Metatarsal Research Articles

Biomechanical Comparison of Headless Compression Screws, Kirschner Wires and Bioabsorbable Pins in Distal Oblique Metatarsal Osteotomy for Correction of Hallux Valgus.

Distal osteotomy of the first metatarsal is a widely used method for the correction of mild-to-moderate hallux valgus deformities. The objective of this study was to compare the stability of headless compression screws, kirschner wires and absorbable pins in terms of stiffness and maximum load in distal oblique metatarsal osteotomy. A total of 30 4th generation first metatarsal synthetic bone models were divided into three groups according to the fixation techniques. The stiffness of the first metatarsal was calculated as the slope of the linear curve that fit with the first linear part of the force displacement curve. The failure strength was recorded as the maximum load. The stiffness and maximum load values in the axillary and transverse configurations were compared between the three fixation groups. The stiffness was statistically higher in Group K and Group C compared to Group B in both axial and transverse loading. Similarly, the maximum load was significantly higher in both Group K and Group C compared to Group B in both loading conditions. No significant difference was found between Group K and Group C in stability. The higher failure strength was obtained with headless compression screws (113.34±35.88 N) in the axial loading. The lowest failure strength was found in the absorbable pins technique (16.17±7.72 N) in the transverse loading. No significant difference was found between the Kirschner wires and headless compression screws techniques, although the highest strength was obtained with headless compression screws that are increasingly used in orthopedic practice.

Minimally Invasive Chevron Akin (MICA) Osteotomy for Severe Hallux Valgus

Category: Bunion Introduction/Purpose: The minimally invasive Chevron Akin (MICA) osteotomy have been widely used treating hallux valgus (HV). The purpose of this study was to present a case series of patients with severe HV undergoing surgical treatment using the MICA procedure, and to evaluate the clinical and radiographic outcomes Methods: Sixty consecutive feet (52 patients) undergoing MICA for severe HV were included. Patients were assessed pre and postoperatively. Clinically evaluation was realized by visual analogue pain scale (VAS) and American Orthopaedic Foot & Ankle Society Score (AOFAS). Radiographic assessments included measurement of hallux valgus angle (HVA), intermetatarsal angle (IMA), metatarsal (MT) length and plantar offset of MT head. Results: The mean age was 59.9 years and follow-up were 18.5 months. The average AOFAS increased from 41.2 to 90.9 points and the VAS decreased from 8.1 to 1.3 at the last follow up. Average HVA decreased from 41.2° to 11.6° and IMA reduced from 17.1° to 6.8°. Average shortening of the first metatarsal and the plantar offset of MT head was 3.9 mm and 2.8 mm respectively. There was significant improvement (p<0.001) in all clinical and radiographic parameters (p<0.001). The most observed complication was hardware discomfort, observed in four feet (6.6%). Conclusion: The MICA technique is a safe and reproducible method to treat severe HV.

Case of Multifocal Non-Hodgkins Lymphoma of Bones of Foot and Ankle

Case of Multifocal Non-Hodgkins Lymphoma of Bones of Foot and Ankle

EFEITO DA FADIGA ESPORTIVA NA DISTRIBUIÇÃO DA PRESSÃO PLANTAR DE ESTUDANTES UNIVERSITÁRIOS MASCULINOS SAUDÁVEIS

ABSTRACT Objective: To understand the influence of sports fatigue on plantar pressure distribution of healthy male college students and provide a theoretical basis for improving their awareness of foot health. Methods: Forty-nine ordinary male college students jogged along the 800-meter runway to moderate fatigue. All the subjects took off their shoes and socks and walked naturally with their usual gait. The dynamic plantar pressure of each foot was measured twice in one step. FootscanUSB2 Belgian flat-plate plantar pressure testing system was used for testing. Results: The average dynamic peak plantar pressure was (206.38 44.59) N for boys, and the changes of AA and CB walking speed in the arch did not change significantly. After fatigue, the peak pressure of FM, AA, RH5 in left foot and FM, AA, CB in right foot decreased significantly (P < 0.05, P < 0.01). The peak time of RH and CB in the left foot was significantly shorter than that before fatigue (P < 0.05, P < 0.01), while FMF, AA, C areas had no significant change but tended to be delayed. There were significant differences in peak force-time between boys’ left and right feet except for the fifth metatarsal bone (P < 0.05). There is a significant difference in the peak force-time between the second and fifth toes of the left foot (P< 0.01), and there is a gender difference in the peak force-time between the second metatarsal and the third metatarsal (P < 0.05). Conclusion: Sports fatigue leads to the decrease of physiological functions such as muscle strength of lower limbs, which leads to the corresponding changes in gait stages, plantar pressure distribution parameters, and foot balance. Level of evidence II; Therapeutic studies - investigation of treatment results.

