Metatarsal Research Articles

Pediatric Osteoarticular Tuberculosis as a Diagnostic Dilemma and a Review of Literature.

IntroductionDespite tuberculosis being rampant in the Indian subcontinent, most cases of osteoarticular (OA) tuberculosis (TB) are missed until significant bony destruction has occurred. Initial presentation of extra-pulmonary TB mimics many other disease entities while many diseases mimic TB. This may lead to an incorrect diagnosis and sometimes creates a dilemma in reaching the correct diagnosis. The aim of this study was to evaluate a series of pediatric cases of osteoarticular TB, which posed a diagnostic challenge to us.Material and methodsRetrospective analysis of case records of pediatric OA-TB patients who had presented to two tertiary level centers of urban India between February 2016 and December 2020 was done. There were a total of 69 patients. ObservationsThere were 37 males and 32 females. The age range was from two to 17 years. Forty-four patients showed evidence of disease within the spine (dorsal region followed by lumbar, followed by the cervical spine), 16 showed disease of the extremities, six had disease of the girdle bones, and three showed disease of the short bones of hands or foot. In our series, patients presented to us between 15 days to six months from the onset of symptoms. From our series, six cases with atypical clinical pictures have been selected for presentation purposes. In all six cases, the initial presentation was not that of OA-TB. However, with a high degree of suspicion, differential diagnosis of TB was kept in mind, and the diagnosis was confirmed microbiologically.ConclusionA high degree of suspicion is required to avoid missing the diagnosis of osteoarticular TB. Non-invasive advanced radiological investigations such as MRI and microbiological analysis of biopsy specimens aid in arriving at the correct diagnosis.

Intraoperative checking of the first ray rotation and sesamoid position through sonographic assistance

IntroductionHallux valgus (HV) deformity affects the orientation of the metatarsophalangeal (MTP) joint in three planes. Displacement in the coronal plane results in axial rotation of the first metatarsal, with progressive subluxation of the first MTP joint. Multiple techniques have been described to correct the malrotation itself. However, none of them have checked intraoperatively the final position of the first metatarsal head and sesamoids previous to the fixation of the Lapidus procedure or first metatarsal bone osteotomies. The aim of this article is to describe a novel technique to check the first ray rotation and sesamoids position through sonographic assistance.Materials and methodsBefore fixation of the Lapidus procedure, with the ankle in maximal dorsiflexion, the surgeon takes the linear ultrasound probe and places it on the sole to visualize the sesamoids, which should be viewed at the same level, with the flexor hallucis longus (FHL) centered between both. Once the ideal position of the head of the first ray has been achieved, temporary fixation with K-wires is performed over the first TMT joint and M1–M2 joint for further sonographic verification of the sesamoids beneath the first metatarsal head. The height of the sesamoids relative to the second metatarsal head should be checked by sonographic control too.ResultsFour patients were included. Three females and one male. Their mean age was 76.4 years (R 61–72). Their mean BMI was 29 (R 27.5–32.24). The mean IMA (intermetatarsal angle) was 18.2 (R 17.2–19) degrees and the mean MPA (metatarsophalangeal angle) was 50 (R 36–63) degrees.ConclusionsSonographic assistance, is a widely available, inexpensive, and comparative imaging technique that can guide the first ray rotation and sesamoids position in HV surgery, theoretically improving radiological outcomes.

Individualized herbal prescriptions for delayed union: A case series

Background Bone fractures are important clinical events for both patients and professionals. Active treatment options are limited for delayed unions and for nonunions; surgery is common but not entirely risk-free. This report describes three cases of delayed union successfully treated with herbal decoction.Participants Three patients had trapezoid and 3rd metacarpal bone fractures, 2nd, and 5th metatarsal bone fractures, respectively. All three patients were diagnosed with delayed union by an independent orthopedic surgeon based on computed tomography (CT) scan/radiographic imaging and fracture duration without a healing process. Patients took herbal decoction, Jeopgol-tang, with individually added herbs based on symptom manifestations, twice daily for 56, 85 and 91 days with no additional interventions except for a splint that they had been wearing since fracture diagnosis.Outcomes Improvement of delayed union was evaluated using radiographic imaging or CT during treatment with Jeopgol-tang.Results After taking herbal medicine, callus and bony bridging were confirmed on follow-up imagings and the patients described their experience with pain reduction at an interview after recovery.Conclusions This case series suggests that the herbal decoction Jeopgol-tang warrants further investigation to establish its role as a complementary and integrative medicine treatment option for delayed unions.

