Impact of Aging on Distal Tibia Metaphysis Diameter

Rapid Communication

Foot Ankle Stud. 2021; 3(1): 1020.

Impact of Aging on Distal Tibia Metaphysis Diameter

Astolfi RS¹, Batista AV²*, Santos ALM³ and Leite JAD¹

1Department of Orthopedic Medicine, Federal University of Ceara, Brazil

2Federal University of Alagoas, Medical School, Brazil

3Department of Orthopedic Medicine, University of Sao Paulo, Brazil

*Corresponding author: Amanda Vieira Batista, Medical School, Federal University of Alagoas, Street Albuquerque Lins; 254; Farol, Maceio, Brazil

Received: January 20, 2021; Accepted: February 15, 2021; Published: February 22, 2021


One of the many bone changes that occur with aging is “cortical drift”, the absorption and deposition of bone on the endosteal and periosteal side, respectively, which results in bone enlargement in some but not all metaphyses. The distal tibia is one of the most fractured sites in the body and where anatomically shaped implants are mostly used. The economic viability of these implants depends on the maintenance of bone contour throughout life. MRI sagittal ankle images from 422 patients aged 18 to 100 years were analyzed and total distal tibia diameter measured. No correlation was observed between the parameters age and distal tibia diameter (Pearson-0.099), or when individuals were separated by sex (Pearson-0.021 for men and 0.049 for women). When separated by age, patients younger and older than 60 years old had a similar average height (1.65 and 1.62 m, respectively, student’s t- test = 0). This is the first study to evaluate possible age-related distal tibia enlargement. Bone changes with age do not result in distal tibia enlargement and possibly the majority of anatomically shaped bone implants are suitable irrespective of age.

Keywords: Distal tibia; Aging


Age-related bone changes age are well described in animal models [1-3], where total bone mass reduction occurs with bone metaphysis, trabecular struts become less thick [2,3], and the cross-sectional moment of inertia increases (bone distribution around the central axis) [2]. “Cortical drift”, the absorption of cortical bone on the endosteal surface and deposition of bone on the periosteal surface, could compensate for the decline in bone mass since it expands the outer diameter [4-6]. The amount of total bone widening at different body sites [7,8] and whether bone proportionality is maintained remains controversial [9]. Non-proportional bone enlargement with aging may alter the bone surface contour between people of different ages [10].

In orthopedics, fracture reduction is essential for successful bone healing [11]. Bone reduction is achieved by connecting the bone surface and the micro relief, and irregularities are used as contact parameters [11,12]. In comminuted fractures, micro bone relief is lost, resulting in poorly aligned postoperative cases [12,13]. This is even more important for the metaphyseal bone, because articular fractures must not have an uneven surface [13,14]. Perfect reduction in ankle fractures is crucial because of the high load in a small area [13,14].

To solve these cases, many anatomically designed bone implants were created for the distal tibia [15,16]. There are still no data available to show the real effectiveness of these implants [15,16], little information is published about bone surface variance in the population [13,16], and even less is known about these variances between populations of different countries [13,19]. Thus, these implants may not be precise enough to provide the necessary anatomical alignment [16,17].

If bone size changes with aging, the bone surface could differ between young and older patients. As such, implants should be distinguished between these individuals, and it is important to understand if this change differs between sexes [18-20]. To determine distal tibia width and if there is a perceptible age-related size difference, 422 ankle Magnetic Resonance Imaging (MRI) scans were evaluated and the distal tibia diameter measured.

Materials and Methods

After institutional ethical committee approval, 422 ankle MRIs (one ankle per patient) from the archives of the radiology department, taken between 2017 and 2019, were retrospectively analyzed. Inclusion criteria were sagittal ankle MRIs, age between 18 and 100 years old and no ankle bone abnormalities after careful analysis by the radiologist and orthopedic surgeon. Measurements were taken using Carestream’s Vue Motion Viewer®.

The decision to use MRI images was based on the fact that there were more MRIs available at the department than ankle CT scans, which could be another option. MRI correlation between images and in vivo findings are well described [21,22]. Ankle x-rays were not used because of the less reliable correlation resulting from the variations in the distance between the ankle and x-ray ampoule [23]. Distal tibia diameter was determined in the sagittal MRI view, where the largest measurement was obtained using the oblique view of former cartilage growth scar tissue (Figure 1).