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PubMed1990

Irreducible dorsal dislocation of the interphalangeal joint of the great toe: report of two cases.

In this paper, we report two cases of dislocation of the hallux interphalangeal joint with interposition of the plantar plate including the sesamoid bone. These dislocations were treated with open reduction: one through lateral approach and the other through plantar approach. Plantar approach afforded repair of the plantar plate with preservation of the sesamoid bone and satisfactory result.

Adult↗
PubMed1994

Substance P immunohistochemical study of the sensory innervation of normal subchondral bone in the equine metacarpophalangeal joint.

Serial sections of bone and soft tissue from the metacarpophalangeal joints of 2 mature and 2 immature horses were evaluated for substance P immunoreactive sensory nerve fibers. Formalin-fixed specimens were sectioned, either nondemineralized or demineralized with formic acid or EDTA. Rabbit antiserum to substance P (SP) was used in the streptavidin-biotin-peroxidase complex method for immunolocalization of SP antigen, and staining with 3,3'-diaminobenzidine was used for permanent identification of SP fibers. Abundant sensory nerve fibers were identified in the joint capsule, synovial membrane subintimal layers, collateral ligaments, suspensory ligament and distal sesamoidean ligament attachments to the sesamoid bones, and the periarticular periosteal layers. Sparse SP-immunoreactive nerve fibers were found in subchondral bone plates of the metacarpus, proximal first phalanx, and dorsal articular surface of the sesamoid bones. Most SP fibers were associated with blood vessels in the small cancellous spaces and haversian canals of the subchondral bone. The deeper marrow spaces contained increased numbers of SP sensory fibers; a few appeared in small groups and as several SP-immunoreactive fibers in a larger nerve. Cortical bone contained only a few SP fibers in the haversian canals. Substance P fibers were not identified in the osteocytic lacunae, canaliculi, or the bony lamellae of the haversian systems of the subchondral bone plate, and its extension to the metaphyseal and diaphyseal cortical bone. Equine metacarpophalangeal joint soft tissues have an abundant sensory nerve supply, similar to that of other species.(ABSTRACT TRUNCATED AT 250 WORDS)

Aging↗
PubMed2003

Radiographic changes in Thoroughbred yearlings. Part 1: Prevalence at the time of the yearling sales.

REASONS FOR PERFORMING STUDY: Radiography in presale examinations of TB yearlings has become standard practice in recent years. OBJECTIVES: To describe the prevalence and distribution of radiographic changes in the fetlocks, carpi, tarsi, stifles and fore feet of Thoroughbred yearlings in central Kentucky when these joints were examined as part of routine pre- and post sale evaluations. METHODS: Horses subjected to radiographs included the fore (n = 1127) and hind (n = 1102) fetlocks, carpi (n = 1130), tarsi (n = 1101), stifles (n = 660) and fore feet (n = 300). Radiographic changes were categorised by location and type of change present (e.g. lucency, fragment) for each series. RESULTS: In the fore fetlocks 1.6% had fragmentation of the proximal dorsal first phalanx and 0.5% fragmentation of the proximal palmar aspect. In the hind fetlocks 5.9% had fragmentation at the plantar aspect and 3.3% fragmentation dorsally. Lucencies, fragments or loose bodies were detected at the dorsal aspect of the distal third metacarpus in 2.8% and, at the same location on the third metatarsus, 3.2%. Most yearlings (98%) had vascular channels in the proximal sesamoid bones and irregular vascular channels (> 2 mm wide or with nonparallel sides) were more common (79%) than regular vascular channels (56%). The intermediate ridge of the distal tibia was the most common location for fragmentation in the tarsus (4.4%). CONCLUSIONS: While some radiographic changes, e.g. vascular channels in proximal sesamoid bones, are very common in Thoroughbred yearlings, others, e.g. fragmentation or subchondral lucency within joints are quite rare usually affecting less than 5% of the population. POTENTIAL RELEVANCE: Veterinarians should expect to find radiographic changes in Thoroughbreds presented for examination prior to the yearling sales. The rarity of some changes thought to affect soundness or racing performance will make further invesigation of these conditions in horses without clinical signs more difficult.

Animals↗
PubMed2002

A comparison between radiographic and sonographic assessment of hand and wrist bones for the estimation of skeletal age in the child patient.

