Os Trigonum Research Articles

In vivo evaluation of ankle kinematics and tibiotalar joint contact strains using digital volume correlation and 3 T clinical MRI

BackgroundIn vivo evaluation of ankle joint biomechanics is key to investigating the effect of injuries on the mechanics of the joint and evaluating the effectiveness of treatments. The objectives of this study were to 1) investigate the kinematics and contact strains of the ankle joint and 2) to investigate the correlation between the tibiotalar joint contact strains and the prevalence of osteochondral lesions of the talus distribution. MethodsEight healthy human ankle joints were subjected to compressive load and 3 T MRIs were obtained before and after applying load. The MR images in combination with digital volume correlation enabled non-invasive measurement of ankle joint kinematics and tibiotalar joint contact strains in three dimensions. FindingsThe total translation of the calcaneus was smaller (0.48 ± 0.15 mm, p < 0.05) than the distal tibia (0.93 ± 0.16 mm) and the talus (1.03 ± 0.26 mm). These movements can produce compressive and shear joint contact strains (approaching 9%), which can cause development of lesions on joints. 87.5% of peak tensile, compressive, and shear strains in the tibiotalar joint took place in the medial and lateral zones. InterpretationThe findings suggested that ankle bones translate independently from each other, and in some cases in opposite directions. These findings help explain the distribution of osteochondral lesions of the talus which have previously been observed to be in medial and lateral regions of the talar dome in 90% of cases. They also provide a reason for the central region of talar dome being less susceptible to developing osteochondral lesions.

Early euprimates already had a diverse locomotor repertoire: Evidence from ankle bone morphology

The morphological adaptations of euprimates have been linked to their origin and early evolution in an arboreal environment. However, the ancestral and early locomotor repertoire of this group remains contentious. Although some tarsal bones like the astragalus and the calcaneus have been thoroughly studied, the navicular remains poorly studied despite its potential implications for foot mobility. Here, we evaluate early euprimate locomotion by assessing the shape of the navicular—an important component of the midtarsal region of the foot—using three-dimensional geometric morphometrics in relation to quantified locomotor repertoire in a wide data set of extant primates. We also reconstruct the locomotor repertoire of representatives of the major early primate lineages with a novel phylogenetically informed discriminant analysis and characterize the changes that occurred in the navicular during the archaic primate–euprimate transition. To do so, we included in our study an extensive sample of naviculars (36 specimens) belonging to different species of adapiforms, omomyiforms, and plesiadapiforms. Our results indicate that navicular shape embeds a strong functional signal, allowing us to infer the type of locomotion of extinct primates. We demonstrate that early euprimates displayed a diverse locomotor behavior, although they did not reach the level of specialization of some living forms. Finally, we show that the navicular bone experienced substantial reorganization throughout the archaic primate–euprimate transition, supporting the major functional role of the tarsus during early primate evolution. This study demonstrates that navicular shape can be used as a reliable proxy for primate locomotor behavior. In addition, it sheds light on the diverse locomotor behavior of early primates as well as on the archaic primate–euprimate transition, which involved profound morphological changes within the tarsus, including the navicular bone.

Эндопротезирование при лечении пациентов с аваскулярным остеонекрозом таранной кости: обзор литературы

Introduction The paper discusses the main issues of treating patients with avascular osteonecrosis of the talus. The importance of the problem of treating patients with avascular osteonecrosis of the talus is explained by its high incidence, the difficulty of diagnosis in the early stages of the disease and poor treatment results with the use of traditional methods. Рurpose Based on the analysis of foreign and domestic literature, to determine the current state of the problem of surgical treatment of avascular osteonecrosis of the talus and to identify the range of possible surgical interventions in patients with the pathology under the study, to analyze in historical retrospect the arthroplasty of the talus bone due to its total involvement in the pathological process. Materials and methods The review analyzes the literature on this topic, in which 79 foreign studies, published in the period from 1911 to 2021, were selected along with 9 domestic publications for the period from 2011 to 2021. PubMed, MedLine and eLibrary Internet resources were used to search for publications. Results Based on the literature data, the issues of the history, etiology, pathogenesis, systematization and diagnosis of this disease are highlighted. The existing methods of treatment have been analyzed along with their advantages and shortcomings. Conclusion The analysis of current professional literature has demonstrated the preference of the method of talus bone arthroplasty in its total avascular osteonecrosis, in comparison with arthrodesis of the joints of the hind foot of various extent. Nowadays, the technology of arthroplasty of the talus bone is scientifically sound, biomechanically confirmed and effective for the treatment of patients with avascular osteonecrosis of the talus bone and its consequences, while the demand for this technology has been growing all over the world. There is a constant improvement of tools, technologies, methods and materials.

