Separate Ossicle Research Articles

Classification and surgical treatment of the angled thumb

In type 1 separate ossicle, variable surgical procedures for the delta phalanx can be applied, however, excision and tightening of collateral ligament is recommended in most cases. In type 2 and 3 abnormal ossification centers, the treatment can depend on the age of the patient. If the angular deformity is seen before the age of one year and the abnormal ossification center is not clearly visible, close observation and periodic follow-up is reasonable. When the abnormal epiphysis is confirmed on radiography, usually between the age of 1 and 2 years, either partial excision of the epiphysis or intra-epiphyseal osteotomy can be done. When the patient is seen late and the remodeling of the joint is not likely to occur, intraepiphyseal osteotomy is recommended with careful attention to the physis and articular cartilage, because it addresses the anatomic deformity and produce better correction regardless of the IP position.

Allograft Tympanoplasty

To present the rise and decline of allograft tympanoplasty and investigate how the challenges it has faced may inform us of its future. Articles and books published over the last 48 years that refer to allograft tympanoplasty or its historical roots. The first published account of allograft tympanoplasty is by Ned Chalat in 1964; however, whether he was the first to use the technique is controversial. In 1966, Jean Marquet published the first clinically successful use of allograft tympanic membranes. Since that time, a number of surgeons have trialed both en bloc tympano-ossicular techniques and tympanomeatal techniques with separate ossicle interposition or columellar reconstruction, often with considerable success. The advent of the human immunodeficiency virus and Creutzfeldt-Jakob's disease resulted in a reduction in its application; however, a number of centers are still successfully using the technique in their current practice. Whether allograft tympanoplasty will have a place in the future of otology remains to be seen, but an understanding of the history of this technique is essential in evaluating its merit.

THE UTILITY OF ISOLATED CRINOID OSSICLES AND FRAGMENTARY CRINOID REMAINS IN TAPHONOMIC AND PALEOENVIRONMENTAL ANALYSIS: AN EXAMPLE FROM THE UPPER PENNSYLVANIAN OF OKLAHOMA, UNITED STATES

The crinoid fossil record is dominated by isolated ossicles, pluricolumnals, arm segments, and other fragmentary remains resulting from postmortem skeletal disarticulation; however, few studies to date have focused on dissociated crinoid elements in taphonomic and/or paleoenvironmental analysis. A diverse, abundant, and taphonomically variable crinoid fauna recovered from a thin mudstone interval within the Upper Pennsylvanian Barnsdall Formation in northeastern Oklahoma presents a unique opportunity to test the value of incomplete crinoid remains in reconstructing paleoenvironmental conditions and understanding taphonomic patterns. Isolated radial plates were identified to the most precise level possible, commonly genus or species, and used to calculate the minimum number of completely disarticulated individuals; this value was then compared to the number of articulated specimens representing that same taxon to determine the proportion of individuals with cups that have undergone disarticulation into separate ossicles. Cladid taxa are shown to be particularly prone to total disarticulation, with disparid microcrinoids and, somewhat surprisingly, flexibles demonstrating more resistance to disarticulation. Genus-level taphonomic trends among cladid taxa indicate that genera with large but thin cup plates, short anal sacs, and arms capable of adopting a trauma posture are less prone to total disarticulation. Analysis of fragmentary crinoid material recovered from disaggregation of bulk mudstone slabs reveals that thin horizons containing abundant articulated crinoid crowns are enriched in skeletal material and encrusted ossicles relative to thicker subjacent and superjacent intervals, providing further evidence that such horizons represent periods of sediment starvation on the distal shelf that were episodically punctuated by storm events.

