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Painful lesions on the plantar aspect of the interphalangeal joint of the great toe respond well to surgical excision of the accessory bone found lying superior to or within the flexor hallucis longus tendon. Several incisional approaches are available, each with potential advantages and disadvantages. Failure to consider each incisional approach and address concomitant deformities may result in a less than desirable postoperative result.
Diffuse idiopathic skeletal hyperostosis (DISH), also known as Forestier's disease, is an ossifying diathesis characterized by excessive bone formation at specific skeletal sites. The condition is best recognized for its spinal features. However, the tendency toward bone formation is often manifested in extraspinal locations, particularly the foot. The radiographical, pathological, and clinical features of the disorder are reviewed with special emphasis on the foot as a target organ. Abnormalities in the foot that suggest the diagnosis of DISH are emphasized.
A macroscopical, arteriographical and histological study was made of the arterial supply of the navicular bones of horses with clinical and/or radiographic signs of navicular disease. Based on the clinical and radiological findings the navicular bones of 40 Warmblood horses are divided into four different groups. In the pattern of the arteriogram obvious changes are noticed: an imbalance and a distal to proximal shift between the distal and proximal arterial supply occur, indicating a reduction of the distal blood supply with a compensatory reaction of the proximal, medial and lateral supply. The changes in the pattern of the arteriogram are histologically defined by arterio(lo) sclerosis and newly formed arteries. The presence of radiologically visible nutrient foramina is associated with a changed pattern in the arteriogram, increased bone remodelling and fibrosis. Ischaemia and increased pressure (hypertension and/or increased intra-articular pressure) are considered to be responsible for changes in form and number of radiologically visible nutrient foramina.
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There are two objectives in this study: the first is to estimate skeletal age by lateral cephalomatric roentgengram of cervical vertebrae instead of X-ray of handwrist, the second is to study the rules of cervical vertebrae's growth and development of children from Beijing. The Auto CAD 12.0 computer software was used in measuring lateral cephalomatric roentgengrams of cervical vertebrae of 280 children from Beijing aged 9-15. The shape of cervical vertebrae of children with that of adults on X-ray films was compared, and the growth and development of cervical vertebrae of 9-15 years old children from Beijing was observed. We found out that the rapid growth period of cervical vertebrae was 12-14 years old for girls and 14-15 years old for boys. During puberty, the change of vertebrae's shape has no difference between male and female. 42 female and 28 male teenagers from the 280 aged 9-13 years old were taken X-ray films of left handwrist. The comparison between the films and roentgengrams shows that the appearance of sesamoid of hand and the concavity of the second vertebrae body is at the same time, which means that the beginning of rapid growth period can be estimated by the lateral cephalometric roentgengrams of cervical vertebrae.
Clinical, radiographical, scintigraphical and histological effects on the navicular bone after resection of the medial and lateral palmar digital arteries in the pastern of one forelimb in ponies are evaluated. The acute disruption of the main blood supply of the distal extremity causes lameness due to the suddenness of the resection in which the collateral circulation is insufficiently developed. Because of the compensatory collateral circulation, no permanent symptoms of ischaemia occur despite the partial resection of both palmar digital arteries. Histologically the percentage of relative osteoid volume of the operated limb was significantly higher than in the control limb.
Mechanical overload due to poor conformation or shoeing has been suggested to contribute to the development of navicular disease. While studies have determined the compressive force exerted on the navicular bone in normal horses, this has not been reported for horses with navicular disease. Also, the force has not been converted to stress by correction for contact area. In this study we developed a technique for the determination of the contact area between the deep digital flexor tendon and the navicular bone in vivo, and used a forceplate system to determine the force and stress on the bone at trot in 6 normal and eight diseased horses. The mean +/- s.d. peak force and peak stress were 5.62+/-1.45 N/kg and 2.74+/-0.76 MPa for the normal group and 6.97+/-1.50 N/kg and 3.07+/-0.55 MPa for the navicular disease group. The peak force and peak stress were similar for both groups but the force and stress in the horses with navicular disease were approximately double control group values early in the stance phase. This was due to a higher force in the deep digital flexor tendon, which was attributed to a contraction of the deep digital flexor muscle in early stance in an attempt to unload the heels.
The fabella is a common normal ossicle lying behind the knee. An experienced observer is unlikely to consider it to be an abnormality but, if there is uncertainty in the mind of the referring clinician, a comparison view of the other knee might be requested. This would be a useful decision if the bone in question was present on the other side in close to 100% of people. The incidence of the fabella was studied in the local population and it was found that it was bilateral in only 63% of people. This percentage is lower than that reported elsewhere (81-85%).1-4 Therefore, there was no reason to X-ray the opposite side to confirm that the ossicle in question was a fabella. If the local incidence of fabella had been a little lower, say 50%, it would have meant that tossing a coin would have been just as reliable as a "comparison view". Therefore, in case of doubt, the best advice seems to be to refresh the memory by consulting a reference book of normal variants and to take comparison views sparingly.