AIM: The purpose of this study was to examine, with a sonographic investigation, the hand and wrist bones of a group of young patients and to compare the results with those obtained with a classical radiographic assessment. MATERIALS AND METHODS: Some 25 subjects, 9-18 years of age, who presented problems concerning their short stature or precocious puberty, were evaluated. Each subject was examined by a standard radiographic assessment and by a sonographic investigation with real-time imaging. Sonographic examination was performed on the metacarpus-phalanx articulation of the first finger in order to locate the sesamoid bone. Sonographic examination was also performed on the second and third phalanxes of the third finger and on the distal portion of the radius to evaluate the characteristics of growth cartilage in the area. RESULTS AND STATISTICS: In all the cases where a sesamoid bone was present, this was correctly identified by the sonogram, even up to the initial appearance of its ossification nucleus. Sensitivity, specificity, and diagnostic accuracy were all 100%. The capping phenomenon seen in radiographs was not detected by sonographic investigation in any of the cases. Sonographic evaluation of the fertile cartilage of the third finger distal phalanx demonstrated a sensitivity of 89%, a specificity of 100% and a diagnostic accuracy of 92%. Sonographic evaluation of the radius cartilage showed a sensitivity of 95%, a specificity of 100% and a diagnostic accuracy of 96%. CONCLUSION: Sonographic evaluation of hand and wrist bones cannot accurately reproduce the results of the classical radiographic evaluation. However, the sonographic investigation may be useful, when integrated in a radiographic investigation.

Journal Article↗
PubMed1993

Effects of short-term cast immobilization on equine articular cartilage.

Hexosamine concentration (an index of proteoglycan content), DNA content (an index of cellularity), and [35S]sulfate incorporation (an index of proteoglycan synthesis) of articular cartilage were measured in biopsy specimens from medial proximal sesamoid bone, medial condyle of the third metacarpal bone, and proximal dorsal rim of the proximal phalanx in both metacarpophalangeal joints of 6 adult horses. One limb was then placed in a fiberglass cast that extended down from the proximal portion of the metacarpus and enclosed the hoof; the other limb was not casted. After 30 days of stall confinement, additional specimens were taken from the medial proximal sesamoid bone, medial condyle of the third metacarpal bone, midproximal portion of the proximal phalanx, distal portion of the proximal phalanx, and proximal portion of the middle phalanx of both limbs for comparison. Immobilization resulted in an apparent decrease in the hexosamine content of the cartilage when the 30-day immobilized vs 30-day mobilized specimens were analyzed. This decrease was accentuated by opposing trends in the 2 limbs. The immobilized cartilage tended to lose hexosamine, whereas the mobilized limb tended to gain hexosamine during the 30-day period; a similar trend also was seen with [35S] incorporation, but this trend was not statistically significant. The largest change was a significant increase in glycosaminoglycan synthesis in the mobilized limb, compared with little change in the immobilized joint cartilage. We concluded that contralateral limbs are unsuitable for controls in immobilization studies because of their biological response to increased weight bearing.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2003

High prevalence of tarsal coalitions and tarsal joint variants in a recent cadaver sample and its possible significance.

Tarsal coalitions (TC) are defined as fibrous (beyond normal ligaments), cartilaginous, or osseous unions of at least two tarsal bones. Most of the clinical studies report the prevalence of TC as <1%, but they disregard the asymptomatic coalitions. Because TC have been associated with pathologic conditions, including degenerative arthritic changes, knowledge of their prevalence has clinical importance. The aim of our study was to establish the prevalence of TC and tarsal joint variants. A total of 114 feet from 62 cadavers (average age = 78 years) without obvious foot pathologies were dissected at the Department of Anatomical Sciences, The University of Adelaide. Ten non-osseous TC in eight subjects were identified: two talocalcaneal and eight calcaneonavicular (occurred twice bilaterally). Variant calcaneonavicular and cuboideonavicular joints were found in 8% and 31% of feet, respectively. Other joint variants included a variable number of talocalcaneal joint surfaces and sesamoid bones. No secondary TC (due to trauma, infections, or neoplasm) were found. Our study demonstrated that the overall prevalence of TC is higher (13%) than previously thought; tarsal joint variations (39%) and sesamoid bones (42%) were common as well. The supposed secular increase in the prevalence of TC as well as the high number of anatomical variants could reflect a short-term response to altered life-style or a microevolutionary trend due to relaxed selection.

Aged↗
PubMed2004

Iatrogenic medial dislocation of hallucal sesamoids with hallux varus in an adolescent.

BACKGROUND: Iatrogenic hallux varus is a rare deformity linked to bunion surgery at late adult age. Here reported is the first adolescent case of acquired hallux varus and medial dislocation of both sesamoid bones. CASE REPORT: The patient had had a surgical intervention under his first metatarsophalangeal joint when he was 10 years old. Correction of the deformity with a tendon transfer and medial capsular release alone-as was recommended for adults-was impossible in this adolescent, 8 years after the index surgery. Excision of the contracted medial structures and repair of the lateral retinaculum of the fibular sesamoid obtained a perfect correction of the dislocated sesamoid bones.