Comparison Between Hallux Rigidus Parameters Assessed by Conventional Radiographs and Weight- Bearing CT

Category: Midfoot/Forefoot; Other Introduction/Purpose: The etiology of hallux rigidus (HR) is not well understood and its association with first-ray hypermobility, hallux valgus and metatarsus primus elevatus (MPE) has not been clearly proven. Recent studies have supported MPE in HR by measuring on weightbearing radiographs (WBR), but there are limitations of WBR due to variation in X-ray projection and superimposed metatarsals. WBCT represent a reliable tool for radiographic analysis of the first ray and can be important for the study pathologies such as HR, which involve several anatomical points to be evaluated for a correct clinical- radiographic diagnosis Our objective was to evaluate radiographic parameters associated with Hallux Rigidus via WBR and WBCT for convergent validity and to evaluate the use of the classification system used in conventional radiography with WBCT. Methods: This is a single-center, retrospective study from prospectively collected data. 20 symptomatic hallux rigidus patient with weightbearing radiograph and WBCT were enrolled from October 2014 to December 2020. Measured parameters included hallux valgus angle (HVA), intermetatarsal angle (IMA), 1st TMT joint version, First and second metatarsal lengths, 2nd cuneiform- 2nd metatarsal angle, Talus-1st Metatarsal angle, First and second metatarsal declination angles, and MPE. MPE was measured as the direct distance between 1st and 2nd metatarsals (modified Horton index). All patients were graded according to the radiographic criteria of Coughlin and Shurnas classification on radiographs and WBCT, separately. Paired T-test was performed to compare radiographic measurements with WBCT. Results: Mean age was 55.9. HVA (15.73° in X-ray vs 14.04° in WBCT), AP first TMT version (16.25° vs 16.47°), 2nd cuneiform- 2nd metatarsal angle (24.54° vs 26.60°), Talus-1st Metatarsal Angle (-7.67° vs -7.89°) were not different between radiograph and WBCT. MPE was measured higher in WBCT by 0.86 mm compared to radiograph. First metatarsal declination angle was lower in WBCT by 2.9° indicating increased MPE. When graded with radiographic findings, 5 (25%) patients were grade 1, 5 (25%) patients were grade 2 and 10 (50%) grade 3, when graded with WBCT, 1 (5%) patient had grade 1, 3 (15%) patients were grade 2 and 16 (80%) grade 3. When graded radiologically, subchondral cyst in proximal phalanx and metatarsal head were better delineated resulting in higher radiographic grade with WBCT. Dorsal subluxation/translation of first metatarsal at first TMT joint was observed 3 (15%) in radiograph and 9 (45%) in WBCT. Conclusion: Hallux Valgus Angle, AP first TMT version, 2nd cuneiform-2nd metatarsal angle, Talus-1st Metatarsal Angel demonstrated consistent measurements in radiograph and WBCT. MPE was measured higher in WBCT when measured with direct distance (0.86 mm) between the first and second metatarsals using modified Horton index and first metatarsal declination angle (2.9°). When graded with WBCT, the subchondral cyst in the proximal phalanx and metatarsal head were better delineated leading to higher grade in WBCT which infer WBCT grading system for HR can aid in early detection of advanced HR with high radiographic grades and potentially guide treatment accordingly.