Osteotomy "scarf" in the treatment of patients with valgus deformity of the first toe

The use of scarf osteotomy in 9 patients (14 feet) with valgus deformity of great toe was analysed. That technique was showed to provide stable correction of varus deviation of the first metatarsal bone and valgus deformity of the great toe as well as correction of the length of the first metatarsal bone and elimination of its pronator rotation without development of avascular necrosis of the head in postoperative period. Rigid fixation of bone fragments provides the possibility of early activization and rehabilitation of patients.

Age and Female Sex Are Important Risk Factors for Stress Fractures: A Nationwide Database Analysis.

Stress fractures are caused by micro-trauma due to repetitive stress on bone, common in active individuals and athletes. Previous studies demonstrate that the weightbearing bones of the lower extremities incur stress fractures most often, especially in women and older adults. Prior literature does not quantify the difference in frequency of stress fractures among different genders, age groups, or body mass indices (BMIs). We hypothesized that older female patients would have higher rates of lower extremity stress fractures than male patients. Epidemiological research. Level 3. Records of female and male patients with lower extremity stress fractures from 2010 to 2018 were identified from the PearlDiver administrative claims database using the International Classification of Diseases (ICD)-9/ICD-10 codes. Stress fractures were classified by ICD-10 diagnosis codes to the tibial bone, proximal femur, phalanges, and other foot bones. Comorbidities were incorporated into a regression analysis. Of 41,257 stress fractures identified, 30,555 (70.1%) were in women and 10,702 (25.9%) were in men. Our sample was older (>60 years old) (37.3%) and not obese (BMI <30 kg/m2, 37.1%). A greater proportion of female patients with stress fracture were older (P < 0.001) and had foot stress fractures (P < 0.001), while a greater proportion of male patients with stress fracture were younger than 19 years (P < 0.001) and had metatarsal (P < 0.001), hip (P = 0.002), and tibia stress fractures (P < 0.001). Stress fractures commonly occur in women and older adults with low BMIs. Metatarsal and tibia stress fractures were the most common, and a greater proportion of women had foot stress fractures. Our study examined the large-scale prevalence of different lower extremity stress fractures among a wide patient population sample of varying ages and BMIs. These findings can help clinicians identify active populations at greater risk for stress fracture injuries.

Predictive factors for the bone union disorder of intramedullary screw fixation in proximal fifth metatarsal bone fractures.

Although intramedullary screw fixation likely leads to successful union of Jones fractures compared to that of nonoperative treatments, bony union disorder after surgical treatment remains to be elucidated. Intramedullary screw fixation was performed for the surgical treatment of proximal fifth metatarsal stress fractures in this series. Between January 2008 and December 2019, the feet of 222 patients were investigated regarding the effective factors for postoperative bony union between the normal union group and the bony union disorder group according to the patients' physical status, radiological assessment, and screw size. The mean postoperative follow-up period was 11.1months. Bone union disorder was defined as delayed union, nonunion, or a re-fracture recognized through a radiographic image. The prevalence rate of union disorders occurred in 14% (31/222) of the patients. The risk of bone union disorder significantly increased when using a small-diameter screw (odds ratio 4.81, 95% confidence interval [CI] 1.62-14.2, p = 0.004) and non-bone graft procedures (odds ratio 3.13, 95% CI 1.22-8.02, p = 0.02). Screw length, preoperative Torg's classification, or patients' physical status did not affect postoperative bony union. Approximately 14.0% of the patients in our study had postoperative bone union disorder. Small-diameter screws and non-bone graft procedures increased the risk of bone union disorder in the intramedullary screw fixation technique of fifth metatarsal bone stress fractures. Level 4, case series.

