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PubMed1997

Skeletal maturation of the hand and wrist and its correlation with dental development.

The maturation status of each hand and wrist bone age of 117 12-year-old Southern Chinese girls was studied using the Greulich and Pyle Atlas (1959) Method. The bone ages were found to range from 12.14 years (scaphoid) to 12.80 years (middle phalanx V). The mean and standard deviation of the skeletal age of the hand and wrist region were 12.57 years and 1.11 years, respectively. Skeletal maturation of 102 of these Southern Chinese girls was correlated to the developmental status of their permanent dentition. A statistically significant difference with p < 0.01 was found between the skeletally above-average and skeletally below-average girls. Contrary to previous studies, the skeletally below-average group had on average 1.1 more erupted permanent teeth than the skeletally advanced group. In addition, there did not seem to be any close relation between apical closure of the permanent mandibular canine and bone age of the adductor sesamoid.

Adolescent↗
PubMed2001

The adductor hallucis revisited.

To evaluate anatomic variability in the insertion of the adductor hallucis into the lateral sesamoid and proximal phalanx of the great toe and to evaluate the extent of release of the adductor hallucis tendon performed through an incision in the dorsal first-web space, we recorded the angle of hallux valgus in 42 fresh-frozen specimens from human cadavers. An incision was made for a realignment of the soft tissues, dissecting down to the level of the intermetatarsal ligament. A loop of suture was placed around the identifiable adductor hallucis tendon through this incision along the lateral aspect of the lateral sesamoid. Then a plantar dissection removed all soft tissue to the level of the intermetatarsal ligament, adductor hallucis (transverse and oblique heads), lateral sesamoid, and lateral flexor hallucis brevis. The Insertion of these muscles into the proximal phalanx was evaluated. Specifically, we looked for separate slips of the adductor tendon inserting into the base of the proximal phalanx or separate insertions of the adductor tendon and the tendon of the flexor hallucis brevis muscle. In 33 of the 42 specimens, the entire adductor hallucis tendon had been isolated by the loop of suture through the incision in the dorsal first web. In eight of the remaining nine specimens, a small slip of the tendon (comprising less than 25% of its substance) had not been included. No specimen was found to have a separate slip of the adductor tendon inserting into the base of the proximal phalanx. Instead, all specimens were found to have only a conjoined insertion of fibers of the adductor hallucis and of the flexor hallucis brevis from the lateral sesamoid into the base of the proximal phalanx. We did not identify a separate tendon-insertion into the proximal phalanx in any specimen. Therefore, great caution should be exercised in releasing an isolated insertion of the adductor tendon from the base of the proximal phalanx of the great toe since it may actually represent the conjoined insertion of the lateral flexor hallucis brevis tendon and the adductor tendon. We found that by simply releasing the adductor tendon from its insertion along the lateral aspect of the sesamoid, accomplished through an incision in the dorsal first web, that an adequate release was achieved in most specimens.

Cadaver↗
PubMed2004

The sesamoid index in psoriatic arthropathy.

OBJECTIVE: The sesamoid index was originally described as an aid to the diagnosis of acromegaly. We performed this study to assess the value of the thumb sesamoid index in the diagnosis of psoriatic arthropathy. DESIGN: Retrospective measurement of the sesamoid index (length x width of the medial thumb sesamoid), along with the age and sex were recorded for patients as described below. Patients with psoriasis were subdivided into those with or without radiographic evidence of hand arthropathy. PATIENTS: Fifty-nine consecutive patients attending rheumatology clinics with arthralgia and psoriasis were studied. Comparison groups with radiographic evidence of rheumatoid arthritis (52 patients), osteoarthritis (44) or normal hands (55) were also recorded. RESULTS: Twenty-one of 59 patients with psoriasis and arthropathy had a sesamoid index>40, compared with two of 52 with rheumatoid arthritis, none of 44 with osteoarthritis and none of 55 normals. CONCLUSIONS: Psoriatic arthropathy is a recognised cause of bone enlargement, usually in the phalanges due to periostitis and proliferative enthesopathy. We have confirmed that psoriatic hand arthropathy can cause significant enlargement of the thumb sesamoids, a feature which is easily quantified and may assist diagnosis.

Adult↗
PubMed1993

Basal sesamoidean fractures in horses: 57 cases (1980-1991).