Reliability of Weight-Bearing Ultrasonography for Diagnosis of Lisfranc Joint Injuries: A Cadaveric Study

Category: Trauma Introduction/Purpose: Ultrasonography is increasingly used to evaluate the stability of various joint in the field of foot and ankle. This study aims to assess and compare the Lisfranc joint stability under stimulated weight bearing condition among progressive stages of Lisfranc ligamentous complex injuries. All the measurements were assessed using ultrasonography, fluoroscopy, and direct open measurement. We hypothesize that there is a correlation between ultrasonographic and fluoroscopic measurements, or between ultrasonographic and direct open measurements when performing stress evaluation of the Lisfranc instability. Methods: Twelve fresh below-knee amputated cadaveric specimens underwent ultrasound, fluoroscopic, and direct gross evaluation of the Lisfranc stability under simulated weight bearing condition. The assessment was first performed with all Lisfranc ligamentous complex intact and thereafter with sequential transection of the dorsal Lisfranc ligament, interosseous Lisfranc ligament, and plantar Lisfranc ligament. The simulated weight bearing condition was performed with 600N of force. The distances evaluated during the experimental set up were C1-M1, C2-M2, C1-M2, C1-C2 and M1-M2. All measurements were recorded in millimeter (mm). The ultrasound machine (GE, LOGIQ E-9 ultrasound machine, Chicago, Illinois, USA) was used to assess the Lisfranc stability by measuring the distances between the hyperechoic bone contours or the pre-defined landmark of the metatarsal and cuneiform bones. Correlations between 1) Ultrasound and fluoroscopic measurements, 2) Ultrasound and direct open measurements, and 3) Fluoroscopic and direct open measurements were evaluated using Pearson correlations coefficient. Results: Strong positive correlations between ultrasonographic and direct open measurements were found when assessed for C1-M1, C1-M2, C1-C2, M1-M2 (Pearson's correlation ranged from 0.73-0.97, p-values <0.001). Strong positive correlations between ultrasonographic and fluoroscopic measurements were found when assessed for C1-M1 from dorsal, medial, and plantar aspect (Pearson's correlation ranged from 0.75-0.90, p-values <0.001). Strong positive correlations between fluoroscopic and direct open measurements were found when assessed for C1-M1, C1-M2, C2-M2, M1-M2 (Pearson's correlation ranged from 0.77-0.93, p-values <0.001). Inter-rater and intra-rater reliability for the ultrasonographic measurements between the MSK radiologist (TK) and the foot and ankle surgeon (JS) were substantial (ICC ranged from 0.81-0.98). Conclusion: Ultrasonography is a reliable and reproducible tool for diagnosing Lisfranc ligamentous complex injuries. Both ultrasonographic and fluoroscopic measurements appear to strongly correlate with values measured by direct open measurement. Based on these data, ultrasonography is likely to become a valuable point of care diagnostic tool due to its ability to readily and dynamically evaluate suspected Lisfranc ligamentous complex injuries, without radiation exposure.

Functional and Radiologic Outcomes Following Fifth Metatarsal Fracture Non-Operative Treatment: A Retrospective Chart Review with Application of the RUST Score From 2019-2021

Category: Midfoot/Forefoot; Sports; Trauma Introduction/Purpose: Fifth metatarsal fractures are a common injury of the foot, however, there remains a lack of consensus regarding the management of Zone I and II fifth metatarsal fractures. The evidence shows varied outcomes between operative management and non-operative interventions. Additionally, there is limited discussion on radiographic outcomes following these fractures, with no established scoring system to assess radiographic healing. The radiographic union scale in tibial (RUST) fractures is an assessment tool designed to standardize radiographic assessment and outcome measures based on cortical bridging. The aim of this study is to assess the functional and radiologic outcomes for patients with base of fifth metatarsal fractures (Zone I-III) utilizing the RUST score as a method for standardized assessment of radiographic healing. Methods: We performed a secondary retrospective chart review of patients with base of fifth metatarsal fractures treated by six orthopedic surgeons at University of Colorado Orthopaedics from 2018-2021. We collected information on treatment modality and the functional, radiographic, and patient reported outcomes. Patients were included who attended minimum two visits and had x-ray available. The x-rays were read by a fellowship trained foot and ankle surgeon, and were assessed based on presence of displacement, resorption, and overall healing. The RUST scoring system was applied when fracture appeared healed and assessed on the four cortices (anterior, posterior, medial, and lateral) of the 5th metatarsal bone by assigning a score from 1 to 3 based on appearance. The scores were combined for a minimum of 4 (not healed) and a maximum of 12 (completely healed). Differences between outcomes were evaluated using an unpaired t-test and figures are reported with standard error. Results: Out of 196 total patients, 109 were excluded due to shaft fracture or insufficient follow-up, leaving 87 non-operative patients with base of fifth metatarsal fractures available for analysis. Radiographically, the average time to resorption was 37 days and average time to healing was 98 days, which was significantly longer than when patients began weight bearing at 44 days (p<0.001), but not significantly different than return to normal shoe wearing at 75 days (p=0.077). While 96% of patients at visit 4 were weight bearing and wearing normal shoes, only 73% had radiographic healing. The average RUST score at visit 2 was 10.14 (n=21) improving to 10.5 (n=12) by visit 4. To note, only 30% of patients presented for all four visits and the average final follow- up was 106 days after injury. Conclusion: Patients treated non-operatively for base of fifth metatarsal fractures have significantly shorter timelines for functional healing compared to evidence of radiographic healing. Overall RUST score at visit 4 supports those patients did not reach full cortical healing as the average score was 10.5 out of 12 possible points. Most patients have signs of resorption on x-ray by their second visit, but many do not continue follow up for complete evidence of healing. This highlights the importance of functional healing in treatment decisions for Zone I and II fractures and overall good prognosis regardless of complete healing radiographically.