Acute, isolated fractures of the metatarsal bones: an epidemiologic study

IntroductionAlthough metatarsal fractures are common, the significance of previous epidemiologic studies is limited to specific fracture entities, subpopulations, or heterogeneous fracture aetiologies. The aim of the study was to assess the epidemiology of isolated metatarsal fractures in an adult population at a level-1 trauma centre.Materials and methodsRadiological and clinical databases were searched for a five-year period. Eligible were all patients with acute isolated metatarsal fractures over the age of 18 years with radiographs in two planes available. Stress fractures, injuries affecting Lisfranc joint stability, and concomitant injuries to other regions than the metatarsals were excluded. Data collection included general demographics, mechanism of injury, season of the trauma and fracture details.ResultsOut of 3259 patients, 642 patients met the inclusion criteria and were included for the analysis. The patients’ mean age was 44.5 ± 18.9 years, 50.6% were female. 83.3% suffered an isolated, 16.7% multiple metatarsal fractures. Single metatarsal fractures occurred predominantly at the fifth metatarsal bone (81.3%), their frequency decreased with increasing age, with a seasonal peak during the summer. Patients suffering multiple metatarsal fractures were significantly older (51.6 ± 21.2 vs. 43.0 ± 18.1 years; p < 0.001) and the injury resulted significantly more often from a high-energy trauma (6.7% vs. 23.4%; p < 0.001). Multiple metatarsal fractures occurred evenly throughout all metatarsals but revealed a focus on female population with no seasonal differences.ConclusionSingle metatarsal fractures predominantly occurred at the fifth metatarsal bone and showed a seasonal, gender and age dependency. Multiple metatarsal fractures were homogeneously distributed between the different metatarsals with distinct age-dependent gender differences.Level of evidenceLevel III.

Case report of unusual insertion of the fibularis brevis muscle

The fibularis brevis and fibularis longus muscles belong to the lateral compartment of the leg. The fibularis brevis is morphologically variable, especially in the number of tendons and place of insertion. Its type of insertion is correlated with the presence of a fibularis digiti quinti, which is also anatomically variable. We present a case study based on dissection of a seventy-three-year-old female cadaver with an unusual insertion of the fibularis brevis muscle. The tendon had three bands inserting into the fifth metatarsal bone. There was a coexisting fibularis digiti quinti, which was fused with the fibularis tertius muscle. Awareness of such anatomical variation could be useful during reconstructive surgery and planning rehabilitation protocols.

MATHEMATICAL MODELING OF THE STRESS-STRAIN RELATIONS OF THE FOOT ELEMENTS IN THE CONDITIONS OF LATERAL MALLEOLUS HYPOPLASIA

One of the most common complications of long-term talocrural joint (TCJ) injury is the development of chronic instability. Among the risk factors for its occurrence - congenital or acquired shortening (hypoplasia) of the lateral malleolus of varying degrees. Objective. Determine the effect of lateral malleolus hypoplasia on the distribution of stresses in the bone and ligament elements of the foot. Methods. Mathematical modeling of the distal end of thelower extremity was performed. There are two variants of the position of the heel bone — varus and valgus with an angle of deviation from the vertical axis in both cases 15°. A vertical distributed load of 700 N was applied to the tibial plateau. On the supporting surface of the feet model's were rigidly fixed. Measurements of mechanical stresses were performed at control points. According to the criteria for estimating the stress-strain relations (SSR), the Misesstress was used. Results. It was determined that lateral malleolus hypoplasia increases the values of stresses on the lateral side of the distal tibial bone from 6.3 MPa to 6.4 MPa, from the medial — on the heel bone from 5.8 MPa to 6.0 MPa, talus from 2.1 MPa to 2.3 MPa. SSR on TCJ are also varies. In the case of a neutral position of the heel bone, lateral malleolus hypoplasia causes a decrease in the values of the ligaments on the lateral side of the TCJ,which can be explained by their elongation and, consequently, the projection increase in length In the case of varus or valgus position of the heel bone under conditions of lateral ankle hypoplasia, it was found that the varus position of the heel bone overstrains the ligaments on the lateral side, valgus - from the medial. Conclusions. Decreased stress in the ligaments of the TCJ in cases of valgus or varus position of the heel bone is one of the factors reducing the functional stability of the joint and may be the cause of its chronic instability.

Treatment system for myoneurogenic foot deformities in adults

Surgical management for the myoneurogenetic foot deformities is suggested. It is based on the differenciated approach to the elimination of all components of the deformity as possibile. The treatment includes 4 complex operations: 1) surgical intervention on soft tussies in combination with osteotomy of the first metatarsal bone; 2) wedge resection and three-articular arthrodesis of foot joints; 3) wedge resection and four-articular arthrodesis of foot and ankle joints; 4) closed correction of the deformity using hinge-distraction device. Results of the treatment (126 patients, 155 feet) confirmed the efficacy of the suggested methods. In 87%) of cases long-term results were good, in 8.4%) satisfactory and in 4.5% of cases -unsatisfactory.

