Bony Angle Research Articles

Ultrasonography-Based Quantitative Evaluation of Second Metatarsophalangeal Joint Instability in Female Patients With Hallux Valgus.

Patients with moderate to severe hallux valgus (HV) sometimes exhibit second metatarsophalangeal (MTP) joint dislocation. Second MTP joint instability due to plantar plate (PP) injury has been suggested as one of the causes. However, there have been no reports that quantitatively evaluate this instability. This study aimed to evaluate second MTP joint instability in patients with HV without dislocation via ultrasonography and investigate its relationship with the presence of PP injury or foot form. Between May 2018 and July 2023, symptomatic female patients with HV without any lesser toe deformity were included in this study. Second MTP joint instability was defined as the dorsal displacement ratio (DDR) of the passively subluxated proximal phalangeal articular surface on the metatarsal head articular surface. The presence of PP injury was assessed using ultrasonography. Foot "form" was determined by measuring standard foot bony angles on weight-bearing foot-ankle radiographs. The relationship between DDR or PP injury and radiographic measurements was investigated. Sixty-four patients (100 feet) were included. The average DDR of the second MTP joint in patients with HV without dislocation was 35.7%. There was an increase in the probability of PP injury, above a cutoff DDR value r of 35.4% (area under the curve = 0.712). The sensitivity, specificity, positive predictive value, and negative predictive value for the presence of PP injury based on this cutoff level were 63.9%, 74.4%, 79.6%, and 56.9%, respectively. Metatarsalgia was reported in 21 feet (21.0%), of which 15 feet (71.4%) showed PP injury. An increase in DDR was weakly associated with increased metatarsus adductus angle and decreased second metatarsal height. In female patients with HV without second MTP dislocation, we found ultrasonographic evidence of second MTP plantar plate injury and joint instability to be a relatively common finding with a high prevalence in those with localized metatarsalgia. Level II, development of diagnostic criteria based on consecutive patients.

Prognostic factors affecting periodontal regenerative therapy using recombinant human fibroblast growth factor-2: A 3-year cohort study.

IntroductionFibroblast growth factor-2 (FGF-2) has been reported to promote periodontal tissue regeneration. However, no study has investigated the long-term prognosis of periodontal regenerative therapy using FGF-2 to date. The aim of this study was to observe the long-term outcomes as well as to investigate the factors affecting the prognosis of periodontal regenerative therapy using FGF-2.MethodsSixty intrabony defects were prospectively investigated for three years after periodontal regenerative therapy with recombinant human FGF-2 (rhFGF-2) by evaluating probing pocket depth (PPD) and radiographic bone defect depth (RBD). The factors influencing RBD were assessed by conducting a multivariate linear regression analysis after adjusting for confounders.ResultsThe mean age of the participants was 62.4 ± 13.4 years, and baseline PPD and RBD were 6.1 ± 1.9 mm and 4.5 ± 1.8 mm, respectively. At six months, one year, and three years after surgery, PPD and RBD had significantly improved to 4.2 ± 1.7, 3.7 ± 1.4, 4.0 ± 1.9 mm and to 3.08 ± 2.05, 2.73 ± 1.90, 2.51 ± 2.15 mm, respectively. At the three-year examination, a significant positive association was deteced between RBD reduction and RBD at baseline, while the association was not significant between RBD reduction and the radiographic bony angle, number of bony walls of the defect, or the furcation involvement at baseline.ConclusionsrhFGF-2 was effective for alveolar bone regeneration in patients with periodontitis and maintained the improved parameters over the three-year observation period. The radiographic bone defect depth at baseline was found to be the factor affecting the periodontal regenerative therapy using rhFGF-2 in the intrabony defects.Trial registration numberUMIN000027979.