Extensive Lesser Toes Plantar Plate Tears Reconstruction

Category: Lesser Toes Introduction/Purpose: The plantar plate is a fibrocartilaginous structure that plays a fundamental role in the sagittal stability of the metatarsophalangeal joint (MTPJ). Traumatic and degenerative lesions affecting the plantar plate have the potential to cause instability, swelling, pain and deformity. Extensive plantar plate tears (grade IV) still challenge surgeons as primary repair is impossible, demanding a reconstructive procedure which, unfortunately, can be associated with high morbidity such as stiffness, persistence of discomfort, vascular compromise to the digit and amputation. The purpose of this work is to describe a new technique that uses a synthetic tape and one absorbable screw to achieve the MTPJ stabilization in plantar plate grade IV tears. We believe that this procedure can achieve better results than other techniques described in the literature. Methods: Two bone tunnels are made at the base of the proximal phalanx. Both medial and lateral tunnels are directed in a light oblique fashion from a distal-dorsal entry point to a proximal, justarticular plantar exit. Two new oblique dorsal-plantar bone tunnels - medial and lateral - are made at the distal metaphyseal metatarsal area. A #2 FiberTape is passed through the bone tunnels guided by a Nitinol wire, creating a mesh for the plantar stabilization of the MTPJ. Then both Fiber Tapes limbs are driven, with the help of a nitinol loop, through the plantar orifices of corresponding sides of the metatarsal bone tunnels, exiting in its dorsal aspect. One of the limbs of the tape is passed from dorsal to plantar trough the other metatarsal orifice. Both limbs are tensioned, and the toe should be kept at neutral sagittal position (flexion-extension). Fixation is made with a Biotenodesis screw. Results: Only a few patients were submitted to this technique. At one year follow up, none of them presented with complaints or complications. Conclusion: The surgical technique described in this article can change the way physicians treat plantar complex plantar plate tears when there is no viable biologic tissue to repair. A lesser complication rate it's also expected. Nonetheless comparative, and biomechanical studies are still needed to confirm our hypothesis.

The Use of Cheilectomy with Hemispheric Reamers in Combination with Autologous Matrix-Induced Chondrogenesis in Treatment of Patients with Hallux Rigidus