Treating Hallux Valgus Associated Metatarsus Adductus by Minimally Invasive Surgery: A Simple Solution for a Difficult Problem

This study aims to assess a novel minimally invasive surgical technique that addresses hallux valgus accompanied by metatarsus adductus.We retrospectively analysed the results of 20 patients (21 feet) that underwent a newly developed percutaneous osteotomy procedure of the lesser metatarsal bones in order to correct hallux valgus deformities accompanied by metatarsus adductus. We used x-ray studies in order to evaluate changes in the hallux valgus angle, the first intermetatarsal angle, and the metatarsal angle (using the modified Sgarlato method). We also compared the pre- and postoperative American Orthopaedic Foot and Ankle Society scores when available. The paired sample t test was used to compare variables.At a 1-y follow-up the mean hallux valgus angle, inter-metatarsal angle and the metatarsal angle have been reduced by 31.62 (-3 to 9), 3.86 (11-52) and 14.69 (4-36) respectively (p < .001 for all). The mean American Orthopaedic Foot and Ankle Society score (n = 15 feet available) has been improved by a mean of 44.53 (22-72, p < .001). In addition, the patient satisfaction rates were high. Patients suffered from mild to moderate midfoot pain during the first few weeks following surgery, which resolved when union occurred. No cases of lesser metatarsal nonunion have been documented.The presented minimally invasive method can be used effectively to correct hallux valgus that is associated with metatarsus adductus. Proximal minimally invasive metatarsal osteotomy can effectively correct hallux valgus accompanied by metatarsus adductus.

Design and manufacture of the Torque test setup for small and shapeless materials

In this study, the design and manufacture of torque test set up has been carried out for small and shapeless speciment. The torque sensor, which has maximum 10 Nm, is used in the test system design. The certain specification of Nema 34 step motor which use to apply torsional force to the specimens is 12 Nm, 24V and 4.2 ampere. The step motor is controlled by the HY- DIV268N-5A Step Motor Driver and the supply voltage of driver is 24 Volts. The information about the degree of the specimen rotation was taken from potantiometer. The information obtained from the sensor and potentiometer was transferred to the LabVIEW software to be representation graphically using the USB 6003 DAQ card. The first metatarsal bone modelled from computerized tomography (CT) images was produced by Ultimaker2 3D printer using polylactic acid (PLA) material. The printed bone model was tested through torsion test set up. At the same time, the 3D bone was prepared for finite element analysis. Boundary conditions were applied in the finite element analysis (FEA) model in accordance with the test setup. The produced bones using 3D printer were subjected to torsion test with the test setup. Also the modelled bone was tested in accordance with the torsion test setup by using finite element analysis. After that, the FEA and experimental test results were compared with each other. As a conclusion, the optimization of the torsional test setup was performed based on the FEA.

Outcome comparison of sural neurofasciocutaneous flap for reconstructing soft tissue defects in forefoot and around ankle.

To summarize our experience with the sural neurofasciocutaneous flap for reconstructing the soft tissue defects over the forefoot distal to the connecting line of midpoints in the metatarsal bones, and to compare the outcomes between the flap for resurfacing the defects distal and proximal to the connecting line. The clinical data of 425 sural neurofasciocutaneous flaps for repairing the soft tissue defects in the middle and lower leg, ankle, and foot between Apr. 2002 and Apr. 2020 were reviewed. Based on the connecting line of midpoints of the metatarsals, the sural neurofasciocutaneous flaps were divided into a forefoot group (flaps with furthest edges distal to the connecting line) and a peri-ankle group (flaps with the furthest edges proximal to the connecting line). The partial necrosis rate in the forefoot group (14.5%, 10/69) was significantly higher than that in the peri-ankle group (7.0%, 25/356), with significant difference (P<0.05). Using the flap alone or in combination with a simple salvage treatment, the ratio of successful coverages of the defects was 98.6% (68/69) in the forefoot group, and 97.8% (348/356) in the peri-ankle group, respectively, with no statistical difference (P>0.05). The sural neurofasciocutaneous flap is a better choice for covering the soft tissue defects over the forefoot distal to the connecting line of midpoints of the metatarsal bones. The survival reliability of the sural neurofasciocutaneous flap reconstructing the soft tissue defect proximal to the connecting line is superior to that of the flap reconstructing the defect distal to the connecting line.

Juxtacortical chondromyxoid fibroma in the small bones: two cases with unusual location and a literature review.

