[Findings on menarche-body height and puberty-sesamoid relations].
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The Fabella Syndrome is recognized by a sharp pain, local tenderness, and intensification of pain in the area of the fabella by full extension of the knee. After diagnostic tests with local anesthesia and ineffective conservative treatment, surgical extirpation may produce lasting relief of symptoms.
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The fibular sesamoidectomy, used frequently in a modified McBride bunionectomy for hallux valgus surgical correction, is a difficult procedure to perform. The authors hope that the descriptive drawings and the technique as described in this article will help to simplify the procedure.
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A vegetative innervation is described for the first time in this district. On the contrary, the finding of Pacini and pacini-like corpuscles, of Golgi Mazzoni's receptors, of muscle spindles and Golgi's tendon-organs testifies the existence of a sensitive innervation in this anatomical territory. According to Karamanlidis free nervous endings are not present. All the above recorded receptors show the typical structure and can be found isolated, grouped to constitute flower-sprays, organized to form opposito-polar corpuscles or associated to originate pecilomorphic fibers. These two last findings are new for this investigated anatomical territory. Moreover, the authors have described in the ox the so-called composed corpuscles previously observed by Ottolenghi (1931) and Karamanlidis in the horse. Finally, it has been demonstrated, contrary to the data reported by Karamanlidis, that the muscle spindles located in the ligament are always supplied with a nervous annulo-spiral termination which is centrally placed in the equatorial region.
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I examined radiographs of the knees of 600 men to determine the incidence of fabellae in radiographically normal knees as compared with knees with primary osteoarthrosis. At least a unilateral fabella was present in 106 (35 per cent) of 300 patients with primary osteoarthrosis of the knee. In an age-matched group of 300 patients with radiographically normal knees, only forty-four (15 per cent) had a fabella. The presence of a fabella may represent an atavistic pattern, and the fact that knees with primary osteoarthrosis are more likely to contain a fabella raises the question of whether an atavistic pattern predisposes a knee to osteoarthrosis.
As I mentioned in the beginning of this discussion, it is imperative to treat all of these intractable plantar keratoses conservatively with proper shoes, metatarsal supports, and local care of the lesion before considering any type of surgical intervention. Many patients will respond to conservative management, and it is certainly the treatment of choice if the patient is satisfied with it.
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The authors present their findings upon evaluation of 26 feet that had undergone a tibial sesamoid planing procedure. A preoperative method of radiographic evaluation is also presented. The subjective success rate was determined to be 88.8%, whereas the objective success rate was 76.9%, and a successful procedure was performed on feet with a first metatarsal declination angle not exceeding 8 degrees. It was also determined that the apparent postoperative changes in the hallux abductus and intermetatarsal angles were 0.73 degrees and 0.6 degrees, respectively. The authors believe this procedure does not significantly alter the biomechanics of the first metatarsophalangeal joint postoperatively.