Angle Osteoplasty and Cosmetic Debulking for Correction of a Case of Unilateral Masseteric Hypertrophy

Facial asymmetry is one of the commonest causes of impaired aesthetics, serving as a strong motivation for patients to seek corrective treatment. Benign masseteric hypertrophy is a well-known, albeit uncommon condition of rather obscure etiology, resulting from unilateral or bilateral increase in volume and bulk of the masseter muscle, that may or may not be accompanied by hyperostosis of the underlying bony angle of the mandible. This report elaborates a modified surgical modality and operative technique that effectively addresses both, the hard as well as soft tissue malformations in the region simultaneously, and is associated with the least incidence of relapse and recurrence of the condition. A 26-year-old woman with severe facial asymmetry resulting from unilateral masseteric hypertrophy was taken up for surgical debulking of the masseter. Surgical resection of one-third of the hypertrophied muscle bulk from its inner or medial aspect, followed by shaving of bony spurs and recontouring of angle of the mandible, was done. The surgical technique described is a definitive, efficacious, and reliable intervention for successful and long-term management of idiopathic masseter muscle hypertrophy that results in an excellent and long-lasting aesthetic outcome.

Role of the petrous ridge and angulation of the trigeminal nerve in the pathogenesis of trigeminal neuralgia, with implications for microvascular decompression.

Vascular compression is the main pathogenetic factor in apparently primary trigeminal neuralgia; however some patients may present with clinically classical neuralgia but no vascular conflict on MRI or even at surgery. Several factors have been cited as alternative or supplementary factors that may cause neuralgia. This work focuses on the shape of the petrous ridge at the point of exit from the cavum trigeminus as well as the angulation of the nerve at this point. Patients with trigeminal neuralgia that had performed a complete imagery workup according to our protocol and had microvascular decompression were included as well as ten controls. In all subjects, the angle of the petrous ridge as well as the angle of the nerve on passing over the ridge were measured. These were compared from between the neuralgic and the non-neuralgic side and with the measures performed in controls. In 42 patients, the bony angle of the petrous ridge was measured to be 86° on the neuralgic side, significantly more acute than that of controls (98°, p = 0.004) and with a trend to be more acute than the non-neuralgic side (90°, p = 0.06). The angle of the nerve on the side of the neuralgia was measured to be on average 141°, not significantly different either from the other side (144°, p = 0.2) or from controls (142°, p = 0.4). However, when taking into account the grade of the conflict, the angle was significantly more acute in patients with grade II/III conflict than on the contralateral side, especially when the superior cerebellar artery was the conflicting vessel. This pilot study analyzes factors other than NVC that may contribute to the pathogenesis of the neuralgia. It appears that aggressive bony edges may contribute-at least indirectly-to the neuralgia. This should be considered for surgical indication and conduct of surgery when patients undergo MVD.

Scapulothoracic Endoscopy for the Painful Snapping Scapula: Endoscopic Anatomy and Scapuloplasty Technique

Chronic painful snapping scapula is characterized by inflammation and scarring of 1 or more bursae in the infraserratus space and is often refractory to conservative treatment. Surgical treatment involves excision of the bursae, as well as partial scapulectomy of the superomedial impinging region; both open and endoscopic approaches have been described with good results. Scapulothoracic endoscopy is technically difficult, and the potential complications can be serious. This report describes an endoscopic approach that can be performed with only 2 medial parascapular portals for visualization and instrumentation. The endoscopic anatomy of the infraserratus space is revisited, and 3 anatomic landmarks (serratus anterior, subspinous bursal curtain, and superomedial bony angle) are identified for safe dissection and intraoperative orientation. The surgical field is subdivided into 3 anatomic zones (superomedial space, subspinous space, and scapular bony angle), and the anatomic boundaries of these zones are demonstrated. The decompression procedure is subdivided into 4 stages (superomedial bursectomy, subspinous adhesiolysis, tuberoplasty, and scapuloplasty), and a measured resection technique for scapuloplasty is performed. The use of newer motorized rasps permits optimal bony resection, and additional portals are unnecessary. Overall, the step-by-step technique provides a methodical approach for safety, reproducibility, and optimization of the procedure.

