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Heavy metal concentrations in injured racehorses.

Records were reviewed of horses that had fatal injuries at California racetracks over a 16-mo period. Horses were categorized based on injury type, sex, age and breed. Arsenic, cadmium, copper, iron, lead, molybdenum and zinc concentrations were measured in the liver and kidneys from each horse. Arsenic and lead were not detected in any tissues. Liver heavy metal concentrations were not related to the injury type. Kidney iron concentrations were significantly (P < 0.05) higher in horses with ligament ruptures and in horses with fractured sesamoid, carpus or metacarpus/metatarsus bones. Liver cadmium, kidney cadmium, and liver iron were higher (P < 0.05) in horses > 2 y old than in 2-y-olds. Liver cadmium concentrations were higher (P < 0.05) in Thoroughbreds than in Quarter Horses.

Aging↗

Cartilaginous sesamoid or nodule of the interphalangeal joint of the big toe.

Since 1971, a cartilaginous sesamoid or nodule has been identified in the plantar ligament of the interphalangeal joint of the big toe in 29 of the 58 patients (50%) from whom spurs of the plantar medical aspect of the adjacent phalanges were removed because of painful callouses. It is felt that the firm mass of the cartilaginous sesamoid may have contributed to the callous formation in many cases. These cartilaginous sesamoids have all been removed when found.

Adult↗

Lateral shifting of the first metatarsal head in hallux valgus surgery: effect on sesamoid reduction.

Thirty feet with hallux valgus (HV) having grade 2 and 3 sesamoid stations on AP radiographs were examined after Lindgren-Turan oblique distal metatarsal osteotomy with a minimum follow-up of 12 months. Adductor tendon release from the lateral sesamoid was not performed to determine the isolated effect of distal metatarsal osteotomy on metatarsosesamoidal reduction. Of the 30 feet, 20 (67%) had reduced and 10 (33%) unreduced sesamoids at the follow-up. Ultimately, distal metatarsal osteotomy (DMO) with lateral shifting of the first metatarsal head more than 7.2 mm was found to reduce the sesamoids in the great majority of the cases (95% CI 7.243-9.757). Sesamoid release is redundant for metatarsosesamoidal reduction if sufficient lateral shift of the first metatarsal head over the sesamoids is accomplished.

Adolescent↗

The sesamoids of the metacarpo-phalangeal joint of the thumb: an anatomical and clinical study.

Two unusual cases of injury to the sesamoids of the M.P. joint of the thumb are described. An anatomical dissection of the M.P. volar plate region, including the sesamoids, was undertaken to delineate the details of the sesamoids' relationship to the M.P. joint, flexor tendon, flexor tendon sheath and capsule of the joint. Histological studies were carried out to demonstrate a tendinous extension of the muscles that attach to the sesamoids.

Adult↗

Extirpation of the fibular sesamoid simplified.

This technique allows the surgeon to maintain a firm grasp on the fibular sesamoid during its dissection, thus minimizing surgical trauma to the surrounding tissue and decreasing the chance of an inadvertent tenotomy of the flexor hallucis longus tendon. The authors have used this technique in 30 sesamoidectomies and found it to lower the frustration level significantly. The only instances in which it does not work as well as expected is with severely osteoporotic sesamoids, and partite sesamoids with fragments too small to pierce with the Kirschner wire. This technique has proved to be relatively simplistic. The small diameter of the Kirschner wire permits both excellent vision of the operative field and easy access to dissection.

Bone Wires↗

First metatarsophalangeal joint arthrodesis. Treatment for sesamoid fractures.

Fractures of both hallucal sesamoids are not commonly reported in the literature. The authors address various surgical procedure choices and present a case history. In their case, conservative treatment failed; therefore, surgical intervention was elected, and fusion of the first metatarsophalangeal joint was performed.

Adult↗

Evaluation of pediatric foot problems: Part I. The forefoot and the midfoot.

Foot problems in children can be the result of infection, trauma or overuse. Ingrown toenails, bunions, sesamoid disease, congenital overriding of the fifth toe, and fractures may occur in both adults and children. Some disorders, such as Freiberg's infarction and Kohler's disease, however, are unique to the pediatric population. The potential for adverse sequelae is greater in children than in adults. A thorough understanding of the anatomy of the pediatric foot and a systematic examination will facilitate the diagnosis of pediatric foot problems. A conservative approach to management will improve both compliance and outcome.

Child↗

Bizarre parosteal osteochondromatous proliferation (Nora's lesion) of the sesamoid: a case report.

We report the a case of Nora's lesion (Bizarre Parosteal Osteochondromatous Proliferation) of the sesamoid. A 32-year-old woman presented with a painless, enlarging mass of two years duration on the plantar aspect of the first metatarsophalangeal joint of the left foot. Radiographs, Computerized Tomographs and Magnetic Resonance images, initially suggested a parosteal osteosarcoma arising from the tibial sesamoid. The mass was excised, and a histological diagnosis of Bizarre Parosteal Osteochondromatous Proliferation of bone (Nora's lesion) was made. The aggressive growth of this lesion may suggest a neoplasm clinically. Histological features, however, are those of a reactive lesion.

Adult↗

The hallux sesamoids revisited.

The hallux sesamoids are vulnerable to significant injury and weight-bearing stress in both the athlete and the nonathlete. Unfortunately, they are often dismissed as inconsequential accessory bones. The historical significance, embryology, anatomy, and physiology of the sesamoids and the salient features of both traumatic and nontraumatic pathologic conditions affecting these structures are presented. Because the sesamoids can be responsible for prolonged disabling foot pain and discomfort, it is important for both clinician and radiologist to pay attention to these bones and recognize the early signs of abnormality.

Bone Diseases↗