Category: Midfoot/Forefoot Introduction/Purpose: Hallux rigidus (HR) is a common disease that occurs, according to the literature, in 2-10% of the population. However, currently there is no single approach to the choice of a surgical method for the treatment of this disease. It is known that the most common method at early stages of HR is cheilectomy, and the first metatarsophalangeal (1st MTP) joint arthrodesis at late stages. On the other hand, autologous matrix-induced chondrogenesis (AMIC) is known to be successfully applied in the presence of the osteochondral defects in the ankle, knee and hip joints. In this regard, we proposed to use cheilectomy in combination with this technique in treatment of patients with HR. Methods: Cheilectomy with AMIC was performed in 35 patients with HR. The operation technique included removing of the osteophytes from the metatarsal bone head and the proximal phalanx basement, clearing of the cartilage defect, microfracturing and covering the metatarsal bone head by the collagen memebrane, then - suturing the memebrane to the periosteum by absorbable thread. 16 patients underwent cheilectomy using hemispheric reamers. The results of surgical treatment were assessed using visual analog scale (VAS) of pain, AOFAS scale and range of motion (ROM) in 1st MTP joint. Also foot X-ray and MRI before and 3, 6, 12 months after the surgery were used. Results: In patients who underwent cheilectomy without reamers (1st group), the median ROM before the surgery was 20o, VAS of pain - 72.5, AOFAS - 49. As for the patients who underwent cheilectomy with reamers (2nd group), the median ROM was also 20o, VAS of pain - 70, AOFAS - 52.In the 1st group, after a year of observation, the median VAS of pain decreased to 10, ROM increased to 72.5o and AOFAS - to 82.5.In the 2nd group, after 12 months the median VAS of pain decreased to 7.5, ROM increased to 77o, AOFAS - to 85.On the radiographs 12 months after the surgery, there was some narrowing of the joint space compared to the first day after the operation. However, the ROM in the 1st MTP joint, on the contrary, increased. Conclusion: The results showed that cheilectomy in combination with AMIC allows to relieve pain and significantly improve the quality of life of patients with HR; the results in patients who underwent cheilectomy using hemispheric reamers were better, therefore, in most cases we recommend to use these reamers. Also, this technique, unlike isolated cheilectomy or arthrodesis, can be used at any stage of HR.

Operative treatment of splint bone fractures in horses

In this study; it is aimed to present the operative treatment and results, which are indicated for the continue of their racing life in splint bone fractures which are frequently occurred in race horses. The 2nd and 4th metacarpal (Mc-II and Mc-IV) and metatarsal bones (Mt-II and Mt-IV) of the horse are accessory structures that support the carpus and tarsus. Fractures of these bones in horses are called “splint bone fractures”. Splint bone fractures are relatively common in horses and usually seen in forelimbs. Fractures of the proximal part are rarer and represent 2.7-5% of all splint bone fractures, but challenging to manage. In the present study, 5 cases of splint bone fractures in different horses were evaluated. The distribution of the fractures were Mc-II in three, Mc-IV and Mt-IV in one each. Localization of the fractures were distal 1/3 in 4 and diaphyseal in 1 horse. For the management of these fractures, surgical removal of the fractured fragments were performed under general anaesthesia. Functional limb usage was achieved following the 30th day postoperatively in all cases.

Outcomes of V-cut Osteotomy on the First Metatarsal Head Combined with Fixation in Mortise-shaped Bone Groove-Plasty and Akin Osteotomy on the First Toe for Hallux Valgus Correction.

Hallux valgus (HV) is a common foot deformity, and recurrence is one of the most serious complications after HV correction. As a result, the surgical technique with a lowerrecurrence rate is a dream. The purpose of the article should be to observe the correction effect of hallux valgus using a novel "V-cut" osteotomy on the first metatarsal head combined with fixation in mortise-shaped bone groove-plasty technique. Twenty-three consecutive patients (40 feet) with HV were included from March 2019 to May 2020, who were all treated using single screw fixation with V-cut osteotomy on the first metatarsal head combined with mortise-shaped metatarsal bone groove-plasty and Akin osteotomy on the first toe for hallux valgus correction. With a mean follow-up time of 21.7 months, the visual analogue scale (VAS) score and American Orthopedic Foot and Ankle Society (AOFAS) forefoot score and the changes of the hallux valgus angle (HVA), intermetatarsal angle (IMA) and distal metatarsal articular angle (DMAA) were evaluated during the clinical follow-up. The paired t test was used for analytical statistics. The VAS score improved from 6.78 ± 1.74 to 1.87 ± 1.45 and the AOFAS score improved from 53.9 ± 12.3 preoperatively to 94.7 ± 6.8 in the latest follow-up postoperatively (P < 0.01). Besides, the HVA improved from 30.0 ± 6.1° to 5.7 ± 2.8° (P < 0.01); the IMA changed from 13.1 ± 2.8° into 3.3 ± 1.6° (P < 0.01); and the DMAA ameliorated from 27.0 ± 8.4° to 5.9 ± 3.5° (P < 0.01). Only five toes had slight numbness and stiffness in early postoperative period, and these symptoms disappeared completely at 6 months after the surgery. Only one foot was corrected to excess. One screw stern protruding beneath the skin happened, which needed secondary screw removal under local anesthesia. Single screw fixation with V-cut osteotomy on the first metatarsal head combined with fixation in mortise-shaped metatarsal bone groove-plasty and Akin osteotomy on the first toe is an effective way with low recurrence rate for HV correction.