Medical records of 57 horses admitted between 1980 and 1991 because of basal sesamoidean fractures were evaluated. Radiographic measurements of fragment size and fracture characteristics were recorded to determine their relationship to outcome. A successful outcome was assessed on the basis of the ability to return to racing, ability to race more than one time, and ability to finish first, second, or third. Any change in racing class also was assessed. There was a significant (P < 0.001) overrepresentation of Thoroughbreds, compared with other breeds in the hospital population. Fractures of the forelimbs accounted for 50 of the 57 fractures, and the right front medial sesamoid was affected significantly (P < 0.0001) more frequently than other proximal sesamoids. Fifty-nine percent of the horses returned to race at least 1 time regardless of treatment, and 41% finished first, second, or third. Horses with smaller fragments (shorter dorsopalmar length) tended to do better than horses with larger fragments. Horses without comminuted fractures tended to do better than horses with comminuted fractures, and horses with fragments only mildly (< 3 mm) displaced had significantly (P < 0.05) better outcomes than did horses with severe displacement of fragments. Only 19% of the horses with moderate (> 3 mm) displacement of fragments raced more than once, whereas 63% of horses with mild displacement of fragments returned to race more than once. Seventy-three percent of the horses that had the fragment removed surgically returned to race, and 57% dropped in class. Only 48% of the horses that did not have the fragment removed returned to race, and 87% dropped in class.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMedDate not supplied

Bipartite tibial sesamoid and hallux abducto valgus deformity: a previously unreported correlation.

A retrospective radiographic study was undertaken to determine the incidence of a bipartite tibial sesamoid and its relationship in hallux abducto valgus (HAV) deformity. It was found that the incidence of a bipartite tibial sesamoid associated with HAV deformity was twice as frequent than a bipartite tibial sesamoid in a general foot population. The authors conclude that the tibial sesamoid plays an important role in the development of HAV deformity.

Adolescent↗
PubMedDate not supplied

Radiographic alterations in the foot following toe-to-thumb free transfer.

Bone radiographs of 15 males who underwent a toe-hand transplant were studied to characterize alterations in the biomechanics of the foot after the procedure. Anteroposterior, lateral, and sesamoid radiographic views were used. Previous research has assessed this surgery clinically; however, this is one of the first investigations of this technique using conventional radiographs. Definite trends were observed on the operative foot, including stress reaction, disuse osteopenia, arch angle changes, and alignment alterations. Eleven patients exhibited both a stress reaction and some degree of disuse osteopenia. Seven of the subjects demonstrated a decreased arch angle on the operated foot as compared with the contralateral foot. Eight subjects exhibited a varus drift of the second ray. Although these donor defects can be anticipated following this surgery, the long-term benefits of a functional thumb outweigh them.

Adult↗
PubMed1985

Interrelationships among measures of somatic, skeletal, dental, and sexual maturity.

The interrelationships among five measures of physiologic maturity for 50 French-Canadian girls are evaluated--menarche, peak height velocity (PHV), 75% skeletal maturity, appearance of the ulnar sesamoid, and 90% dental development. The mean ages of occurrence of the events differed significantly (P less than 0.01). Menarche and 90% dental maturity showed the least variability. Ages of PHV, menarche, and 75% skeletal maturity were significantly correlated (P less than 0.05). Age of menarche was most closely associated with PHV. The appearance of the ulnar sesamoid was highly correlated with 75% skeletal maturity; both were equally related to the ages of PHV and menarche. The age at which French-Canadian girls attain 90% of their dental development showed no significant relationships with the other maturity indicators. The results imply that the mechanisms controlling dental development are independent of somatic and/or sexual maturity.

Adolescent↗
PubMed1994

[Comparison of skeletal development between rural and urban school-age children].

Skeletal development and other related indicators were measured in 1680 children aged 7-18 in urban areas of Harbin and rural areas of Hailun County in 1990-1992, and comparisons were made. The results showed that the skeletal age of urban children aged 7-17 was higher than that of rural children in both sexes, and this difference was significant in the early puberty stage. The difference in mean values of cortical thickness of the metacarpals between urban and rural children showed similar tendency. Sesamoid ossification in urban children occurred one year earlier than that in rural children in both sexes. In primary school-age children, skeletal age was highly correlated with body height and weight. The development of secondary sex characteristics in both sexes and the age at menarche in girls in urban areas were earlier than those in rural areas, and the onset of puberty occurred one year earlier in urban than that in rural children.

Adolescent↗
PubMed1997

The relationship of static foot structure to dynamic foot function.

