New instrumentation for removal of the fibular sesamoid.
An alternate method for removal of the fibular sesamoid is described. The author utilizes a cartilage knife to facilitate excision of the sesamoid with minimal surgical trauma.
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An alternate method for removal of the fibular sesamoid is described. The author utilizes a cartilage knife to facilitate excision of the sesamoid with minimal surgical trauma.
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Sixteen adolescents presented with symptoms referable to the posterior lateral compartment of the knee, specifically the region of the fabella. The salient features of the syndrome include intermittent pain in the posterolateral region, accentuated by knee extension and localized tenderness when the fabella is compressed against the femoral condyle. The condition appears to be unique to late adolescence (15-17 years of age). Five patients responded to conservative measures. Eleven patients required surgery, all of whom obtained immediate relief of symptoms with removal of the ossified fabella, cartilaginous fabella, or thickened gastrocnemius fibers.
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Iatrogenic dorsal bunions in children, observed mostly after operations for post-poliomyelitic paralysis or club foot, have been successfully treated by an operation in which the tendons of the flexor brevis and the abductor and adductor muscles of the hallux are transferred to the neck of the first metatarsal. This is supplemented by removal of the sesamoids, capsulotomy of the metatarsophalangeal joint, and when necessary by arthrodesis or tenodesis of the metatarsophalangeal joint. In seventeen feet treated in this way only one failure, in a patient with arthrogryposis, was recorded.
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The classic features of chronic sesamoid osteomyelitis are prolonged pain without clinical of systemic evidence of infection and a delayed appearance of roentgenographic changes. Radionuclide imaging assists in early detection. Surgical drainage and appropriate antibiotics are essential to healing. The most common etiologic agents are Pseudomonas species.
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Cadaveric and fresh amputation dissection studies revealed that condylar anomalies, metatarsal axial rotation, and bowstrung flexor tendos will commonly produce subluxation and degenerative changes at the metatarsophalangeal-sesamoid joint. The average arc of motion of the sesamoids from maximum plantar- and dorsiflexion was measured at 71.9 +/- 11 degrees. The anatomic variations presented are correlated with the incidence of chronic sesamoiditis, painful bipartite sesamoids, and chronic nonunions.
The metacarpophalangeal joint complex represents an articulation not only between the metacarpal and proximal phalanx but in the case of the thumb also between the metacarpal and sesamoids. The collateral ligaments and volar plate contribute significantly to the stability of the metacarpophalangeal joints. Detailed knowledge of the anatomy of the articulations and soft-tissue supports of this complex is necessary for MR imaging detection of subtle injuries to these structures. The role of MR imaging in both acute and chronic trauma to the collateral ligaments and in the often difficult diagnosis of chronic thumb sesamoiditis is presented, with illustrative examples of the normal and pathologic conditions of metacarpophalangeal joints.
There are many causes of knee pain in the athlete. Clearly, common things, such as meniscal tears, ligament sprains, contusions, and patellofemoral dysfunction, are common. The infrequency of other entities, however, should not make the physician complacent. A thorough history and physical examination will, in most cases, elicit inconsistencies in the occasional athlete presenting with one of these uncommon causes of knee pain (Table 1). Diagnosing these uncommon causes, when they do present to the health care provider, allows for early and correct treatment with a more rapid return to sports.
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In sheep, the muscle component of the proximal sesamoidean ligament, which is well developed at birth, undergoes a progressive involution postnatally. The development of muscle fibres in the proximal sesamoidean ligament was compared with masseter and semimembranosus muscles from before birth into adult life, using histochemical, immunohistochemical and biochemical methods. Neonatal myosin (a marker for developmental immaturity) disappeared earlier, and the adult pattern of myosin expression and fibre type composition was reached earlier in the proximal sesamoid ligament than masseter and semimembranosus. Proximal sesamoid ligament muscle fibres therefore complete normal development, but with a faster time course than the other muscles. Invasion of fibrous connective tissue between muscle fibres of the proximal sesamoidean ligament adjoining the tendinous component (one feature of the involution) was found to begin perinatally, eventually resulting in a marked fibrosis and atrophy of peripheral fibres. Regeneration of muscle fibres was absent or abortive, even near areas of fibre necrosis.
Classical ballet is a popular but physically demanding activity. Minor injuries become increasingly common as the dancer encounters the greater workload of professional dancing. The doctor must have a basic knowledge of ballet technique and an understanding of the mental approach of dancers to accurately diagnose and effectively treat their injuries. The practice of dancing on the toes, the exaggerated turn out of the feet, and the extreme flexibility of the hips and spine all lead to unusual injuries. With informed conservative treatment, most ballet injuries will heal, but surgery is occasionally required.