علاج الابهام الأروح عند البالغين: دراسة مقارنة بين نتائج خزع عظم المشط الأول بطريقة الاسفين المغلق والخزع بطريقة سكارف

Objective: The aim of this study is to evaluate the results of surgical treatments of hallux valgus by a scarf or closing wedge osteotomy of the first metatarsal. In addition to, detection complications resulting from the surgery. Patients and Methods: Descriptive comparative study was conducted for the period of one year (June2020 – June2021) at Tishreen University Hospital in Lattakia- Syria. The study included two groups of patients that were compared: group1 consisted of 19 patients (57.6%) who underwent closing wedge osteotomy, whereas group 2 consisted of 14 patients (42.4%) who underwent scarf procedure. Results: The mean hallux valgus angle (HVA) decreased from (31.43 º ±3.1) preoperatively to (9.15 º ±0.1) at postoperative in closing wedge group (group. 1), and from (29.45 º ±2.7) preoperatively to (10.10 º ±3.7) at postoperative in scarf group (group. 2), p:0.0001. The Foot and Ankle Disability Index (FADI) score increased significantly in the two groups during follow- up periods. Complications developed in the two groups, more frequently in the scarf group which included: wound healing after 8 weeks (35.7% vs 22.2%), operation site infection (21.4) % vs (11.1%), sudeck's disease (14.3% vs 5.6%), impaired wound healing (14.3% vs 5.6%) and recurrence of hallux valgus (7.1% vs 5.6%), without any case of the non- healing wound in the two groups. Satisfaction of the patients was complete in 84.8%, moderate in 9.1%, and 6.1% of the patients were unsatisfied. Conclusion: The current study demonstrated favorable results in correction deformity with two techniques, with fewer complications in closing wedge compared with the scarf method.

Ancient DNA confirmation of lepromatous leprosy in a skeleton with concurrent osteosarcoma, excavated from the leprosarium of St. Mary Magdalen in Winchester, Hants., UK

To establish a biological profile and disease aetiologies for one of four burials recovered during a Time Team dig at the St. Mary Magdalen leprosarium, Winchester, UK in AD 2000. Osteological techniques were applied to estimate age at death, biological sex, stature and pathology. Visual assessment of the material was supplemented by radiographic examination. Evidence for leprosy DNA was sought using ancient DNA (aDNA) analysis. The remains are those of a male individual excavated from a west-east aligned grave. The skeleton shows signs of two pathologies. Remodelling of the rhino-maxillary area and degenerative changes to small bones of the feet and reactive bone on the distal lower limbs suggest a multibacillary form of leprosy, whereas the right tibia and fibula show the presence of a primary neoplasm identified as an osteosarcoma. The aDNA study confirmed presence of Mycobacterium leprae in several skeletal elements, and the strain was genotyped to the 3I lineage, one of two main SNP types present in mediaeval Britain and ancestral to extant strains in America. This is a rare documentation of leprosy in association with a primary neoplasm.

Cattle stock (Bos taurus) in Yeniseysk (Krasnoyarsk Krai) in the 18th–19th centuries

As a result of the large-scale rescue excavations on the territory of the town of Yeniseysk (58°27'N, 92°10'E) in Eastern Siberia, a large osteological collection has been assembled. In this study, cattle bone remains from the excavations on the territory of the architectural complex ‘Balandin mansion’ have been analysed. The deposits of the mansion span both the initial period of settlement in Yeniseysk, almost from the moment of its foundation, as well as the late period — the end of the 19th century. The focus of the livestock production in the 17th–19th cen-turies in Yeniseysk was cattle breeding. The sex and age structure of the herd and size of the body of the animals have been reconstructed using special techniques from the parameters of the lower jaws and size of the metatar-sal, metacarpal, and talus bones, as well as the first phalanges. On this basis, the breed characteristics and cases of economic use of the cattle have been described. The presence of a large percentage of newborn ani-mals indicates that the cattle were kept within the town territory. Some amount of beef was imported to Yeniseysk as a result of the trade with indigenous cattle farmers. The reconstructed age and sex structure, where about 50 % of animals are cows older than 4 years, while the proportion of young animals among the slaughtered stock does not exceed 40 %, indicates the meat-and-dairy use of the cattle. The livestock was predominantly horned, and the polledness was not pronounced. Yeniseysk livestock had an average body size. The cattle in Yeniseysk were bigger than those of the Russian population in the forest belt of the European part of Russia. The sizes of cattle from other Russian cities in Siberia are identical to the Yenisei cattle. With a high degree of probability, the de-scribed breed can be attributed to the Siberian cattle, which were widespread on the territory of Siberia, the Urals, and the Far East.

