Metatarsal Research Articles

Metatarsal bone model production using 3D printing and comparison of material properties with results obtained from CT-based modeling and real bone.

Using a real bone is very important to find correct results for the biomechanical studies. However, it is very difficult to find the real bone and sometimes artificial bone models can be preferred instead of real bone. The aim of this study is to obtain an easy-to-manufacture, easy-to-customize and inexpensive method the artificial first metatarsal bone model that is similar material properties with the real bone. 3D printer technology was used to produce the artificial bone model. First metatarsal bone was modeled using MIMICS software to produce and determined the mechanical properties. The bone mechanical properties were calculated via MIMICS software using computer tomography images. 3D bone models were produced in different infill density and infill pattern to determine the real bone mechanical properties using 3D printer. The infill density of the bone model was adjusted as 20%, 40%, and 60%. Five different infill pattern types were used as grid, cubic, triangle, trihexagon, and gyroid. The produced models were subjected to torsional test and the elasticity modulus of all models were obtained. The results of the elasticity modulus of all produced (artificial) and modeled (calculated) bone were compared and the optimum bone model was obtained. The optimum infill density and infill pattern was determined as 40% and trihexagon, respectively.

Long-Bone-Regeneration Process in a Sheep Animal Model, Using Hydroxyapatite Ceramics Prepared by Tape-Casting Method.

This study was designed to investigate the effects of hydroxyapatite (HA) ceramic implants (HA cylinders, perforated HA plates, and nonperforated HA plates) on the healing of bone defects, addressing biocompatibility, biodegradability, osteoconductivity, osteoinductivity, and osteointegration with the surrounding bone tissue. The HA ceramic implants were prepared using the tape-casting method, which allows for shape variation in samples after packing HA paste into 3D-printed plastic forms. In vitro, the distribution and morphology of the MC3T3E1 cells grown on the test discs for 2 and 9 days were visualised with a fluorescent live/dead staining assay. The growth of the cell population was clearly visible on the entire ceramic surfaces and very good osteoblastic cell adhesion and proliferation was observed, with no dead cells detected. A sheep animal model was used to perform in vivo experiments with bone defects created on the metatarsal bones, where histological and immunohistochemical tissue analysis as well as X-ray and CT images were applied. After 6 months, all implants showed excellent biocompatibility with the surrounding bone tissue with no observed signs of inflammatory reaction. The histomorphological findings revealed bone growth immediately over and around the implants, indicating the excellent osteoconductivity of the HA ceramic implants. A number of islands of bone tissue were observed towards the centres of the HA cylinders. The highest degree of biodegradation, bioresorption, and new bone formation was observed in the group in which perforated HA plates were applied. The results of this study suggest that HA cylinders and HA plates may provide a promising material for the functional long-bone-defect reconstruction and further research.

Lower Extremity Response to Blast Loading: A Computational Study.

This study has investigated the response of the Total Human Model for Safety (THUMS) lower extremity finite element model under blast loading. Response of the model was estimated in simulated underbody blast (UBB) loading using floorplate impact velocities of increasing severity. Correlation and analysis (CORA) ratings suggested a good match between numerical response and available experimental data. The model response was then investigated in an antipersonnel landmine explosion. The model was found stable in the nearfield blast and sensitive to the threat definition. The lower extremity injury was predicted when detonation occurred below the heel. The model predicted major injuries localized to the hindfoot and midfoot with minimal damage to the forefoot, consistent with the findings in the literature. The damage to the individual bones of the foot was measured in terms of percentage change in mass and element eroded.