Association Between Pronation External Rotation IV Fracture Pattern and Regional Bone Density.

Throughout the musculoskeletal system, fracture patterns and subsequent healing rely partly on bone density. In the foot and ankle, bone density has been shown to play a role in supination and external rotation fracture patterns. Adding to previous research, this investigation examines the association between bone density and trimalleolar versus trimalleolar equivalent fracture patterns following pronation and external rotation injuries using computed tomography (CT)-derived Hounsfield units (HU). A retrospective chart review was conducted among patients without a history of fracture or osteoporosis who sustained a PER IV fracture. Demographic data were collected. Fractures were separated between PER IV equivalent and fracture groups. CT-derived HU was assessed at the distal tibia and fibula. Density was compared between PER IV equivalent and fracture groups and among posterior malleolar fracture patterns. Seventy-five patients met the selection criteria, with 17 comprising the equivalent group and 58 in the fracture group. There were 38 type 1, 9 type 2, and 11 type 3 posterior malleolus fractures. The ankle bone density of the PER fracture equivalent group (331.98 ± 65.71HU) was greater than the PER fracture group (281.61 ± 76.99HU; P = .008). A statistically significant difference in tibial bone densities among equivalent and all PER fracture types (P = .01) with the equivalent group (331.98 ± 65.71HU) maintaining a greater tibial bone density than the type 2 posterior malleolus fracture group (252.35 ± 57.33HU; P = .009). Higher bone density was associated with PER IV equivalent fractures; however, there was no density difference among posterior malleolus fracture types. When presented with PER IV fractures, consider fixation that addresses a lower bone density. III.

Deltoid ligament injury and repair.

The deltoid ligament is the primary stabilizer of the medial side of the ankle joint. It is a complex structure with an origin at the medial malleolus from where it spreads fan shaped distally with an insertion into the medial side of the talus, calcaneus and navicular bone. This chapter gives an overview of the anatomy, function, and pathology of the deltoid ligament.The deltoid ligament can become insufficient as a result of an ankle injury or prolonged strain. In the acute setting, deltoid insufficiency often coincides with multi ligament injury the ankle joint; syndesmosis injury, or ankle fractures. Management in the acute phase remains a subject of debate. Some orthopedic surgeons have a tendency towards repair, whereas most trauma surgeons often treat the deltoid nonoperatively. In the chronic setting the ligament complex is often elongated as a result of prolonged strain. It often coexists with a hindfoot valgus, as is the case in planovalgus feet. In such a case a realignment procedure should be combined with the deltoid repair.

Radiological-nuclear medicine hybrid diagnostics with SPECT/CT for chronic foot and ankle diseases : Anew and important diagnostic tool

In contrast to standard methods (sonography, X‑ray, CT(computed tomography), MRI(magnetic resonance imaging), numerous diseases of the foot or ankle can be diagnosed using SPECT/CT (single photon emission computed tomography/computed tomography) with regard to their clinical relevance with high accuracy (up to > 90%). The aim of this review is to provide an up-to-date overview of the importance of SPECT/CT in selected diseases of the foot and ankle. Aliterature search was carried out in the Pubmed database using the following terms: SPECT/CT, SPECT, skeletal scintigraphy, CT, computed tomography, foot and ankle disease, OSG, tarsal root, foot pain. The publications were selected with regard to questions and diagnoses that frequently occur in foot and ankle diagnostics. Furthermore, papers that describe amore precise diagnosis, achange in therapy management or areduction in symptoms due to the use of SPECT/CT were selected. Several studies have shown that afocally increased bone metabolism in osteoarthritis and osteochondral lesions correlates significantly with the development of pain. The presence of symptomatic ossicles such as the os naviculare accessorium typeII and os trigonum can be clearly demonstrated with the help of SPECT/CT and cannot be assigned as the source of the symptoms as accurately with any other imaging method. Bony reactions in the area of coalitions, arthrodesis, osteosynthesis, occult fractures, prostheses and diabetic foot cannot be detected with comparable accuracy using any other imaging method, so that therapy concepts in unclear cases, based only on standard imaging are changed inup to 2/3 of cases by SPECT/CT information. SPECT/CT is useful when there are clinical uncertainties despite standard imaging.

