper eyelid defects—a case series

A blepharoplasty flap has been previously reported as a useful reconstruction approach for anterior lamellar defects lying between the lash line and the eyelid crease.We herein describe a variation of the blepharoplasty flap and suggest its use as an adjunct in the reconstruction of full-thickness lateral upper eyelid defects.Technique description and retrospective interventional case series.The reconstruction technique was used by an experienced oculoplastics surgeon(ASL)in 3 adults with malignant lesions involving the lateral upper eyelid margin,resulting in a post-excision 50%full-thickness defect between November 2017 and June 2020.The posterior lamella was reconstructed using an ipsilateral free tarsal graft and an inferiorly hinged transposition periosteal flap.The anterior lamella reconstruction was then performed using a local advancement flap utilizing the principles of upper blepharoplasty and Burow’s triangle.Almost full eyelid excursion and full gentle closure were evident at 1–2 weeks follow-up in all three cases.One case later developed 1–2 mm of gentle closure lagophthalmos and was managed successfully with topical lubricants.In all patients,the final eyelid contour and symmetry were adequate,with only minimal scarring,evident already 3 to 4 months postoperative.There were no major complications or need for revisions.The technique described herein highlights the utility of the blepharoplasty flap for lateral,full-thickness upper eyelid defects.This logical variation enables the reconstruction of significant defects using only local tissue,obeying the“like with like”principle,and helps avoid the need for a bridging flap.We provide preliminary evidence of the potential of a good cosmetic outcome of upper lid appearance and contour,together with a fast recovery of appropriate eyelid function.

Comparison of stem cell characteristics between perichondral-derived stem cells and periosteal stem cells in postnatal rats

Bone marrow mesenchymal stem cells(BMSCs),periosteal stem cells(PSCs),and other bone stem cells originate from embryonic bone formation,but their function and stem cell characteristics such as proliferation ability and differentiation ability change at different anatomical locations.Perichondral-derived stem cells(PCSCs)are more closely related to PSCs in origin and function,usually used to be studied together with PSCs as one type of stem cell.However,this leads to the ignoration of the PCSCs'characteristics.Since the anatomical locations of these two types of stem cells diverse,PCSCs should have some differences from PSCs.In this study,the PCSCs in the perichondrium surrounding the growth plate cartilage expressed CTSK and CD200 same as PSCs.However,when compared the stem cell characteristics of PCSCs with that of PSCs,PCSCs were more elongated than PSCs in morphology and have stronger self-renewal ability,as well as stronger chondrogenic and adipogenic differentiation potentials.This study revealed the stem cell characteristics of PCSCs distinguished from PSCs,which may indicate PCSCs and PSCs should not be treated as one type of cell to research in the future.

Primary malignant tumors of bone surface:a review with emphasis in differential diagnosis

Surface tumors of the bone are broadly defined as a diverse group of osteogenic and chondrogenic benign and malignant neoplasms that arise adjacent to the outer surface of cortical bone.They may be a cause of diagnostic difficulty due to a degree of histological overlap,rarity,and nomenclature.In this review we summarize the different histological types of primary malignant tumors of bone surface,namely,secondary peripheral chondrosarcoma,periosteal chondrosarcoma,parosteal osteosarcoma,dedifferentiated parosteal osteosarcoma,periosteal osteosarcoma,and high-grade surface osteosarcoma.We provide a comprehensive updated review of their pathogenesis and highlight radiological,macroscopic,and histopathological features and recently available ancillary diagnostic tools that may aid in the differential diagnosis.