Many theories have been advanced concerning the relationship between structure and function in the human foot, yet few of these theories have been subjected to quantitative examination. In this study, foot structure was characterized by 27 measurements taken from standardized lateral and dorsi-plantar weight-bearing plain radiographs of 50 healthy adult subjects. Regional plantar pressure distribution data collected from the same feet were chosen as the functional measures. A stepwise regression analysis was performed to (1) explore what portion of the variance in peak plantar pressure during walking can be explained by the radiographic measurements, and (2) identify structural characteristics of the foot which are significant predictors of peak plantar pressure under the heel and the first metatarsal head (MTH1). Most of the radiographic measurements were highly reliable. However, only 31 and 38% of the variance in peak plantar pressure at the heel and MTH1, respectively, could be explained using multiple regression analyses with the radiographic measurements as independent variables. Among the structural predictors that were identified, soft tissue thickness (e.g. calcaneus or sesamoid heights), and arch-related measurements were the strongest predictors of plantar pressure under both the heel and the first metatarsal head. We conclude that, in normal subjects, only about 35% of the variance in dynamic plantar pressure can be explained by the measurements of foot structure derived from radiographs. This implies that the dynamics of gait are likely to exert the major influences on plantar pressure during walking.

Adult↗
PubMedDate not supplied

Biomechanics of the first ray. Part II: Metatarsus primus varus as a cause of hypermobility. A three-dimensional kinematic analysis in a cadaver model.

Variation in functional stability of the first metatarsocuneiform joint was analyzed between transverse plane deviated (adducted) and corrected first metatarsal positions in a closed kinetic chain model. Six fresh frozen cadaver specimens with intact ankles and feet were fitted with a custom fabricated titanium metatarsal jig, which allowed for manipulation of the first metatarsal in the transverse plane. Specimens were mounted into a custom-made acrylic load frame and axially loaded to 400 N. Radiowave three-dimensional tracking transducers were attached to the following osseous segments: first metatarsal head and base, medial cuneiform, and second metatarsal. A dorsally directed load was applied to the first metatarsal segment and resultant movements were measured. Repeated testing was performed on a transverse deviated and corrected first metatarsal positions with the hallux plantargrade and maximally dorsiflexed to engage the windlass mechanism. With the windlass mechanism engaged and first metatarsal corrected, a 26% increase in first ray plantarflexion occurred from a deviated to a corrected first metatarsal position (p < or = .05). This suggests that the windlass mechanism is more efficient when the first metatarsal, sesamoid apparatus, and hallux position are properly aligned with the orientation of the plantar aponeurosis. Clinically, this may explain the correlation of first ray hypermobility with the progression of bunion severity. Our study validates the earlier work of Hicks and adds additional insight into the functional stability in the medial column of the foot.

Acrylic Resins↗
PubMed1998

Disorders of the hallux sesamoid complex: MR features.

Numerous painful conditions can affect the first metatarsophalangeal-sesamoid joint complex. Symptoms can be of sudden or insidious onset, and be of acute or chronic duration. Although conventional radiography is recognized as the initial diagnostic procedure for these symptoms, there is often a need to proceed to MR imaging. MR imaging is sensitive and can be utilized in the investigation of the hallux sesamoid complex to differentiate soft tissue from osseous pathology. Synovitis, tendonitis, and bursitis can be distinguished from bony abnormalities such as sesamoid fracture, avascular necrosis, and osteomyelitis. An understanding of MR imaging features and techniques will result in the highest diagnostic yield. Early and accurate diagnosis of sesamoid complex disorders can guide the physician to the appropriate clinical management and prevent potentially harmful longstanding joint dysfunction.

Adult↗
PubMedDate not supplied

Forefoot pain involving the metatarsal region: differential diagnosis with MR imaging.

Many disorders produce discomfort in the metatarsal region of the forefoot. These disorders include traumatic lesions of the soft tissues and bones (eg, turf toe, plantar plate disruption, sesamoiditis, stress fracture, stress response), Freiberg infraction, infection, arthritis, tendon disorders (eg, tendinosis, tenosynovitis, tendon rupture), nonneoplastic soft-tissue masses (eg, ganglia, bursitis, granuloma, Morton neuroma), and, less frequently, soft-tissue and bone neoplasms. Prior to the advent of magnetic resonance (MR) imaging, many of these disorders were not diagnosed noninvasively, and radiologic involvement in the evaluation of affected patients was limited. However, MR imaging has proved useful in detecting the numerous soft-tissue and early bone and joint processes that occur in this portion of the foot but are not depicted or as well characterized with other imaging modalities. Frequently, MR imaging allows a specific diagnosis based on the location, signal intensity characteristics, and morphologic features of the abnormality. Consequently, MR imaging is increasingly being used to evaluate patients with forefoot complaints. Radiologists should be familiar with the differential diagnosis and MR imaging features of disorders that can produce discomfort in this region.

