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PubMedDate not supplied

[Correction of high-grade sesamoid bone dislocation in hallux valgus using Austin's osteotomy with and without lateral soft tissue release].

INTRODUCTION: Aim of this study was to analyze if, using the Austin technique for correction of hallux valgus deformity, the additional soft tissue procedure is capable to achieve better correction of the sesamoid subluxation, the hallux valgus angle and the intermetatarsal angle. PATIENTS AND METHODS: 19 patients with 20 feet operated according to the original Austin technique and 26 patients with 28 feet operated according to a modified technique with lateral soft tissue release both with a preoperative sesamoid subluxation grade 3 were compared with the help of a standardized questionnaire in respect to clinical and radiological results. RESULTS: Analyzing the clinical outcome of the two procedures, there was no statistical difference. Comparison of the radiological results revealed a significantly better correction of the sesamoid position and a better correction of hallux valgus and intermetatarsal angle by using the additional soft tissue procedure. DISCUSSION: The lateral soft tissue procedure with release of the adductor hallucis, dissection of the deep transverse plantar ligament and mobilisation of the sesamoids is capable of a significantly better correction of the sesamoid position. Only a combination of osseus and soft tissue correction is capable to correct the pathomechanism and to guarantee long lasting results.

Adult↗
PubMed1987

Comparative anatomy and significance of the sesamoid bone of the peroneus longus muscle (os peroneum).

The os peroneum is found in only a few primate families and seems to be completely absent in the non-primate pentadactyl mammals, in the Prosimii and in the Platyrrhinii (New World monkeys). In the Cercopithecidae (Catarrhinii, Old World monkeys) and the Hylobatidae, the os peroneum is a coffee bean-shaped constant, large and regular bone. The lateral surface of the bone is convex in all directions and non-articular. The medial surface is covered with hyaline cartilage and articulates by means of a synovial joint with the corresponding facet of the cuboid bone. The histological structure and the mode of ossification of the os peroneum are identical to that of other short bones of the skeleton. The os peroneum of the Cercopithecidae and Hylobatidae is an example of a new skeletal element that has appeared in a tendon subject to unusual mechanical stress. In the case of the peroneus longus tendon the stress is due to repetitive friction because of the functional importance of this muscle in the adduction and pseudo-opposability of the hallux. This osseous element is genetically fixed and hereditarily transmitted. Its mode of appearance is analogous to that accepted for the origin of the patella. In the Pongidae, the os peroneum is absent or rare. In man, this bone is relatively infrequent (approx 20% of mature individuals) and its shape is most irregular. In this case, the os peroneum appears as a regressive form of the typical bone observed in the above families, which is in the process of disappearing. Besides fundamental genetical factors, this regression is probably in relation to the disappearance of the functional importance of the peroneus longus muscle to the loss of the hallux opposability. Thus the mechanical factors cannot be dissociated from the genetic and phylogenetic factors in explaining the appearance and the regression of the os peroneum.

Aged↗
PubMed1994

A silver-impregnation and immunocytochemical study of innervation of the distal sesamoid bone and its suspensory ligaments in the horse.

The innervation of the navicular bone (os sesamoideum distale) and its suspensory ligaments (ligamenta sesamoidea collateralia) (CSL) or proximal suspensory ligament and the ligamentum sesamoideum distale impar or the distal sesamoidean impar ligament (DS-impar ligament) was examined using combined anatomical techniques of silver impregnation and immunocytochemistry. Silver impregnation studies revealed an abundance of nerve fibres present in both the CSL and DS-impar ligament with the latter having relatively more nerve fibres. These silver-impregnated nerves coursed parallel to and were associated with the vasculature rather than appearing to innervate the vessels. Immunocytochemistry identified several sensory-related neuropeptides (calcitonin gene-related peptide (CGRP), substance P (SP) and neurokinin A (NKA)) in the nerves of the navicular bone and suspensory ligaments. More peptidergic nerves were evident within the synovial membrane and loose connective tissue in the dorsal part than in the palmar aspect of the CSL. In the CSL along the synovial membrane bordering the distal interphalangeal joint, the CGRP, SP and NKA were present in the nerves of vessels as well as the intimal layer of the distal interphalangeal joint. In the DS-impar ligament, there were many more nerves innervating vessels and the synovial membrane between the navicular bone and the third phalanx than were present in these structures in the CSL. Nerves with all 3 peptides entered the navicular bone via the proximal border and the distal groove to innervate the perichondrium, trabeculae and osteons. SP-like nerves also innervated the cortical bone underlying the articular cartilage. We suggest that these sensory nerve peptides contribute to the pathology of the navicular syndrome. The distribution of the nerves in the CSL and the DS-impar ligament could explain the clinical effects of local anaesthetics injected into the distal interphalangeal joint.

Animals↗
PubMedDate not supplied

[Sesamoid bone complex and hallux valgus deformity. A retrospective analysis of 82 Mitchell osteotomies].

The aim of the operative treatment of the hallux valgus deformity is to correct the medial luxation of the first metatarsal head out of the sesamoid complex, the restoration of a congruent joint, the patient after treatment should be painfree. 82 patients were available for an independent clinical and radiological review. The median follow up was 32 months. The evaluation of the results are based on objective and subjective assessment of the patients as well as on radiographic criteria, such as hallux valgus angle, intermetatarsal angle, shortening of the first metatarsal bone, subluxation, lateral positioning of the osteotomized MT I-head and position of the sesamoid complex. Depending on the degree of "lateralisation" of the sesamoid complex seven groups were defined: 0/0, 1/0, 1/1, 2/1, 2/2. 2/3, 3/3 following Appel. Following objective criteria 61% of the patients were evaluated excellent or good, following subjective criteria 77% were evaluated excellent or good. Isolated parallel shifting seems to be sufficient in mild forms of hallux valgus (sesamoid complex group 2/2 or less), while the severe subluxation in the metatarsophalangeal joint (sesamoid complex group 2/3, 3/3) requires an additional lateral wedge osteotomy.

Adolescent↗
PubMed1991

Pseudomonal osteomyelitis of the medial sesamoid bone.

Because osteomyelitis may complicate puncture wounds about the first metatarsophalangeal joint, we believe sesamoid roentgenograms are mandatory. These views may show subtle demineralization, which cannot be seen on standard films. Treatment must include excision of the sesamoid and culture-directed antibiotics.

Adult↗