Induced membrane technique combined with a retrograde intramedullary nail for the treatment of infected bone defects of the ankle

In this study, we treated infected ankle bone defects with the induced membrane two-stage technique. The ankle was fused with a retrograde intramedullary nail in the second stage, and the aim of this study was to observe the clinical effect. We retrospectively enrolled patients with infected bone defects of the ankle admitted to our hospital between July 2016 and July 2018. In the first stage, the ankle was temporarily stabilized with a locking plate, and antibiotic bone cement was used to fill the defects after debridement. In the second stage, the plate and cement were removed, the ankle was stabilized with a retrograde nail, and tibiotalar-calcaneal fusion was performed. Then, autologous bone was used to rebuild the defects. The infection control rate, fusion success rate and complications were observed. Fifteen patients were enrolled in the study with an average follow-up of 30 months. Among them, there were 11 males and 4 females. The average bone defect length after debridement was 5.3 cm (2.1–8.7 cm). Finally, 13 patients (86.6%) achieved bone union without recurrence of infection, and 2 patients experienced recurrence after bone grafting. The average ankle-hindfoot function score (AOFAS) increased from 29.75 ± 4.37 to 81.06 ± 4.72 at the last follow-up. The induced membrane technique combined with a retrograde intramedullary nail for the treatment of infected bone defects of the ankle after thorough debridement is an effective treatment method.

The clinical effect of Huoxue Huayu Recipe combined with ibuprofen in patients with postoperative pain after ankle fracture

ABSTRACT The curative effect of Huoxue Huayu Recipe combined with ibuprofen in the postoperative pain in patients with ankle fractures was analyzed. 68 patients with ankle fractures were divided into study group (n = 34, Huoxue Huayu Decoction combined with ibuprofen) and control group (n = 34, ibuprofen). The levels of inflammatory factors, ankle joint function, VAS score and bone metabolism indexes were compared. Complications, isokinetic muscle strength and clinical related index levels were compared after treatment. High AOFAS score and low VAS score were identified in the study group compared with the control group at 1 week, 1 month and 2 months after operation. Compared to the control group, the incidence of postoperative complications was declined in the study group. After treatment, IL-6 and TNF-α levels in both groups were significantly decreased, and the study group had lower IL-6 and TNF-α levels. After treatment, the torque acceleration energy, relative peak torque value and endurance in the study group were obviously improved. The disappearance time of swelling and pain, fracture healing time, and complete weight-bearing time in the study group were reduced compared to the control group. After treatment, BGP and BALP levels in study group were higher than control group. Huoxue Huayu Recipe combined with ibuprofen can reduce inflammatory factors levels in patients with ankle fracture, improve isokinetic muscle strength and ankle function, and accelerate the recovery of patients.

Talus bone: normal anatomy, anatomical variations and clinical correlations.

Talus is a pivotal bone that assists in easy and correct locomotion and transfers body weight from the shin to the foot. Despite its small size, it is implicated in many clinical disorders. Familiarity with the anatomy of the talus and its anatomical variations is essential for the diagnosis of any disorder related to these variations. Furthermore, orthopedic surgeons must be fully aware by this anatomy during podiatry procedures. In this review, we attempt to present its anatomy in a simple, updated and comprehensive manner. We have also added the anatomical variations and some clinical points relevant to the unique and complex anatomy of talus. The talus has no muscle attachment. However, it does have many ligaments attached to it and others around it to keep it in place. Moreover, the bone plays a pig role in movements due to its involvement in many joints. Most of its surface is covered with articular cartilage. Therefore, its blood supply is relatively poor. This puts the talus at greater risk for poor healing as well as more complications in the event of injury than any other bone. We hope this review will make it easier for clinicians to pursue and understand the updated essential knowledge of one of the most complex bone anatomies that they need in their clinical practice.

Multi-Body 3D-2D Registration for Robot-Assisted Joint Reduction: Preclinical Evaluation in the Ankle Syndesmosis.

