Accessory Ossicles Research Articles

The Prevalence and the Clinical Importance of os vesalianum pedis.

Os vesalianum pedis (OVP) is a rare accessory bone of the foot located at the base of the fifth metatarsal bone. It is usually asymptomatic and incidentally seen on radiographs. When symptomatic, it manifests itself with lateral foot pain. OVP, which can become symptomatic as a result of traumatic injuries, can also be confused with fracture. The aim of this study is to determine the prevalence and morphometric characteristics of OVP in the Turkish population. Radiographic images of 5268 individuals aged 16 years and older (mean 39.65±17.21) who completed ossification of the fifth metatarsal bone were evaluated for OVP. Of the cases included in the study, 44.8% were female and 55.2% were male. The general and sex-based prevalence of OVP was calculated, and morphometric measurements were done. OVP prevalence in the Turkish population was found to be 0.15% regardless of sex. OVP prevalence was calculated to be 0.24% in men and 0.04% in women. Anatomy, radiology, orthopedics and emergency medicine physicians are frequently encountered with foot disorders in clinical and educational practices. It is important to keep in mind the rare presence of OVP (0.15%), in the preliminary diagnosis. os vesalianum pedis, accessory ossicle, foot, radiography.

The prevalence and anatomy of accessory navicular bone: a meta-analysis

PurposeThere have been over 40 descriptions of the common developmental variants of the accessory ossicles of the feet. Although predominantly asymptomatic, they sometimes may be linked to painful conditions. One of the most common accessory ossicles in the foot is the accessory navicular bone (AN), located on the medial side of the foot. Our research provides a first meta-analysis on this topic that establishes its frequency by contrasting 39 studies from across the globe.MethodsUp to February 2024, PubMed and Embase databases were thoroughly searched for research on the AN. Eligible data regarding AN prevalence was extracted. This study strictly adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.ResultsA total of 39 studies, 11,015 patients, and 36,837 feet were analyzed in our study. The pooled prevalence estimate (PPE) of AN was found to be 17.5% (95%CI: 11.5–25.7) and 12.6% (95%CI: 10.1–15.5) in patients and feet analyses, respectively. Accessory navicular occurred bilaterally in 50.0% of patients, with similar distribution in gender-based groups (21.1% of males and 22.0% of females were confirmed with AN). Accessory navicular was most prevalent in the East Asian population (38.4%) and least prevalent in North Americans (8.0%). No significant differences in AN prevalence were found when comparing different imaging modalities (X-ray and cadaver dissection).ConclusionAccessory navicular is a common finding in imaging studies. Its prevalence depends on the population covered by the study but is not affected by the patient’s gender or the imaging modality utilized for AN assessment.

Rare Case Report: Radiologic Findings of Stress Fracture and Avascular Necrosis of the Type 2 Accessory Navicular Bone

The accessory navicular bone (ANB) is one of several accessory ossicles of the foot and is considered as a normal anatomic and radiographic variant (1). It occurs due to failure of fusion of a secondary ossification centre within the navicular bone. Fewer than %1 of ANBs are symptomatic, and most of symptomatic ANBs are type II ANBs. Stress fracture of the type II ANB is a rare cause of symptomatic accessory navicular syndrome. We report a case of stress fracture and avascular necrosis of the type II ANB on radiographs and magnetic resonance images in a 23- year- old male.

Prevalence of accessory carpal ossicles - a CT-based survey

This observational study aimed to determine the prevalence of accessory carpal ossicles (ACO) using a computerized tomography examination. The digital imaging database of the authors’ institution was retrospectively reviewed, and all wrist computerized tomography examinations for any indication were identified between 2014 and 2021. Patients with previous wrist surgery and severely impaired carpal anatomy, such as severe osteoarthritis or congenital or acquired deformities that may preclude evaluation and identification of accessory carpal ossicles, were excluded from the study. Four orthopedic surgeons reviewed the computerized tomography scans and identified patients with accessory carpal ossicles on two-dimensional (coronal, axial, and sagittal planes) and three-dimensional computerized tomography reconstructions. Two thousand two hundred thirteen patients, with a mean age of 36.8±12.8 years, were identified and included. Accessory carpal ossicles were detected in 156 (7.1%) subjects, with 186 ACOs identified. The most common accessory carpal ossicles were os praetrapezium (n:34, 1.536%), os triquetrum secundarium (n:28, 1.265%), os epitriquetrum (n:20, 0.903%), os hamuli proprium (n:18, 0.813%), os ulnostyloideum (n:16, 0.723%), os epilunatum (n:12, 0.542%) and os styloideum (n:11, 0.497%) respectively. The study provides valuable information on the prevalence and distribution of accessory carpal ossicles, which can aid in accurately diagnosing and managing wrist pathologies. Further research is warranted to explore the clinical significance and potential impact of rare accessory carpal ossicles on wrist disorders.