Analysis of the Anatomic Changes of the Aging Facial Skeleton Using Computer-Assisted Tomography

The bony skeleton serves as the scaffolding for the soft tissues of the face; however, age-related changes of bony morphology are not well defined. This study sought to compare the anatomic relationships of the facial skeleton and soft tissue structures between young and old men and women. A retrospective review of CT scans of 100 consecutive patients imaged at Duke University Medical Center between 2004 and 2007 was performed using the Vitrea software package. The study population included 25 younger women (aged 18-30 years), 25 younger men, 25 older women (aged 55-65 years), and 25 older men. Using a standardized reference line, the distances from the anterior corneal plane to the superior orbital rim, lateral orbital rim, lower eyelid fat pad, inferior orbital rim, anterior cheek mass, and pyriform aperture were measured. Three-dimensional bony reconstructions were used to record the angular measurements of 4 bony regions: glabellar, orbital, maxillary, and pyriform aperture. The glabellar (p = 0.02), orbital (p = 0.0007), maxillary (p = 0.0001), and pyriform (p = 0.008) angles all decreased with age. The maxillary pyriform (p = 0.003) and infraorbital rim (p = 0.02) regressed with age. Anterior cheek mass became less prominent with age (p = 0.001), but the lower eyelid fat pad migrated anteriorly over time (p = 0.007). The facial skeleton appears to remodel throughout adulthood. Relative to the globe, the facial skeleton appears to rotate such that the frontal bone moves anteriorly and inferiorly while the maxilla moves posteriorly and superiorly. This rotation causes bony angles to become more acute and likely has an effect on the position of overlying soft tissues. These changes appear to be more dramatic in women.

The relationship between the angle of the trochlear groove and patella cartilage and bone morphology – a cross-sectional study of healthy adults

Although the geometry of the trochlear groove is considered important in the pathogenesis of patellofemoral joint pathology it is unclear how the shape of the trochlear groove relates to patella morphology. This cross-sectional study investigated the relationship between the shape of the trochlear groove and patella cartilage and bone morphology in healthy adults. Two hundred and ninety-seven healthy adults aged between 50 and 79 years with no clinical history of knee pain or pathology were examined using magnetic resonance imaging (MRI). From the magnetic resonance (MR) images, the bony angles formed at the distal and proximal trochlear groove were measured, together with patella cartilage and bone volumes and patella cartilage defects. After adjustment for potential confounders, there was an 8.70mm(3) (95% confidence interval (CI) 2.15, 15.26) increase in patella cartilage volume (P=0.009), with no increased prevalence of cartilage defects (odds ratio=0.99 (95% CI 0.96, 1.02), P=0.35), for every 1 degrees increase (i.e., as the angle became more flatter) at the distal trochlear groove. Moreover, there was a 53.86mm(3) (95% CI -90.26, -17.46) reduction in patella bone volume for every 1 degrees that the angle at the distal trochlear groove became more flattened (P=0.004). No significant association between the proximal trochlear groove angle and the patella cartilage or bone properties was observed. A more flattened bony angle at the distal trochlear groove was associated with increased patella cartilage volume and reduced patella bone volume, but no increased prevalence of patella cartilage defects in adults with no history of knee pain or clinical disease. These cross-sectional findings suggest that a flattened distal trochlear groove may protect against degenerative patellofemoral conditions, such as osteoarthritis, but this will need to be confirmed in a longitudinal study.

Anatomy of the superior glenoid rim. Repair of superior labral anterior to posterior tears.

Successful placement of a fixation device on the superior glenoid rim during superior labrum repairs requires accurate knowledge of the glenoid rim anatomy. To investigate the normal bony anatomy of the superior glenoid rim. Descriptive anatomic study. Twenty cadaveric glenoid specimens were scanned to obtain cross-sectional images with peripheral quantitative computed tomography in three different positions, each perpendicular to the articular surface. Two straight lines were drawn along the interior bony margins of the articular surface and cortex, and image analysis software was used to calculate the angle between these lines. Three bony angles were measured. The bony angles from the 10:30-, 12-, and 1:30-o'clock cross-sections were 55 degrees +/- 5 degrees, 64 degrees +/- 5 degrees, and 62 degrees +/- 8 degrees, respectively. The posterosuperior angle (at the 10:30-o'clock position) was statistically significantly lower than the superior and anterosuperior angles. Intraobserver variation was less than 3%. The most superior point of the glenoid rim (12-o'clock position) seems to provide the most bone stock for anchor insertion. The available bone support was found to decrease posteriorly on the glenoid rim. During superior labral repairs, the anchor or fixation device should be inserted at approximately a 30 degrees angle in relation to the articular surface for maximal bone support.

