Search

Objectives Digital annular pulleys (DAPs) are important anatomical structures for finger function. The anatomy, histology and imaging assessment of DAPs, particularly at the level of their entheses, are still not clearly defined. The advent of high-frequency US transducers opened new perspectives in evaluating submillimetre-scale structures, such as pulleys, paving the way for their global assessment. The study aimed to characterize DAPs from an anatomical, histological and US perspective, focusing on the detection and complete description of pulley entheses. Methods US assessment and gross anatomy dissection were conducted on 20 cadaveric hands to study DAP thickness and structure, including enthesis identification. The results of the US and anatomical measurements were correlated. DAP entheses identified by US were characterized via histological analysis. DAPs in 20 healthy controls (HCs) were detected and measured by US. The A1, A2 and A4 DAP entheses were assessed using a new dynamic manoeuvre to better evaluate those structures. Results A total of 1200 DAPs (400 cadaveric, 800 HCs) were analysed. The cadaveric study demonstrated strong correlation between anatomical and US measurement of DAPs (r  = 0.96). At the histological level, DAP entheses at the volar plate, sesamoid bones or phalangeal ridges contained fibrous and fibrocartilaginous tissue. US assessment of A1, A2 and A4 DAPs in HCs allowed the identification of 718/720 (99.73%) entheses. Conclusion US is an effective tool to detect and study DAPs. DAP entheses reveal both fibrous and fibrocartilaginous characteristics. A newly described manoeuvre to optimize DAP enthesis visualization enhances their detection by US. [ABSTRACT FROM AUTHOR]

OBJECTIVE To describe the development and maturation of equine proximal sesamoid bones (PSBs) in fetuses and young horses using radiography, microcomputed (micro)-CT, and histology. METHODS A descriptive study. Forelimb PSBs from 12 equids ranging in age from 105 days of gestation to 540 days postgestation were evaluated. Radiography was used for preliminary assessment of metacarpophalangeal joint and PSB mineralization, and micro-CT imaging was performed to assess mineralized PSBs. Tissue volume, bone volume fraction, height, width, depth, trabecular thickness, and anisotropy were quantified from midplanar micro-CT sections in 3 dimensions. Midsagittal PSB histologic sections stained with H&E and Safranin O/Fast Green were used to determine the ratio of ossification center to cartilage template size and to describe the formation and development of the cartilage template, ossification center, spherical growth plate, articular cartilage, and entheses. RESULTS Mineralization of equine PSBs is associated with cartilage canals and a spherical growth plate that undergoes endochondral ossification during the late gestation to early postgestational period. The apical, flexor, basilar, and articular ossification fronts demonstrate morphologic variability. Structural organization of the articular cartilage and entheses occurs concurrently with the development of an underlying plate of compact bone. At 540 days postgestation, the fibrocartilaginous entheses of the flexor cortex of the PSB had yet to mature. CONCLUSIONS Equine PSBs mineralize predominantly by endochondral ossification during the late gestation to early postgestational period. Mineralization precedes maturation of the articular cartilage and fibrocartilaginous entheses. CLINICAL RELEVANCE The postgestational maturation of the PSB and its surrounding tissues may predispose young horses to developing lesions at these sites, such as apical avulsion fractures, warranting further investigation. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to establish a standardized structured workflow to compare findings from high-resolution, optimized reconstructions from post-mortem computed tomography (pmCT) with autopsy results in the detection of fractures of the laryngohyoid complex in strangulation victims. Method: Forty-two strangulation cases were selected, and pmCT scans of the laryngohyoid complex were obtained. Both pmCT scans and autopsy reports were analyzed using a structured template and compared using Cohen's kappa coefficient (κ) and the McNemar test. The study also compared the prevalence of ossa sesamoidea and non-fusion of the major and minor horns of the hyoid bone between both diagnostic methods. Results: The detection of fractures showed a very good correlation between autopsy and pmCT results (κ = 0.905), with the McNemar test showing no statistically significant difference between the two methods. PmCT identified 28 sesamoid bones, 45 non-fusions of the major horns, and 47 non-fusions of the minor horns of the hyoid bone, compared to four, six, and zero, respectively, identified by autopsy (p < 0.0001). Conclusions: Autopsy and pmCT findings correlate well and can be used in a complementary manner. PmCT is superior to autopsy in identifying dislocations and detecting anatomical variations in the laryngohyoid complex, which can lead to misinterpretations during autopsy. Therefore, we do not advocate replacing autopsy with pmCT but propose using a structured workflow, including our standardized reporting template, for evaluating lesions in the laryngohyoid complex. [ABSTRACT FROM AUTHOR]

This article, titled "Accessory Ossicles of the Foot and Their Clinical Significance," discusses the various accessory ossicles found in the foot and ankle and their importance in clinical practice. These ossicles, which are anatomical variations, can be asymptomatic or cause painful syndromes and fractures. The article emphasizes the use of radiography as the gold standard for evaluating these variations, but advanced imaging techniques like computed tomography and magnetic resonance imaging may be necessary to diagnose complications. The article provides information on the prevalence, location, classification, clinical significance, pathologic mechanism, and imaging characteristics of these ossicles, along with examples and images from the authors' database and the literature. The authors highlight the importance of radiologists having knowledge of these ossicles and their manifestations on advanced imaging. [Extracted from the article]

Introduction: The fabella is a sesamoid bone found in the posterior and lateral region of the knee, identified on X-rays behind the femoral condyle in a true lateral view. Occasionally, it is a source of knee pain and is associated with radiological evidence of osteoarthritic knees. Due to its uncommon occurrence, there are very few studies related to an ossified fabella. While posteromedial pain and varus are common entities in knee arthritis, attention needs to be given to posterolateral structures like the fabella, as its radiological appearance may indicate the presence of arthritis. Aim: To determine the occurrence of the fabella and its association with arthritis and knee deformities, such as varus or valgus, in Indian knees on X-rays. Materials and Methods: This was a single-centre, X-ray-based, cross-sectional study conducted in the Joint Replacement Unit-II of the Department of Orthopaedics between June 2022 and March 2023 at KLE's Dr. Prabhakar Kore Hospital in Belagavi, Karnataka, India. A total of 500 knees were radiologically studied using Medsynapse/Picture Archiving and Communication System (PACS), and Cohen's Kappa Test statistics were employed to measure the agreement between the radiologist and orthopaedician regarding the presence or absence of the fabella interpreted on X-rays. Results: The occurrence of ossified fabella was observed in 87 (17.4%) subjects. Amongst these 27 (31.03%) had bilateral fabella, while remaining 60 (68.97%) had it either on left or right side. There was a high association between the occurrence of the fabella with age, Osteoarthritis (OA), and knee deformity (p-value<0.001), and a significant association with gender (p-value<0.05), while no association was found between the occurrence of the fabella with the side involved or any previous operations performed (p-value>0.05). Conclusion: The study revealed that ossified fabella is significantly associated with knee OA, age, and knee deformities. [ABSTRACT FROM AUTHOR]

Scanning electron microscopy (SEM) coupled with energy‐dispersive X‐ray spectroscopy (EDX) enables the determination of the composition and structure of tiny calcified remains occasionally recovered during burial excavations. To deepen the practical application of this technique, we performed SEM/EDX analysis on three different tiny mineralized, roughly rounded structures with a diameter of less than 5 mm recovered from a pre‐Hispanic collective funerary cave from El Hierro (Canary Islands) and a mineral spherulite of similar size and outer aspect. After SEM imaging and spectroscopic analysis, we conclude that the three samples represent a sesamoid bone, a kidney stone, and a possible case of sialolithiasis. In contrast, the spherulite is a mineral formation composed of calcium carbonate. Our data confirm SEM analysis's usefulness in identifying small, mineralized remains recovered during burial excavations and its contribution to studying past populations. However, we are aware that taphonomic changes may alter, at least partially, the structure, and/or elemental composition of archaeological samples, obscuring differential diagnosis. [ABSTRACT FROM AUTHOR]