Talus Bipartitus: A Rare Skeletal Variation

Talus bipartitus (also known as talus partitus or frontal split ) is a rare anatomic variant of the talus, first described by Strehle in 19281. Since then, to the best of our knowledge, only seven more cases have been described in the medical literature, and all of these cases occurred in adolescents who were between thirteen and eighteen years of age2-7. Three recent reports utilized a computed tomography (CT) scan for evaluation5-7, but none outlined the exact three-dimensional anatomy of the ossicle. A detailed follow-up has not been provided on any of the prior patients. The term talus bipartitus describes a large, separate piece of bone that constitutes about one-third of the posterior aspect of the talar body and is separated from that structure by a frontal split. A talus bipartitus is therefore considerably larger than an os trigonum, which contains part of the lateral tubercle of the posterior process of the talus. The os trigonum is not uncommon, with a calculated prevalence of 7% to 13%8,9. Over a period of ten years, we have observed four young adult patients with radiographic findings of talus bipartitus. The clinical and radiographic findings were different in all four cases, and treatment consequently had to be tailored individually. This is the first case series of this rare anatomic variant, and we report for the first time on the three-dimensional appearance of this separate ossicle. An average follow-up of 2.5 years after treatment was obtained. The patients were informed that data concerning the cases would be submitted for publication, and they all consented. Case 1. A thirty-one-year-old woman presented with a fourteen-month history of occasional pain in the right ankle. She had a history of repetitive inversion sprains of both …

Incudomalleal joint formation: the roles of apoptosis, migration and downregulation

BackgroundThe middle ear of mammals is composed of three endochondrial ossicles, the stapes, incus and malleus. Joints link the malleus to the incus and the incus to the stapes. In the mouse the first arch derived malleus and incus are formed from a single Sox9 and Type II collagen expressing condensation that later subdivides to give rise to two separate ossicles. In contrast the stapes forms from a separate condensation derived from the second branchial arch. Fusion of the malleus and incus is observed in a number of human syndromes and results in conductive hearing loss. Understanding how this joint forms during normal development is thus an important step in furthering our understanding of such defects.ResultsWe show that the developing incudomalleal joint is characterised by a lack of proliferation and discrete areas of apoptosis. Apoptosis has been suggested to aid in the removal of pre-cartilaginous cells from the joint region, allowing for the physical separation of the cartilaginous elements, however, we show that joint initiation is unaffected by blocking apoptosis. There is also no evidence of cell migration out of the presumptive joint region, as observed by labelling of joint and ossicle cells in culture. Using Type II collagen lacZ reporter mice, however, it is evident that cells in the presumptive joint region remain in place and downregulate cartilage markers.ConclusionThe malleus and incus first appear as a single united condensation expressing early cartilage markers. The incudomalleal joint region forms by cells in the presumptive joint region switching off cartilage markers and turning on joint markers. Failure in this process may result in fusion of this joint, as observed in human syndromes such as Branchio-Oto-Renal Syndrome or Treacher Collins Syndrome.

Elongated patellae at the final stage of Osgood–Schlatter disease: A radiographic study

Aetiology of Osgood–Schlatter disease (OSD) is still unknown. Relative length of the patellar articular surface with the length of the patella, relative height of the tibial tubercle with the sagittal diameter of the tibia, Insall–Salvati, Blackburne–Peel, and Caton–Deschamps indexes, as well as Grelsamer-morphology type of the patella were measured from preoperative plain X-rays in 82 knees of 20-year-old males with OSD and in 87 knees of 20-year-old male controls with normal MRI findings of the knee. Seventy-eight of the OSD patients had separate ossicles. Their mean patellar morphology index was 1.44 and that of the controls was 1.28 ( p < 0.001), indicating significant lengthening of the patellar body among the OSD group. OSD patients had also significantly more often Grelsamer type II (elongated patellae) than the controls. Tibial tuberosity was significantly higher among OSD patients, but was not correlated with the lengthening of the patella. An increased patellar height among OSD patients was shown by the Blackburne–Peel and Caton–Deschamps indexes ( p < 0.001) and the Insall–Salvati index ( p = 0.018). OSD patients exhibit elongated patellae and patellar tendons which may result from long-standing tension of the extensor apparatus during growth spurt, when femoral growth exceeds that of the anterior structures of the knee.