Reliability and validity of combined imaging and pressures assessment methods for diabetic feet

Commean PK, Mueller MJ, Smith KE, Hastings M, Klaesner J, Pilgram T, Robertson DD. Reliability and validity of combined imaging and pressures assessment methods for diabetic feet. Arch Phys Med Rehabil 2002;83:497-505. Objectives: To determine the reliability of using 3-dimensional (3D) spiral x-ray computed tomography (SXCT) imaging methods to measure anatomic foot structure and to test the validity of using a loading device to simulate walking pressures on the plantar foot during SXCT examination. Design: Nonrandomized control trial of consecutive patients with complete data compared with age-matched controls. Setting: A clinical SXCT scanner and physical therapy laboratory in a local hospital. Participants: Eight subjects with diabetes and a history of forefoot ulcers and 8 control subjects. Interventions: SXCT imaging and plantar pressure analysis were used to acquire 3D volumetric structure and pressure data of the foot during 4 foot positions, 2 weight bearing and 2 non–weight bearing. Main Outcome Measures: Differences between repeated SXCT measures of foot structure. Comparisons of plantar foot pressure. Foot structure measurements. Methods for measuring the bony angles and soft-tissue thickness were developed and reliability tests were performed. Results: There was essentially no bias (<±0.5mm or ±0.5°) and a high degree of reliability (81% of the measures had a reliability <2.0mm or 2°) when measuring foot structures. Correlations of pressure measures collected on the loading device compared with those collected during walking were (mean ± standard deviation) r =.66 ±.06. The percentage agreement between the pressures collected on the loading device and during walking was 91.1% ± 4.7%. Conclusion: Reliability of anatomic foot structure measurements and validity of plantar loading during visualization were good. These methods may be used to determine structural differences between diabetic and healthy feet and to evaluate how these differences relate to plantar pressures. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Measurement of first-ray mobility in normal vs. hallux valgus patients.

Hypermobility of the first ray is one causative factor in development of hallux valgus and an important factor in the treatment of hallux valgus, but measuring first-ray motion is difficult. There are two known ways of measuring first-ray motion. One is measuring the bony angle on the lateral foot X-ray using a modified Coleman block. The other is using devices. However, neither is suitable for clinical application. We introduce a simple, fast and easy way of measuring first-ray range of motion. Using this method, we compared the first-ray motion between a normal group and a hallux valgus group. Forty normal and 60 hallux valgus patients were included in the measurement. We measured the first-ray range of motion in the following way: with one hand we held the 2nd, 3rd, 4th, and 5th rays at the metatarsal head level with a simple right-angled indicator. With the other hand, we held the first ray at the metatarsal head level using a simple right-angled device, such as a scale. Keeping the other rays fixed, we moved the first ray up and down and recorded the average distance (d) 10 times to reduce intra-measurement differences. We also measured and recorded the first metatarsal length (L) on the anteroposterior foot X-ray film. Finally, we calculated the first-ray range of motion (alpha) using the above data. We also measured the hallux valgus angle and intermetatarsal angle in the hallux valgus patient group. With this method, the average first-ray motion was 10.3 degrees in the normal group and 12.9 degrees in the hallux valgus patient group. If we define 14 degrees, (that is, above the 95th percentile in the normal group) as having hypermobility, 38% of hallux valgus patients had first ray hypermobility. There was no correlation between first-ray hypermobility and either hallux valgus angle or intermetatarsal angle.