Investigation on the site of coronal deformities in Hallux valgus

Hallux valgus (HV) is a common foot deformity that is more prevalent in females, characterised by abnormal adduction of the first metatarsal (MT) and valgus deviation of the phalanx on the transverse plane. Increasing evidence indicates that HV is more than a 2D deformity but a 3D one with rotational malalignment. Pronation deformity is seen during clinical examination for HV patients, but the exact origin of this rotational deformity is still unknown. Some attribute it to first tarsometatarsal (TMT) joint rotation, while others attribute it to intra-metatarsal bony torsion. In addition, the correlation between the rotational and transverse plane deformity is inconclusive. Identifying the origin of the rotational deformity will help surgeons choose the optimal surgical procedure while also enhancing our understanding of the pathophysiology of HV. This study aims to (1) develop an objective method for measuring the first MT torsion and first TMT joint rotation; (2) investigate the exact location of the coronal deformity in HV; (3) investigate the relationship between the severity of deformity on the transverse and coronal planes as well as the correlation between deformity severity and foot function/symptoms in HV. Age-matched females with and without HV were recruited at the Foot and Ankle Clinic of the Department of Orthopaedics and Traumatology. Computed tomography was conducted for all subjects with additional weight-bearing dorsal-plantar X-ray examination for HV subjects. Demographic information of all subjects was recorded, with symptoms and functions related to HV evaluated. The intra-class correlation was used to explore the relationship between deformities on different planes and the deformity severity and functional outcomes, respectively. An Independent t-test was used to compare joint rotation and bone torsion degrees. TMT joint rotation is significantly correlated with foot function. HV patients had more TMT joint rotation but not MT torsion compared to normal controls. No relationship was found between the coronal rotation and the 1,2-intermetatarsal angle (IMA) or Hallux valgus angle (HVA) on the transverse plane. Our results indicate that coronal deformities in HV may originate from TMT joint rotation. In addition, the severity of the TMT joint coronal rotation correlates with worse foot function; thus, multi-plane assessment and examination will be necessary for more precise surgical correction.

Neurogenic Аrthropathy, Сhronic Osteomyelitis, Diabetic Foot: Differential X-Ray and MSCT Diagnostics

X-ray and MSCT-differential diagnostics between neurogenic arthropathy, diabetic osteoneuroarthropathy (DONAP), complicated by osteomyelitis and chronic osteomyelitis, has not been studied enough.The purpose of the study was to study the MSCT semiotics of various variants of neurogenic arthropathy, DONAP complicated by osteomyelitis and chronic post-traumatic osteomyelitis in order to substantiate etiopathogenetic treatment. In 44 patients with neurogenic arthropathy, DONAP, complicated by osteomyelitis and chronic osteomyelitis, the results of polypositional radiography, MSCT were studied before treatment for the purpose of differential diagnosis. Single center retrospective study. MSCT and x-ray revealed differential diagnostics differences between neurogenic arthropathy, DONAP, complicated by osteomyelitis and chronic osteomyelitis. They are manifested by the localization of destructive processes, characteristic changes in the angles of the foot and a violation of the architectonics of the bones, concomitant changes in blood vessels and soft tissues. Neurogenic arthropathy is characterized by disorganization of the joints, bone resorption, giving the impression of surgical amputation, sharpening of the ends of the metatarsal bones, a symptom of «pestle in a mortar», a violation of the structure of spongy bones. DONAP is manifested by pronounced destructive changes in the midfoot, collapse of the tarsal bones with defects, fragmentation, vascular calcifications (Menckeberg), a «pathological» reference line, an increase in the Meary angle, a decrease in the angle of the calcaneus, and a «rocking foot», increased density of the calcaneus. Chronic osteomyelitis is characterized by an isolated lesion of one or more bones; the presence of a fistulous tract, focal disorders of the trabecular pattern, a decrease in the density of adjacent bones, the presence of isolated foci of sclerosis.