Adolescent↗
PubMedDate not supplied

Arthroscopic surgery of the metatarsophalangeal first joint.

Arthroscopic surgery of the metatarsophalangeal first joint was used to treat a dorsal impingement syndrome of the hallux by removing the dorsally located osteophytes. Also, osteochondritis dissecans, painful sesamoid bones resistant to conservative therapy, and hallux rigidus were arthroscopically treated in a prospective study enrolling 24 consecutive patients. Seventeen patients were high-level athletes. Pain, swelling, sports, and work involvement were recorded. The operative technique is described. There was one persistent loss of sensitivity of the hallux. In the dorsal impingement group, 8 of 12 patients had a good or excellent result after a minimum follow-up of 2 years. In patients with osteochondritis dissecans, 3 of 4 showed good or excellent results. In hallux rigidus and sesamoid bone removal the results were less favorable. As in all arthroscopic procedures there was a fast rehabilitation and work resumption. Especially in athletes arthroscopically, treatment of a dorsal impingement syndrome or osteochondritis dissecans can be recommended because of the diminished chance of scar fibrosis.

Adolescent↗
PubMed2003

The intersesamoidal ridge of the first metatarsal bone: anatomical basics and clinical considerations.

The first metatarsal shows a ridge at the plantar side of the head, aligned nearly longitudinally. On 100 macerated first metatarsals (53 right, 47 left) the existence and alignment of this ridge was examined. On the basis of a regression formula, the specimens were assigned to the genders; accordingly, 29 bones were female, the remaining 71 bones male. The intersesamoidal ridge existed in 95 cases (50 right, 45 left); all 29 female bones showed this ridge, male ones in 66 cases. The ridge deviated on average 7.99 degrees from the longitudinal axis of the first metatarsal towards distal-lateral (from -3 degrees to 19 degrees ). Significant differences ( p=0.001) were found for side (left: 6.04 degrees, right: 9.74 degrees ) but not for gender (female: 8.14 degrees, male: 7.92 degrees ). Noticeable correlations with the length of the first metatarsal and the size of the head could not be determined. The mean values of the alignment of the intersesamoidal ridge seem also not to correlate with the metatarsophalangeal angle. The ridge separates the joint surfaces for the sesamoid bones, which are built-in to the tendons of the two heads of the flexor hallucis brevis muscle. Thus, from the alignment of the ridge, the functional direction of this muscle can be concluded. Since the alignment deviates from the longitudinal axis of the first metatarsal, an adduction, in addition to the flexion, can be concluded. Operative techniques for the correction of hallux valgus often change the alignment of the ridge, and therefore also the biomechanical properties of the flexor hallucis brevis muscle. This could explain failures in several surgical therapies.

Female↗
PubMed2006

[Scarf osteotomy for the treatment of forefoot deformity].