Existing methods to improve the accuracy of tibiofibular joint reduction present workflow challenges, high radiation exposure, and a lack of accuracy and precision, leading to poor surgical outcomes. To address these limitations, we propose a method to perform robot-assisted joint reduction using intraoperative imaging to align the dislocated fibula to a target pose relative to the tibia. The approach (1) localizes the robot via 3D-2D registration of a custom plate adapter attached to its end effector, (2) localizes the tibia and fibula using multi-body 3D-2D registration, and (3) drives the robot to reduce the dislocated fibula according to the target plan. The custom robot adapter was designed to interface directly with the fibular plate while presenting radiographic features to aid registration. Registration accuracy was evaluated on a cadaveric ankle specimen, and the feasibility of robotic guidance was assessed by manipulating a dislocated fibula in a cadaver ankle. Using standard AP and mortise radiographic views registration errors were measured to be less than 1 mm and 1° for the robot adapter and the ankle bones. Experiments in a cadaveric specimen revealed up to 4 mm deviations from the intended path, which was reduced to <2 mm using corrective actions guided by intraoperative imaging and 3D-2D registration. Preclinical studies suggest that significant robot flex and tibial motion occur during fibula manipulation, motivating the use of the proposed method to dynamically correct the robot trajectory. Accurate robot registration was achieved via the use of fiducials embedded within the custom design. Future work will evaluate the approach on a custom radiolucent robot design currently under construction and verify the solution on additional cadaveric specimens.

Vascular Anomalies in the Course and Branching Pattern of the Dorsalis Pedis Artery: A Case Report

The dorsalis pedis artery (DPA) vascularizes most of the dorsum of the foot where it provides several branches. During a scheduled examination of the lower extremities of a male cadaver, a significant deviation was observed in the course and pattern of distribution of the left DPA. The artery trifurcated from its point of origin and was found to deviate from its normal course on the superior surface of the intermediate cuneiform, talus, and navicular bones. A lack of the arcuate artery was observed, and a varied branching pattern was established among the branches of the DPA on the dorsum of the foot. Knowing the detailed anatomy of the DPA and understanding its variability is of great clinical importance to surgeons, radiologists, and orthopedists due to the usefulness of this artery in different surgical interventions relating to the foot.

Postrenal transplant tuberculosis of the ankle joint

Tuberculosis (TB) is one of the common infections after renal transplantation in developing countries. Patients who receive kidney grafts are at an increased risk for the development of mycobacterial disease than the general population, because of uremia and the immunosuppressants used in the posttransplant period, all of which interfere with T-cell function. Extrapulmonary TB is more common in renal allograft recipients and may present with dissemination or atypical features. Although extrapulmonary TB occurs frequently, isolated ankle joint TB is a rare form of extrapulmonary TB infection. We report here a renal allograft recipient with ankle joint TB presenting 6 months after transplantation with persistent pain in the left ankle joint associated with swelling and mild restriction of joint movement. He was diagnosed to be having an osteomyelitis of the talus bone extending to the navicular and anterior part of the calcaneus. He underwent open debridement and CB-NAAT of the tissue, which showed mycobacterium TB and rifampicin resistance was not detected. He was started on antituberculous treatment. This report highlights the need for a high index of suspicion for diagnosing TB early among renal transplant recipients and diagnostic difficulties of the TB disease due to insidious and nonspecific clinical presentation. Also, the treatment has to be monitored closely due to drug interaction between immunosuppressants and anti-TB drugs.

FRACTURES OF THE BONES IN THE ANKLE JOINT

Introduction: Ankle fractures are usually frequent in emergency departments worldwide, with an incidence of 187/100,000 inhabitants per year. Especially the type B fracture according to Webers classification, which may lead to long-term osteoarthritis in approximately 14%. It is essential to recognize that stability in the ankle joint is the fundamental pillar in the correct treatment strategies in ankle trauma. Objective: to describe current information related to ankle bone fractures, etiology, anatomy, epidemiology, mechanism of action, presentation, classification, evaluation, prognosis, treatment and complications of ankle fractures. Methodology: a total of 38 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 26 bibliographies were used because the other articles were not relevant to this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: ankle fracture, fractura do tornozelo, ankle, tibia, fibula, ankle fracture. Results: Bimalleolar ankle fractures occur in a quarter of the patients and trimalleolar fractures in the remaining 5% to 10%. The incidence of ankle fractures is close to 187 per 100,000 inhabitants per year. Open fractures are infrequent, representing only 2 % of all fractures of the ankle joint. In children, these injuries are also frequent, occupying the second place after hand and wrist injuries, especially in those between 10 and 15 years of age. Likewise, pediatric ankle fractures occur in a 2:1 male to female ratio, representing 5% of all fractures in children and approximately 9% to 18% of all fissure injuries. Conclusions: the ankle joint is complex, in gynglimus, formed by the fibula, the tibia and the talus and also deeply related to the ligamentous complexes. The bony anatomy that provides stability is formed by the distal part of the tibia and fibula, its articulation with the talus and with each other. Generally ankle fractures are caused by different trauma mechanisms such as impact, twisting and crushing injuries. Ankle injury depends on several factors such as mechanism, chronicity, bone quality, patients age, magnitude, direction, impact velocity and foot position. A complete and comprehensive medical history is essential in the medical evaluation. X-rays are the first-line adjunctive tests that aid in the evaluation of an injury that impacts the ankle. The classification system is important for the treatment decision. The treatment of fractures of the ankle bones can be performed conservatively or surgically, depending on certain criteria, and immobilization should be performed afterwards to reduce the risk of complications. It is essential to follow the ATLS scheme in order to define and manage any alteration that may be life-threatening for the patient. Ankle fracture-dislocation requires urgent manipulation to recover the ankle mortise. KEY WORDS: fracture, ankle, tibia, fibula, bones.