Estimating the shape of the proximal articular border of the navicular bone and grading the radiological navicular bone condition (grades 3 and 4 representing the most severe changes), the aim of this study was to assess potential age-related implications of the previously reported shape predisposition to navicular disease in 746 normal and 174 clinically affected Dutch Warmbloods age 3-19 years. A significant, age-independent, shape-grade association found in normal and affected horses emphasises the fundamental character of the shape predisposition to navicular disease. A significant age-related increase of the least susceptible shape prevalence was found in elderly normal horses. A shape-independent low grades 3 and 4 prevalence (mean 15%) was found in normal horses, vs. a high grades 3 and 4 prevalence (mean 85%) in the affected horses. Therefore, the clinical manifestation of the disease is grade-rather than shape-dependent. A significant age-related appearance of inverted flask-shaped channels and enthesophytes was found in the clinically affected horses. However, considering the significant shape-radiological features association previously reported in 3-year-old normal horses, this association may be shape- rather than age-dependent.
BACKGROUND: Having observed the apparent absence of a bony patella in a Madagascar flying fox (Pteropus sp.), other species from the two suborders of bats (Megachiroptera and Microchiroptera) were examined to determine the presence or absence of a bony patella and the distribution of this feature among bats. METHODS: Gross, radiographic, and histologic examination of seven megachiropteran species representing four genera, as well as six microchiropteran species representing six genera, was performed. RESULTS: A bony patella was observed in all six microchiropteran and in three megachiropteran species. The tendon of the quadriceps femoris muscle in Microchiropteran species was composed mainly of dense regular connective tissue. The quadriceps tendon in Megachiropteran species with a patella contained an abundance of fibrocartilage and hyaline cartilage, unlike the quadriceps femoris tendon of the Microchiroptera or a laboratory mouse examined for comparison. CONCLUSIONS: Four species of the megachiropteran genus Pteropus lacking a bony patella displayed a similar occurrence and distribution of fibrocartilage and hyaline cartilage within the quadriceps tendon as seen in the other bats. In reference to this singular feature, Pteropus is unique among the representatives of megachiropteran and microchiropteran genera examined here.
A case of haematogenous osteomyelitis of the medical first metatarsal sesamoid is presented and the differential diagnosis discussed. Review of the literature suggests that the condition is rarely seen and tends to present in childhood and adolescence. This contrasts with metatarsal sesamoid osteomyelitis due to direct spread of infection, which occurs in the elderly as an important complication of the diabetic foot.
Bony or cartilaginous ossicles occur at the plantar aspect of the interphalangeal joint of the great toe. The variation in pattern, prevalence, and anatomic relationships of these structures is not clearly established in the literature, especially in a Caucasian population. Without this knowledge, pathology at this joint may be underestimated and surgical approaches may be poorly planned particularly as radiographs underestimate the incidence of ossicles at this joint. The aims of this study were to determine the incidence and pattern of ossicles at this joint and to establish their anatomic relationships to aid planning the approach for their excision. The interphalangeal joint of the left hallux was dissected in 40 British Caucasian cadavers and the pattern of nodules and their anatomic relationships were established. In 27.5% of subjects, there was no identifiable ossicle and, in these specimens, the tendon of flexor hallucis longus was adherent to the joint capsule. In the remaining specimens (72.5%), a bursa separated the tendon of flexor hallucis longus from the plantar joint capsule and nodules were found embedded within the joint capsule. More than half (52.5%) of the specimens had a single nodule located centrally within the plantar capsule and the remaining 20% had two nodules lying within the capsule. This study shows that a large proportion of the population have either one or two bony or cartilaginous ossicles at this joint. It has also shown that, when present, these structures do not lie within the tendon of flexor hallucis longus and may be most safely excised from a medial approach.
We report 3 cases of dorsal dislocation of the first metatarsophalangeal joint treated by closed reduction. Associated dislocation of the sesamoid complex may make reduction difficult. We suggest a modification of Jahss's classification and have confirmed our findings in amputation specimens.
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The first metatarso-sesamoid joint is separately identified from the first metatarso-phalangeal joint and its anatomical characteristics are described from a study of one hundred anatomical specimens of normal adult and children's feet and two hundred radiographs of patients' feet. The author finds that the metatarso-sesamoid joint is assymmetrical both in children and adults, the medial surface being larger than the lateral. The medial sesamoid lies centrally, and the lateral sesamoid lies laterally, under the head of the first metatarsal. A knowledge of the shape and function of this joint is important in understanding the pathology as well as the therapeutic indications of various conditions of forefoot imbalance, mainly of hallux valgus.
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