Articular Margin Research Articles

Radiographic anatomy of the first metatarsal

Normal radiographic anatomy of the first metatarsal bone is established through cadaver dissection, examination of bone specimens, and radiography. Extra-articular and distal articular anatomical landmarks are identified with wire markers. Dorsoplantar, lateral, lateral oblique, and medial oblique radiographs of 15 osteologic sites are presented, including the articular margins of the first metatarsal head, the borders of the three diaphyseal surfaces, the origins of the metatarsophalangeal collateral and metatarsosesamoid suspensory ligaments, and the insertions of the first cuneiform-metatarsal joint ligaments and the tibialis anterior and peroneus longus tendons. The correlation of gross anatomy and radiographs is described.

Posterior Instability of the Talus: An Anatomic Evaluation

A cadaver study was conducted to evaluate the role of the posterior tibial margin or posterior malleolus, as well as medial and lateral supporting structures, in providing posterior stability for the talus. Posterior malleolar fractures consisting of approximately 30%, 40%, and 50% of the articular margin on the lateral radiograph were created in specimens that were then subjected to posterior stressing. No posterior talar subluxation was noted in any specimen. Repeat stressing following removal of the medial malleolus again revealed no subluxation in any specimen. The lateral supporting structures, primarily the posterior fibulotalar and fibulocalcaneal ligaments, appeared to be the key structures providing posterior talar stability. If the fibula is stable in an anatomic position, feared posterior instability of the talus would not appear to be an indication for internal fixation of posterior malleolar fractures.

Osteochondritis in the female gymnast's elbow

Ten cases of osteochondritis dissecans of the humeral capitellum are reviewed in seven high-performance female gymnasts, ranging in age from 10 to 17 years old. All but one were evaluated and treated with arthroscopy and/or arthrotomy, with curettage of loose articular margins, drilling of the lesion, and removal of loose bodies. The average length of follow-up is 2.9 years, and includes interview, physical examination, and roentgenographic evaluation. This injury has been previously described in relation to compressive forces across the radiocapitellar joint from repetitive valgus loading in a developing epiphysis. Only one of the athletes, at the time of follow-up, was still in competitive gymnastics. Each has a minimal limitation in range of motion, with crepitus and often catching noted by history and on examination. These cases double the limited literature on this injury in young, female gymnasts. They stimulate concern for the proper and early evaluation and treatment of elbow injuries in this at risk group. Once the bony changes in the capitellum are detected, and pain remains despite conservative management, we have found that symptoms can be improved with surgery, but persist in female gymnasts. Our experience in this more-advanced group is that the return to high-level competitive gymnastics is unlikely.

The Differential Diagnosis of Geodes

Lytic lesions close to or at the articular margins are secondary to a wide range of etiologies, including osteoarthritis, rheumatoid arthritis, hemophilic arthropathy, and crystal deposition disease as well as tumor and tumor-like conditions. In many cases the features of these "cysts" are distinctive, and the purpose of this article is to outline the characteristic hallmarks in some of the more frequently encountered arthropathies.

Accessory carpal bone fractures in the racing greyhound. Classification and pathology.

Fractures of the accessory carpal bone in 35 racing Greyhounds were classified into five types. Type I fractures (27 fractures) involved the distal articular surface of the accessory carpal bone, type II (6 fractures) were of the proximal articular margin, type III (1 fracture) were at the origin of the accessorometacarpal ligaments, type IV (6 fractures) were avulsion fractures at the tendon of insertion of the flexor carpi ulnaris muscle, and type V (3 fractures) were comminuted fractures.

Bone erosion in synovial chondromatosis.

Of 30 patients with synovial chondromatosis, nine had prominent pressure defects at the articular margins of the hip and shoulder. Erosions of bone may be extensive, and the patient can be at risk for developing a pathologic fracture. Synovial chondromatosis should be considered in the differential diagnosis of lesions causing erosions of the articular ends of the bones; it is not as uncommon as has been previously suggested.

Antigen-induced experimental septic arthritis in rabbits after intraarticular injection of Staphylococcus aureus.