Background: Sesamoiditis causes intermittent lameness in horses and is characterized by the enlargement of vascular channels, local osteolysis, osteophyte and enthesophyte formation on radiography. This study aimed to report the relationship between the clinical and radiological findings of racehorses diagnosed with sesamoiditis, the treatment applied and long-term results. Methods: The study included a total of 30 Arabian and Thoroughbred racehorses aged 2-7 years diagnosed with sesamoditis based on clinical and radiological examinations. These horses were treated and followed for nine months. Result: Radiographic examination revealed different numbers of enlarged vascular channels in the proximal sesamoid bones in all the cases and osteophytosis (n=3), enthesophytosis (n=9), osteolysis (n=3) and fractures (n=6) in some cases. In addition, low heels were important in 27 cases. The body conformation and low-heeled hoof structure play a role in the development of sesamoiditis in horses and should be considered. As a result, body structure and low heel structure play a role in the development of sesamoiditis in horses and should be considered. This situation should be tried to be corrected by farriers during the foaling period. Sesamoiditis can have a positive prognosis with appropriate treatment and adequate rest, for this reason, treatment should be started in the early period. [ABSTRACT FROM AUTHOR]

This article discusses the efficacy of focused extracorporeal shock wave therapy (fESWT) for the treatment of fabella syndrome, a condition characterized by persistent and atypical posterolateral knee pain. The fabella is a sesamoid bone found in 10%–30% of the population, and its function in humans is largely unknown. Conservative management options for fabella syndrome include injections, immobilization, and manual therapy, but surgical excision may be necessary in some cases. The article presents a case study of a 66-year-old male patient who experienced significant pain reduction and functional improvement after undergoing fESWT treatment. The study suggests that fESWT may be an effective and safe nonsurgical option for managing painful fabella syndrome. [Extracted from the article]

Focal bone lesions are often found prior to clinically relevant stress-fractures. Lesions are characterized by low bone volume fraction, low mineral density, and high levels of microdamage and are hypothesized to develop when bone tissue cannot sufficiently respond to damaging loading. It is difficult to determine how exercise drives the formation of these lesions because bone responds to mechanical loading and repairs damage. In this study, we derive steady-state rate constants for a compartment model of bone turnover using morphometric data from fractured and non-fractured racehorse proximal sesamoid bones (PSBs) and relate rate constants to racing-speed exercise data. Fractured PSBs had a subchondral focus of bone turnover and microdamage typical of lesions that develop prior to fracture. We determined steady-state model rate constants at the lesion site and an internal region without microdamage using bone volume fraction, tissue mineral density, and microdamage area fraction measurements. The derived undamaged bone resorption rate, damage formation rate, and osteoid formation rate had significant robust regression relationships to exercise intensity (rate) variables, layup (time out of exercise), and exercise 2-10 months before death. However, the direction of these relationships varied between the damaged (lesion) and non-damaged regions, reflecting that the biological response to damaging-loading differs from the response to non-damaging loading.

Medial proximal sesamoid bones (PSBs) from Thoroughbred racehorses that did (Case) or did not (Control) experience unilateral biaxial PSB fracture were evaluated for bone volume fraction (BVF), apparent mineral density (AMD), tissue mineral density (TMD), and microdamage in Case fractured, Case contralateral limb intact, and Control bones. A majority of Case bones had a subchondral lesion with high microdamage density, and low BVF, AMD, and TMD. Lesion microdamage and densitometric measures were associated with training history by robust linear regression. Exercise intensity was negatively related to BVF (0.07 ≤ R2  ≤ 0.12) and positively related to microcrack areal density (0.21 ≤ R2  ≤ 0.29) in the lesion; however, in an undamaged site, the relationships were opposite in direction. Regardless of location, TMD decreased with event frequency for both Case and Control, suggesting increased bone remodeling with exercise. Measures of how often animals were removed from active training (layups) predicted a decrease in TMD, AMD, BVF, and microdamage at regions away from the lesion site. A steady-state compartment model was used to organize the differences in the correlations between variables within the data set. The overall conclusions are that at the osteopenic lesion site, repair of microdamage by remodeling was not successful (e.g., lower bone mass, increased damage, and lower mineralization) but that in regions away from the lesion remodeling successfully controlled damage (e.g., higher bone mass, less microdamage, and lower mineralization).

The study aims to analyse the normal anatomical and radiographical features of the Manus of the southern Aswanian‐adapted Arabian one‐humped camel, providing crucial data for diagnosing and treating various ailments. Our study was applied to 10 cadaver forelimbs of adult male one‐humped camels (4–5 years old) for an explanation of the gross anatomy of the bones of the Manus region from under the carpal bones by using traditional techniques, including the gross anatomical, radiographic and x‐ray (at the dorsopalmar and lateral planes) of the preparation of Manus bones. Our results showed that the large fused (third and fourth) metacarpal bones, in which the fusion extended along the entire length of the bone except at the distal end, diverged to form separate articulations with cross‐ponding digits. As described in all ruminant species, especially the camel, there were two digits, and each digit consisted of three phalanges and two proximal sesamoid bones. Our radiographic x‐ray data revealed that the complete radiopaque septum that completely divided the medullary cavity into two separate parts was clear from the dorsopalmar view, while the lateral view showed the proximal sesamoid bones that were placed over each other and located palmar to the head of the large metacarpal bone. In conclusion, our study reveals the adaptations of the Arabian one‐humped camel to Egyptian conditions, aiding in the early diagnosis of lameness and digit problems and enabling veterinarians and camel owners to better address these issues, thereby improving the overall health and well‐being of these animals. [ABSTRACT FROM AUTHOR]

Objectives: The position of sesamoid of thumb metacarpophalangeal (MCP) joint changed clearly when the joint was dislocated dorsally. However, the significance of sesamoid location in diagnosing joint dislocation was unclear. The present study aimed to explore the positional relationship between sesamoid bone and thumb metacarpophalangeal joint in normal and dorsal dislocation joints. Methods: Between January 2018 and August 2023, we collected 60 isometric plain films from sixty outpatients and reviewed 56 anisometric plain films from twenty‐eight emergency patients with dorsal dislocation of thumb MCP joint at Tianjin Hospital, then took measurements on the hand X‐ray images. The sesamoid length on its longitudinal axis was defined as DP, the distance between the distal edge of sesamoid and thumb MCP joint was defined as DJ, and the ratio of DJ and DP was R. An independent‐samples t‐test and paired‐samples t‐test was utilized to analyze difference among data groups. Results: The 60 isometric images were from 30 male and 30 female outpatients with normal bone structure in their hands, and the 56 anisometric images of the 28 emergency patients included both preoperative and postoperative materials. Among the outpatients, the actual distance between the distal edge of sesamoid and thumb MCP joint space (DJ) was 2.09 mm and 1.40 mm in males and females, respectively. The authentic average length of sesamoid (DP) was 4.46 mm in males and 4.22 mm in females. The average value of R (the ratio of DJ and DP) in males and females was 0.49 and 0.34, respectively. There were gender‐related statistical differences in DJ (p < 0.01) and R (p=0.01), but no statistical difference in DP (p > 0.05). For the 28 emergency patients, the mean value of R was –0.47 before joint reduction and 0.58 after joint reduction, with statistical difference between them (p < 0.01). Conclusions: There was significant difference in the relative position between sesamoid and thumb MCP joint when joint dislocation and joint reduction. The distal edge of sesamoid beyond thumb MCP joint could be an evidence in diagnosing joint dorsal dislocation. The distal edge of sesamoid below thumb MCP joint could be an evidence of joint reduction. [ABSTRACT FROM AUTHOR]