PURPOSE OF THE STUDY: The outcome of surgical treatment in hallux valgus is sometimes unsatisfactory for both the patient and the surgeon. The valgus position of the big toe in the metatarsophalangeal joint is associated with a deviation to varus of the first metatarsal, resulting in the space between the first and second metatarsals called the intermetatarsal (IMT) angle. In most patients the angle is between 10 and 20 degrees. These patients were indicated for scarf osteotomy as this method has been reported to achieve good outcomes. The results are compared with the relevant literature data on foot osteotomy. MATERIAL: Our group involved 62 scarf osteotomies carried out on 49 patients who were followed up for an average of 18 months (range, 6-36 months). Three patients underwent surgery on both feet in one stage, five had bilateral surgery in two stages. The average pre-operative IMT angle was 16 degrees (range, 9-21 degrees) and the average hallux valgus angle was 37 degrees. METHODS: The patients were indicated for surgery on the basis of subjective complains and weight-bearing radiographs. Scarf osteotomy was performed by the Barouk technique. From a signle incision in the first intermetatarsal space, the lateral articular capsule was released, adductor tendon was dissected and sesamoid bones were reduced. The first metatarsal was exposed from an incision along its medial axis, the bunion was excised and Z-osteotomy of the metatarsal was performed. The distal fragment was shifted laterally, fixed with two 3.5 mm Poldi screws, and the capsule was closed under tension with transosseal suture. If necessary, an additional procedure on the big toe phalanges or osteotomy of the other metatarsals are carried out. From the second post-operative day the patients were allowed to walk on the heel, after removal of sutures they walked wearing a special sandal and, from the third week onwards, full weight-bearing was allowed. The average hospital stay lasted 4 days. The evaluation of post-operative results was based on radiograms, subjective feelings of the patients and clinical assessment of the range of big toe motion. RESULTS: Out of 62 operations carried out on 49 patients (average age, 41.5 years), 23 were performed on the right and 23 on the left foot; bilateral surgery was carried out in three patients in one stage and in five patients in two stages. Simultaneously, the Weil osteotomy was performed on six feet, Akin osteotomy of the big toe phalanges on five feet, Braggard surgery of the second toe on three feet, and scarf osteotomy of the fifth metatarsal on three feet. All feet were indicated for scarf osteotomy because of pain and, in 56 feet, also esthetic reasons were involved. The patients' subjective post-operative assessments were as follows: satisfaction with the outcome in 58 feet, pain associated with tight shoes in two feet, pain while walking in six feet, and dissatisfaction with the big toe shape in one patient.The average IMT angle of 16 degrees and hallux valgus angle of 37 degrees on the pre-operative radiograms showed improvements to 9 degrees and 18 degrees, respectively, on the post-operative X-ray. The sesamoid bones were reduced in all cases. After surgery the average range of motion was restricted as follows: plantar flexion by 7 degrees (to 23 degrees) and dorsal flexion by 6 degrees (to 54 degrees). The complications included one fracture of the head requiring osteosynthesis, one failure of fixation with repeat valgus osteotomy, three cases of insufficient correction of a valgus position that had to be treated by additional osteotomy of the first toe phalanges. DISCUSSION: Out of other types of osteotomy (Funk, Dega, spike osteotomy), outcomes similar to scarf osteotomy have been achieved only by the Austin procedure. However, in this, shifting of the distal fragment is limited and the results show that the Austin method should be preferred in deformities with an IMT angle of about 10 degrees. Scarf osteotomy in addition allows for early weight-bearing, does not produce shortening of the first metatarsal but permits its elongation and elevation by oblique osteotomy, if necessary. It can also be used for the fifth metatarsal. The drawbacks include a more complicated surgical technique and higher risk of complications; shifting of the distal fragment is also limited and, for this reason, scarf osteotomy is not effective in deformities with an IMT angle higher than 20 degrees. CONCLUSIONS: Scarf osteotomy is an effective procedure for a moderate valgus deformity of the big toe with an IMT angle between 10 and 20 degrees. It permits early weight-bearing of the treated extremity. It requires exact pre-operative planning and strict adherence to the operative technique.

Adult↗
PubMed1993

Homeotic transformations and limb defects in Hox A11 mutant mice.

Hox A11 is one of the expanded set of vertebrate homeo box (Hox) genes with similarities to the Drosophila homeotic gene, Abdominal-B (Abd-B). These Abd-B-type Hox genes have been shown to be expressed in the most caudal regions of the developing vertebrate embryo and in overlapping domains within the developing limbs, suggesting that these genes play important roles in pattern formation in both appendicular and axial regions of the body. In this report whole-mount in situ hybridization in mouse embryos gave a precise description of Hox A11 gene expression in the developing limbs and in the axial domain of the developing body. In addition, we generated a targeted mutation in Hox A11 and characterized the resulting phenotype to begin to dissect developmental functions of the Abd-B subfamily of Hox genes. Hox A11 mutant mice exhibited double homeotic transformations, with the thirteenth thoracic segment posteriorized to form an additional first lumbar vertebra and with the sacral region anteriorized, generating yet another lumbar segment. Furthermore, skeletal malformations were observed in both forelimbs and hindlimbs. In mutant forelimbs, the ulna and radius were misshapen, the pisiform and triangular carpal bones were fused, and abnormal sesamoid bone development occurred. In mutant hindlimbs the tibia and fibula were joined incorrectly and malformed at their distal ends. Also, an enlarged sesamoid developed ventral to the tibiale bone. Both heterozygous and homozygous mice displayed mutant phenotypes adding an additional level of complexity to the Hox code hypothesis.

Animals↗
PubMed1995

Suspensory ligament desmitis.

The gross and functional anatomy of the suspensory ligament (SL) and its ultrasonographic variability are described. Injuries of the suspensory apparatus are divided into lesions confined to the proximal one third of the metacarpus or metatarsus (proximal suspensory desmitis and avulsion fractures), lesions of the body, and branch lesions. Complete breakdown injuries are also discussed. In view of the close association of the SL, the second, third, and fourth metacarpal or metatarsal bones, and the proximal sesamoid bones, associated bony lesions are also considered.

Animals↗
PubMed2000

Topographical mapping of biochemical properties of articular cartilage in the equine fetlock joint.