Os acromiale: frequency, anatomy, and clinical implications.

Os acromiale is present when the anterior portion of the acromion has one or more separate ossicles. Its frequency has been documented, in radiographic and anatomical studies, to be between 1 and 15 percent. Reports of os acromiale associated with subacromial pathology have been cited to imply that this entity is a cause of subacromial impingement; however, no study has demonstrated an increased frequency of os acromiale in patients with shoulder pain compared with the frequency in the general population. Inconsistencies in the literature concerning anatomy, development, and frequency prompted the current anatomical study. The purpose of this study was to better define the frequency and anatomy of os acromiale in the general population. Two thousand three hundred and sixty-seven scapular bones from 1198 human skeletons from the Hamann-Todd Osteological Collection were studied for evidence of os acromiale. The sample consisted of specimens from 1033 men and 165 women, 843 of whom had been white and 355, black. The mean age of the individuals at the time of death was 44.7 years (range, eighteen to eighty-nine years). The frequency of os acromiale was noted, and the specimens were measured. There were 128 cases of os acromiale in ninety-six (8.0 percent) of the 1198 skeletons, and the condition was bilateral in thirty-two (33.3 percent) of the ninety-six skeletons. In twenty cases, the free fragment had been lost but it was assumed that a fragment had been present because the acromion was truncated. Os acromiale was more frequent in blacks than in whites (13.2 compared with 5.8 percent; p < 0.001) and in men than in women (8.5 compared with 4.9 percent; p = 0.09). The mean proportional length of the free fragment was 0.42 compared with the overall length of the acromion. Care was taken to differentiate os acromiale from a normal immature acromion. Six skeletons demonstrated persistent acromial apophyses. All six cases were bilateral; seven fragments were fusing, and five were free. The oldest age at which a persistent normal apophysis was found was twenty-one years. The frequency of os acromiale in specimens from individuals who had been less than twenty-two years old was not significantly different from that in the remainder of the collection (p = 0.74). Twenty-one scapulae had a distinct circumferential line that was suggestive of an acromial joint, but the distal and proximal portions were solidly fused. However, the findings on plain axillary radiographs of sixteen of these specimens were indistinguishable from those of specimens with os acromiale. An anatomical study, performed to better define the frequency and anatomy of os acromiale in the general population, showed that fused os acromiale, which has not been described previously, might be mistaken for a free ossicle in the clinical setting.

Pathogenesis, dynamics, and management of os odontoideum

Os odontoideum is an uncommon craniovertebral junction (CVJ) abnormality that exists as a separate ossicle apart from a hypoplastic dens. It usually moves with the clivus or the anterior arch of C-1 (dystopic) or rarely with the dens (orthotopic). Its genesis and natural history have been debated, and its proper treatment remains uncertain. Two hundred and sixty patients, with symptomatic os odontoideum, were evaluated by the author over a 20-year period; the author performed surgery in 134 of these patients. In a prospective study the author evaluated the early childhood history of trauma, the dynamic studies of motion, and the effects of traction by using pleuridirectional tomography, computerized tomography (CT), CT myelography and magnetic resonance (MR) imaging. Operative findings were documented. Early childhood trauma to the CVJ was recorded in 74 patients, in 30 of whom normal odontoid processes were documented at initial examination prior to the patient reaching age 4 years. Acute neurological deterioration following trauma occurred in 63 of 134 patients. Symptoms were insidious in 71 of 134 patients. In six patients, who presented with acute neurological deterioration after trauma and in whom an abnormal spinal cord signal in the cervicomedullary junction was demonstrated on MR imaging, normal CVJ motion dynamics were shown. Motion dynamics varied and were unique to each patient. Irreducible ventral CVJ disease causing cervicomedullary compromise occurred in 28 patients in whom a transpharyngeal ventral decompressive procedure was necessitated. During the transoral operation, the transverse portion of the cruciate ligament was found to be located anterior to the axis body. All patients required dorsal CVJ arthrodesis, which, in 46, was limited to the C1-2 segment. Instability at the C1-2 joints was always multidirectional, as demonstrated on preoperative neuroimaging studies as well as at operation. Sixteen patients presented after completed primary C1-2 dorsal fusion and with worsening deficits. They improved when the range of the fusion was extended to the occiput or if the ventrally located lesion was excised. Os odontoideum is associated with early childhood trauma and is an acquired phenomenon. The presence of abnormal motion dynamics necessitates surgical intervention as do associated neurological deficits. Asymptomatic patients in whom os odontoideum is incidentally discovered and in whom no abnormal motion dynamics are demonstrated should be followed closely.