Patient-Specific Instruments for Resection and Reconstruction of Osteoblastoma in the Talus

Osteoblastoma of the talus is a rare and challenging pathology both to diagnose and treat successfully. Treatment of an inadequate osteoblastoma resection is usually a wide resection, however, achieving the desired margins in the foot and ankle bones can lead to complications such as fractures or joint loss. We present a case of an incomplete talar neck Osteoblastoma resection and a novel technique that was followed for 3 years after surgery. Level of Evidence: Diagnostic Level V—technique description. See Instructions for Authors for a complete description of levels of evidence.

Biomechanical comparison of nitinol compression staples versus fully threaded lag screws for talonavicular arthrodesis

BackgroundTalonavicular arthrodesis (TNA) is indicated for treatment of disorders that require immobilization of the hindfoot. Lag screw fixation is considered the reference standard technique for TNA. Despite consistently favorable clinical results using lag screw fixation, it is still associated with higher than desired complication and failure rates. Nitinol compression staples have been used for TNA based on potential advantages over lag screw fixation. However, functional biomechanical data comparing lag screw and nitinol compression staples for TNA are lacking. Therefore, the objective of this study was to compare nitinol compression staples to fully threaded lag screws for use in TNA with respect to their biomechanical properties during functional robotic testing. MethodsTNA was performed on cadaveric feet (n = 12; 6 matched pairs) using either two nitinol compression staples (Arthrex, Naples, FL) or two fully threaded lag screws (Arthrex, Naples, FL) in random order, alternating between paired left and right feet. After instrumentation, specimens were mounting in a robotic testing system and loaded at 89 N/sec from 30 N to 445 N for 1 min. Then, continuous compressive load of 445 N was applied while cycling from 30° plantarflexion to 15° dorsiflexion for 10 cycles. Optical tracking markers attached to the talus and navicular bone tracked displacements. Translation data were recorded along the X, Y, Z planes. Rotation data were recorded for roll, pitch, and yaw. Significant (p < 0.05) differences between fixation methods were determined using paired t-Tests for each measured variable. ResultsThere were no statistically significant differences between staples and screws for translation in X, Y, or Z planes. When comparing rotation (roll, pitch, and yaw), there were no statistically significant differences with the exception of increased roll rotation for staple fixation versus lag screw fixation during static compression testing (p = 0.009). ConclusionBased on comparison to the reference standard lag screw fixation for clinically relevant biomechanical properties measured during functional robotic testing of the hindfoot, nitinol compression staples are a viable option for talonavicular arthrodesis.

Implementation of automated behavior metrics to evaluate voluntary wheel running effects on inflammatory-erosive arthritis and interstitial lung disease in TNF-Tg mice