Background: Injuries or inflammation of the sesamoid bones can be very painful. In order to properly diagnose and treat problems affecting the hand, it is necessary to have a thorough grasp of the number and location of sesamoid bones in the hand. This study was carried out with an objective to study the distribution and pattern of sesamoid bones of the hand in the Saudi population. Materials and Methods: This three-month retrospective study was conducted from May 2023 to July 2023in orthopedics and radiology department of Saudi Arabia's Medical Centre, Majmaah University's. The study analyzed 200 patient who had sesamoid bone in hand by radiographs. Patients had two radiological examinations. All patients had posteroanterior (PA) and oblique direct hand radiographs. The radiologist and orthopedic surgeon examined hand sesamoid bones, including at the metacarpophalangeal (MCP) and interphalangeal (IP) joints. Radiologist analyzed X-rays of hand injury patients using demographic data and imaging tests. The patients' sesamoid bone distributions and locations were meticulously recorded. Data was analysed in SPSS Version 23, and Chi-square test was applied to test the statistical significance. A p-value of <0.05 was considered significant. Results: Total 200 patients had sesamoid bone examined in their first radiological examination of MCP. Among them 72 (36%) patients had 1st, 2nd and 5th MPC followed by 1st MCP in 58 (29%), 1st and 5th MCP in 45 (22.5%), 1st and 2nd MCP in 43 (21.5%) with average age of sesamoid bone at MCP joint as 47.71±17.09, 41.76±18.08, 48.16±15.76 and 42±14.77 respectively. Sesamoid bone was reported 1st, 2nd and 3rd MCP in 1 (0.5%) and 1st, 2nd, 4th and 5th MCP 1 (0.5%) patients in first radiological examination. Second radiological examination in same patients showed, 64 (32%) patients had 1st, 2nd and 5th MPC followed by 1st MCP in 47 (23.5%), 1st and 5th MCP in 43 (21.5%), 1st and 2nd MCP in 17 (8.5%) with average age of 48.38±17.13, 41.09±16.72, 49.02±16.59 and 38.24±14.59 respectively at MCP joint. The association between first radiological examination and second radiological examination of sesamoid bone at MCP was statistically significant (chi square 623.73, p value <0.001). Conclusion: This is the first radiological assessment with two imaging evaluations in the same 200 patients who had sesamoid bone in hand. In the first and second imaging evaluations, we recorded 7 and 9 sesamoid bone distribution patterns respectively. 1st, 2nd and 5th metacarpophalangeal (MCP) sesamoid bones pattern was seen in patient. Trauma victims rarely have hand sesamoid bones, which are typically misdiagnosed when they appear elsewhere. This study provides orthopedic surgeons with anatomical data to help diagnose and treat patients. [ABSTRACT FROM AUTHOR]

Background. The fabella, a sesamoid bone in the posterolateral aspect of the knee, induces clinical conditions. Considering its ethnic variations and surgical importance, we measured the dimensions and recorded the prevalence of fabella in a Saudi population. This study aims to compare the features of fabella in Saudis with other populations and to test whether its incidence is associated with gender, side, laterality, and age. Methods. In this retrospective cross-sectional study, we reviewed knee radiographs and magnetic resonance imaging films of 820 patients aged 20-90 years. Descriptive statistics were performed to estimate the prevalence of fabella. The chi-square test was used to evaluate the associations of sex, age, and laterality with the prevalence of fabella. The size of the fabella was measured and compared between the sexes and with other studies using independent t-tests. The level of significance was set at p < 0.05. Results. The overall prevalence of bony fabellae was 20.73 %, but no cartilaginous fabella was identified. Its prevalence was significantly associated with age (p = 0.009), right side (p = 0.003) and laterality (p = 0.002). The mean length, thickness, and width were 6.4 mm, 6.07 mm, and 4.74 mm, respectively. The size was significantly larger in males than in females (p < 0.001). The size of the fabella in Saudis is significantly larger than in Turks and smaller than in Asians (p < 0.001). Conclusions. The anatomical features and prevalence of fabella in Saudis vary from those of other ethnic populations. It is clinically crucial to comprehend its variations and features for health professionals, aiding in the differential diagnosis of pathological loose bodies and preventing complications during knee arthroplasty. [ABSTRACT FROM AUTHOR]

Background: Degenerative changes at the sesamoid-metatarsal joints (SMJs) may be a source of pain following hallux valgus surgery. The aims of this study were to describe degenerative changes at the SMJs on weightbearing computed tomography (WBCT) scans and, secondarily, investigate their association with 1-year patient-reported outcome scores following a modified Lapidus procedure for hallux valgus. We hypothesized that reduced joint space in the SMJs would correlate with worse patient-reported outcomes. Methods: Fifty-seven hallux valgus patients who underwent a modified Lapidus procedure had preoperative and minimum 5-month postoperative WBCT scans, and preoperative and at least 1-year postoperative PROMIS physical function (PF), pain interference, and pain intensity scores were included. Degenerative changes at the SMJs were measured using distance mapping between the sesamoids and first metatarsal head on preoperative and postoperative WBCT scans. The minimum and average distances between the first metatarsal head and tibial sesamoid (tibial-SMJ) for each patient preoperatively and postoperatively were measured. Sesamoid station was measured on WBCT scans using a 0 to 3 grading system. Linear regression was used to investigate the correlations between minimum preoperative and postoperative tibial-SMJ distances and 1-year postoperative PROMIS scores. Results: The median minimum and average tibial-SMJ distances increased from 0.82 mm (interquartile range [IQR] 0.40-1.03 mm) and 1.62 mm (IQR 1.37-1.75 mm) preoperative to 1.09 mm (IQR 0.96-1.23 mm) and 1.73 mm (IQR 1.60-1.91 mm) postoperative (P < .001 and P < .001), respectively. In a subset of patients with complete sesamoid reduction, we found an association between preoperative minimum tibial-SMJ distance and 1-year postoperative PROMIS PF scores (coefficient 7.2, P = .02). Conclusion: Following the modified Lapidus procedure, there was a statistically significant increase in the tibial-SMJ distance. Additionally, in patients with reduced sesamoids postoperatively, reduced preoperative tibial-SMJ distance correlated with worse PROMIS PF scores. [ABSTRACT FROM AUTHOR]

Background: The white rhinoceros (Ceratotherium simum) is close to extinction, listed as "Near Threatened", with a decreasing population on the Red List of Threatened Species of the International Union for Conservation of Nature. In at least 50% of the specimens in captivity, podiatric diseases, such as osteitis, osteomyelitis, chip fractures, enthesophytes, fractures and osteoarthritis were found during necropsy. These osteal deformations cause further pathogenic alterations in the soft tissues, particularly in the digital cushion. The literature provides good description of the skeleton of the rhino's limbs, but similar for the vascular system is non-existent. In order to recognize the symptoms in an early state and for a successful surgical treatment, precise knowledge of the vascular anatomy is essential. The purpose of our study was to provide detailed anatomical description of the blood supply of the digits and that of the digital cushion. Results: The blood supply of the distal foot, digits and digital cushions were perfectly visible on the reconstructed and coloured 3D models. The deep palmar arch provided not only the blood supply to the digits but had a palmaro-distal running branch which developed a trifurcation proximal to the proximal sesamoid bones of the third digit. Two of its branches participated in the blood supply of the digits' proximal palmar surface, while the major branch supplied the digital cushion from proximal direction. Conclusions: Our findings show a unique blood supply: the main vessels of the digital cushion stem both directly from the deep palmar arch and from the digits' own arteries. The detailed description of vessels may be useful in planning surgery of the region and also in cases where the veins of the ear are not accessible. [ABSTRACT FROM AUTHOR]

Les pathologies mécaniques de l'avant-pied sont fréquentes. Elles peuvent intéresser l'hallux et les rayons latéraux. L'imagerie repose avant tout sur le couple radiographies en charge–échographie. Le scanner et l'IRM sont le plus souvent des examens de seconde intention. L'anatomie compartimentale de l'avant-pied doit être connue et facilite le diagnostic des différentes pathologies rencontrées : hallux valgus, hallux rigidus et pathologies sésamoïdiennes pour le premier rayon, maladie de Morton, instabilité douloureuse et bursites pour les rayons latéraux. La place de chaque technique d'imagerie et la sémiologie des différentes pathologies sont décrites et illustrées pas de nombreux cas cliniques. Mechanical pathologies of the forefoot are common. They may involve the hallux and lateral rays. Imaging is primarily based on the combination of weight-bearing X-rays and ultrasound. CT and MRI are most often second-line examinations. The compartmental anatomy of the forefoot must be known and facilitates the diagnosis of the various pathologies encountered: hallux valgus, hallux rigidus and sesamoid pathologies for the first ray, Morton's disease, painful instability and bursitis for the lateral rays. The place of each imaging technique and the semiology of the different pathologies are described and illustrated by numerous clinical cases. [ABSTRACT FROM AUTHOR]