Chondromyxoid fibroma is a rare bone tumor of cartilaginous origin, representing less than 1% of all bone tumors. It preferentially arises in the eccentric location of the metaphysis of a long tubular bone. Juxtacortical locations are reported infrequently in the long bones and even more rarely in short tubular bones, with only three cases documented. Here we present two new cases of juxtacortical chondromyxoid fibroma in the small bones. One was an intracortical osteolytic lesion of the metatarsal bone of the foot with degenerative atypia that histologically should be differentiated from chondrosarcoma. The other was a phalangeal mass protruding into the interphalangeal joint of the hand, which had been labeled mistakenly as a soft tissue mass preoperatively. These cases illustrated that chondromyxoid fibromas have various the manifestations and should be included in the differential diagnosis of an osteolytic lesion or an exophytic mass in the small bones.

Moderate to Severe Hallux Valgus Deformities. Surgical treatment with SCARF Osteotomy Technique.

Introduction; Many procedures are described in the literature for the surgical management of hallux valgus. There are over 130 surgical procedures described. There is ever rising enthusiasm among orthopedic surgeons regarding diaphyseal osteotomy ever since Burutaran described the procedure in 1973. We report our experience of treating severe cases of Hallux Valgus deformity with a SCARF osteotomy at the last three years follow-up, at patients diagnosed and operated in the University Hospital of Trauma, from January 2015 - February 2018. The technique we are presenting, provides the correction of moderate to severe hallux valgus deformities.&#x0D; Material and Methods: Correction of hallux valgus deformities was achieved using a Z step osteotomy cut to realign the first metatarsal bone. A retrospective analysis was undertaken in 38 consecutive patients (54 feet). All results were analyzed by clinical examination, a questionnaire including the AOFAS forefoot score, modified, and plain roentgenograms.&#x0D; Results: Hallux valgus and intermetatarsal angle improved at mean 19.6° and 6.9°, respectively. Mean forefoot score improved from 50.1 to 91 points out of 100 possible points. Satisfactory healing time was expressed by an average return back to their attitude of 6-12 weeks, without including physiotherapy. Persistence or recurrence of hallux valgus was seen in 3 patients (8%). The complication rate was 5.4% including superficial wound infection, atrophy of the muscles, traumatic dislocation of the distal fragment.&#x0D; Conclusion: Scarf osteotomy is a powerful and versatile procedure to correct hallux valgus deformity, and provides a predictable and satisfying result. Scarfs are not considered as a single osteotomy but as a combination of several procedures and displacement in several planes are possible.

Features of the Extraction of the Anterior Tibial Vessels in the Formation of Vascularized Bone Grafts

Background. The currently existing techniques for dissection the anterior tibial vascular bundle in the proximal third of the lower leg do not provide sufficient length of the vascular pedicle to rotate the tibial bone graft to the level of the middle third of the thigh.&#x0D; The aim of the study to substantiate the possibility of pedicled transfer to the level of the thigh middle third of two blood-supplied bone autografts on a common permanent pedicle, including the anterior tibial vascular bundle.&#x0D; Material and Methods. The study was conducted on 62 lower limbs of non-fixed (native) corpses. We studied the topographic and anatomical relationship between the anterior tibial vascular bundle and the deep peroneal nerve at the level of the proximal third of the leg.&#x0D; Results. The distance between the tip of the greater trochanter of the femur and the distal edge of the anterior tibial bone graft using a combination of grafts at the same level in men was Me 176.7 [173.7; 193.9] mm, in women Me = 151.6 [146.9; 159.9] mm. An analysis of limb lengths ratios in men and women indicates standard level that can be achieved with graft rotation in each person.&#x0D; Conclusion. Dissection of the anterior tibial vascular bundle at the level of the proximal third of the lower leg allows rotation of the complex of the anterior tibial bone autograft and the autograft of the second metatarsal bone into the area of the middle third of the femur on a single vascular bundle. Prevention of injury to the deep peroneal nerve branches during dissection of the vascular pedicle requires the use of microsurgical techniques and preoperative preparation.

Effect of Displacement Degree of Distal Chevron Osteotomy on Metatarsal Stress: A Finite Element Method.