BackgroundAlthough treatment options and algorithms for rheumatoid arthritis (RA) have improved remarkably in recent decades, there continues to be no definitive cure or pharmacologic intervention with reliable long-term efficacy. For this reason, the combination of medications and healthy lifestyle modifications are essential for controlling joint disease, and extra-articular manifestations of RA, such as interstitial lung disease (ILD) and other lung pathologies, which greatly impact morbidity and mortality. Generally, exercise has been deemed beneficial in RA patients, and both patients and clinicians are motivated to incorporate effective non-pharmacologic interventions. However, there are limited evidence-based and specific exercise regimens available to support engagement in such activities for RA patients. Here, we provided the continuous opportunity for exercise to mice and implemented automated recording and quantification of wheel running behavior. This allowed us to describe the associated effects on the progression of inflammatory-erosive arthritis and ILD in the tumor necrosis factor transgenic (TNF-Tg) mouse model of RA.MethodsWild-type (WT; males, n=9; females, n=9) and TNF-Tg (males, n=12; females, n=14) mice were singly housed with free access to a running wheel starting at 2 months until 5 to 5.5 months of age. Measures of running included distance, rate, length, and number of run bouts, which were derived from continuously recorded data streams collected automatically and in real-time. In vivo lung, ankle, and knee micro-computed tomography (micro-CT), along with terminal micro-CT and histology were performed to examine the association of running behaviors and disease progression relative to sedentary controls.ResultsTNF-Tg males and females exhibited significantly reduced running distance, rate, length, and number of run bouts compared to WT counterparts by 5 months of age (p<0.0001). Compared to sedentary controls, running males and females showed increased aerated lung volumes (p<0.05) that were positively correlated with running distance and rate in female mice (WT: Distance, ρ=0.705/rate, ρ=0.693 (p<0.01); TNF-Tg: ρ=0.380 (p=0.06)/ρ=0.403 (p<0.05)). Talus bone volumes were significantly reduced in running versus sedentary males and negatively correlated with running distance and rate in TNF-Tg mice (male: ρ=−903/ρ=−0.865; female: ρ=−0.614/ρ=−0.594 (p<0.001)). Histopathology validated the lung and ankle micro-CT findings.ConclusionsImplementation of automated wheel running behavior metrics allows for evaluation of longitudinal activity modifications hands-off and in real-time to relate with biomarkers of disease severity. Through such analysis, we determined that wheel running activity increases aerated lung volumes, but exacerbates inflammatory-erosive arthritis in TNF-Tg mice. To the end of a clinically relevant model, additional functional assessment of these outcomes and studies of pain behavior are warranted.

Clinical and radiological results of posterior ankle endoscopy treatment for the flexor hallusis longus tenosynovitis and os trigonum syndrome

Objectives: This study investigated the effect of two portal posterior ankle arthroscopy (PAA) procedures using American Orthopaedic Foot and Ankle Society (AOFAS) and Visual Analog Scale (VAS) scores for the treatment of patients with ankle pain associated with Os trigonum (OT) and Flexor hallusis longus (FHL) tenosynovitis. The effect of PAA treatment on the degree and localization of effusion around the FHL tendon was also investigated. Methods: Between March 2016 and August 2021, 41 patients who underwent PAA with the diagnosis of OT and stenosing FHL tenosynovitis, whose arthroscopy video records could be reviewed retrospectively, and who had at least 1 year of follow-up results were included in the study. Patients in the pediatric age group, diabetes patients, patients with inflammatory disease, and those with subtalar and tibiotalar osteoarthritis were excluded from the study. Preoperative and postoperative physical examinations, lateral radiography of the pressing foot, MRI, and the VAS and AOFAS scores were evaluated. In the statistical analysis, data were statistically analyzed using SPSS 19.0 (SPSS, Chicago, Illinois, USA). p &amp;lt; 0.05 was accepted as statistically significant. Results: The mean age was 35.6 years (range: 19-55), among which the mean age of the women was 36.2 years (range: 24-48), and the mean age of the men was 35.2 years (range: 19-55). The mean follow-up was 34 months (range: 14-62). The AOFAS value increased from 38.61 ± 7.176 preoperatively to 89.83 ± 6.34 at the postoperative follow-up, and the difference was statistically significant (p &amp;lt; 0.001). Five patients fully regained their normal function (AOFAS score = 100 points). The VAS value increased from 90 ± 5.916 preoperatively to 18.682 ± 7.688 at the last postoperative follow-up, and the difference was statistically significant (p &amp;lt; 0.001). Pre-PAA FHL tenosynovitis was seen only in zone 1 in 26 patients, zones 1 and 2 in 14 patients, and in zones 1, 2, and 3 in two patients. There was no significant decrease in effusion in the magnetic resonance imaging (MRI) at 1 month after the PAA (p = 0.117). A significant decrease in effusion was observed in the MRI taken at the last control (p &amp;lt; 0.001). Conclusions: In the treatment of patients with ankle pain associated with OT and FHL tenosynovitis, the two-portal PAA treatment was observed to be an effective method that resulted in significant improvement in the AOFAS and VAS scores.

