Sesamoid Research Articles

Alternative surgical treatment for synovial ganglion cyst of the digital tendon sheath in one horse

SummaryA 6‐year‐old Highland pony gelding was presented with severe left fore (LF) limb lameness of acute onset. The lameness occurred concomitantly with mild digital flexor tendon sheath (DFTS) effusion and focal painful swelling on the lateral aspect of the LF fetlock region. Clinical examination and diagnostic analgesia localised the lameness to the fetlock region and on ultrasound, a cyst‐like structure filled with anaechoic fluid was detected just proximal to the lateral sesamoid bone, at the proximo‐lateral aspect of the DFTS and adjacent to the lateral neurovascular bundle. Communication between the cyst‐like structure and the DFTS was suspected ultrasonographically and then confirmed with contrast tenography. Tenoscopic examination of the LF DFTS was performed and the communication between the fluid‐filled structure and the synovial cavity was detected. The defect in the DFTS wall was enlarged tenoscopically and the lining of the cyst‐like structure was debrided. The horse recovered well post‐operatively and was back in work with no evident lameness 8 months after surgery. This alternative minimally invasive surgical treatment had an excellent outcome and has the advantage of reducing the risk associated with en bloc resection.

Fabella Syndrome: A Typical Case of Misdiagnosis and Discussion

Background: Fabella is a natural occurring sesamoid bone, cartilage or a mixture of both that is usually located at the posterolateral corner (PLC) of the knee [1]. Recently the PLC of the knee has been extensively investigated because it is a common site of injuries and diseases [2] [3]. The complexity of PLC anatomy needs to be fully understood because the fabella could be missed diagnosis as an osteochondral defect, osteochondritis dissecans (OCD), calcific tendinitis, or foreign body. We present a case report of fabella syndrome triggered by trauma and also performed a review of literature for the various diagnoses that might be confused with fabella syndrome. Case presentation: A 29-year-old, Sudanese male presented to the trauma center in King Khalid Hospital in KSA, complaining of pain and partial swelling in his left knee joint due to trauma. Fabella was detected in the posterior lateral corner (PLC) of the knee joint embedded in the lateral head of the gastrocnemius muscle. All other pathological conditions were excluded. Conclusion: Fabella is sesamoid bone with variable size, found in the PLC. Commonly if present it causes periodic pain especially in the fully extended knee or it remains asymptomatic. Trauma, surgery, sports or heavy extreme activities may trigger the pain of asymptomatic fabella. Clinicians should consider that pain in the PLC of the knee can result from the presence of the fabella in a condition called fabella syndrome.

In vitro biomechanical comparison of headless compression versus cortex screws for fixation of simulated midbody proximal sesamoid bone fractures in horses

A midbody fracture of a proximal sesamoid bone (PSB) is a severe injury, especially in racehorses. Screw fixation may be the only option for horses to return to athletic activity. In a cadaveric biomechanical study, fixation of simulated transverse midbody PSB fractures with a 4.5 mm headless compression screw (HCS) was compared to the fixation using a 4.5 mm cortex screw (CS) inserted in lag fashion. The front limbs of 8 horses were prepared with a standardized midbody transverse osteotomy in each medial PSB. The left or the right limb of each pair was randomly assigned to the CS or HCS group. Fracture reduction and fixation was controlled by radiography. Markers were fixed proximal and distal to the osteotomy to document gap opening by an image correlation measurement. Cyclic compressive loading was applied with a hydraulic cylinder in an axial manner leading to tensile cyclic loading in the PSBs. After mechanical testing all limbs were radiographed to document the mode of failure. The mean cycles to total failure were 27,803 for the HCS group and 36,624 for the CS group, respectively. A mean of 14,444 cycles (HCS group) versus 27,464 cycles (CS group) was recorded at a fracture gap opening of 10 %. The mean value of initial stiffness was 300 N/mm (HCS group) versus 590 N/mm (CS group). On post-testing radiographs, failure by screw breakage was detected in 3/8 limbs of the HCS group and in 2/8 limbs of the CS group. Screw pullout and bone failure was noted in 5 limbs in each group. In one limb of the CS group, the medial suspensory branch was disrupted and the fracture fixation was intact. None of the differences between HCS and CS constructs reached statistical significance. However, the lower absolute numbers of cycles sustained before failure, at 10 % gap opening and lower initial stiffness of HCS constructs as well as limitations of the study warrant further investigation before clinical use of the HCS for this indication can be recommended.