An intermediate phenotype in IDH related enchondromatosis spectrum

Mosaic variants of IDH1 (isocitrate dehydrogenase-1) R132 and IDH2 (isocitrate dehydrogenase-2) R172 loci were detected in most of the bone cysts of Ollier and Maffucci series and in the blood and tissue samples of metaphyseal enchondromatosis with D-2-hydroxyglutaric aciduria (MC-HGA) patients. We aimed to report an intermediate phenotype comparing with the reported cases. The proband was a 9-year-old boy with widespread metaphyseal enchondromatosis involving metaphyses of long tubular bones, iliac bones and tubular bones of both hands and feet and sparing spine and flat and short bones. He underwent quad whole exome sequencing (index-both parents-healthy sibling). Sanger sequencing was performed for confirmation and segregation purposes. Heterozygous IDH1 R132H (c.395G > A) variant was detected in his blood via whole exome sequencing and Sanger analysis in mosaic state, 22% of the reads and Sanger signal. He had no D-2-hydroxyglutaric aciduria in urinary organic acid analysis. Our case is unique with the presence of IDH1 R132H variant in blood with metaphyseal enchondromatosis without D-2-hydroxyglutaric aciduria. It was a transitional phenotype. With his phenotype, we expand the IDH1/IDH2 related enchondromatosis phenotypes.

Histopathological Perspectives of Multiple Organs in a Red- Footed Tortoise (Chelonoidis carbonaria) with Suspected Metabolic Bone Disease: A Case Report

Introduction: Exotic pet lovers' interest in keeping tortoises is increasing all over the world, including Indonesia. However, this trend cannot be separated from the potential emergence of various health problems in tortoises. One of the problems that often affects tortoises is metabolic bone disease. Metabolic bone disease (MBD) is a disorder related to the mechanisms of vitamin D and calcium metabolism, which generally occurs in reptiles, especially Chelonia and Lizards. Case Presentation: A 3-month-old redfooted tortoise, which was clinically suspected to have a MBD, was necropsied as an effort to support the provisional diagnosis through histopathological evaluation. The purpose of this examination was to analyze the impact of the disease on various organs microscopically in patients with suspected MBD. The results showed a decrease in the number of trabeculae and hematopoietic cells in the metatarsal bones; moderate myonecrotic changes and atrophy in the skeletal muscle; inflammation of the perineuron; acute tubular necrosis and mild edema of the renal cortex; congestion and an increase in the number of melanomacrophages in the liver; as well as epicarditis and myocarditis in the heart. Conclusion: Several forms of the histopathological changes seem to indicate a pathophysiological relationship between the suspected metabolic bone disease and the multiple organs examined.

An Osteoid Osteoma of the 4th metatarsal mimicking a stress fracture – A case report

Osteoid osteoma is a common benign bone tumor that infrequently affects the metatarsal bones. We present the case of a 29-year-old female that has mistakenly been treated for a stress fracture of the 4th metatarsal bone for almost 3 years. During this period, 4 conventional radiographs, 4 MRIs and 1 CT have been performed. After referral to our institution repeated thorough anamnesis and reevaluation of the diagnostic imaging raised suspicion for an osteoid osteoma. The patient was successfully treated with magnetic resonance-guided focused ultrasound (MRg-FUS). Osteoid osteoma is a rare but important differential diagnosis of stress fractures. Typical clinical presentation and diagnostic pathways should be known by professionals treating patients with nontraumatic foot and ankle pain.

Tenosynovitis of the Anterior Tibialis Tendon: Typical Clinical Radiological Correlation: A Case Report

The Anterior Tibialis Tendon (ATT) is usually the site of minor injuries due to its straight course, however, overuse injuries still possible due to repetitive foot dorsiflexion. This tendon crosses the anteromedial aspect of the ankle running toward the medial border of the foot under the inferior and superior extensor retinacula and inserts at the level of the medial cuneiform and the base of the first metatarsal bone. It can be prone to tendinosis, tenosynovitis, partial or complete tear. In the first cases, the patient experiences a pain and a swelling along the distal part of the ATT worsening while dorsiflexion. The diagnosis may be easily suspected clinically, particularly in significant lesions such a complete tear, but the compensation by the extensor hallucis longus and extensor digitorum longus muscles may delay the diagnosis [1].

The Minimally Invasive SERI Osteotomy for Pediatric Hallux Valgus.