Background: The complex framework of the human foot enables movement and weight support. The os peroneum (OP) is a sesamoid bone located in the tendon of peroneus longus. Though tiny, it plays crucial roles in foot movement and arch stability injuries to the tendon are significant, and the OP itself can fracture, dislocate, or impinge. Its presence, size, and even histological type influence the proper functioning of the foot. Studying this sesamoid bone, with its variable prevalence and morphology, can fill gaps in foot and ankle pathology research. Aims and Objectives: To analyze the prevalence, morphology, morphometry, and histology of OP in human adult cadavers in the South Indian population. Materials and Methods: Forty-two formalin-fixed human adult cadaveric free lower limbs were selected and studied from the Department of Anatomy, Pushpagiri Institute of Medical Sciences and Research Centre, Tiruvalla, Kerala. The prevalence of OP in peroneus longus tendons (PLT) and its various configurations were carefully observed, along with their histological types, and then statistical analysis of the data was done using SPSS version 20. Results: Thirty-nine out of the forty-two free lower limbs showed the presence of an OP bearing a smooth oval facet, except for one OP with a round facet. All OP were invariably present in the tunnel for PLT on the plantar surface of the cuboid bone. Three different histological types of this tissue were observed, i.e., osseous, cartilaginous, and fibrous. Conclusion: The present study has attempted to fill the gap in the research data regarding OP in the adult South Indian population. In addition, the knowledge of OP and its configuration in PLT could provide a better radiological and clinical approach to mid- and fore-foot pathologies. [ABSTRACT FROM AUTHOR]

This article, published in Modern Rheumatology Case Reports, presents a case of painful snapping of the middle finger caused by hyperplasia of the ulnar lateral band. The patient, a 26-year-old female, experienced snapping and pain in her middle finger when flexing it from a hyperextended position. Surgery was performed to resect the hyperplastic ulnar lateral band, resulting in the disappearance of the snapping phenomenon. The article emphasizes the importance of considering this condition as a differential diagnosis for snapping finger and highlights the need for a careful physical examination for accurate diagnosis. [Extracted from the article]

Background: The fabella is a sesamoid bone that is a normal anatomic variant yet a rare cause of pathology in the posterolateral portion of the knee. The fabella can cause chronic knee pain in patients with knee osteoarthritis and athletes at all levels and in rare cases can cause neuropathy. Initially, treatment for a painful fabella includes conservative measures, with surgical intervention after conservative treatments have failed. This technique describes our arthroscopic-assisted fabella removal technique with a concomitant medial meniscus revision repair. Indications: The goal of treatment is to relieve pain and numbness. Conservative measures (i.e., nonsteroidal anti-inflammatory drugs [NSAIDs], range of motion exercises, heel cord stretching, etc.) are the initial step in treatment. Patients are treated surgically after conservative measures have failed. The surgical approach involves an open incision, arthroscopy, or a combination. Technique Description: With the patient in the supine position, a physical examination is performed under anesthesia to compare to validate clinical findings. An open lateral knee approach helps to locate the fabella which is grasped with an Alice clap. An arthroscopy is performed, and viewing posterolaterally will confirm that the fabella is within the grips of the Alice clamp. After repair of the meniscus, the surgical bed is repositioned to identify the fabella properly. Excision of the fabella is performed sharply from the lateral gastrocnemius tendon, and palpation is demonstrated to ensure complete removal. Caution is essential to avoid complications including damage to nearby anatomic structures, such as the lateral gastrocnemius tendon, and incomplete fabella removal. Results: A clinical study by Dekker et al reported that 80% of patients were able to return to full activities and postoperative patient-reported outcomes improved from preoperative to postoperative. Fabella excision is recommended for patients with fabella pain who do not respond to conservative treatment. Discussion: We describe a technique for removing the fabella with arthroscopic assistance. Patients who have not responded appropriately to conservative treatment for a painful fabella should consider surgical intervention. With the early initiation of rehabilitation, patients will have an increased likelihood of decreased pain, resolution of symptoms, and reduced knee stiffness. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication. [ABSTRACT FROM AUTHOR]

Greater cane rats (Thryonomys swinderianus) are now being captive reared and domesticated in the sub-Saharan Africa because of increase in their demand for biomedical research and traditional medicine and as a source of meat. This research was performed to provide the normal radiological anatomy of the pelvis and pelvic limb in greater cane rats for a reference in biomedical research, in anatomical studies, and in clinical use. Radiological examination of the pelvis and right pelvic limb was done in five greater cane rats. Radiological results were correlated with bones of the pelvis and right pelvic limb. The pelvic bone had a prominent caudoventral iliac spine. The pelvic symphysis was long and obturator foramina appeared teardrop-shaped elongated craniocaudally. The prominent major trochanter extended proximally higher than the femoral head. The middle third of the body of the tibia presented a very prominent tuberosity. In all specimens, the tarsal sesamoid bone was visualised. Mineralised popliteal sesamoid bone was not visualised. In male greater cane rats, the os penis was visualised. The lateral and medial menisci of the stifle joint were seen with ossicles. The first metatarsal bone was rudimentary with greater plantar divergence. Despite of the pelvic limb and pelvis of greater cane rats sharing anatomical structures with other rodents, it retains some exceptional anatomical features. Findings of this study will serve as a reference for anatomical studies, clinical veterinary practice, and in biomedical research. [ABSTRACT FROM AUTHOR]

The patella is the largest sesamoid bone in the body and an important structure of the extensor apparatus which is under undue stress during flexion and extension of the knee. Bilateral fracture of the patella without trauma is a very rare event and may be multifactorial without a single cause. A repetitive stress reaction in a previously predisposed bone can be an important cause. We report a case of a 45-year-old female with a nontraumatic bilateral transverse patella fracture with loss of extensor mechanism. A stable surgical fixation for such a displaced fracture with a good rehabilitation program can lead to a good functional outcome. [ABSTRACT FROM AUTHOR]

Background: Lameness associated with the distal limb region in dromedary camels is quiet prevalent. The diagnosis of lameness relies on a comprehensive orthopedic examination conjugated with an appropriate imaging modality to achieve a decisive diagnosis. Using of modern imaging tools provoked a significant breakthrough in the diagnosis of lameness. Ultrasonography (US) is widely established in dromedaries, whereas computed tomography (CT) and magnetic resonance imaging (MRI) are gaining popularity. CT provides a considerably higher bone detail than any other imaging modality. US and MRI continue to be the best options for soft tissue imaging. A truthful assessment of the clinical US, CT and MRI images dictates a comprehensive familiarity with the standard US, CT and MRI tissue deviations. Accordingly, our purposes were to present a full MRI protocol for investigating the dromedary camel distal limbs as well as comparing and illustrating the merits of using MRI, CT and US for evaluation of the front and hind distal limbs in 10 healthy lameness free dromedary camel cadavers. The limbs were scanned via a high-field 1.5 Tesla MRI magnet and a multi-detector CT scanner then subjected to a systematic US examination in both longitudinal and transverse planes. The obtained MRI, CT and US images were evaluated, correlated and compared. Results: CT and MRI eliminated the structural superimposition in the dromedary camel distal limbs and afforded assessment of minute ligamentous and tendentious structures that were inaccessible by US including the axial collateral ligaments, ligaments supporting the proximal sesamoid bones and the palmar/plantar aspects of the inter-phalangeal joints. US and MRI were appreciated for the assessment of the articular cartilage that was not visible on the plain CT images. Conclusions: CT and MRI accurately identified and characterized bones and soft tissues constituting the dromedary camel distal limbs. US was appreciated for assessment of soft tissues, articular cartilage and bone contours. CT and MRI may be considered when US results are inconclusive or to evaluate the unreachable parts of the camel distal limbs. Images presented in this study could be used as a reference standard for evaluating dromedary camel distal limb diseases. [ABSTRACT FROM AUTHOR]