Objective assessment of lameness in cattle after foot surgery.

Assessment of lameness in cattle after foot surgery is important to monitor the recovery period, to improve the long-term success and the cows` welfare. This longitudinal multicenter retrospective study was carried out to evaluate the usefulness of automated tools of weight bearing and gait analysis following foot surgery to support the clinician to monitor lameness in cattle. For this purpose, the effect of involvement of different anatomical structures and the use of different surgery methods on gait parameters of post-operative recovery was assessed. The study consisted of 2 experiments and included cattle with unilateral foot pathologies located in the digital region which needed 1 (experiment 1; n = 30) or 2 (experiment 2; n = 4) surgical interventions. The surgical techniques were debridement, joint lavage, partial resection of bones, tendons or synovial structures, total resection of the sesamoid bone and digit amputation. Two accelerometers (400 Hz; kinematic outcome = stance phase duration; kinetic outcome = foot load and toe-off), a 4-scale weighing platform (difference of mean weight distribution across the limbs; Δweight) and a subjective locomotion score were used to evaluate gait parameters every 3 to 4 days after surgery. A repeated measures ANOVA was used in experiment 1 and a receiver operator characteristic analysis was used to determine the optimal cutoff values in experiment 2. Results showed that the differences across limbs for the pedogram variables of stance phases and peaks of foot load and toe-off, Δweight and the locomotion score were highest if joints or sesamoid bones were involved, suggesting that these cattle were more severely lame compared to cattle with more superficial foot pathologies. There was a significantly lower degree of lameness after surgical debridement and after digit amputation compared to partial and total resection of anatomical structures of the foot. The use of accelerometers and a 4-scale weighing platform represent promising objective tools for post-operative monitoring of lameness and can support the clinician in gait assessment to improve the long-term success of surgical interventions in the area of the foot.

Ultrasonographic, Computed Tomographic, and Magnetic Resonance Imaging of the Normal Donkeys (Equus asinus) Digit

The present study was designed to provide a descriptive imaging database of the anatomic features of the digit of normal donkeys using ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI) as a means to improve diagnosis and clinical decision-making regarding digit lameness in donkeys. Ten healthy donkeys with sound limbs were assigned for US examination of the digit in each forelimb. In addition, five donkey’s forelimb digit cadavers were subjected for CT and MRI examination. The donkey's digit was divided into three regions: fetlock, pastern, and foot. For evaluation of the digit, longitudinal and transverse US images were obtained. In CT evaluation, three plans were taken: axial, sagittal, and coronal. Whereas, in MRI evaluation, two plans were taken: axial and sagittal with two sequences, T1 and proton density. All US, CT, and MRI images of the donkey's digit were labeled and serially interpret using correlated anatomic cross-sections and references. There was a full description and proper differentiation of the anatomical features of the digit bony (distal third of cannon bone [MCIII], proximal sesamoid bones, phalanges, navicular bone, and digital cushion) and soft tissue structures (superficial digital flexor tendon, deep digital flexor tendon, suspensory ligament, intersesamoidean ligament, straight distal sesamoidean ligament, common digital extensor tendon, annular ligament, and fetlock joint capsule) on US, CT, and MRI images. In conclusion, US, CT, and MRI provide a useful noninvasive method for evaluation of the digit and give a well-defined baseline reference images for the donkey's digit for educational, research, and radiologic purposes.

Computational model for the patella onset.

The patella is a sesamoid bone embedded within the quadriceps tendon and the patellar tendon that articulates with the femur. However, how is it formed is still unknown. Therefore, here we have evaluated, computationally, how three theories explain, independently, the patella onset. The first theory was proposed recently, in 2015. This theory suggested that the patella is initially formed as a bone eminence, attached to the anterodistal surface of the femur, while the quadriceps tendon is forming. Thereafter, a joint develops between the eminence and the femur, regulated by mechanical load. We evaluated this theory by simulating the biochemical environment that surrounds the tendon development. As a result, we obtained a patella-like structure embedded within the tendon, especially for larger flexion angles. The second and third theories are the most accepted until now. They state that the patella develops within tendons in response to the mechanical environment provided by the attaching muscles. The second theory analyzed the mechanical conditions (high hydrostatic stress) that (according to previous Carter theories) lead to the differentiation from tendon to fibrocartilage, and then, to bone. The last theory was evaluated using the self-optimizing capability of biological tissue. It was considered that the development of the patella, due to tissue topological optimization of the developing quadriceps tendon, is a feasible explanation of the patella appearance. For both theories, a patella onset was obtained as a structure embedded within the tendon. This model provided information about the relationship between the flexion angle and the patella size and shape. In conclusion, the computational models used to evaluate and analyze the selected theories allow determining that the patella onset may be the result of a combination of biochemical and mechanical factors that surround the patellar tendon development.

