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 Table of Contents  
Year : 2023  |  Volume : 6  |  Issue : 1  |  Page : 115-118

Bone names and “ization” in orthopedics

Department of Orthopaedics, Government Medical College, Haldwani, Uttarakhand, India

Date of Submission27-Jun-2022
Date of Decision01-Aug-2022
Date of Acceptance05-Aug-2022
Date of Web Publication27-Dec-2022

Correspondence Address:
Ganesh Singh Dharmshaktu
Department of Orthopaedics, Government Medical College, Haldwani - 263 139, Uttarakhand
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jodp.jodp_53_22

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Various terms in orthopedics are formed using or incorporating the name of native bones and these terms then describe a clinical entity or a procedure. The term thus created, however, may or may not be directly related to the bone associated. There are a few interesting examples of such terms that are encountered in the orthopedic literature. A short recollection of those few notable terms that have the name of a known bone within their terminology is described here for general reading and knowledge.

Keywords: Acetabulization, bones, olecranization, radialization, skeletal system, tibialization, ulnarization

How to cite this article:
Dharmshaktu GS. Bone names and “ization” in orthopedics. J Orthop Dis Traumatol 2023;6:115-8

How to cite this URL:
Dharmshaktu GS. Bone names and “ization” in orthopedics. J Orthop Dis Traumatol [serial online] 2023 [cited 2023 Mar 30];6:115-8. Available from: https://jodt.org/text.asp?2023/6/1/115/365283

  Introduction Top

The discipline of orthopedics demands a dedicated study of human musculoskeletal and osteoarticular structures, and the skeletal elements (bones) are key contributors to its rich clinical spectrum. Various disorders affecting bones of the axial and appendicular skeleton are studied, treated, and prevented with evidence-based knowledge gained through a huge body of scientific literature. At times, various notable terms are encountered which have a specific meaning and a basic knowledge of these terms is required for their better comprehension and application. Terms associated with the names of human bones are common and are well described in the literature. A few outstanding terms are briefly described below for the purpose of their working knowledge. Detailed study regarding them can then be undertaken by the learner as per the requirement.

  Tibialization Top

Tibialization is a surgical procedure that includes the use of native fibula bone for specific indications. Fibula bone has a special quality of gradual hypertrophy and this property is well described in the literature. The use of fibula as central graft has been associated with the increased diameter of the graft and size with time (1–4 years), and more hypertrophy is noted in a younger age.[1] Large segmental defects are challenging problems in skeletal reconstruction and require robust planning of the surgery. The use of ipsilateral fibula is one of the various described techniques in specific cases with segmental tibial defects [Figure 1]. Segmental defects, congenital tibial deficiency, infection, and neoplastic lesions are major indications for fibula grafting within the tibia (also called medial transport of fibula) through various described techniques. The techniques such as Ilizarov frame, Tuli's technique, or Huntington's procedure are described in this regard. Vascularized ipsilateral fibula grafting is another viable alternative in the presence of poor recipient vascular bed or in the settings of gap nonunion of tibia following osteomyelitis. Fibula also offers sound mechanical base for early union in such scenario.[2] Innovative use of tibialization procedure can also be used in many neoplastic conditions for skeletal stabilization.[3],[4] Similarly, tibialization in cases of open fracture (like Grade 3) is also attempted as an alternative option in selective cases.[5]
Figure 1: The diagram showing example of tibialization by central grafting of the ipsilateral fibula strut graft within the medullary cavity of tibia to manage a segmental tibial defect

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  Acetabulization Top

Rotator cuff tears are nagging clinical problems and massive tears result in significant morbidity and inferior clinical outcome. Hamada, in the year 1990, proposed a classification of massive rotor cuff tears with five grades on a radiological basis.[6] A massive tear includes detachment of at least two or more entire tendons and typically includes tear of at least supraspinatus and infraspinatus tendon. Acromiohumeral interval (AHI) narrowing is seen in long-standing tear cases with maintenance and narrowing of AHI in Grade 1 and 2, respectively. Grade 3 includes findings of Grade 2 and acetabulization that is concave deformity of the acromion undersurface. Additional narrowing of glenohumeral joint is seen in Grade 4 and humeral head collapse in Grade 5.[7]