Hallux valgus (HV), one of the most common forefoot pediatric pathologies, is characterized by lateral deviation of the big toe and medial displacement of the first metatarsal bone. Different surgical techniques have been described to correct the deformity, but no consensus has been reached regarding the best surgical option. The aim of this retrospective study was to report the results of the SERI technique in 58 pediatric HV of 45 consecutive patients. Pre- and postoperative VAS, AOFAS score, HVA, IMA and DMAA were collected. Preoperatively 3 patients (5.2%) had a mild deformity, 52 patients (89.6%) had moderate deformity and 3 patients (5.2%) had severe deformity according to Coughlin et al. Mean VAS score decreased from 5.2 ± 2.2 preoperatively to 0.8 ± 0.4 postoperatively. Mean AOFAS score improved from 68.1 ± 6.8 (range 59-75) preoperatively to 96.3 ± 3.2 (range 88-100) postoperatively, mean HVA reduced from 28.4° preoperatively to 13.2° postoperatively, mean IMA decreased from 15.2° preoperatively to 9.5° postoperatively (p < 0.01); mean DMAA decreased from 13.7° preoperatively to 8.2° postoperatively (p < 0.01). SERI technique showed satisfactory results when treating mild to severe pediatric HV deformity. No major complications were reported.

Neuropeptide Y Promotes mTORC1 to Regulate Chondrocyte Proliferation and Hypertrophy.

Peripheral neuropeptide Y (NPY) has been reported to regulate bone metabolism and homeostasis; however, its potential roles in growth plate chondrogenesis remain unclear. Here, we found that NPY expression decreased during chondrocyte differentiation in vitro and in vivo. NPY was required for chondrocyte proliferation; in contrast, knockdown of NPY facilitated chondrocyte hypertrophic differentiation. Administration of recombinant NPY in rat chondrocytes and metatarsal bones uncoupled normal proliferation and hypertrophic differentiation during chondrogenesis and thereby inhibited growth plate chondrogenesis and longitudinal bone growth. Remarkably, NPY activated the mTORC1 pathway in chondrocytes, whereas attenuation of mTORC1 activity by administration of rapamycin in vitro partially abrogated NPY-mediated effects on chondrocyte proliferation and hypertrophic differentiation. In addition, a combination of Y2R antagonist but not Y1R antagonist with NPY abolished NPY-mediated inhibition of metatarsal growth and growth plate chondrogenesis. Mechanistically, NPY activated Erk1/2 by NPY2R, then phosphorylated ERK1/2 activated mTORC1 to initiate PTHrP expression, which in turn promoted chondrocyte proliferation and inhibited chondrocyte hypertrophic differentiation. In conclusion, our data identified NPY as a crucial regulator of chondrogenesis and may provide a promising therapeutic strategy for skeletal diseases.

Rate of tarsal and metatarsal bone mineral density change in adults with diabetes mellitus and peripheral neuropathy: a longitudinal study

BackgroundIn people with diabetes (DM) and peripheral neuropathy (PN), loss of bone mineral density (BMD) in the tarsals and metatarsals contribute to foot complications; however, changes in BMD of the calcaneal bone is most commonly reported. This study reports rate of change in BMD of all the individual bones in the foot, in participants with DM and PN. Our aim was to investigate whether the rate of BMD change is similar across all the bones of the foot.MethodsParticipants with DM and PN (n = 60) were included in this longitudinal cohort study. Rate of BMD change of individual bones was monitored using computed tomography at baseline and 6 months, 18 months, and 3–4 years from baseline. Personal factors (age, sex, medication use, step count, sedentary time, and PN severity) were assessed. A random coefficient model estimated rate of change of BMD in all bones and Pearson correlation tested relationships between personal factor variables and rate of BMD change.ResultsMean and calcaneal BMD decreased over the study period (p < 0.05). Individual tarsal and metatarsal bones present a range of rate of BMD change (-0.3 to -0.9%/year) but were not significantly different than calcaneal BMD change. Only age showed significant correlation with BMD and rate of BMD change.ConclusionThe rate of BMD change did not significantly differ across different foot bones at the group level in people with DM and PN without foot deformity. Asymmetric BMD loss between individual bones of the foot and aging may be indicators of pathologic changes and require further investigation.Trial registrationMetatarsal Phalangeal Joint Deformity Progression—R01. Registered 25 November 2015, https://clinicaltrials.gov/ct2/show/NCT02616263

A Pilot Study of Plantar Mechanics Distributions and Fatigue Profiles after Running on a Treadmill: Using a Support Vector Machine Algorithm.