Simple SummaryIn this study, the finite element method was used to explore the effect of distal chevron osteotomy displacement on metatarsal stress. For the subjects used in this study, the metatarsal stress was minimized by moving 4 mm. For the displacement of chevron osteotomy, both postoperative stability and stress distribution of metatarsal should be considered. The most appropriate distance is suggested to be obtained by combining HVA, IMA, age, body weight, and metatarsal width. The finite element method can be used for preoperative estimation of chevron osteotomy and guide the operation.Background: The stress of foot bone can effectively evaluate the functional damage caused by foot deformity and the results of operation. In this study, the finite element method was used to investigate the degree of displacement of distal chevron osteotomy on metatarsal stress and metatarsophalangeal joint load; Methods: Four finite element models of displacement were established by using the CT images of a patient with moderate hallux valgus (hallux valgus angle and intermetatarsal angle were 26.74° and 14.09°, respectively), and the validity of the model was verified. Each finite element model consisted of bones and various cartilage structures, ligaments, and plantar fascia, as well as encapsulated soft tissue. Except for soft tissue, the material properties of other parts were isotropic linear elastic material, and the encapsulated soft tissue was set as nonlinear hyperelastic material. The mesh was tetrahedral mesh. Link elements were used in ligament and plantar fascia. A ground reaction force with a half-body weight was applied at the bottom of the floor to simulate the ground reaction when standing. The upper surfaces of the encapsulated soft tissue, distal tibia, and distal fibula were fixed. The stress distribution of metatarsals and the stress of cartilage of the first metatarsophalangeal joint were compared and analyzed; Results: Compared with the hallux valgus without osteotomy, the stress of the first metatarsals and second metatarsals of 2–4 mm decreased, and the stress of the interarticular cartilage of the first metatarsophalangeal joint with 4 mm was reduced. In the case of 6 mm, the stress value between the first metatarsal and the first metatarsophalangeal joint increased, and 4 mm was the most suitable distance; Conclusions: Compared with the hallux valgus without osteotomy, the stress of the first metatarsals and second metatarsals of 2–4 mm decreased, and the stress of the interarticular cartilage of the first metatarsophalangeal joint with 4 mm was reduced. In the case of 6 mm, the stress value between the first metatarsal and the first metatarsophalangeal joint increased, and 4 mm was the most suitable distance. For the degree of displacement of the distal chevron osteotomy, the postoperative stability and the stress distribution of metatarsal bone should be considered. Factors such as hallux valgus angle, intermetatarsal angle, patient’s age, body weight, and metatarsal width should be considered comprehensively. The factors affecting osteotomy need to be further explored. The degree of displacement of osteotomy can be evaluated by FE method before the operation, and the most suitable distance can be obtained.

The discrepancy between radiographically-assessed and self-recognized hallux valgus in a large population-based cohort

BackgroundThere has been a paucity of literature revealing the discrepancy between self-recognition about hallux valgus (HV) and radiographically-evaluated foot configuration. Knowing this discrepancy will help to make a comparative review of the findings of previous literatures about epidemiological studies about the prevalence of HV.Questions/purposes(1) Is there a discrepancy between radiographically-assessed and self-recognized HV in the general population? (2) What factors affect the self-recognition of HV in the general population?MethodsThe fifth survey of the Research on Osteoarthritis/Osteoporosis against Disability study involved 1996 participants who had undergone anterior-posterior radiography of bilateral feet and answered a simple dichotomous questionnaire on self-recognition of HV. Measurements of the HV angle (HVA), interphalangeal angle of the hallux (IPA), and intermetatarsal angle between 1st and 2nd metatarsals (IMA) were performed using radiographs. Radiographic diagnosis of HV was done using the definition of hallux valgus angle of 20° or more. After univariate comparison of the participant backgrounds and radiographic measurements between participants with or without self-recognition of HV, multivariable logistic regression analysis was conducted in order to reveal independent factors affecting self-recognition.ResultsSignificant difference was found between the prevalence of radiographically-assessed and self-recognized HV (29.8% vs. 16.5%, p < 0.0001). The prevalence of self-recognized HV increased with the progression of HV severity from a single-digit percentage (normal grade, HVA < 20°) up to 100% (severe grade, HVA ≥ 40°). A multivariable logistic regression analysis demonstrated that HVA, IMA, and female sex were independent positive factors for self-recognition of HV (HVA [per 1° increase]: OR, 1.18; 95% CI, 1.15–1.20; p < 0.0001; IMA [per 1° increase]: OR, 1.15; 95% CI, 1.09–1.20; p < 0.0001; and female sex [vs. male sex]: OR, 3.47; 95% CI, 2.35–5.18; p < 0.0001).ConclusionsThere was a significant discrepancy between radiographically-assessed and self-recognized HV which narrowed with the progressing severity of HV. HVA, IMA, and female sex were independent positive factors for self-recognition of HV. Attention needs to be paid to potentially lowered prevalence of HV in epidemiological studies using self-reporting based on self-recognition.