  Femoralization/Femurization Top

Associated scalloping of the undersurface of acromion, in cases with massive rotator cuff tears as described above, forms a sort of pseudo-articulation between humeral head and upper concave acromion undersurface. This finding is termed acetabulization of the acromion, and corresponding changes in the humeral head are called femurization.[8] Femurization or femoralization thus involves humeral head bone. The description of femurization is mostly limited to passing remarks in the medical literature and is not well described in detail.

  Humerization Top

As the femurization is related to proximal humerus bone, the term humerization, in fact, is used in relation to the femur bone. In cases of hip osteoarthritis and fractures and pseudoarthrosis of neck femur, osteotomy and humerization of upper femur is described.[9] No substantial information, however, is described regarding this term in the literature.

  Radialization Top

Radialization is one of many surgical techniques to treat radial club hands (also called radial dysplasia or radial aplasia). The surgery is called radialization, as after the excision of fibrotic tissues, the hand and radial carpal bones are placed over the distal end of ulna fixed with K-wires in moderate ulnar deviation.[10] Transposition of radial wrist extensors and flexors to ulnar side adds to improved mechanical forces and better muscle balance. These surgeries create either a synchondrosis (cartilage-to-cartilage connection) or synostosis (bone-to-bone union) and may thus result in suboptimal wrist movement. Radialization combined with other procedures such as ulnar cuff osteotomy is also described for various radial longitudinal deficiency disorders.[11] Single-stage radialization technique also has been described to reduce the number of surgeries.[12] Radialization is well-described procedure, and many textbooks have separate chapters on radial club hand describing various techniques of its treatment.

  Ulnarization Top

This is another surgical technique (apart from radialization and centralization) to correct radial club hand, in which hand and carpus are moved to the ulnar side of the distal ulna [Figure 2]. The deforming forces are thus converted to stabilizing ones around the distal ulna that acts as a fulcrum. Ideal age for surgery is between 12 and 18 months of age but can be done in children as old as 6 or 8 years. This technique was described as a modified approach to other aforementioned techniques by Dror Paley.[13] The surgery is stabilized by an external frame for 3 months to allow fibrous healing and essentially creates a syndesmosis or fibrous connection between the carpus and the distal ulna. The technique was developed in 1999, and the dorsal transfer of flexor carpi ulnaris converts its function from the deforming force into a corrective force. Paley later modified this technique as modified Paley ulnarization by adding acute shortening of the diaphysis and temporary fixation of station of carpus to the ulnar head at the level of scaphoid to prevent prominent bump as seen in the previous technique.[14]
Figure 2: The diagram showing ulnarization procedure to correct radial club hand

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Both radialization and ulnarization are widely known techniques, and one or the other is used extensively in the treatment of managing radial club hand disorder.

  Lumbarization/Sacralization Top

Transitional anatomical variants at lumbosacral area, also called lumbosacral transitional vertebrae (LSTV), are common and the deformity alters the load-bearing mechanism at the lower back.

Lumbarization (or lumbarized first sacral vertebra) of the spine is a congenital abnormality, in which the first sacral vertebra is not fused to the rest of the sacrum and appears to be part of lumbar region. Lumbarization may be partial (incomplete separation of S1-S2 bodies and their neural aches) or complete separation of the S1 from S2 segment.[15] The condition, therefore, gives the radiological appearance of six lumbar vertebrae and four sacral vertebrae. The condition may present clinically with lower back pain with its variable impact on activities of daily living. Sacralization (or sacralized fifth lumbar vertebra), on the other hand, results from assimilation of L5 to the sacrum. The whole spine imaging is advocated to correctly diagnose LSTV. Both the anomalies have clinical implications such as the impact on spino-pelvic measurements, anatomical consideration during pedicle screw fixations, and biomechanics of normal labor in affected females among others.[16] Besides it, their presence can also cause lower back problems (like lumbar disc herniation) even in younger ages like adolescents.[17] We all need to carefully assess these radiological anomalies in routine practice for documentation and patient education.