The treadmill is widely used in running fatigue experiments, and the variation of plantar mechanical parameters caused by fatigue and gender, as well as the prediction of fatigue curves by a machine learning algorithm, play an important role in providing different training programs. This experiment aimed to compare changes in peak pressure (PP), peak force (PF), plantar impulse (PI), and gender differences of novice runners after they were fatigued by running. A support vector machine (SVM) was used to predict the fatigue curve according to the changes in PP, PF, and PI before and after fatigue. 15 healthy males and 15 healthy females completed two runs at a speed of 3.3 m/s ± 5% on a footscan pressure plate before and after fatigue. After fatigue, PP, PF, and PI decreased at hallux (T1) and second-fifth toes (T2-5), while heel medial (HM) and heel lateral (HL) increased. In addition, PP and PI also increased at the first metatarsal (M1). PP, PF, and PI at T1 and T2-5 were significantly higher in females than in males, and metatarsal 3-5 (M3-5) were significantly lower in females than in males. The SVM classification algorithm results showed the accuracy was above average level using the T1 PP/HL PF (train accuracy: 65%; test accuracy: 75%), T1 PF/HL PF (train accuracy: 67.5%; test accuracy: 65%), and HL PF/T1 PI (train accuracy: 67.5%; test accuracy: 70%). These values could provide information about running and gender-related injuries, such as metatarsal stress fractures and hallux valgus. Application of the SVM to the identification of plantar mechanical features before and after fatigue. The features of the plantar zones after fatigue can be identified and the learned algorithm of plantar zone combinations with above-average accuracy (T1 PP/HL PF, T1 PF/HL PF, and HL PF/T1 PI) can be used to predict running fatigue and supervise training. It provided an important idea for the detection of fatigue after running.

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.

Correlation between Leg Length Discrepancies (LLD) with ITB Syndrome: A Systematic Review

Backgrounds: Iliotibial band syndrome (ITBS) is one of the many different causes of lateral knee pain. The iliotibial band (ITB) is the distal fascial continuation of the tensor fascia lata, gluteus medius, and gluteal maximus. It traverses superficial to the vastus lateralis and inserts on the Gerdy tubercle of the lateral tibial plateau and partially to the supracondylar ridge of the lateral femur. The etiology of ITBS is controversial and likely multifactorial. One theory advocates that repetitive friction of the ITB and the lateral epicondyle during flexion and extension lead to inflammation of the contact area of the ITB. The discrepancy in leg length has long been a source of controversy in the research and clinical environment. It disagrees on many aspects, such as its effect on various neuro musculoskeletal disorders and the evaluation of different measurement methods. Several orthopaedic disorders have also been associated with LLD, including low back pain, iliotibial band syndrome, hip osteoarthritis, intervertebral disc disease, and stress fractures of the femur, tibia, fibula, and metatarsal bones. Methods: Our trial was an international, expertise-based, randomized, controlled trial. Details of the trial objectives and design have been published previously. To identify studies about correlation between leg length discrepancy with ITB Syndrome, we reviewed the Cochrane, Pubmed, Embase databases for relevant articles published up to June 2022. Following the PICOS (Participants, Interventions, Comparisons, Outcomes and Study design) principle, the key search terms included (P) patients with ITB syndrome; (I) Leg length discrepancy; (C/O) the comparisons between ITB syndrome with leg length discrepancy thant without leg length discrepancy; (S) RCT, cohort study, or case-control study. Results: This study results Literature search through The flow diagram of study selection that shown in Figure 1. A total of RCT, cohort and case control study, meta analysis and systematic review about correlation between leg length dicrepancy with ITB Syndrome.Discussions: There can be a predisposition to developing IT band syndrome. Anatomy issues may include leg length discrepancy, an abnormal tilt to the pelvis, or bowed legs (genu varum). These situations can cause the IT band to become excessively tight, leading to increased friction and irritation as the band crosses over the femoral condyle with movement. leg length discrepancy, which can also increase ITB tightness. Leg length discrepancy can make an impact to biomechanical abnormalities. ITBS is usually caused by biomechanical abnormalities, often combined with overtraining. Conclusions: This confirms that may be leg length discrepancy also a factor that contributes to iliotibial band syndrome (ITBS).