A novel physiotherapeutic approach for the treatment of Os Naviculare: A case study.

Background: Os naviculare in general alters the functional and anatomical balances of the longitudinal plantar arch. A substantial number of the posterior tibialis tendon fibers insert on the accessory ossicle instead of its insertion on tarsal and metatarsal bones resulting in unbalanced stress forces on the tendon. The presence of an accessory navicular type II or type III is a risk factor for PTT tendinopathy and possible PTT tear. Methodology: In this single subject case study, the participant reported with the pre-diagnosed Os naviculare. On examination at initial presentation, the navicular tuberosity of the affected foot was prominent as compared to the contralateral limb. The site was tender on palpation. Ankle range of motion was within normal ranges except ankle dorsiflexion was slightly compromised. Mild pain on active and resisted was noted. Functional tests like star excursion balance test, single leg standing could not be performed due to pain. Pre and post protocol assessment was graded and measured on Cumberland ankle instability tool. The tenderness was recorded using numeric pain rating scale. Star excursion balance test was performed one on 8th day and post protocol. MWM was performed at distal tibiofibular joint on 6 days every week for 3 weeks alongside the conventional regime exercises and ultrasound was applied post treatment session. Result: Result of this study suggested that addition of MWM of distal tibiofibular joint in the conservative exercise protocol was effective in the reduction of pain, dysfunction and improved dynamic control. Conclusion: The results of this study suggests that the addition of MWM of distal tibiofibular joint alongside conservative management shows appreciable effect in improving dysfunction, dynamic stability and reducing pain in individual with congenital Os naviculare.

Os subtibiale displacement secondary to pronation-external rotation ankle injury: A case report.

Os subtibiale is a rare accessory ossicle of the ankle, considered not of clinical significance. But its presence in trauma patients may cause misdiagnosis as malleolar fracture and over-treatment. Because the ossicle is attached to the deltoid ligament, ankle trauma that cause medial compartment injury may detach os subtibiale from medial malleolus. In these situations, MR imaging may help to diagnose the deltoid injury, demonstrate the features of the ossicle, and guide treatment.

Accessory and Sesamoid Bones in the Body: A study on their Size and Presence

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.

Accessory tympanic plate ossicle: a new osteological entity.

The auricular cartilage, which is typically soft and flexible, can calcify or ossify because of diseases such as diabetes mellitus, trauma, radiation therapy for cancer, and more commonly from frostbite. Calcified, ossified, or hardened auricular cartilage is a rare finding in the clinical literature and appears to be absent in the physical and forensic anthropological literature. This study examines the ossified auricular cartilage and tests whether the hypothesis can be identified in postmortem skeletonized tissue and be part of the external auditory meatus. A total of 290 crania were examined for accessory ossicles. A descriptive and interpretative analysis was performed grossly, histologically, and morphometrically to document the morphology and location of the ossicles, investigate their structure, and perform hypothesis testing. Results revealed that seven females and one male crania from a total of 290 crania (2.76%) exhibit semi-ossified auricular cartilage attached to the tympanic plate of the temporal bone. The morphology and location of the ossicles at the junction of the auricle and external auditory meatus indicate they are hardened auricular cartilage that was verified with histological observations. Regression analysis indicates that addition of the ossicle to the depth of the auditory tube significantly changes coefficient of determination (R2) with respect to cranial breadth. In conclusion, results indicate that small cartilaginous structures of the external ear may ossify forming accessory tympanic plate ossicles that potentially could be identified in skeletal remains as a new osteological entity. This report highlights the types of information that can be gained using an approach that integrates forensic anthropology, gross anatomy, and histology.

Prevalence and distribution of sesamoid bones and accessory ossicles in the hand region in patients presenting to the emergency department: a radiographic study

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.

Male elite soccer players have a higher incidence of accessory ossicles in the foot and ankle.