Screw fixation in the treatment of displaced intra-articular calcaneus fractures: a systematic review protocol

BackgroundThe Calcaneus is the largest bone of the foot and the most frequent tarsal bone to be fractured. Overall, it causes round about 10 cases per 100,000 residents per year mainly in men. Especially displaced intra-articular calcaneus fractures often have early and late complications and its associated disability. There are various strategies for the treatment of displaced intra-articular calcaneus fractures, but the gold standard is still subject of a long-standing controversy. Minimally invasive procedures became more common in an attempt to reduce the high rate of complications associated with open reduction and internal fixation. With the increase in minimally invasive techniques, screw fixation also gained in significance. The current literature does not sufficiently elucidate whether the screw fixation is superior to other treatment options especially in relation to adverse events, health-related quality of life and postoperative pain. This study aims to investigate benefits and harms of treating displaced intra-articular calcaneus fractures (types II, III and IV according to Sanders) with screw fixation in adults.MethodsA systematic review will be conducted based on the principles described in the Cochrane Handbook. We will include adults with displaced intra-articular calcaneus fractures of Sanders type II, III and IV. The surgical method of screw fixation shall be compared to other surgical interventions to stabilise calcaneus fractures. Primary outcomes are serious adverse events, health-related quality of life and postoperative pain level. MEDLINE, CENTRAL, CINAHL, Web of Science and bibnet.org, ClinicalTrial.gov and the World Health Organization International Clinical Trials Registry Platform (ICTR) will be searched. Screening and data extraction will be performed by two authors independently. A third author will arbitrate disputes. Risk of Bias will be assessed with the Cochrane tool. Meta-analysis will be performed if participants, interventions, comparisons and outcomes are sufficiently similar to ensure a result that is clinically meaningful.DiscussionDue to the increasing use of minimally invasive techniques and the increasing use of screw fixation instead of open reduction and plate fixation, it is important to analyse the benefits and harms of screw fixation for calcaneus fractures. Screw fixation could, in the future, help to operate in a less invasive and tissue preserving manner while still achieving an adequate functional result for the patientSystematic review registrationCRD42021244695

The Tendon of the Anatomical Snuffbox Exists in Numerous Configurations

Introduction: The muscles connected to the anatomical snuff box are crucial for stabilising the wrist. De Quervian's Syndrome and tendinitis are conditions caused by morphological abnormalities in these muscles, which are often developing in nature. There is limited information available about the tendon types in the Nepalese population, despite studies showing distinct tendon-splitting patterns of the abductor pollicis longus (APL), extensor pollicis longus (EPL), and extensor pollicis brevis (EPB).&#x0D; Methods: A routine dissection of 30 upper limbs from 15 cadavers was carried out according to Cunningham’s Manual of Practical Anatomy, Volume 1. Age estimation was not done, but all the cadavers in the department that had entire upper limbs were examined. The forearm's flexor and extensor compartments were dissected. It was done to trace the muscle’s tendons up to their insertion. The investigation eliminated any upper limbs with fractures or wrist or forearm deformities.&#x0D; Results: Seven upper limbs, out of 30, only possessed one tendon. All the upper limbs have a trapezium and the base of the first metatarsal bone where the APL was inserted. It was noted that neither EPB nor EPL had changed. APL and EPL did not split within a single osseo-fibrous tunnel in any specimen.&#x0D; Conclusions: Anatomical information on the muscles' fibres and their insertion at anatomical snuff boxes is provided in this study. When considering alterations at the wrist joint under pathological situations, these statistics could be considered.