The aim of this study was to evaluate topographical differences in the biochemical composition of the extracellular matrix of articular cartilage of the normal equine fetlock joint. Water content, DNA content, glycosaminoglycan (GAG) content and a number of characteristics of the collagen network (total collagen content, levels of hydroxylysine- (Hyl) and the crosslink hydroxylysylpyridinoline, (HP) of articular cartilage in the proximal 1st phalanx (P1), distal 3rd metacarpal bone (MC), and proximal sesamoid bones (PSB) were determined in the left and right fetlock joint of 6 mature horses (age 5-9 years). Twenty-eight sites were sampled per joint, which included the clinically important areas often associated with pathology. Biochemical differences were evaluated between sampling sites and related with the predisposition for osteochondral injury and type of loading. Significant regional differences in the composition of the extracellular matrix existed within the joint. Furthermore, left and right joints exhibited biochemical differences. Typical topographic distribution patterns were observed for each parameter. In P1 the dorsal and palmar articular margin showed a significantly lower GAG content than the more centrally located sites. Collagen content and HP crosslinks were higher at the joint margins than in the central area. Also, in the MC, GAG content was significantly lower at the (dorsal) articular margin compared with the central area. Consistent with findings in P1, collagen and HP crosslinks were significantly lower in the central area compared to the (dorsal) articular margin. Biochemical and biomechanical heterogeneity of articular cartilage is supposed to reflect the different functional demands made at different sites. In the present study, GAG content was highest in the constantly loaded central areas of the joint surfaces. In contrast, collagen content and HP crosslinks were higher in areas intermittently subjected to peak loading which suggests that the response to a certain type of loading of the various components of the extracellular matrix of articular cartilage are different. The differences in biochemical characteristics between the various sites may help to explain the site specificity of osteochondral lesions commonly found in the equine fetlock joint. Finally, these findings emphasise that the choice of sampling sites may profoundly influence the outcome of biochemical studies of articular cartilage.

Amino Acids↗
PubMed1981

The sesamoids of the hallux.

The seemingly innocuous tiny sesamoids play an important role in the function and pathomechanics of the hallux. The recent active participation of people of all ages in jogging and long-distance running, activities introducing repetitive stressful forces on the forefoot, induces sesamoiditis. Bones normally asymptomatic, such as the sesamoids, require renewed interest in embryology, anatomy, congenital variations, infection, osteochondritis, trauma and effective treatment.

Bone Diseases↗
PubMed1996

[Sesamoid osteoopathy of the foot].

Taking parts of sesamoids in several arthroosteopathies of 160 males and 156 females in the retrospective study were investigated. On the comparative dorsi-plantar, oblique, inversion and eversion pedal plain films could demonstrate bony hypotrophy and hypertrophy of sesamoids in 124 (39.55%) of 316 subjects. Until the dorsi-plantar radiographs were obtained with 15 degrees cephalic tube angulation, then the oblique, inversion and eversion ones were unangled. Radiographically the sesamoid osteopathies were divided into mild (grade 1, 36 of 124 cases), moderate (grade 2, 44 of 124 cases) and severe (grade 3, 44 of 124 cases) forms. The affictions involved the constant sesamoid bones of forefeet (1st and 5th metatarsophalangeal joints) exclusively. Sesamoid osteopathy was clinically specified by the serious locomotive pain of ball of the feet as well unfavourable chances against conservative treatment.

Adult↗
PubMed2004

The mole's thumb -- evolution of the hand skeleton in talpids (Mammalia).

Osteological specimens representing 15 out of the 16 currently recognized talpid genera were examined and scored for seven discrete morphological characters of the hand. The phylogenetic distribution of these characters was studied in the context of alternative hypotheses of talpid relationships, using three species of shrews and a hedgehog as outgroups. All talpids show a similar number and arrangement of carpal bones. The most obvious differences concern the presence of additional sesamoid bones, the relative size of the os falciforme when present, and the degree of fusion of the scaphoid and lunate in the proximal carpal row. Marked differences in the relative length and proportions of the metacarpals also exist. The development of the carpals in Talpa europaea was studied through examination of histological sections of the hand of an embryo and a neonate. Whereas carpal anatomy in the neonate mirrors the arrangement and proportions of the adult, in the embryo the scaphoid and lunate are still separate, there are no signs of the os falciforme, and the size proportions of metacarpals to carpals are obviously different to those of the adult. A prehallux or tibial sesamoid, serial homologue to the os falciforme or prepollex (a radial sesamoid), does not have an obvious functional role, and its presence might be the result of a common epigenetic control in the hand and the foot resulting in a non-adaptive structure in the latter.

Animals↗