Prevalence, knowledge, and awareness of hallux valgus among the general population in Saudi Arabia

Background: Hallux valgus (HV) is a common structural foot deformity that manifests as a medial bony expansion of the first metatarsal head and occurs when the hallux deviates more than 15&amp;#xb0; degrees toward the lesser toes concerning the first metatarsal bone. This study aims to assess the prevalence, knowledge, and awareness of HV among the general population in Saudi Arabia. Methods: A descriptive cross-sectional study was done based on an online questionnaire initiated after consultation with the field experts. The questionnaire of this study included participants&amp;apos; demographic data, medical history, the shape of the foot, wearing habits, and awareness of HV. Results: A total of 3,199 eligible participants completed the study questionnaire. Participants&amp;apos; ages ranged from 18 to 60 years, with a mean age of 28.3 ± 13.9. The exact of 2,044 (63.9%) are females. About 37.2% of the study participants had HV by some degree which was unilateral among 7.9% of them and bilateral among 29.3%. A total of 1,521 (47.5%) respondents had an overall good awareness level of HV, while 1,678 (52.5%) had an overall poor awareness level. Young age, female gender, high education, and having more severe HV were associated with higher awareness levels (p &amp;lt; 0.05). Conclusion: In conclusion, the study revealed that nearly one-third of the Saudi population complained of HV deformity, which was mainly bilateral with mild degrees. Also, the study showed that about half of the participants were knowledgeable regarding HV, mainly for preventive measures and clinical presentation.

A Rare Occurrence of Enchondroma in the Head of Femur in an Adult Male: A Case Report

Introduction: Enchondroma is a solitary, benign, and intramedullary cartilaginous tumor occurring most commonly in small bones of hands and feet contributing to 3–10% of all bone tumors. They originate from the growth plate cartilage which later on proliferates to form enchondroma. Lesions are central or eccentric and metaphyseal involvement is most common for long bones. We report a case of atypical occurrence of enchondroma in the head of femur in a young male. Case Report: A 20-year-old male patient presented with a history of pain in the left groin for 5 months. Radiological examination showed a lytic lesion in the head of femur. The patient was managed by safe surgical dislocation of the hip, curettage with autogenous iliac crest bone graft with countersunk screw fixation. Histopathology confirmed the lesion to be enchondroma. At the latest follow-up after 6 months, the patient was symptom-free and there was no evidence of any recurrence. Conclusion: Lytic lesions in the neck femur can have a good prognosis provided timely diagnosis and interventions are done. The present case of enchondroma in the head of femur represents a very rare differential diagnosis for the same and this must be kept in mind. So far, no such case has been reported in the literature. Magnetic resonance imaging and histopathology are of the essence to confirm this entity. Keywords: Enchondroma, atypical presentation, safe surgical dislocation of hip.