Fifth Metatarsal Injuries in NCAA Division I Athletes: Management and Return to Play

Category:Midfoot/Forefoot; Sports; TraumaIntroduction/Purpose:Optimal management of metadiaphyseal fifth metatarsal fractures (Jones fractures) in athletes remains controversial. In high-level athletes, surgical treatment with intramedullary screw fixation is commonly recommended to minimize the risk of nonunion and to allow for faster return to sport. The purpose of this study was to report the rate and time to return to sport in collegiate athletes who sustained an isolated fracture to the fifth metatarsal bone.Methods:From 2003 to 2020, we retrospectively reviewed the clinical notes and imaging studies of all athletes participating in NCAA Division I sports at a single college and who sustained a fracture of the fifth metatarsal bone. Athletes with a diagnosis of 5th metatarsal bone fracture were included. Athletes were excluded if they had a fracture in any of the other metatarsal bones (1st-4th). Data collected were: demographic information (age, gender), type of sport, date of injury and/or surgery, diagnosis of Jones fracture, type of treatment received (operative with intramedullary screw fixation versus non operative with the application of boot or cast of the lower extremity and non- weightbearing activity), rate of return to sport, and time to return to sport. The rate and time to return to sport were reported as percentage and mean-standard deviation, respectively. The level of statistical significance was set at <0.05.Results:From 2003 to 2020, we retrospectively reviewed the clinical notes and imaging studies of all athletes participating in NCAA Division I sports at a single college and who sustained a fracture of the fifth metatarsal bone. Athletes with a diagnosis of 5th metatarsal bone fracture were included. Athletes were excluded if they had a fracture in any of the other metatarsal bones (1st-4th). Data collected were: demographic information (age, gender), type of sport, date of injury and/or surgery, diagnosis of Jones fracture, type of treatment received (operative with intramedullary screw fixation versus non operative with the application of boot or cast of the lower extremity and non- weightbearing activity), rate of return to sport, and time to return to sport. The rate and time to return to sport were reported as percentage and mean-standard deviation, respectively. The level of statistical significance was set at <0.05.Conclusion:Jones fractures of the 5th metatarsal bone are a relatively rare injury in collegiate athletes at our institution occurring mostly in male football and basketball players at a rate of about one fracture per year for 21 intercollegiate teams. These fractures are treated with a high level of success with intramedullary screw fixation. Given that postoperative recovery may last for approximately 3 months, return to play following surgical fixation of a Jones fracture is highly dependent on the timing of injury; an athlete who sustains the injury in-season is unlikely to return to play that same season.

Comparative morphological study of the male and female metacarpal and metatarsal bones of the dromedary camel with special reference to the blood vasculature.

It is vital to understand the gross anatomy and dimensions of the metacarpal and metatarsal bones in camels in order for veterinarians to identify fraud cases between males and females by carefully distinguishing between them. It is to make comparisons of the morphological characteristics and measurements of the metacarpus and metatarsus bones of male and female camels. Forty metacarpus and metatarsus of adult camels of both sexes were collected from a typical Burydah slaughterhouse in KSA. The bones were treated according to the established methods of boiling, drying, and bleaching to study morphology. The measurement of the bones in this study has been taken by using digital vernier calipers. The metacarpus and metatarsus consisted of two large and two small bones. The large metacarpal and metatarsal bones consisted of fused III and IV. Except for the distal side in which the two bones diverge more from each other. The metacarpal bone is similar to the metatarsus, except that it is smaller in measurement majority. The small Mc-Mt II and Mc-Mt V were smaller and present on the palmo-lateral or planto-lateral aspect of the large bones, respectively. The length of the metacarpus and metatarsus is almost equal nearly in camels unlike the rest of the animals as well as the metacarpus bone was unlike the metatarsus in form and measurements generally. The large metacarpus and metatarsus bones are distinguished by the fusion of the third and fourth bones along the length of the bone. Except for the distal side in which the two bones diverge more from each other like the rest of the animals. The morphologically characterized majority of the metacarpal bone was similar to the metatarsus, except that it was proximal extremity, cross-section, and measurement.