Prevalence of the fabella and its association with pain in the posterolateral corner of the knee: A cross-sectional study in a Romanian population.

The functions and clinical consequences of the fabella, a sesamoid bone found in the posterolateral aspect of the knee joint, are still a reason of intense debate in the scientific literature. Its incidence was reported to range between 20% and 87% and its presence was usually associated with the persistent pain in the posterolateral region of the knee. The aim of our study was to measure the prevalence, anatomic and clinical features of the fabella within a cross-sectional study, conducted in a Romanian orthopaedic center. Between 2015 and 2017, a consecutive series of 562 patients with knee injuries or persistent knee pain has been examined by radiographs and Magnetic Resonance Imaging and a set of anatomical and clinical parameters have been recorded. Collected data was evaluated with RadiANT DICOM Viewer and statistically analyzed with GraphPad Prism 7. The level of significance was set at P <.05. The incidence of the fabella in our study group was 16.93%, lower than previously reported for Caucasian populations. We found statistically significant differences regarding the possible association of the fabella with pain in the posterolateral corner of the knee (P = .04) and the 2 dimensions of the bone according to gender (P = .03 respectively P = .01), but the prevalence was not influenced by gender (P = .6). The anatomic characteristics could be important in differentiating this sesamoid bone from calcifications or loose bodies located in the knee joint region. Due to the high association with the posterolateral knee pain, the fabella should be recorded during knee examination as a differential diagnosis, before any surgical procedure.

The hyoid bone: an overview

ABSTRACTThe hyoid bone is a small horseshoe-shaped bone located between the mandible and the shoulder girdle. It is classified as a sesamoid bone which means it is a freely floating bone. However, it is anything but freely floating. The hyoid bone is a vestigial structure and is found as part of the tongue in lower animal forms. The hyoid bone is attached to the base of the skull, the mandible, the tongue, the larynx, and the scapular belt. Even though the hyoid bone is an important structure, it has not received the attention that it deserves. It participates in the function of speech, respiration, mastication, and swallowing, as well as maintaining the patency of the airway between the oropharynx and the tracheal rings. Knowledge of the anatomy and physiology of the hyoid is necessary for recognition of the clinical presentation of related disorders and syndromes.

Comparison of Thermographic Imaging and Other Diagnostic Techniques in Diagnosis of Cattle with Laminitis

Background: Lameness results in major economic losses on dairy farms. The proportion of lameness in cows are between 4-55%, the origin of 90% lameness are caused by foot diseases. Hoof abnormalities such as laminitis are major contributors to lameness. Aim of the study, compared with thermographic imaging (IRT) and radiographic, magnetic resonans (MR), computer tomography (CT), histopathological analysis on the diagnosis of laminitis.Materials, Methods &amp; Results: Preliminary, the animals (20 Holstein-Fresian) were selected by lameness examination for evaluation of the for any obvious signs of disease. The animals were examined when rising and walking of the free stalls. Walking was very painful and clinical symptoms of general distress become present for laminitic group. The cows were scored on a 1 to 5 scale for their locomotion (1 = normal locomotion; 5 = severely lame). Thermographic examinations were performed the all animals after the routine clinical examination methods. The infrared images were taken from the dorsal view of all hoovesto monitor the temperature of coronary band. All images were scanned using a hand-held portable infrared camera (Wahl, Thermal Imager HSI3000 Series), which was calibrated to ambient temperature and absorptive conditions. Incentives radiological examinations, dorso-palmar and latero-medial shooting was done for using of (Regius Model 110 Konica, Minolta) 70 kV and 30 mAs for each claws. MRI images of all isolated digits were performed at the Department of Radiology, by using Siemens Symphony Erlangen, Germany. Continuous series of transversal, sagital and dorsoplantar scan were obtained from all digit. Computer tomography (CT), isolated digits were performed at the Imaging Department of Radiology, by using Siemens Symphony Erlangen, Germany. CT scanner was used to obtain contiguous slices from the region of the proximal sesamoid bones to the toe. Anterior side (laminar and perilaminar tissues) of the claws was uncovered with electric wheel. Tissue samples were taken 10% buffered formaldehyde solution after establishing a routine laboratory procedure following the prepared paraffin blocks 5 micrometers thick sections with hematoxylineosin dye method according to the staining. It was finally examined by light microscopy. The computer soft ware of the infrared thermal camera showed increased local temperature, by 0.5-1.5°C, between the normal and suspected regions for laminitic cases. Clinically, animals suspected of laminitis were showed general stiffness, lameness during walking difficulty. Examination of the claws was demonstrated of rings and plump appearance was evident in paries ungulae. The main damage was seen during trimming of the sole from no hemorrhages or discoloration of control group. The transversal MRI images provided excellent depictions of anatomical structures when compared to their corresponding pictures. Identifiable anatomic structure was labeled on the line drawings of the limb sections and on the corresponding CT images. Twenty out of 30 claws (65%) were shown laminitis statistical with histopathological examination. In histopathological examination; mononuclear cells and neutrophil granulocytes infilrations and edema, haemorrhagia, mild hyperemia in the lamellar region was remarkable in laminitic cases.Discussion: As a results, thermographic examination may have potential as a detection tool for laminitis. MR transversal images provided excellent depiction of anatomical structures and many biometric research in the bovine hoof can be easily investigated. The usefulness of IRT, MRI, CT in evaluating laminitis in the acute patient remains stil open. The use of diagnostic techniques during the initial active phase of laminitis as a means to increase the understanding of the disease and also serves as a justification for the development of an experiment involving live cows induces laminitis.