Support vector machines are superior to principal components analysis for selecting the optimal bones’ CT attenuations for opportunistic screening for osteoporosis using CT scans of the foot or ankle

ObjectivesTo use the computed tomography (CT) attenuation of the foot and ankle bones for opportunistic screening for osteoporosis. MethodsRetrospective study of 163 consecutive patients from a tertiary care academic center who underwent CT scans of the foot or ankle and dual-energy X-ray absorptiometry (DXA) within 1 year of each other. Volumetric segmentation of each bone of the foot and ankle was done in 3D Slicer to obtain the mean CT attenuation. Pearson's correlations were used to correlate the CT attenuations with each other and with DXA measurements. Support vector machines (SVM) with various kernels and principal components analysis (PCA) were used to predict osteoporosis and osteopenia/osteoporosis in training/validation and test datasets. ResultsCT attenuation measurements at the talus, calcaneus, navicular, cuboid, and cuneiforms were correlated with each other and positively correlated with BMD T-scores at the L1-4 lumbar spine, hip, and femoral neck; however, there was no significant correlation with the L1-4 trabecular bone scores. A CT attenuation threshold of 143.2 Hounsfield units (HU) of the calcaneus was best for detection of osteoporosis in the training/validation dataset. SVMs with radial basis function (RBF) kernels were significantly better than the PCA model and the calcaneus for predicting osteoporosis in the test dataset. ConclusionsOpportunistic screening for osteoporosis is possible using the CT attenuation of the foot and ankle bones. SVMs with RBF using all bones is more accurate than the CT attenuation of the calcaneus.

Reconstruction of large midfoot bone loss using titanium spinal mesh cage with bone graft: A case report

High energy trauma injuries in the lower extremity represent unique challenges to surgeons and often involve complex, limb threatening wounds with extensive soft tissue and bone loss. In this case report, we present a case of a 20 year old male who was presented to us with a history of 8 months old high impetus road traffic trauma which resulted in multiple open fracture of the midfoot with ipsilateral closed tibial - fibular shaft and medial malleolar fracture. Open midfoot injury with severe bone loss included complete loss of navicular, all three cuneiforms, base of 1st and 2nd metatarsals. For reconstructing this severe midfoot defect, we have utilized a titanium mesh cage which is routinely used in spinal surgeries. This innovative technique and orthoplastic approach has given the patient a stable plantigrade foot with a near normal midfoot biomechanics and ultimately, restoration of this patient's quality of life.

Reconstruction of extensive bone loss of the first metatarsal with osteodistraction and homologous graft in an immature skeleton: case report

Reconstruction of extensive bone loss in the foot requires a set of strategies involving various surgical techniques and orthopedic devices. Semicircular Ilizarov external fixator combined with a structural homologous bone graft may be advantageous in pediatric patients. This case report describes the technique of reconstructing an extensive bone loss of the first metatarsal with osteodistraction and homologous graft in an immature skeleton. The combination of the external fixator and the homologous graft provided sufficient bone volume without recurrent infection, minimal complications, substantial length gain of the metatarsal bone, and improved soft tissue conditions. It is a viable treatment option for severe foot injuries in immature skeletons. Level of Evidence V, Therapeutic Studies, Expert Opinion.

Occurrence and associated risk factors of long bone fractures in food and pet animals in Mymensingh district of Bangladesh: A retrospective study

The aim of this study was to determine the prevalence of fracture and the risk variables connected to its occurrence in calves and cats at Veterinary Teaching Hospital, Bangladesh Agricultural University, Mymensingh. A total of 96 (calves) and 17 (cats) retrospective datasets were compiled between January 2015 and December 2019. Age, sex, breed, season, involvement of the bone, and type of fracture were considered to characterize fractures. To examine the data, simple descriptive statistics were used. At around 6 months, there were the highest rates of long bone fractures in both calves and cats (77%, n = 74; and 65%, n = 11). According to sex variation, fracture was more common in male calves (61%, n = 59) and female cats (76%, n = 13). Calves and cats from native breeds had the highest fracture rates (52%, n = 50) and (100%, n = 17), respectively. The summer season saw the highest rates of long bone fractures in both calves (41%, n = 39) and cats (53%, n = 9). The majority of the fractures in calves (42%, n = 41) were found to be in the metatarsal bone during pre-operative clinical assessment. In cats, this primarily affected the femur (41%, n = 7). Cats (59%, n = 10) and calves (55%, n = 53) had the highest rate of transverse long bone fractures. This study will help to establish the frequency of fractures, which is very important clinically in the examination and diagnosis of fractures in calves and cats.