Accessory ossicles are caused by the failure of the fusion of secondary ossification centres and are more likely to occur due to heavy loading during the growth period or improper treatment after injury. This study aimed to investigate the incidence of foot and ankle accessory ossicles in male professional soccer players. This study included male professional soccer players who underwent medical checkups at our hospital between 2017 and 2023 as the soccer group. Medical checkups included radiographs of bilateral anteroposterior and oblique foot, as well as bilateral anteroposterior and lateral ankle. Male patients age-matched with the soccer group who visited our hospital undergoing anteroposterior and oblique foot or anteroposterior and lateral ankle radiography were included in the control group. The incidence of accessory ossicles was investigated and compared between the soccer and control groups. In this study, 276 ankles and 276 feet, as well as 121 ankles and 79 feet, were included in the soccer and control groups, respectively. The incidence of accessory ossicles in the soccer and control groups was as follows: accessory navicular 35.9%, 24% (P = .049), os peroneum 8.0%, 2.5% (P = .09); os supranaviculare 7.6%, 1.3% (P = .039); os infranaviculare 1.4%, 1.3% (P = .090); os calcaneus secundarius 4.3%, 0% (P = .059); os vesalianum 0%, 0%; os subfiblare 12.7%, 2.5% (P < .001); os subtibiale 18.1%, 2.5% (P = .001); and os trigonum 89%, 24% (P < .001). Male professional soccer players had a higher incidence of accessory navicular, os supranaviculare, os subfiblare, os subtibiale, and os trigonum.

Breaking down the small bones: understanding accessory ossicle fractures

Breaking down the small bones: understanding accessory ossicle fractures

Multiossicle accessory navicular bones – A symptomatic presentation of rare variant anatomy

The foot and ankle are common sites for variant anatomy, of which a known symptomatic entity is the accessory navicular bone. These accessory ossicles may have a varied appearance based on their relationship to the parent navicular and are usually solitary and bilateral. However, a rare multi-ossicle variant is also described, which may lead to an erroneous diagnosis of navicular avulsion fracture with fragmentation in the setting of an ankle injury. We describe such a case of the incidental multi-ossicle accessory navicular bone, which proved a diagnostic confounder in a lady with a history of an ankle injury.

Proposing novel dorsal Proatlas-manifestations: Description and classification of three rare phenomena in humans.

The craniocervical junction (CCJ) of humans and other vertebrates is a developmental restless region. Due to complex phylogenetic and ontogenetic processes, many anatomical variations can be found in that transitional area. Therefore, newly described variants must be registered, named, and classified into existing concepts explaining their genesis. This study aimed to describe and classify anatomical peculiarities that have not or rarely been reported on before in the literature. This study is based on the observation, analysis, classification, and documentation of three rare phenomena of three different human skull bases and upper cervical vertebrae, which come from the body donor program of the RWTH Aachen. As a result, three osseous phenomena (accessory ossicles, spurs, and bridges) at the CCJ of three different body donors could have been documented, measured, and interpreted. Due to extensive collecting efforts, careful maceration, and accurate observation, it is still possible to add new phenomena to the long list of Proatlas-manifestations. Further on, it could have been shown again that these manifestations can cause damage to the elements of the CCJ due to altered biomechanic conditions. Finally, we have succeeded in showing that phenomena can exist that can imitate the presence of a Proatlas-manifestation. Here, a precise differentiation between Proatlas-based supernumerary structures and the results of fibroostotic processes is necessary.

Symptomatic Os Vesalianum Pedis in Young Adult: A Case Report

Os vesalianum pedis is a rare accessory foot ossicle, which is located proximal to the base of the fifth metatarsal bone. This anatomic variant is usually asymptomatic and detected incidentally on routine foot radiographs. However, it can be an infrequent cause of lateral foot pain and rarely become symptomatic following traumatic injuries to the ankle or foot. To date, there are few reported cases of symptomatic os vesalianum pedis described in the literature and most of them were treated surgically. We report a case of symptomatic os vesalianum pedis in a young adult female, which was misdiagnosed initially and managed conservatively with physiotherapy. Patient’s symptoms regressed completely after a few sessions of physiotherapy and didn’t require surgical intervention. We intended to publish this case to increase the awareness of this rare entity among radiologists and clinicians.

Os Navicular Syndrome: A Symptomatic Accessory Ossicle of the Foot

Accessory navicular bone occurs due to failure of fusion of a secondary ossification center with the navicular. It is the second most common ossicle of the foot, with majority of them being identified incidentally on imaging studies. We report a case of 45-year-old female who presented with complaints of pain and localized redness over the medial aspect of the right foot which was aggravated on walking. This brief review aims to describe the pathophysiology, radiographic findings and management of Os naviculare syndrome. We also wish to highlight to the physicians that it must be suspected in patients with localized painover the medial aspect of the midfoot without obvious trauma. The presence of accessory navicular should not be disregarded as an incidental radiological variant in a symptomatic patient.

Osseous variability around the elbow joint.

There are many osseous variants that occur around the elbow joint such as supracondylar process, supratrochlear foramen, accessory ossicles, and others. Scientific databases were searched for variants around the elbow joint. Elbow radiographs from our center demonstrating some of these findings were included in the study. The aim of the present review was to provide comprehensive information on the terminology, prevalence, history, etiology, and clinical importance of these variants. These anatomical variants are important for radiologists while interpreting radiographs, computed tomography, and magnetic resonance imaging for trauma and orthopedic surgeons during osteosynthesis at the distal humerus, proximal ulna, and radius.