The fabella is a sesamoid bone found in the gastrocnemius muscle that is present in about 10-30% of all humans. There are however strong variations between different ethnics groups. The current review summarizes the literature regarding the prevalence and laterality of the fabella in recently published population studies. Six eligible population studies published in 2020 and 2021 were identified that investigated the prevalence of the fabella in Chinese, Korean, Nigerian, Omani and Turkish populations. The fabella prevalence rate in the included studies ranged from 11.1 to 57.2%. However, like in past research, there were significant variations between different populations in recent studies. Unfortunately, only a selected number of the recently published studies reported on the percentage of fabellae that present uni-or bilaterally. The percentage of cases that showed a bilateral fabella ranged from 27.1 to 78.8%. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The objective of this study was to develop a robust machine-learning approach for efficient detection and grading of sesamoiditis in horses using radiographs, specifically in data-limited conditions. SAMPLE: A dataset of 255 dorsolateral-palmaromedial oblique (DLPMO) and dorsomedial-palmarolateral oblique (DMPLO) equine radiographs were retrospectively acquired from Hagyard Equine Medical Institute. These images were anonymized and classified into 3 categories of sesamoiditis severity (normal, mild, and moderate). METHODS: This study was conducted from February 1, 2023, to August 31, 2023. Two RetinaNet models were used in a cascaded manner, with a self-attention module incorporated into the second RetinaNet's classification subnetwork. The first RetinaNet localized the sesamoid bone in the radiographs, while the second RetinaNet graded the severity of sesamoiditis based on the localized region. Model performance was evaluated using the confusion matrix and average precision (AP). RESULTS: The proposed model demonstrated a promising classification performance with 92.7% accuracy, surpassing the base RetinaNet model. It achieved a mean average precision (mAP) of 81.8%, indicating superior object detection ability. Notably, performance metrics for each severity category showed significant improvement. CLINICAL RELEVANCE: The proposed deep learning-based method can accurately localize the position of sesamoid bones and grade the severity of sesamoiditis on equine radiographs, providing corresponding confidence scores. This approach has the potential to be deployed in a clinical environment, improving the diagnostic interpretation of metacarpophalangeal (fetlock) joint radiographs in horses. Furthermore, by expanding the training dataset, the model may learn to assist in the diagnosis of pathologies in other skeletal regions of the horse. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To determine the dose effect of peri-neural liposomal bupivacaine (LB) in an induced forelimb lameness model. ANIMALS: 12 clinically normal adult horses. METHODS: A randomized cross-over design was performed with 1 limb receiving saline and the other LB: low dose (6), high dose (6). Lameness was induced in 1 forelimb using a frog-pressure model. In the lame limb, peri-neural injection of the palmar nerves at the proximal sesamoid bones was performed using saline, low dose LB (0.25 mg/kg) (LDLB), or high dose LB (0.5mg/kg) (HDLB) in random order with a 1-week washout period between treatments. Distal limb swelling, mechanical nociceptive thresholds (MNT), and objective lameness data were collected before and up to 72 hours after peri-neural anesthesia. Data analysis was performed with mixed model ANOVA, equality of medians test, and Kaplan Meier survival analysis. RESULTS: Compared with baseline, horses treated with LDLB and HDLB had improvements in MNT and lameness (P < .001). In the LDLB group, the median duration of analgesia was 4.5 hours (range = 3-6 hours) and the median return to lameness was 7 hours (range = 4-24 hours). In the HDLB group, the median duration of analgesia was 12 hours (range = 4-48 hours) and the median return to lameness was 9 hours (range = 3-48 hours). Mild to moderate swelling was identified in 11/12 (92%) LB limbs. CLINICAL RELEVANCE: Both LDLB and HDLB resulted in loss of skin sensation and improvement of lameness. There was high variability among horses in duration of action for both doses. [ABSTRACT FROM AUTHOR]

Painful os peroneum syndrome encompasses a spectrum of disorders associated with lateral foot and ankle pain. In the setting of an os peroneum fracture or diastasis of a partitioned os peroneum, marked displacement of the proximal fragment on radiographs is often used as an imaging surrogate for detection of a complete peroneus longus tendon tear. We present a case of a displaced proximal fragment of the os peroneum above the level of the ankle joint on radiographs and MRI associated with incomplete tear of the peroneus longus tendon. We hypothesize that such an injury pattern results from an anatomic prerequisite where the os peroneum occupies a portion of the cross-sectional diameter of the tendon. We suggest that the retracted proximal moiety of the sesamoid bone is the result of elastic recoil of delaminated fibers of the peroneus longus directly inserting on the os, whereas eccentric bundles of the tendon draping over the os remain in continuity. Although treatment implications are debatable, the case questions the assumption of a complete peroneus longus tear based on a retracted os peroneum on radiography and highlights the role of MRI in providing a full description. [ABSTRACT FROM AUTHOR]

Aim: Accessory and sesamoid bones are hidden anatomical structures that fulfil a wide variety of functions in the human body. Therefore, studying the nature, formation and dimensions of these structures is of great importance for the medical literature. In our study, we aimed to measure the presence and area (size) of these ossicles. Material and Method: Our study was performed retrospectively on the images of individuals who applied to Ordu University and whose radiological images were obtained. The presence of accessory and sesamoid ossicles (present/absent) and their sizes (measured using the PACS system) were evaluated on radiographs and Computed Tomography (CT) images. The results of the ossicles were divided into gender, age, and bilateral groups. Statistical analyzes were performed with the SPSS program. Results: The most common and largest accessory ossicles in the foot were os peroneum (18.2%), os naviculare accessoria (17.4%), os trigonum (12.1%) and os intermetatarsarum (7.8%). Sesamoid ossicles at the level of the first metatarsophalangeal (mtp) joint of the foot and the first metacarpopgalangeal (mcp) joint of the hand were found to be 100% common. The second most common sesamoid bone in the hand and foot was at the fifth mtp (22.22%) and mcp (68.53%) joints. In the hand, the most common accessory ossicles were os triangulare (6.08%), os radiale externum (2.60%) and os centrale (1.73%). Accessory ossicles (fabella: 19%, cyamella: 17.5%) were found in 25.5% of the knee. Conclusion: Accessory and sesamoid ossicles are most commonly found in the hand, foot, and knee. The presence and size of these ossicles can be both beneficial and harmful. Sesamoids provide mechanical benefit, whereas accessory ossicles can be mistaken for fractures and may lead to unnecessary medical conditions. Knowing the dimensions of these ossicles allows them to be clinically differentiated from avulsion fractures. [ABSTRACT FROM AUTHOR]

Background: The impact of pronation and sesamoid coverage on clinical outcomes following percutaneous hallux valgus surgery are not currently known. The aim of this study was to investigate if sesamoid coverage was associated with worse clinical outcomes at 12-month follow-up following percutaneous hallux valgus surgery. Methods: Retrospective comparative observational study of clinical and radiographic outcomes based on a previously published prospective dataset. Patients were stratified into 3 cohorts based on the degree of sesamoid coverage (normal, mild, or moderate) on 12-month weightbearing radiographs following fourth-generation percutaneous hallux valgus surgery. Primary outcome was a validated patient-reported outcome measure (PROM), the Manchester-Oxford Foot Questionnaire (MOXFQ). Secondary outcomes included Euroqol-5D, VAS Pain, and radiographic deformity correction. Results: Forty-seven feet underwent primary fourth-generation HV surgery and were stratified into 3 cohorts. There were 19, 16, and 12 feet in the normal, mild, and moderate cohorts respectively. There was no significant difference in either pre- or postoperative foot function (all MOXFQ domains, P > .05) or health-related quality of life (EQ-5D Index or VAS, P > .05). The MOXFQ Index preoperatively was as follows: normal cohort, 56.1 ± 26.9; mild cohort, 54.1 ± 17.9; and severe cohort, 49.6 ± 23.8; and postoperatively was as follows: normal cohort, 15.6 ± 21.5; mild cohort, 11.4 ± 15.5; and severe cohort, 11.4 ± 13.6 (P = .737-.908). There was significantly worse hallux valgus angle (HVA) and intermetatarsal angle (IMA) between the cohorts (P < .01). Although HVA and IMA were corrected to normal parameters following surgery in all cohorts, there was a significantly worse postoperative HVA in the moderate sesamoid coverage (5.3 ± 3.9 vs 7.9 ± 5.3 vs 11.4 ± 3.7, P < .01); however, IMA was not significantly different (3.4 ± 2.2 vs 4.1 ± 2.7 vs 5.2 ± 2.9, P = .168). Conclusion: This study found that cases where the sesamoids were not reduced had a poorer correction and had worse preoperative deformity. Clinical outcomes and foot function following fourth-generation percutaneous hallux valgus surgery were not affected by sesamoid coverage at the 12-month follow-up. The long-term implications in the difference in radiographic deformity between the 3 cohorts are not known, and further work should explore the relationship of first ray pronation and sesamoid position, particularly with regard to recurrence. [ABSTRACT FROM AUTHOR]

The article focuses on a case study of a 65-year-old recreational golfer with left hand pain and triggering of the third, fourth, and fifth digits. Despite initial nonimage-guided cortisone injections and radial extracorporeal shockwave therapy (rECSW), the patient developed worsening pain over the fifth metacarpophalangeal (MCP) joint, which was diagnosed as trigger finger due to A1 pulley thickening and sesamoid bone constriction of the flexor tendon.