オスグッド・シュラッター病に対する骨片摘出術の検討

In 19 knees of 16 patients with Osgood-Schlatter disease, a separate ossicle was noted at the proximal aspect of the tibial tubercle. Between January 1984 and July 1996, we treated Osgood-Schlatter disease in 13 males and 3 females ranging in age from 12 to 17 years. The preoperative observation period ranged from 3 months to 3 years.Postoperative clinical findings were evaluated by Wray's method. Fifteen knees did not show symptoms (Excellent), while 4 knees occasionally showed mild pain (Good). Surgical excision is necessary to relieve the symptoms of Osgood-Schlatter disease involving a separate ossicle.

Os trigonum syndrome

The os trigonum is a frequently encountered accessory bone of the foot. It is located at the posterior aspect of the talus, and may appear either as a separate ossicle or fused to the talus. The separate ossicle may represent an accessory bone or a fracture of the posterior process (also called the trigonal process) of the talus. The author reviews the mechanism of injury and the diagnosis and treatment. A case report of a fracture of the trigonal process is presented.

The so-called unresolved Osgood-Schlatter lesion

Of 118 patients with 151 knees treated for Osgood-Schlatter disease, fourteen patients (fifteen knees) had a distinct and separate ossicle at the proximal aspect of the tibial tubercle. This ossicle appeared after the child was first seen in all but three of the fifteen knees. When the ossicle failed to unite with the tubercle, the non-union was associated with local discomfort during activity and when direct pressure was applied on the tubercle. The symptoms did not respond to conservative treatment for an average of 3.8 years. Resection of the ossicle along with the adjacent bursa was followed by prompt relief of symptoms. Histological studies showed no evidence of avascularity. All ossicles were attached to the distal part of the undersurface of the ligamentum patellae and were separated from the tubercle by a bursa or scar tissue. The findings strongly support the concept that avulsion of the proximal cartilaginous part of the tibial tubercle is the cause of Osgood-Schlatter disease and they also suggest that once a separate ossicle is formed and becomes symptomatic, surgical excision is necessary to relieve the symptoms.

The Latero‐sensory Component of the Dermal Skeleton in Lower Vertebrates and Its Phyletic Significance

AbstractØrvig, T. (Section of Palaeozoology, Swedish Museum of Natural History, Stockholm, Sweden.) The latero‐sensory component of the dermal skeleton in lower vertebrates and its phyletic significance. Zool. Scripta 1(3–4): 139–155, 1972.–A latero‐sensory component of the dermal skeleton is met with not only in teleostomian fishes, but also in arthrodires, holocephalians (the lateral line canal “rings”), some fossil selachians, bradyodonts and acanthodians, and a few, at least, of the Osteostraci. Although not yet traceable with certainty in the Heterostraci, such a component probably existed even in early stages of vertebrate history. The persistence in the adult of this component as separate ossicles embracing the lateral line canals is surely the result of regression or other modifications of the dermal skeleton in fishes like arthrodires, coelacanthids and actinopterygians, but is apparently a primitive feature in e.g. acanthodians. In discussing the phyletic relations between the latero‐sensory and membranous components of the dermal skeleton, it is concluded that these probably were separate formations from the very beginning. A condition (exemplified by certain acanthodians) where separate latero‐sensory ossicles of the lateral line canals are surrounded by a mosaic of small scales of membranous origin is presumably that from which the various dermal bone‐patterns in lower vertebrates are all derived. A discussion is also included in this paper of the scales and otoliths in acanthodians.

