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An additional bone in the carpal region of raptorial birds.

In a series of 4 species of owls and 12 species of diurnal raptors, an additional bone was present bilaterally in the area of the carpus. Designating the bone as an "additional bone of the raptorial carpal region" is suggested pending appropriate embryological studies to determine the origin of the bone. Generally, the bone was present in owls and in diurnal raptors with relatively short, rounded wings, but was absent in species with longer, more tapered wings. The bone lies at the cranial edge of the carpal area near the radial carpal bone, and is fixed to the surrounding skeleton by ligaments. The tendon of the tensor patagium longus muscle has one slip that attaches to the additional bone and another that passes over its craniodorsal surface en route to insertion. Awareness of the occurrence of this bone in some raptors, but not others, is essential in clinical evaluation of wing injuries, as well as in forming a prognosis for the return to soundness, the potential for release, and, therefore, the life of an injured raptor.

Animals↗

Os peroneum fracture. A case report.

A 40-year-old woman with a history of injury to the left foot was initially treated for an ankle sprain. When the initial roentgenograms were reassessed, os peroneum fracture with diastasis was diagnosed. This may be the second case of fracture of the uncommon anomaly to be reported in the literature. A fracture of the os peroneum may be confused with ankle sprain. Only careful examination of serial roentgenograms may avoid an incorrect diagnosis and further complications.

Adult↗

Traumatic lateral dislocation of the great toe fibular sesamoid: case report.

Traumatic dislocation of the hallucal sesamoids is uncommon. This case involves a 17-year-old female driver involved in a head-on collision who sustained traumatic lateral dislocation of the fibular sesamoid associated with intersesamoidal ligament disruption, partial plantar plate avulsion, and impaction fracture of the metatarsal head. The diagnosis was delayed due to incorrect interpretation of initial radiographs. In addition, the severity of the soft-tissue injury was not appreciated, possibly further delaying the diagnosis. The patient was treated with open reduction of the fibular sesamoid and reconstruction of the intersesamoidal ligament. Eight months after surgery, she had mild persistent symptoms, decreased range of motion, and near full resumption of prior activities.

Adult↗

Diagnosis and treatment of delayed and non-union stress fractures in athletes.

Stress fractures in athletes usually heal well with merely rest and conservative treatment. It has been estimated that in Finland 400-500 athletic stress fractures occur annually per year. In sports clinic series stress fractures comprise 3.3 to 4.6 per cent of all overuse injuries. Delayed and non-union have been reported to occur in athletes quite often, up to 10 per cent of athletic stress fractures in Finland. The reason is on the one hand delayed diagnosis due to late consultation of expert physicians, and on the other hand too short a rest from hard physical activity. Delayed and non-union are most often seen in the hallux sesamoids, mid-tibial staft, base of fifth metatarsal, tarsal navicular and olecranon. The pars articularis of the fourth and fifth lumbar vertebra is a site of stress fracture and spondylolysis. In this report the diagnosis, symptoms and findings as well as the operative treatment of these overuse injuries is discussed.

Athletic Injuries↗

Bilateral os peroneum fractures: comparison of conservative and surgical treatment and outcomes.

Acute fracture of the os peroneum without concurrent rupture of the peroneus longus is a rarely cited injury. Sudden violent contraction of the peroneus longus muscle and direct trauma are documented mechanisms of injury. This injury can easily be overlooked due to its infrequency, and it may lead to chronic pain and impairment of function. Presented is a case of acute fracture of the os peroneum bilaterally. The fractures occurred approximately 21 months apart. Treatment varied with the right foot responding to 4 months of conservative therapy, and the left foot undergoing surgical excision of the fractured ossicle following 5 weeks of failed conservative therapy. This case is unique as it presents bilateral os peroneum fractures. This unique situation allows for a comparison of the two distinct treatment options. A fractured os peroneum without peroneus longus tendon rupture may be treated conservatively, however, surgical excision of the ossicle following 4 weeks of conservative therapy may expedite the recovery period and avoid chronic pain.

Adult↗

Peroneus longus tendon rupture as a cause of chronic lateral ankle pain.

Rupture of the peroneus longus tendon with an associated fracture of the os peroneum is an uncommon injury, which may present as chronic lateral ankle instability. There have been only seven cases documented in the literature since 1966. A case of chronic peroneus longus tendon rupture with os peroneum fracture is presented. The authors review their clinical, radiographic, and operative treatment of this patient and review the literature of this unusual injury.

Ankle Joint↗

Pediatric foot fractures.

Fractures of the foot in children usually have a good prognosis and generally are treated nonoperatively. Displaced fractures of the talus and calcaneus and tarsometatarsal dislocations are rare in children and their outcome is generally good in the younger child. Older adolescents with these injuries need treatment similar to how an adult would be treated for the same injury in order to achieve a good result. Foot fractures in children may pose a diagnostic challenge particularly in the absence of obvious radiographic changes. Repeated clinical examination and judicious use of imaging techniques such as isotope bone scans and magnetic resonance imaging are needed to establish a diagnosis. Knowledge of the anatomy and significance of accessory bones of the foot and disorders of the growing foot skeleton are helpful in managing injuries of child's foot. In this study, we review common injuries of a child's foot and include a discussion on differential diagnosis.

Adolescent↗

Scarf osteotomy for correction of hallux valgus. Surgical technique and results as compared to distal chevron osteotomy.

With the Scarf osteotomy, a good correction of moderate hallux valgus can be obtained, comparable to the distal or proximal Chevron or crecentic osteotomy. Correction of the IMA averages between 5 degrees to 6 degrees. When used in combination with an adductor release and proximal phalangeal osteotomy, the indication can be extended to severe hallux valgus deformities as long as there is no arthrosis at the MTP joint. The Scarf osteotomy, however, is certainly a more extensive surgical procedure, with a longer learning curve than a distal Chevron osteotomy. With more than 1000 Scarf procedures performed, the author has not encountered one delayed union, even in osteoporotic bone, or an avascular necrosis. In two cases a stress fracture was encountered in the first 3 months after surgery, but these healed uneventfully with partial weight bearing for 5 weeks.

Hallux Valgus↗