With the Dumonde-Glynn model of antigen-induced arthritis, a rabbit model was developed to examine the histopathologic differences between normal and arthritic joints in the same animal infected by intraarticular injections of Staphylococcus aureus. Microscopic examination of whole joint sections and a quantitative histopathologic scale were used to compare changes in all the articular components of 17 normal and 17 arthritic joints infected for less than two weeks. The histological changes were more severe in infected arthritic joints than in infected normal joints (mean +/- SD total histology score, 13.8 +/- 2.4 and 9.3 +/- 4.0, respectively; P less than .001). In infected arthritic joints, subsynovial abscesses extended into subchondral bone via the pannus of chronic synovitis at articular margins and intraarticular attachments of cruciate ligaments, rather than by initial cartilage destruction and direct extension into subchondral bone.

Joint reaction to polyethylene implantation: a method for inducing osteoarthritic change and osteophyte formation in the rabbit knee joint.

Joint lesions were induced by implantation of a rigid piece of polyethylene sutured under the patella and quadriceps tendon of the rabbit's right knee. Compared to the left sham-operated knee, follow-up studies revealed progressive changes that consisted of early and transient synovial hyperemia and proliferation and late osteoarthritis. By day 7 after surgery, soft synovial-like tissue proliferated around the implant and the articular margins of the femoral trochlea indicating primitive "osteophytic" protuberances (synoviophytes). By day 15 after surgery, the synoviophytes had acquired a more solid consistency and were composed mostly of fibrocartilage covered by a fibro-cellular synovial lining (chondrophytes). By that time, this tissue was invaded with vascular channels; signs of ossification were already present in the deepest layer adjacent to bone. Between the 2nd and 12th weeks, this fibro-cartilaginous tissue, except for the surface fibrous or fibrocartilaginous layer, was progressively replaced by immature bone (osteophyte). Secondary bone remodeling started soon after the first lamellae of immature bone were deposited. Complete integration of the osteophyte into the distal femur occurred during the 2nd and 3rd month.

The response of articular cartilage to weight-bearing against metal. A study of hemiarthroplasty of the hip in the dog

Hemiarthroplasty of the hip and some other joints has been used for many years with satisfactory results, but the fate of articular cartilage when weight-bearing against metal has not been reported. Replacement of the head of the femur was carried out in one hip of each of 26 dogs, and the changes in acetabular cartilage studied at intervals of up to 24 weeks. There was early loss of proteoglycan, followed by surface damage to the cartilage, progressive degenerative changes, and growth of pannus from the articular margins. At 24 weeks after operation there was little remaining articular cartilage, while intense subchondral activity suggested that the bony skeleton was being remodelled to conform to the shape of the prosthesis. This study is not intended to suggest that hemiarthroplasty does not help patients.

Hypertrophy of the talar beak.

Hypertrophy of the talar beak is the product of traction of the insertion of the joint capsule. It is commonly seen in athletes and may be entirely asymptomatic despite its size. It should not be mistaken for spurring of the articular margin of the talus which is seen in tarsal coalition.

Fracture of the medial margin of the patella, a finding diagnostic of lateral dislocation.

Afracture or cortical irregularity of the medial articular margin of the patella was noted in a number of patients admitted to The Hospital for Special Surgery, New York, with the diagnosis of recurrent lateral dislocation of the patella. We regard this roentgen finding as pathognomonic evidence of previous lateral dislocation of the patella. In a few instances, we have been able to diagnose this previous dislocation from the x-ray examination without knowledge of the patient's history or clinical findings. The purpose of this presentation is to discuss and illustrate the roentgen abnormalities which follow lateral dislocation of the patella and to point out the importance of the tangential view of the patella in the examination of the knee. Presentation of Material Records of 150 patients admitted to the hospital with a diagnosis of lateral dislocation of the patella were obtained, and their roentgen examinations and charts reviewed. In 16 cases, 12 females and 4 males, the fracture of the medial articular margin of the patella was demonstrated. Not all the 150 patients had a complete roentgen examination, including tangential views, and therefore the exact statistical occurrence of the marginal fracture could not be established. A concurrent finding also previously described (1–4), the compression fracture or irregularity of the lateral margin of the lateral femoral condyle, was seen in only a few cases. It appears to be less common and more difficult to evaluate than the patellar rim fracture. In none of the 16 cases was any congenital abnormality of the patella such as hypoplasia demonstrated. A history of previous trauma was obtained in 12. Mechanism of Injury The laterally dislocated patella locks itself over the lateral margin of the lateral femoral condyle; then, upon contraction of the quadriceps, the patella is pulled back into its normal position. The impingement of the medial margin of the patella upon the lateral condyle causes a compression defect in the condyle and a fracture of the medial margin of the patella either by compression or by shearing as the patella slides back, pulled by the contracting quadriceps. This process produces a predominantly chondral fracture at the margin of the articular surface, which becomes radio-graphically visible only when a sufficient portion of subchondral bone is involved. Discussion Of the 16 patients in whom the medial marginal fracture of the patella was demonstrated, the youngest was twelve years of age. We assume that the fracture also occurs in younger children but is not radio-graphically detectable because the articular cartilage is thick and the ossification center proportionally small. Here the fracture is purely chondral in nature and therefore invisible. A dislocating patella in a patient eight years of age is demonstrated in Figure 1. No marginal fracture is visible.