Episternal bones. A case report.

Episternal bones, also known as suprasternal bones or ossa suprasternalia, are found on or just above the posterior margin of the manubrium. They are anomalous structures which may be single or paired, small or large, fused or free; they vary considerably in shape and may articulate with the manubrium or with one another. Caffey has included a case in his text on Pediatric X-Ray Diagnosis, with illustrations (1). The only other case which could be found in the English literature, with an illustrative roentgenogram, was that of Morris (4). These ossicles are probably of little clinical significance unless involved by infection, trauma, or arthritic change, or unless a single and somewhat atypical episternal bone is mistaken for a possibly significant lesion. In 1937, Cobb (2) reviewed comprehensively the anatomical literature on this subject and cited 91 references. The paper describes so well the various aspects of the anomalous ossicles that it is probably the authoritative source. The variation and incidence of suprasternal bones and the form of the superior manubrial border were investigated on 2,188 human and 107 anthropoid sterna in the Hamann Museum of Western Reserve University, a larger and better documented collection of material than had hitherto been available. The following notations are extracted from the summary of Cobb's paper. “Roentgenograms of 1,010 of the human sterna taken before maceration and with the clavicular ligaments still attached made possible the detection of minute ossicles otherwise lost. Comparison of manubria with their roentgenograms demonstrated that the dry manubrium may show no evidence of a suprasternal bone which was present. The incidence of separate ossicles was relatively higher in our roentgenographed series than in that composed of dry bones alone. Estimates of incidence based on macerated material are, therefore, unreliable. "Suprasternal bones range in size between that of a small shot and an average female lunate bone. An average is: length 10.4 mm., breadth 10.4 mm., height 7.3 mm. “Variation: Suprasternal bones occur in pairs and singly. They may separate, forming a diarthrodia1 joint with the manubrium complete with articular cartilage and synovial membrane; they may be united to the manubrium by synchondrosis; or as small nodules they may be ensconced within the suprasternal ligaments and have no contact with the manubrium. The ossicles exhibit various degrees of fusion with the manubrium and with each other, almost complete incorporation in the former being sometimes detectable. When fusion occurs can only be surmised but is probably early. Paired suprasternal bones may be of subequal size and symmetrical form and position on the manubrium or of unequal size and asymmetrical arrangement. One element may be separate and the other fused.

Bilateral antecubital ossicles (fabellae cubiti) and other rare accessory bones of the elbow.

Accessory ossicles are rare in the elbow. The one best substantiated is the patella cubiti at the dorsal aspect of the joint (1–5). Even here, some of the published reports do not conclusively eliminate the possibility of mistaking a traumatic fragment for a sesamoid ossicle of the triceps tendon. Other sources of diagnostic error are: an articulated olecranon spur (i.e., a calcification in the triceps tendon at its attachment to the posterior aspect of the olecranon), calcareous bursitis dorsal to the triceps tendon, and loose bodies secondary to osteochondritis dissecans. Finally the epiphysis of the olecranon process may fail to unite with the body of the ulna in an occasional case (6). This epiphysis develops usually from two or three ossification centers, first appearing on radiographs at ten to thirteen years of age. When arrested, it may give the appearance of one or more separate ossicles in the dorsum of the elbow. Usually this can be recognized by the fact that the line of separation leads into ...

Fracture of the promontory of the calcaneus.