Simple Summary: Most catastrophic musculoskeletal injuries in Thoroughbred racehorses involve the fetlock region. Magnetic resonance imaging (MRI) and computed tomography (CT) aid detection of potentially serious abnormalities, before they become identifiable on radiographs. However, no data exist in live horses regarding how these injuries develop and progress. The aim of this study was to describe MRI, CT and radiographic findings in the front fetlock of Thoroughbreds entering racehorse training. Forty non-lame yearlings underwent low-field MRI, CT and radiographic examinations of both front fetlocks. The most common finding was a lesion consistent with osteochondrosis (developmental abnormality) in the cannon bone. Of the 33 lesions seen in CT images, about two-thirds were detected on radiographs. In the majority of the cannon bones, there was some increase in bone density and enlargement of vascular channels, consistent with the bone's response to exercise. Small defects in the joint surface were seen in both the cannon bone (11 limbs) and the long pastern bone (19 limbs) which may indicate developmental abnormalities or subtle injuries. In conclusion, variants or abnormalities occur in the cannon bone in the fetlock region of yearling Thoroughbreds and may reflect early changes as the bone adapts to exercise or changes secondary to osteochondrosis. Most catastrophic injuries in Thoroughbred racehorses involve the fetlock. There is no description of comparative imaging in Thoroughbreds entering racehorse training. The aim was to describe MRI, CT and radiographic findings in the metacarpophalangeal joint of non-lame Thoroughbred yearlings. Forty Thoroughbreds underwent low-field MRI, fan-beam CT and radiographic examinations of both metacarpophalangeal joints. Images were assessed subjectively. A hypoattenuating lesion of the sagittal ridge of the third metacarpal bone (McIII) was identified in 33/80 limbs in CT reconstructions. Cone-shaped mineralisation in the sagittal ridge was detected in MR images (n = 17) and in CT images (n = 5). Mild hyperattenuation was common in trabecular bone in the dorsomedial (36/80) and palmarolateral (25/80) metacarpal condyles in CT reconstructions. A focal lesion in the subchondral bone was seen in the proximal phalanx (n = 19) and in McIII (n = 11). Enlarged vascular channels were detected in the metacarpal condyles in 57/80 limbs and in the proximal sesamoid bones in all limbs. Signs of bone modelling are seen in yearling Thoroughbred fetlocks. Sagittal ridge lesions were common and are likely associated with osteochondrosis or other developmental osteochondral defects. Focal lesions in the subchondral bone of McIII and proximal phalanx can indicate developmental abnormalities or subtle subchondral bone injuries. [ABSTRACT FROM AUTHOR]

Background: The current minimally invasive distal metatarsal osteotomy for hallux valgus (HV) is V-shaped, which prevents the correction of the rotational metatarsal head deformity and reduction of the sesamoid bones. We sought to determine the optimal method for sesamoid bone reduction during HV surgery. Methods: We reviewed the medical records of 53 patients who underwent HV surgery between 2017 and 2019 using one of three techniques: open chevron osteotomy (n = 19), minimally invasive V-shaped osteotomy (n = 18), and a modified straight minimally invasive osteotomy (n = 16). The sesamoid position was graded using the Hardy and Clapham method on weight-bearing radiographs. Results: When compared to open chevron and V-shaped osteotomies, the modified osteotomy resulted in significantly lower postoperative sesamoid position scores (3.74 ± 1.48, 4.61 ± 1.09, and 1.44 ± 0.81, respectively, P < 0.001). Furthermore, the mean change in postoperative sesamoid position score was greater (P < 0.001). Conclusion: The modified minimally invasive osteotomy was superior to the other two techniques in correcting HV deformity in all planes, including sesamoid reduction. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to retrospectively examine the accessory ossicles and sesamoid bones of the patients who applied to the emergency department with any hand and wrist complaints, on radiological images according to gender, frequency of incidence and extremity side. Materials and Methods: This retrospective study was performed on radiological images (digital x-ray) of 500 patients (297 men, 203 women). Presence, prevalence, coexistence and distribution of accessory ossicles and sesamoids in the hand of patients without hand skeletal deformities were retrospectively analyzed. Results: Accessory ossicles were detected in 8 (1.6%) of 500 cases. In our study, all of the accessory ossicles seen in the wrist and the hand region were ulnar styloid ossicles. Sesamoid bone was detected in 500 cases (100%) in metacarpophalangeal I (MCP I), in 192 cases (38.4%) in metacarpophalangeal II (MCP II), in 17 cases (3.4%) in metacarpophalangeal III (MCP III), in 2 cases (0.4%) in metacarpophalangeal IV (MCP IV), and in 34 cases (6.8%) in metacarpophalangeal V (MCP V). Conclusion: This study will contribute to the literature in terms of Turkish population incidence by using digital x-ray images for hand sesamoid bones and accessory ossicles. [ABSTRACT FROM AUTHOR]

Accessory bones in the elbow region are rare anatomical variations with important clinical significance as they can be misdiagnosed as pathological lesions. Usually, they are asymptomatic and found incidentally during X-ray examination in the context of trauma. Although these bones have been previously described, their development is not fully understood. The present case provides complex macroscopic, X-ray and histological descriptions of a sesamoid bone in the posterior region of the elbow—patella cubiti and the related surrounding structures. Moreover, this report indicates the presence of a well-defined syndesmosis between patella cubiti and the proximal ulna. [ABSTRACT FROM AUTHOR]

The most prevalent causes of death in racehorses are musculoskeletal injuries, causing ~83% of deaths within the racing industry in California and elsewhere. The vast majority of these injuries have preexisting lesions that predispose to fatal injury. A 4-y-old Thoroughbred colt suffered an acute suspensory apparatus failure, including biaxial proximal sesamoid bone fractures of the right front fetlock, causing loss of support of the fetlock joint and consequent fall with fractures of the cervical and sacral spine. Cervical fracture caused spinal cord damage that resulted in sudden death. A preexisting lesion in the medial proximal sesamoid bone likely predisposed to complete fracture of this bone and fetlock breakdown. Interestingly, a comparable osteopenic lesion was present in the intact medial proximal sesamoid bone of the left forelimb, which is consistent with bilateral repetitive overuse injury in racehorses. The morphologic features of the cervical and sacral spine fractures were compatible with acute injury; no evidence of preexisting lesions was seen. Most likely, these acute vertebral fractures occurred as a result of the horse falling. This case emphasizes the importance of performing a detailed autopsy in horses that suffer an appendicular musculoskeletal injury, particularly in fatal cases when the horse dies following a leg injury.