The arterial supply and venous drainage of the bones of the human knee joint.

AbstractThis paper is based on a study of bones from fifty‐five (55) knee joints, ages ranging from newborn to ninety (90) years. Full details of techniques of specimen injection and preparation are given.The gross arterial and venous patterns in adult bones are identical with the patterns present within these structures which are largely cartilaginous at birth.The lower end of the femur is penetrated by radiate epiphyseal arteries around its circumference. These terminate in sinusoidal capillaries within the cartilage, the corresponding veins leaving along the lines of entry of the radiate arteries. No anastomoses exist between adjacent intracartilaginous vessels, their distribution in the epiphysis being segmental. The lateral superior genicular radiate epiphyseal arteries, for example, supply a relatively fixed segment of the lateral femoral condyle. This arrangement no longer exists when the ossific center extends to involve the sinusoidal tips of more and more vessels, effective anastomoses eventually developing between all vessels supplying the lower end of the femur.Analagous findings are reported in the tibia.The patella is penetrated at its center and lower pole by nutrient arteries.In adult bones a subarticular collecting vein system is orientated parallel to articular surfaces. Short venous stems of subchondral capillary loops drain into these subarticular collecting veins which then drain off at articular margins into tributaries of the main veins. These are original findings.

Bone and Joint Changes in Hemophilia

Bone and joint changes are among the most common manifestations of hemophilia. In their absence one is inclined to question the diagnosis in adult life. Roentgenologically, these changes are varied and relatively non-specific, depending to a large extent on the frequency of hemarthroses, the joints involved, and the age of the patient. During the past eight years we have had the opportunity of studying a group of hemophiliacs of various ages. In several instances x-ray examinations of involved joints were made initially prior to epiphyseal closure and periodically thereafter for several years. Thus a record of the progression of the bone and joint changes has been obtained. In addition to the serial changes, a variety of joint lesions ranging from minimal to far advanced are demonstrated in this group of patients. Clinical and Radiological Data Twelve cases are presented here, representing 6 families (Table I) . The first 5 cases have been under observation since 1945. Cases 6 through 9, from the third family, were seen in 1949. The last 3 cases, from unrelated families, were seen in 1952. In all of these cases the following laboratory criteria have been met: prolonged coagulation time of blood; positive Quick test; normal prothrombin, bleeding and clot retraction times. In 8 of the cases the prothrombin consumption was determined and found to be poor. The other 4 patients were studied prior to the development of prothrombin consumption determinations. The whole blood coagulation time in these subjects was as shown in the accompanying table. The details of the clinical course, laboratory data, and genealogical history are reported elsewhere (1). In the first family (McC.) there are 3 known hemophiliacs, the only children of their parents. Figure 1 shows the physical appearance of one of these brothers (T. McC.). Note the presence of genu valgum on the left, with posterior displacement of the tibia, associated with general atrophy of the left lower extremity. The carrying angle of the left elbow is reduced. The x-ray changes in this subject are of moderate severity. Figure 2 shows the right elbow, with enlargement and flaring of the radial head. Small rounded radiolucent defects are seen along its articular margin and along the lateral epicondyles of the humerus, indicative of cystic dissolutions. Figure 3 (HH4) shows bulging of the synovium and slight widening of the joint space due to a massive hemarthrosis in the right knee. The intercondylar fossa is slightly wider than normal, but the articular margins are smooth. Small ill-defined rarefactions are present in the subarticular portion of the tibial epiphysis, suggesting early cyst formation. During a seven-year period, x-ray studies of this knee have disclosed progressive changes. Figure 4 (1951) shows increased widening and deepening of the intercondylar fossa, decreased joint space with irregularity of articular surfaces, and slightly increased cystic changes.