ИГРАЛЬНЫЕ КОСТИ ИЗ РАСКОПОК СЕЛИЩА ПОДЫМАЛОВО-1 В БАШКИРСКОМ ПРИУРАЛЬЕ ()

The article presents the results of the research of astragali (talus bones) excavated in 2022 at the Golden Horde Podymalovo-1 (XIV). Settlement. The collection of animal astragals was studied with use-wear analysis. The obtained data were compared with the results of studies of similar artefacts made of talus bones which had been discovered at the ethnographic expedition in 2019 in the village of Nyzhnebaltachevo, the Tatyshlinsky district, in the Republic of Bashkortostan. Those objects were used in the game known as “loedyiga” (a kind of game similar to “fi ve stones/bones”). The analysis of two collections revealed identical processing traces which had been left when the bones had been extracted from the limbs of animals. However, the wear marks differed in their character. The use of use-wear analysis and comparative methods in the study of the talus bones of animals discovered at the village of Podymalovo-1 made it possible to classify them as dice (“chips” and “bits”). It was concluded that the astragals could have been used in a version of the game different from the game“five stones/bones”.

Методика выделения парных астрагалов Ovis aries в закрытых археологических комплексах (на примере средневекового клада альчиков из Торопово-7А в Кузнецкой котловине)

The article examines a collection of dice, of 91 talus bones or astragalus from domestic sheep (Ovis aries), found during the excavations at the Toropovo-7A cult site in the valley of the Kasma river in the Kuznetsk basin. These archaeological objects were found in one cluster in the upper filling of the soil pit. The archaeological site according to analogies of the totality of finds was dated back to the 11th–14th centuries and attributed to the Shandin archaeological culture. The preliminary analysis of the astragalus collection from the Toropovo-7A cult site showed that it was formed by versatile bones, of which 44 were left and 47 were right, and on 20 bones there were traces of artificial damage. These data led to the question of the real number of sheep that could belong to the found alchiki, since their number could range from 47 to 91. To solve this problem, based on the approach of L. Lyman, a method was developed to identify versatile paired astragalas potentially belonging to one individual. It is based on the classification of bones by cluster analysis, taking into account morphometric differences between the left and right astragalus belonging to the reference individual. The Euclidean distance, calculated from two dimensions: the length of the astragalus along the lateral side and the width of its lower articular block, was used as a measure of distance in the construction of the similarity dendrogram by the arithmetic mean method. As a threshold value, the level of association of reference astragalus served, below which versatile astragalus, united in separate clusters, were considered as potentially belonging to one species. As a result of cluster analysis, versatile pairs of astragalus were singled out from a sample of 75 samples, which hypothetically can belong to 9 animals. Taking into account the results obtained, it is assumed that the minimum number of rams whose astragalus appeared in the collection at Toropovo-7A was at least 80 species.

Squatting Facets and Trochlear Extensions of Talus Bone in Indian Population

Introduction: The talus is a tarsal bone articulated with the tibia, fibula, navicular, and calcaneus bones to form supratalar, pretalar, and subtalar joints, respectively. A squatting facet is a kind of anomaly that forms on the surfaces where the tibia and talus articulate. The squatting facet states the daily activities and living style of society. Squatting is described as the hyperflexion of the hip and the knee and the movement of hyperdorsiflexion between the leg and the ankle. Materials and Methods: In the present cross-sectional study, 600 dry adult human tali were taken from the osteology laboratory in the Department of Anatomy, King George's Medical University, UP, Lucknow. Each talus was examined for the presence of various patterns of articular facets on the neck of the talus and extensions of its trochlear surface. Ethical clearance was obtained from the Institutional Ethics Committee, King George's Medical University, Lucknow, as reference code: 121 ECMIIA/P3. Results: In our study, we observed that the lateral, medial, and combined squatting faces are 282 (47.64%), 49 (8.28%), and 22 (3.72%), respectively. Lateral, medial, and continuous trochlear extensions are 126 (21.12%), 120 (20.58%), and 31 (5.36%), respectively, in the Indian population. Conclusion: Modifications of the neck of the talus (squatting facets and trochlear extensions) are the result of prolonged squatting positions, which is a common habit of the Indian population, and incidences of these variations can be used as an anthropological marker for racial and regional differentiation of unidentified bones.