Chronic insertional Achilles tendinopathy secondary to congenital os Achilles: A case report.

IntroductionInsertional Achilles tendinopathy is a common overuse disorder affecting the foot and ankle that can lead to the development of a Haglund's deformity with chronicity, a retrocalcaneal exostosis that forms at the Achilles insertion site, further increasing pain and dysfunction.Presentation of caseWe report a case of a healthy, 35–40-year-old male with chronic left-sided insertional Achilles pain beginning in early adolescence. Physical exam demonstrated bilateral prominences on the posterior aspect of both heels, exquisitely tender on the left and without range of motion deficits. Imaging demonstrated a large calcific ossicle clearly within the tendinous insertion of the Achilles onto the left calcaneus. He underwent surgical intervention to provide pain relief and restore function. He exhibited full recovery post-operatively and has now returned to full functional activities.DiscussionGiven his symptom pathogenesis and progression, this patient may likely have suffered from chronic insertional Achilles tendinopathy due to an accessory ossicle that we believe was congenital. Current literature describes an additional secondary ossification center that appears over the dorsal, posterosuperior surface of the calcaneus. We suspect that there was a lapse in fusion at this additional ossification center that contributed to his pathological condition.ConclusionThis case report presents a unique occurrence of Achilles tendinopathy likely due to an accessory ossicle of congenital etiology. This highlights the importance of investigating the prevalence of this condition in those with chronic insertional Achilles tendinopathy, thus providing meaningful insight in considering effective treatment modalities in the management of these patients.

History Page: Leaders in MSK Radiology.

Charles Thurstan Holland was the first radiologist in the world and also the founder of the first radiology department. In the early days, radiographs were used primarily in the musculoskeletal system. Holland contributed significantly to the understanding of musculoskeletal radiology as seen on radiographs, including the appearance of ossification centers and accessory ossicles. The small triangular metaphyseal fragment in Salter-Harris type 2 fractures is called the "Thurstan Holland fragment."

Differentialdiagnose dorsaler Fersenschmerz

Heel pain is a common complaint with a prevalence of 15%. Besides inflammatory, infectious, neuropathic or tumor associated causes of pain, a mechanical bony or soft-tissue related disorder can be identified in most cases. Implementing a successful therapy can be challenging due to the variety of clinically similar differential diagnoses. Degenerative pathologies of the Achilles tendon frequently cause posterior heel pain and are subdivided into insertional tendinopathy (often associated with dorsal heel spurs) and mid portion tendinopathy, which is situated in a hypovascular ”critical zone” 2 to 6cm proximal to the calcaneal insertion site. Other typical disorders causing dorsal heel pain are retro-calcaneal or retro-Achilles bursitis, bony deformities (Haglund́s Syndrome), accessory ossicles (Os trigonum), calcaneal apophysitis (Severˊs disease) or flexor hallucis longus entrapment. A thorough physical examination and imaging diagnostics with sonography and MRI are crucial to identify the cause of pain. The therapy includes a wide range of conservative and surgical options depending on the main pathology.

A Radiographic Study on Prevalence and Distribution of Accessory Ossicles and Sesamoids of the Foot in Indian population

Background: The prevalence of accessory ossicles and sesamoid bones are variable in distribution. The accessory ossicles and sesamoids are usually asymptomatic, normal variants, and misdiagnosed or overlooked.&#x0D; Objective: The primary objective is to estimate the prevalence and distribution of accessory ossicles and sesamoid of the foot by radiographic study in the Indian population.&#x0D; Materials and Methods: A retrospective study of 1034 radiographs of the foot (anteroposterior and oblique view) performed—the prevalence of accessory ossicles and sesamoids—descriptive statistics used for data analysis.&#x0D; Results: One thousand thirty-four radiographs did, in which 68% of male and 32% of female patients. In our study, the prevalence of sesamoid bone hallux sesamoid, another sesamoid, and accessory ossicles are 100%, 9.2%, and 25.9%, respectively. The hallux sesamoid visualized in all individuals, (a) medial bipartite, (b) lateral bipartite, and (c) absent medial hallux are (3.38%), (0.58%), (1.16%) respectively. Our study group has three accessory ossicles location: forefoot, midfoot, and hindfoot. The prevalence of accessory ossicles found to be forefoot, midfoot, and hindfoot are (2.03%), (20.5%), (3.3%) respectively.&#x0D; Conclusion: Diagnosis of accessory ossicles and common sesamoids of the foot helps avoid the common pitfall in clinical practice. Accessory ossicles often misdiagnosed as fractures; further imaging is required to confirm the clinical suspicion and decision-making for different management.