Značaj mekotkivnih hirurških intervencija na distalnom dijelu stopala u liječenju hallux valgus-a

Since pathological anatomical changes in the distal soft tissues of the front part of the foot in hallux valgus deformity are degenerative in nature and more pronounced than changes in the bony structures, interventions on ligamentous, capsular and tendinous structures are an indispensable part of its surgical treatment. A consensus has not been established regarding the nature and method of performing distal soft tissue interventions. To avoid the risk of consequent aseptic necrosis of the first metatarsal bone head in case of simultaneous osteotomy at its distal level, it is necessary that the osteotomy be performed in a safe place and the plantar and dorsal segments of this capsule must remain preserved. To avoid the occurrence of iatrogenic hallux varus deformity, lateral sesamophalangeal ligament, lateral sesamoid and associated part of the plantar aponeurosis must remain preserved. Since the deep transverse metatarsal ligament keeps the sesamoid apparatus in the anatomical position, its release should be avoided. Lateral release of adductor tendons of the thumb, lateral collateral ligament and associated part of the capsule facilitate correction of the position of the thumb with a modest contribution to the overall correction of deformity and allow access to the shortened lateral metatarsosesamoid ligament, which must be completely released, making the greatest contribution to overall correction. At the same time, the mentioned interventions are safe from the aspect of risk of possible complications, especially when performed using a special dorsal intermetatarsal approach. Reconstructive interventions on the soft tissues of the medial side of the metatarsophalangeal joint of the thumb include their tightening while stabilizing the thumb in a neutral position.

Morphometric Analysis of Peroneus Tertius and Extensor Digitorum Longus

Objective: The objective of this study was to analyse morphometric characteristics of the Peroneus Tertius (PT) and Extensor Digitorum Longus (EDL) muscles with important correlations and associations that may describe their functional significance.Material and Methods: The measurements PT and EDL muscles of cadavers were taken using a standard measuring tape. Minitab software Version 20.1 was used for statistical analysis methods of Spearman rho, Mood’s Median test, Fishers Exact test, and Two-sample T-test. Results: Of the 54 specimens of lower limbs, the mean length of origin of the PT from the fibula was 13.80±5.52 cm and 76% of the specimens with a separate origin of PT extended to its proximal half. The distal insertion of PT tendon was mostly as a single insertion into the base of the fifth metatarsal bone (55.55%). Spearman rho correlation value for the EDL muscle belly circumference with the number of intertendinous connections showed a mild negative correlation. Conclusions: Knowledge of morphometric characteristics and the variations of these muscles aid in clinical applications and suggest the use of radiological assessment of the muscle prior to surgical intervention.

Metatarsal Gradual Lengthening for Brachymetatarsia Using a Mini-rail External Fixator System.

To describe the surgical technique for gradual lengthening of the metatarsal using the Orthofix MiniRail System (Orthofix Medical Inc., Lewisville, TX, USA). Brachymetatarsia refers to the shortening of the metatarsal bone. When indicated, metatarsal lengthening is performed to treat this deformity. A dorsal approach to the short metatarsal is performed, protecting the neurovascular structures and the extensor tendons. The most proximal wire or screw is inserted first, followed by the most distal wire or screw. The distal wire or screw should not be inserted in the metatarsal head. The middle wires or screws are inserted thereafter. All wires or screws should be placed perpendicular to the anatomic axis of the bone. Once the MiniRail lengthener is assembled, a 1.6 mm K-wire is inserted from the tip of the toe into the metatarsal head, blocking the motion of the metatarsophalangeal joint and avoiding joint subluxation during lengthening. The osteotomy is then performed perpendicular to the metatarsal shaft, in between the middle two wires and screws. The surgical technique for gradual lengthening of the metatarsal using the Orthofix MiniRail System was described in detail with accompanying step-by-step intraoperative clinical and fluoroscopic images. This surgical technique of metatarsal lengthening is simple and effective. An understanding of the surgical technique of gradual lengthening of the metatarsal bone is important when treating shorting deformities of more than 1 cm. Marwan Y, Abu Dalu K, Bernstein M, et al. Metatarsal Gradual Lengthening for Brachymetatarsia Using a Mini-rail External Fixator System. Strategies Trauma Limb Reconstr 2022;17(3):184-188.