  Olecranization Top

Olecranization of patella (OP) or patello-tibial transfixation is a described surgical technique used sometimes to maintain the normal relationship of femorotibial articulation following posterior cruciate ligament (PCL) instability, repair, or reconstruction. PCL restricts posterior tibial translation and as the knee flexion adds to the tension on PCL, knee was usually immobilized in extension.[18] Olecranization was thus proposed to reduce tension on PCL while avoiding extended knee immobilization. The cited advantages were earlier rehabilitation while maintaining the correct position. Cadaveric studies also showed a significant reduction in posterior drawer after PCL transection after fixing knee in 70° flexion.[19] A provisional patella-tibial fixation with a large diameter pin (Steinmann pin) is done and patella thus holds the tibia forward and protects PCL [Figure 3]. Despite the theoretical advantage, many studies conclude that this procedure not only fails to protect PCL but may cause untoward posterior drawer forces during knee flexion.[20] Studies also reveal that, though the procedure reduces strain on PCL within the selected range of motion, the negative impact of high contact pressures of patellofemoral articular cartilage may outweigh the benefits.[21] This procedure though not commonly performed is worth an acknowledgment but should be reserved for selected indications in clinical practice.
Figure 3: The diagram showing the procedure of patello-tibial transfixation with a thick pin for additional knee stability in specific indications. The procedure is also called olecranization

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  Occipitalization Top

Occipitalization of the  Atlas More Details is a developmental anomaly (most common craniocervical junction anomaly) that involves partial or complete fusion of atlas to occiput with a prevalence of 0.08%–2.76%. Failure of segmentation between the first cervical sclerotome and the fourth occipital sclerotome is supposed to be the embryological etiology.[22] Its clinical association may exist with atlantoaxial instability or basilar invagination with pain and neurological dysfunctions in selected cases. Owing to many known and unknown anatomical changes associated with this anomaly, the condition warrants a cautious approach in diagnosis and surgery to avoid neurovascular complications.[23],[24]