Wound Healing in Transtibial Amputees Related to Surgical Technique

Transtibial amputations (TTAs) have traditionally been surgically bevelled at the anterior tibia by a surgical saw. Furthermore, the fibula has been cut shorter than the distal tibia by 2 to 3 cm. It is thought that these two measures result in quicker wound healing by virtue of less of a “pressure point” irritating the soft tissue from sharp, bony angles. In our rehabilitation practice of a largely dysvascular population, most TTAs presenting for prosthetic fitting and gait retraining at a rehabilitation hospital had the tibia bevelled and fibula shortened. However, a large number did not. It was our impression that the patients who had these measures taken had quicker healing of the surgical incision than those who did not. A review of the literature from 1965 to the present revealed that the issue has never been formally studied. There are only clinical impressions of various authors stating that, in their experience, it is better to bevel the tibia and shorten the fibula. We have reviewed the radiographs and charts of 142 TTAs admitted to a rehabilitation facility between January of 1993 and December of 1995. We categorized the patients according to the types of surgical bone cuts and correlated them with the time from the date of surgery to the point of healing (as estimated by the date of first prosthetic fitting). Our results show that shortening the fibula at the time of TTA correlates with a shorter time to heal the wound (p = .046), but bevelling of the tibia is of questionable value in the dysvascular patient (p = .91).

The postsaccal, idiopathic dacryostenosis ? experimental and clinical aspects

The 'idiopathic' dacryostenosis has not yet been cleared up in its aetiological aspects. For further explanation of aetiology and pathomechanisms an experimental, anatomical study was made. Its object was to define the angles and measurements within the bony lacrimal structures and to establish possible connections between the development of the postsaccal stenosis and certain bony constellations of the lacrimal system. The main goal of these examinations was to determine the angle between the lacrimal fossa and the main direction of the nasolacrimal canal, as well as the angles which are found in the course of the nasolacrimal canal. Macerated half skulls obtained from anatomical dissection courses were used for this study. After cleaning the bony lacrimal passages, the distal orifice of the nasolacrimal canal was closed with bone wax. The canal and the lacrimal fossa were filled with epoxy resin. After hardening the preparations were radiographed in order to make sure that the whole system was completely filled with resin. Then the surrounding bone was removed chemically and the resin casts were laid free. They were photographed and the photographs were traced and measured. A trigonometric method was then used for constructing the maximum angle between the lacrimal fossa and nasolacrimal canal. This angle was mainly directed dorsomedially and showed a considerable amount of variation. A bony system with a large angle increases the possibility of acquiring a postsaccal dacryostenosis. The bony angle is one of many factors facilitating an ascending inflammation in the lacrimal mucosa. Clinically we have to differentiate the acute, fresh dacryocystitis from the chronic, recurrent dacryocystitis. The main symptoms are epiphora, pain and inflammation in the medial canthal area and headache. The most important diagnostic examinations are the slitlamp examination of the eyelids, of the lacrimal puncta and of the anterior segment of the globe, the 'lacrimal punctum excursion test', the diagnostic rinse of the lacrimal passages, the dacryocystography and the rhinological examination. The result of a successful treatment of the acute, beginning dacryocystitis is to open the incomplete, transitory, distal stenosis of the nasolacrimal duct. The stenosis is caused by an ascending inflammation from the nose and by the swelling of the lacrimal mucosa. The blockage can be solved by massage after application of vasoconstrictory drops. The therapy of a complete, postsaccal lacrimal stenosis always has to be a dacryocystorhinostomia externa ('Toti-operation'). The Kaleff-Hollwich modification proved successful and is extended by a fibrin sealing method.(ABSTRACT TRUNCATED AT 400 WORDS)

FRACTURE-DISLOCATIONS OF THE CARTILAGINOUS NOSE: ANATOMICOPATHOLOGIC CONSIDERATIONS AND TREATMENT

While the pathology and the treatment of bony nasal fractures are well established, the results of injury to the cartilaginous components of the nose, being less definite, are often misinterpreted. In this paper I shall discuss dislocations of the cartilaginous nasal structures and their relationship to external deformities and outline a method of reconstruction based on the anatomic changes resulting from trauma. ANATOMIC CONSIDERATIONS The fibrocartilaginous structure of the nose is based on the position and the interrelationship of the septum and the lateral cartilages, on the one hand, and the bony framework, on the other. The septal cartilage is solidly fixed in a bony angle formed by the perpendicular plate and the vomer (fig. 1A). The topography of its inferior border is of great surgical significance. The upper border of the vomer presents a groove of varying depth in which the septum is affixed and whence a cartilaginous