Diagnosis, Differential↗
PubMed1981

Less common stress fractures in the foot.

In a series of 827 stress fractures in soldiers, 15 were found in the first metatarsal, representing 11% of all stress fractures in the metatarsals. All were in the proximal end of the bone. Eight fractures were found in the fourth and four in the fifth metatarsal. In the cuneiform bones three fractures were found, and one in the talus. One fracture was revealed in the lateral sesamoid of the hallux and one in the peroneal bone. Ten patients had stress fractures in other bones too. The radiological appearance and the corresponding stress mechanisms are discussed.

Finland↗
PubMed1991

The infracalcaneal os peroneum.

There is some confusion in the literature regarding the nature of the os peroneum. It has been claimed to be either a supranumerary os or a sesamoid in the tendon of the peroneus longus muscle. Its position in the foot is also a subject of dispute. Most authors state that it is related to the cuboid bone, and it has in the past been termed the 'cuboidum secundarius.' Occasionally an ossicle is seen inferior to the distal calcaneus distal to the calcaneocuboid articulation. This may represent a developmental anomaly of position of the os peroneum or be the sequel of a rupture of the peroneus longus muscle.

Classification↗
PubMed1998

Characterization of collagens and proteoglycans at the insertion of the human Achilles tendon.

This study provides a unique correlation between a molecular biological and biochemical analysis of the extracellular matrix (ECM) macromolecules in one half of 28 human Achilles tendons with an immunohistochemical study of the other. Both the insertion site and the mid-tendon were studied. The insertion (enthesis) is characterized by three distinctive fibrocartilages, two in the tendon (enthesial and sesamoid) and one on the heel bone (periosteal). Thus, its structure contrasts markedly with the fibrous character of the mid-tendon. RT-PCR analyses were performed on RNA extracted from mid-tendon and from the tendon fibrocartilages to investigate transcription of collagens and proteoglycans. Western blotting was also used to identify and characterize these macromolecules, and immunohistochemistry to localize their distribution. The results demonstrate striking differences in the ECM between the mid-tendon and its insertion. Types I, III, V and VI collagens, decorin, biglycan, fibromodulin and lumican were found in both the mid-tendon and the fibrocartilages, although their precise distribution often differed with site. mRNA for type II collagen was constantly present in the fibrocartilages, but it was only found in the mid-tendon of one specimen. The patterns of distribution for versican and aggrecan mRNA were complimentary - versican mRNA was present in the mid-tendon and absent from the fibrocartilages, while aggrecan mRNA was present in the fibrocartilages and absent from the mid-tendon. The range and distribution of ECM molecules detected in the Achilles tendon reflect the differing forces acting on it - the mid-tendon largely transmits tension and is characterized by molecules typical of fibrous tissues, but the fibrocartilages must also resist compression and thus contain, in addition, molecules typical of cartilage.

Achilles Tendon↗
PubMed1986

Fracture of the os peroneum with rupture of the peroneus longus tendon. A case report and review of the literature.

Subcutaneous rupture of the peroneus longus tendon occurring through a fracture of the os peroneum sesamoid in the foot, confirmed at surgery, is a rare injury, possibly with only one previously reported case. In the present case, the patient fell from a curb with the foot and ankle in supination; to prevent the fall, the patient forcibly everted the foot and ankle. Differential diagnosis of the injury includes chronic ankle ligament sprains, avulsion of the bony insertion of the peroneus brevis tendon, peroneal tendon subluxation, trauma to a congenitally multipartite os peroneum, and calcific tendonitis of the peroneus longus tendon. Primary repair with surgical approximation of the fractured os peroneum was performed with a satisfactory outcome.

Female↗
PubMed1976

The effects of a 20-week nutritional insult on the skeletal development of Cebus albifrons during the 1st year of life.

Using an atlas constructed from records of a group of normal monkeys in the same colony, the effects of a 20-week low-calorie or low-protein nutritional insult on skeletal development were determined. The most significantly retarded sites were the late-forming ossifications (epiphyses, sesamoids, and tuberosites). A general increase in ossification anomalies and in individual variation was evident. The similarity of these findings to studies previously reported for man indicates the utility of nonhuman primate models for the further study of nutritional deficiency.

Age Determination by Skeleton↗