  Conclusion Top

The conditions, techniques, or facts with striking names are usually easy to remember and frequently are part of quizzes or assessment questions in the field of respective clinical discipline. Orthopedics is also full of various such examples, and this short article briefly describes entities with names of bones as part of their terminology to serve as a quick revision.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Rahimnia A, Fitoussi F, Pennecot G, Mazda K. Treatment of segmental loss of the tibia by tibialization of the fibula: S review of the literature. Trauma Mon 2012;16:154-9.  Back to cited text no. 1
Date AS, Solanki SB, Badhe NP, Sonsale PD, Pandit HG. Management of gap non-union of tibia by tibialisation of ipsilateral vascular fibula. J Postgrad Med 1996;42:109-11.  Back to cited text no. 2
[PUBMED]  [Full text]  
Wiratnaya IG. Wide margin excision followed by tibialisation of fibula and ankle arthrodesis as novel surgical technique in giant cell tumor patient. J Clin Orthop Trauma 2019;10:1004-7.  Back to cited text no. 3
Puri A, Subin BS, Agarwal MG. Fibular centralisation for the reconstruction of defects of the tibial diaphysis and distal metaphysics after excision of bone tumors. J Bone Joint Surg Br 2009;91:234-9.  Back to cited text no. 4
Paramaksizoglu F, Censu E, Unal MB, Yener Ince A. Acute emergency tibialization of the fibula: Reconstruction of a massive tibial defection a type IIIC open fracture. Strat Trauma Limb Recontr 2013;8:127-31.  Back to cited text no. 5
Hamada K, Fukuda H, Mikasa M, Kobayashi Y. Roentgenographic findings in massive rotator cuff tears. A long-term observation. Clin Orthop Relat Res 1990;254:92-6.  Back to cited text no. 6
Hamada K, Yamanaka K, Uchiyama Y, Mikasa T, Mikasa M. A radiographic classification of massive rotator cuff tear arthritis. Clin Orthop Relat Res 2011;469:2452-60.  Back to cited text no. 7
Imaging Diagnosis of Shoulder Arthropathy. In: Bencardino JT, editor. The Shoulder. Imaging Diagnosis with clinical Implications. Cham Switzerland: Springer; 2019. p. 239-40.  Back to cited text no. 8
Camera U. Osteotomy with diaphysial support and humerization of the upper end of the femur in treatment of hip osteoarthrosis and of fractures and pseudarthrosis of the femur neck. Technical details. Film. Minerva Ortop 1965;16:631-3.  Back to cited text no. 9
Buck-Gramcko D. Radialization as a new treatment for radial club hand. J Hand Surg Am 1985;10:964-8.  Back to cited text no. 10
Bhat AK, Acharya AM, Nahas N. Radialization with ulnar cuff osteotomy: A technique for deformity correction in radial longitudinal deficiency. J Hand Surg Am 2018;43:293.e1- 293.e7.  Back to cited text no. 11
Luangjarmekorn P, Pongernnak N, Yamprasert N, Kitidumrongsook P. Single-stage radialization and pollicization for radial longitudinal deficiency with thumb hypoplasia. Tech Hand Up Extrem Surg 2020;24:71-8.  Back to cited text no. 12
Paley D. Shortening: The orthopedic theory of relativity. J Limb Lengthen Reconstr 2020;6:1-4.  Back to cited text no. 13
  [Full text]  
Paley D. The Paley ulnarization of the carpus with lunar shortening osteotomy of radial club hand. SICOT J 2017;3:5.  Back to cited text no. 14
Mahato NK. Morphological traits in sacra associated with complete and partial lumbarization of first sacral segment. Spine J 2010;10:910-5.  Back to cited text no. 15
Mahato NK. Transitional female sacrum: Dimensions, alterations in dorsal pelvic structures, and potential obstetric copications. Oman Med J 2018;33:22-8.  Back to cited text no. 16
Zhang B, Wang L, Wang H, Guo Q, Lu X, Chen D. Lumbosacral transitional vertebra: Possible role in the pathogenesis of adolescent lumbar disc herniation. World Neurosurg 2017;107:983-9.  Back to cited text no. 17
Hermens KA, Hackenbruch W. Olecranization of the patella in posterior instability of the knee. Orthop Rev 1986;15:596-9.  Back to cited text no. 18
Rouvillain JL, Benzakour A, Odri GA, Renard G, Pesenti S, Severyns M. Posterior drawer after olecranization of the patella in posterior cruciate-injured knees: A cadaveric study. Orthop Trauma Surg Res 2019;105:95-9.  Back to cited text no. 19
Rungee JL, Fay MJ, Deberardino TM. Olecranization of the patella. Orthopedics 1995;18:27-34.  Back to cited text no. 20
Kambic HE, Dass AG, Andrish JT. Patella-tibial transfixation for posterior cruciate ligament repair and reconstruction: A biomechanical analysis. Knee Surg Sports Traumatol Arthrosc 1997;5:245-50.  Back to cited text no. 21
Menezes AH. Craniocervical developmental anatomy and its implications. Childs Nerv Syst 2008;24:1109-22.  Back to cited text no. 22
Bodon G, Glasz T, Olerud C. Anatomical changes in occipitalization: Is there an increased risk during the standard posterior approach? Eur Spine J 2013;22 Suppl 3:S512-6.  Back to cited text no. 23
Gholve PA, Hosalkar HS, Ricchetti ET, Pollock AN, Dormans JP, Drummond DS. Occipitalization of the atlas in children. Morphologic classification, associations, and clinical relevance. J Bone Joint Surg Am 2007;89:571-8.  Back to cited text no. 24


  [Figure 1], [Figure 2], [Figure 3]


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