Simple Summary: Radiography is important for the diagnosis of prematurity and musculoskeletal abnormalities in foals. Given that no data on the normal radiographic anatomical development of the mule foal are available, we evaluated the radiographic development of the mule fore digit and carpal joint from 0 to 3 months of age. The radiographs highlighted that growth plate closure times differed depending on the fore digit bones, and on whether the carpal bones were immature at birth. Distal phalanx was triangular at birth, palmar processes had developed by one month, and proximal sesamoid bones were trapezoidal by three months. No distal phalanx remodeling was evident within the hoof capsule or variations in the hoof axis with growth, and hoof capsule thickness increased. We identified a baseline for the interpretation of radiological features of the forelimb in the mule foal, and we highlighted specific radiographic parameters that were intermediate between those found in horses and donkeys. Few studies have established the normal radiographic anatomical development of the donkey foal and, to date, no data are available for mules. Our aim was thus to evaluate the radiographic development of the fore digit and carpal joint in the mule foal from 0 to 3 months of age. Ten forelimbs of five healthy full-term mule foals were included. Radiographs of the fore digit lateromedial and dorsopalmar and the carpus dorsopalmar were performed weekly for the first month of age, and bi-monthly during the following two months. Fore digit growth plate closure times, morphological, angular, and linear radiographic parameters, and also carpal cuboidal bone mineralization were evaluated. Growth plates were graded as open, closing, and closed. Carpal bone appearance was graded as mature, slightly immature, or immature. Growth plate closure times showed the following: middle phalangeal distal physis (DP) closed at birth, and proximal physis (PP) started to close at around two months; first phalanx DP closed at seven days, and PP started to close at three months; and third metacarpal bone DP started to close at two months. Carpal bones were immature at birth. Distal phalanx (PD) was triangular at birth, palmar processes had developed by one month, and proximal sesamoid bones were trapezoidal by three months. The hoof wall, PD dorsal wall, and palmar angles values changed in parallel, and hoof capsule thickness increased. No PD remodeling evidence within the hoof capsule or variations in the hoof axis with growth were found. We identified a baseline for the interpretation of forelimb radiological features in mule foals. The specific features found were intermediate between those found in horses and donkeys. [ABSTRACT FROM AUTHOR]

Summary: Background: The digital flexor tendon sheath (DFTS) is a common site of pathology in the UK equine population, often necessitating tenoscopic exploration. Common intrathecal pathologies may lead to fetlock canal constriction. The palmar/plantar annular ligament (PAL) is often surgically transected to relieve constriction or to facilitate surgical access and instrumentation. Objectives: The objectives of this study were (1) to establish whether diagnostic quality needle tenoscopy can be achieved in the proximal DFTS in cadaver limbs; (2) to determine if needle tenoscopy can be used to safely guide PAL transection; and (3) to evaluate iatrogenic damage when undertaking needle tenoscopy and PAL transection. Study design: Ex vivo experimental. Methods: Six cadaveric limbs were used and needle tenoscopy of the DFTS was performed via biaxial approach at the base of the sesamoids. Access to and diagnostic assessment of the proximal DFTS, as well as the completeness of needle tenoscopically guided transection of the PAL was recorded. Limbs were dissected and examined for iatrogenic damage and completion of PAL transection. Results: Positioning of the cannula/obturator unit was achieved on the first attempt 11/12 times. Laterally 16/24 and medially 18/24 proximal DFTS channels were accessed. Images were of diagnostic quality in 12/24 and 11/24 channels following lateral and medial approach, respectively. The PAL was completely transected in 4/6 limbs with partial transection in 1/6 limbs. The superficial digital flexor tendon (SDFT) was longitudinally lacerated instead of the PAL in one limb, with other iatrogenic damage limited to mild fibrillation to the intersesamoidean ligament. Main limitations: Ex vivo and sample size. Conclusions: The findings in this pilot study suggest that needle tenoscopically guided PAL transection in the live horse is not recommended currently. While diagnostic needle tenoscopy offered partial assessment of most of the proximal DFTS, further refinement is necessary before needle tenoscopy could be considered a viable alternative to traditional tenoscopy. [ABSTRACT FROM AUTHOR]

Background: Research on the surgical treatment of stress fractures and AVN of the sesamoid bone is the goal of this paper. Material and Methods: A group of twenty individuals who exhibited clinical indications of avascular necrosis of the sesamoids had a dynamic assessment of blood circulation using a high-resolution gamma chamber equipped with a rectangular double detector. The purpose of doing this test was to ascertain the presence or absence of the ailment among the patients. The examination was conducted with both frontal and lateral projections of the patient's area of interest. Results: The age range of the patients included in the study spanned from 18 to 51 years, with a mean age of 30.52±3.69 years. The sample consisted of 20 patients, of which 16 (80%) were female and 4 (20%) were male. Out of the total sample size of 20 patients, it was observed that 8 individuals, constituting 40% of the participants, presented with a pathological state in their right foot. Conversely, 12 patients, accounting for 60% of the cohort, exhibited a pathological condition in their left foot. Each individual displayed the sensation of discomfort in the affected forefoot, and further examination revealed that three individuals, constituting 15% of the sample, also presented with localised edoema and rubor. Out of the sample population, 12 patients (representing 60% of the sample) exhibited undivided sesamoids, whereas 6 patients (representing 30% of the sample) had bipartite tibial sesamoids. Additionally, 2 patients (representing 10% of the sample) demonstrated bipartition of both the tibial and fibular sesamoids. In a sample of patients, it was observed that the tibial sesamoid was affected in 11 individuals, accounting for 55% of the cases, while the fibular sesamoid was influenced in 9 people, representing 45% of the cases. It was determined that each patient was donning footwear that was ill-suited for their individual foot structure, and/or the patients self-reported experiencing traumatic incidents, with or without accompanying fractures. Out of the total patient population, five individuals were engaged in dancing activities, while one patient participated in football. Out of the total number of female patients observed, specifically two individuals or fifty percent, were found to be utilising any form of contraceptive method. Twelve patients, about 60% of the total, did not experience any relief of symptoms. In these cases, surgical excision of the necrotized sesamoid tissue was necessary. Three individuals experienced the emergence of discomfort, edoema, and localised paresthesia, ultimately resulting in a minor degree of claudication. Conclusions: The current body of research lends credence to the idea that early non-surgical care of instances with avascular necrosis of the sesamoid should be pursued. The recommended treatment regimen would encompass the utilisation of antiinflammatory pharmaceuticals, the utilisation of suitable footwear, and the avoidance of activities that involve bearing weight. [ABSTRACT FROM AUTHOR]

This study was designed to study gross morphological and basic osteometric features of the digit bones of Chinkara. The osteometry were performed manually through a digital vernier calliper on twenty (20) adult Chinkara (10 each male and females). The digits of Chinkara in each limb comprised the lateral and medial proximal, middle and distal phalanx. The first two phalanges were long bones. The shaft of the phalanx proximalis (P1) was thick proximally than distally and slightly arched. The phalanx media (P2) was shorter in length than the proximal. Its proximal articular surface was divided into two glenoid cavities "axial and abaxial' by a dorsopalmar ridge. The phalanx distalis (P3) was triangular, with four surfaces and six borders. The descriptive analysis indicates, no statistically significant (p>0.05) differences between the lateral and medial phalanges of all measured parameters. All the measured parameters for the digits of the forelimb were statistically significantly different (p>0.05) between male and female adult Chinkara except greatest Length (Lg) of the phalanx media of the forelimb. Similarly, significant differences (p>0.05) were present in all the studied parameters of the P1, P2 and P3 of the hindlimb except for maximum breadth of the shaft (Bs) of the P2. [ABSTRACT FROM AUTHOR]

Raden Andri Primadhi, Rio Aditya, Nucki Nursjamsi Hidajat Department of Orthopaedics and Traumatology, Universitas Padjadjaran Medical School / Hasan Sadikin Hospital, Bandung, IndonesiaCorrespondence: Raden Andri Primadhi, Department of Orthopaedics and Traumatology, Universitas Padjadjaran Medical School / Hasan Sadikin Hospital, Jalan Pasteur 38, Bandung, 40161, Indonesia, Tel/Fax +62 22 2035477, Email randri@unpad.ac.idAbstract: Hallux valgus interphalangeus (HVIP) is a deviation of the distal phalanx in relation to the proximal phalanx. Its etiology is considered multifactorial, including growth development disturbances, external pressure, and biomechanical alteration involving the interphalangeal joint. Here, we report a case of HVIP with the presence of a large ossicle at the lateral side, which was considered related to HVIP development. A 21-year-old woman presented HVIP that had developed since childhood. She complained of pain in her right great toe that worsened in the previous several months, particularly when walking and wearing shoes. Surgical correction consisted of Akin osteotomy, fixation with headless screw, ossicle excision, and medial capsulorrhaphy. The interphalangeal joint angle was improved from 28.69⁰ pre-operatively to 8.93⁰ post-operatively. The wound healed uneventfully and the patient was satisfied. Akin osteotomy with concomitant ossicle excision was effective in this case. Gaining more knowledge regarding ossicles around the foot will provide a better understanding of deformity correction, especially from the biomechanical standpoint.Keywords: hallux valgus, interphalangeal, ossicle, sesamoid bones