Though the subject of fractures of the calcaneus has been extensively covered (1, 5, 11, 12, 13, 14, 17, 20, 21), our attention has been directed, within the past few months, to a simple calcaneal fracture which to our knowledge has received slight attention in the literature, yet is important clinically and from the medicolegal aspect. Only a few writers (2, 7, 8) have reported small series of cases briefly describing the anatomy and mechanism of this fracture. The portion of the calcaneus involved appears never to have been given a specific anatomical name, though it rightly deserves one. Textbooks of anatomy (6, 10, 19) describe the calcaneus (os calcis) as having on the anterior surface a saddle-shaped facet which articulates with the cuboid bone. On the medial surface at the anterior superior margin is a facet known as the anterior articular surface, which articulates with the anterior calcaneal facet of the talus. Yet the entire anterior superior margin of the calcaneus, especially as seen on the lateral or oblique roentgenogram, presents a definite ledge-like appearance. Arbitrarily, we have named this portion the calcaneal promontory. Several ligaments have their point of attachment along this ledge, principally the bifurcated ligament, which sends fasciculi to the cuboid and to the navicular bones, and the dorsal calcaneocuboid ligament, which connects the calcaneus and the cuboid superiorly. The mechanism inducing fracture of the calcaneal promontory seems to be (1) a combination of inversion with plantar flexion or (2) acute dorsiflexion of the foot. A “rolling” type of injury is often sustained, in which the long arch of the foot is acutely “cupped” over an object. The separation of the fragment probably depends primarily on the tensile pull of the ligamentous attachments. Evidently there is a sudden increase in tension on the bifurcated ligament and the dorsal calcaneocuboid ligament which pull the promontory from the main bone. Another factor which probably contributes to the fracture is the leverage effect of the posterior superior margin of the cuboid on the overhanging ledge-like promontory of the calcaneus when the foot is forced into abrupt exaggerated dorsiflexion. ROENTGEN ASPECTS The roentgen differentiation of several entities (3, 4, 9, 13, 18) presents medicolegal overtones. A recent fracture offers no difficulty from the roentgenologic standpoint. The features of dehiscence of bone, with loss of continuity of the cancellous structure, and separation of the “beak” fragment are demonstrable, while the fractured surfaces show rather distinct frayed margins with absence of cortex in this area. When a separate ossicle is noted at the site of the calcaneal promontory, it must be determined whether it is (a) a calcaneus secundarium, (b) a fragment of fractured bone with non-union and ossicle formation, or (c) possibly an ununited epiphysis.

Supra sternal ossicles in primates other than man: some isolated cases in gorilla and chimpanzee.

SCHULTZ1 examined nearly three hundred gibbon skeletons and his report contains the following interesting observation: “Separate suprasternal ossicles occur in two of the gibbons examined (= 0.07%)…. These ossicles are quite common in Man.… Never before have they been observed in primates other than man”. Cobb2 found no evidence of suprasternal ossicles in the skeletons of sixty-one gorillas, thirty-eight chimpanzees and eight orangs. Schultz has not seen this primitive condition “among many hundreds of monkey and ape skeletons examined, except in the two gibbons mentioned”.

The os trigonum.

1. Previous papers on the subject of the os trigonum are reviewed. 2. Evidence is produced to show that the posterior part of the talus normally develops from separate centres. 3. An explanation is given for the presence in adults of separate ossicles (the so-called os trigonum) in one or both ankles and for the variety of shapes adopted by them. 4. Contrary to opinions expressed by previous writers, these ossicles may give rise to symptoms.

An Accessory Bone and Other Bilateral Skeletal Anomalies of the Elbow

True accessory bones of the elbow have not been established with certainty (1). Separate ossicles have been reported in relation to the olecranon fossa, to the medial or lateral epicondyles, and to the coronoid fossa. In the first situation they are interpreted to be either sesamoid bones associated with the tendon of the triceps brachii or the ununited epiphysis of the olecranon process of the ulna. In the other positions they have been considered to be the result of ossific centers avulsed at an early age or parts of the normal bones separated by trauma. In each of these conditions there are resultant defects in the skeleton of the elbow (2). Wulfing (1) and Zeitlin (3) are among those who consider the presence of an accessory bone of the elbow to be invariably the result of trauma. Rarely has the bone been removed for histologic study (3). The elbows of a 65-year-old Negro male cadaver were conspicuous on the dissecting table because the joints were in semi-flexion and resisted extension beyond 135°. F...