Osteoarthritis of the hip joint.

The term osteoarthritis is loosely applied to all sorts and conditions of joints. In fact, whenever the radiograph shows any change in the appearance of the surfaces of the joint, it is frequently labelled osteoarthritis, irrespective of its nature. It is unfortunate that the distinctive features are not better known, for then the term could be kept strictly to that degenerative condition of the joint which is associated with (1) changes in the sub-articular bone (Figs. 1 and 9), (2) progressive destruction of the articular surfaces (Figs. 5, 6, and 11), and (3) the formation of the osteophytes at the articular margins (Figs. 3, 5, 6, 7, 11, and 17). Other features include the clinical evidence of progressive destruction of the joint, a varying amount and severity of pain aggravated by function, atrophy of muscles controlling and protecting the movements of the joint and restriction of the range of movement. But bony ankylosis is never present. The last feature must be stressed for there is a widely accepted erroneous teaching that the joint must be kept moving to prevent it becoming stiff. The truth is that the more the joint is given weight-bearing function the more rapid is the destruction of the joint; the more perfect the rest, the better the joint's chance for repair, and the less severe the symptoms and signs.

COMPLETE TRANSVERSE CERVICAL MYELITIS CAUSED BY TRAUMATIC HERNIATION OF AN OSSIFIED NUCLEUS PULPOSUS

Cervical herniation of the nucleus pulposus is not rare. Stookey, 1 Love and Walsh, 2 Mixter 3 and many others have written extensively on this abnormality. However, rupture of the annulus fibrosus and protrusion of an ossified intervertebral disk causing complete transverse myelitis in the cervical region is rare. Horwitz 4 in 1940 showed that degenerative changes in the cervical intervertebral substance occurred in 76 per cent of 50 unselected male cadavers examined by both roentgenograms and careful dissection. The average age at death was 56 years (the age of the subject of the present report) and the range was from 46 to 80 years. Narrowing of the joint space, irregularity of the articular margins, sclerosis of adjacent vertebral spongiosa and marginal proliferation of facets are the main changes of degeneration found by Horwitz. He reported complete ossification with fusion of adjoining vertebrae in 3 of the 50 cases studied.

On the Dorsal Region of the Vertebral Column of a new Dinosaur (indicating a new Genus, Sphenospondylus ), from the Wealden of Brook in the Isle of Wight, preserved in the Woodwardian Museum of the University of Cambridge

This small series of six vertebral bones is remarkable for the great lateral compression of the centrum and the depressed form of the neural arch, and, as exhibiting the characters of the dorsal region in a new generic type, seems to me worthy of some notice. The centrums of the vertebrae have an average length of 9 centim. each; the transverse width of the articular faces is about 7 centim., with a vertical depth of at least 8 centim.; but the lower part of the centrum is much compressed from side to side, so as to have a wedge form, and terminates inferiorly in a sharp longitudinal ridge. The articular margins of the centrums are moderately elevated. The transverse processes of the neural arch are at first directed backward, but soon become directed transversely outward, and retain their upward direction. The facet for the head of the rib is at first large, and at the base of the transverse process, and bounded posteriorly by the sharp ridge which runs below the transverse process to the hinder margin of the neural arch; but after a time the ribhead rises higher, so as to be chiefly above the zygapophysial facet; and then it becomes smaller, the ridge behind it more or less disappears or rounds away, and the transverse process, which was at first triangular in section, becomes vertically compresed and thin. The interest of the series is in exhibiting the gradation of characters as the bones extend backward, though, as the