Sampling Procedures

Ribs Usually, they are sawed in a horizontal plane. The section should include costal cartilage, costochondral junction, and bony rib.

Sternum A sagittal midline slice through the manubrium is usually saved. Fragments of bone marrow can be dug out with a sturdy knife. These fragments should contain only cancellous bone so that minimal decalcification time is required.

Vertebrae We prepare a sagittal saw section through the center of a vertebra after the anterior half of the spinal column has been removed for exposure of the spinal cord. Intervertebral disk tissue should be part of the slice selected for histologic study, particularly in the presence of degenerative diseases, ochronosis, or ankylosing spondylitis. In this latter condition, costovertebral and costotransverse joints should be included.

Iliac Crest This site is particularly recommended for the study of metabolic bone disease. A slice of iliac crest tissue can easily be removed with an oscillating hand saw. The plane of sawing should be perpendicular to the iliac crest surface.

Calvarium This is an important part of the skeleton to study metabolic bone diseases, neoplastic involvement (myeloma, metastatic carcinoma, or multifocal Langerhans cell histiocytosis), and certain hemolytic anemias (thalassemia). A strip of calvarium should be removed so that it includes the external and internal tables and the diploe.

Bones of Extremities Removal of the femur requires a long lateral skin incision. The knee joint is exposed by flexing the knee and cutting the quadriceps tendon, the joint capsule, and the cruciate ligaments. The muscular attachments are dissected from the shaft of the femur, starting at the distal end and continuing toward the hip. The capsule of the hip can be palpated and then incised by flexing and rotating the femur.

If only the femoral head, neck, and trochanter region are needed, essentially the same procedure is used except that the femoral shaft is sawed off about 10 cm below the trochanter major.

The upper femoral shaft and the bone marrow in this region are usually exposed from an anterolateral incision. A 5-cm portion of the anterior half of the femoral shaft is then removed with an electric saw. The continuity of the bone can thus be preserved.

The humerus can be dislocated anteriorly in the humeroscap-ular joint. In this way the muscle attachments of the proximal humerus can be dissected away from the whole circumference of the bone without additional skin incisions. The upper shaft of the humerus is then exposed and sawed off. For removal of the complete bone, a skin incision down to the elbow is necessary.

The bones of the distal extremities, particularly of the hands, should be exposed from the volar surfaces (see Chapter 1).

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