Background: Sesamoiditis is a common inflammatory condition affecting the sesamoid bones at the plantar aspect of the first metatarsophalangeal joint (1MTPJ). However, there are currently no recommendations or clinical guidelines to support podiatrists in their assessment or management of sesamoiditis. The aim of this study was to explore the views of podiatrists in Aotearoa New Zealand on their approaches to the assessment and management of patients with sesamoiditis. Methods: This qualitative study included focus group discussions with registered podiatrists. Focus groups took place online via Zoom and were guided by a detailed focus group question schedule. The questions were designed to encourage discussion around assessment approaches used in the diagnosis of sesamoiditis and the treatment tools used to manage patients with sesamoiditis. Focus groups were audio-recorded and transcribed verbatim. Reflexive thematic analysis was used to analyse the data. Results: A total of 12 registered podiatrists participated in one of three focus groups. Four themes were constructed relating to the assessment of sesamoiditis: (1) obtaining a patient history; (2) recreating patient symptoms; (3) determining contributing biomechanical factors; and (4) ruling out differential diagnoses. Seven themes were constructed relating to the management of sesamoiditis: (1) consideration of patient factors; (2) patient education; (3) cushioning of the sesamoids to allow more comfortable weightbearing of the 1MTPJ; (4) pressure redistribution and offloading of the sesamoids; (5) immobilisation of the 1MTPJ and sesamoids; (6) facilitating efficient sagittal plane motion during gait; (7) referring to other health professionals to find different ways to treat or manage patient symptoms. Conclusion: Podiatrists in Aotearoa New Zealand demonstrate an analytical approach in the assessment and management of patients with sesamoiditis based on their clinical experience and knowledge of lower limb anatomy. A range of assessment and management techniques are selected based on the practitioners personal preferences, as well as the patient's social factors, symptomology, and lower limb biomechanics. [ABSTRACT FROM AUTHOR]

Background. Sesamoids are generally regarded as structures that are not part of the tetrapod body plan. The presence of a palmar sesamoid is assumed to serve as a distribution point for the forces of the flexor digitorum communis muscle to the flexor tendons of the digits, which are embedded in the flexor plate. It has been considered that the palmar sesamoid is present in most anuran groups, and it has been suggested that it acts by inhibiting the closing of the palm, preventing grasping. Typical arboreal anuran groups lack a palmar sesamoid and flexor plate, a pattern shared with other tetrapod groups, which can retain a reduced sesamoid and flexor plate. We focus on the anatomical structure of the Rhinella group, which includes species that present an osseous palmar sesamoid and climb bushes or trees to avoid depredation or escape dangerous situations, and can exhibit scansorial and arboreal behaviors. We also add data on the bony sesamoids of 170 anuran species to study the anatomy and evolution of the osseous palmar sesamoid within this amphibian group. Our objective is to bring an overview of the osseous palmar sesamoid in anurans, unveiling the relationship between this element of the manus, its phylogeny, and the anuran habitat use. Methods. Skeletal whole-mount specimens of Rhinella were cleared and double-dyed to describe the sesamoid anatomy and related tissues. We review and describe the palmar sesamoid of 170 anuran species from CT images downloaded from Morphosource.org, representing almost all Anuran families. We performed an standard ancestral state reconstruction by optimizing two selected characters (osseous palmar sesamoid presence, distal carpal palmar surface) along with the habitat use of the sampled taxa, using parsimony with Mesquite 3.7. Results. Our primary finding is that sesamoid optimization in the anuran phylogeny revealed that its presence is associated with certain clades and not as widespread as previously anticipated. Additionally, we will also be delving into other important outcomes of our study that are relevant to those working in the field of anuran sesamoids. The osseous palmar sesamoid is present in the clade Bufonidae-Dendrobatidae-Leptodactylidae-Brachicephalidae that we named as PS clade, and also in the archeobatrachian pelobatoid Leptobranchium' all strongly terrestrial and burrowing species, though with exceptions. The osseous palmar sesamoid is always present in Bufonidae, but varies in form and size, depending on the mode that they use their manus, such as in the Rhinella margaritifera which has a cylindrical one and also grasping abilities that involve closing the manus. The scattered presence of the bony palmar sesamoid among anuran clades raises the question whether this sesamoid can be present with a different tissular composition in other groups. [ABSTRACT FROM AUTHOR]

Background and Objectives: Hallux valgus is one of the most common chronic foot complaints, with prevalences of over 23% in adults and up to 35.7% in older adults. However, the prevalence is only 3.5% in adolescents. The pathological causes and pathophysiology of hallux valgus are well-known in various studies and reports. A change in the position of the sesamoid bone under the metatarsal bone of the first toe is known to be the cause of the initial pathophysiology. Purpose: The relationships between the changes in the location of the sesamoid bone and each radiologically measured angle and joint congruency in the hallux valgus remain as yet unknown. Therefore, this study investigated the relationships of sesamoid bone subluxation with the hallux valgus angle, intermetatarsal angle, and metatarsophalangeal joint congruency in hallux valgus patients. The goal is to know the hallux valgus angle, the intermetatarsal angle, and metatarsophalangeal joint congruency's correlation with hallux valgus severity and prognosis by revealing the relationship between each measured value and sesamoid bone subluxation. Materials and Methods: We reviewed 205 hallux valgus patients who underwent radiographic evaluation and subsequent hallux valgus correction surgery in our orthopedic clinic between March 2015 and February 2020. Sesamoid subluxation was assessed using a new five-grade scale on foot radiographs, and other radiologic measurements were assessed, such as hallux valgus angle, the intermetatarsal angle, distal metatarsal articular angle, joint congruency, etc. Conclusions: Measurements of the hallux valgus angle, interphalangeal angle, and joint congruency exhibited high interobserver and intraobserver reliabilities in this study. They also showed correlations with sesamoid subluxation grade. [ABSTRACT FROM AUTHOR]

Presently, developments in weightbearing computed tomography and biplanar fluoroscopy technologies offer exciting avenues for investigating normative and pathologic foot function with increasing precision. Still, data quantifying sesamoid bone and proximal phalange motion are currently sparse. To express joint kinematics and compare various clinical cohorts, future studies of first ray motion will necessitate robust coordinate frames that respect the variations in underlying anatomy while also aligning closely with the functional, physiological axes of motion. These activity-dependent functional axes may be represented by a mean helical axis of the joint motion. Our cadaveric study quantified joint kinematics from weightbearing computed tomography scans during simulated toe lift and heel rise tasks. We compared the spatial orientations of the mean finite helical axes of the metatarsosesamoidal and metatarsophalangeal joints to the primary joint axis of two relevant methods for defining metatarsal coordinate frames: inertial axes and fitting of geometric primitives. The resultant kinematics exhibited less crosstalk when using a metatarsal coordinate system based on fitting cylindrical primitives to the bony anatomy compared to using principal component axes. Respective metatarsophalangeal and metatarsosesamoidal arthrokinematic contact paths and instantaneous centers of rotation were similar between activities and agree well with currently published data. This study outlines a methodology for quantitatively assessing the efficacy and utility of various anatomical joint coordinate system definitions. Improvements in our ability to characterize the shape and motion of foot bones in the context of functional tasks will elucidate their biomechanical roles and aid clinicians in refining treatment strategies. [ABSTRACT FROM AUTHOR]

Different anatomical variants can be found in the ankle and foot, generally as occasional findings, although they can be the cause of diagnostic pitfalls and difficulties, especially in radiographic interpretation in trauma. These variants include accessory bones, supernumerary sesamoid bones, and accessory muscles. In most cases, they represent developmental anomalies found in incidental radiographic findings. This review discusses the main bony anatomical variants, including accessory and sesamoid ossicles, most commonly found in the foot and ankle that can be a cause of diagnostic challenges. [ABSTRACT FROM AUTHOR]