18 F-sodium fluoride positron emission tomography of the racing Thoroughbred fetlock: Validation and comparison with other imaging modalities in nine horses.

Early and accurate detection of stress remodelling in racehorses is of utmost importance to prevent catastrophic injuries. Current imaging techniques have limitations in assessing early changes predisposing to catastrophic breakdowns. Positron emission tomography (PET) using 18 F-sodium fluoride (18 F-NaF) is a sensitive method for the detection of early bone turnover and may improve early recognition of subtle injuries. To validate the clinical use of 18 F-NaF PET in Thoroughbred racehorses, to assess the value of PET in the detection of bone lesions and to compare PET results with findings of other advanced imaging modalities, clinical examination and pathology. Experimental exploratory study. Twenty fetlocks from nine Thoroughbred racehorses were imaged using 18 F-NaF PET, computed tomography (CT) and scintigraphy. Five fetlocks were also imaged with magnetic resonance imaging and four fetlocks were also examined histologically. Imaging findings were independently reviewed by three board certified radiologists. Imaging, clinical and histopathological findings were correlated. PET imaging was well-tolerated by all horses. PET detected focal areas of 18 F-NaF uptake in instances where other imaging modalities did not identify abnormalities, in particular in the proximal sesamoid bones. Maximal standardised uptake values could be measured to quantify the activity of lesions. Areas of 18 F-NaF uptake corresponded to regions of increased vascularity and increased osteoblastic activity. Limited number of cases. 18 F-NaF PET imaging of the Thoroughbred fetlock is feasible and compares favourably with other imaging modalities in detecting stress remodelling in Thoroughbred racehorses. PET appears to be a beneficial imaging modality when used for early detection of stress remodelling in an effort to prevent catastrophic musculoskeletal injuries in this population of horses.

Associations between the radiographic appearance of vascular channels in proximal sesamoid bones, their microstructural characteristics and past racing performance in Thoroughbreds

Associations between the radiographic appearance of vascular channels in proximal sesamoid bones, their microstructural characteristics and past racing performance in Thoroughbreds

Horses with solar foot penetration, deep digital flexor tendon injury, and absence of concurrent synovial sepsis can have a positive outcome.

Solar foot penetration is one of the causes of deep digital flexor tendon injuries in horses, however, limited information is available on the prognosis for return to soundness in the absence of synovial sepsis. Objectives of this retrospective observational study were to describe low-field magnetic resonance imaging (MRI) findings and long-term outcome for a group of horses with this combination of clinical problems. Horses were included if low-field standing MRI of the foot was performed following puncture wounds, injury of the deep digital flexor tendon was diagnosed, and sepsis was confirmed to be absent in all adjacent synovial structures (distal interphalangeal joint, navicular bursa, and digital flexor tendon sheath). Medical records were reviewed and MRI studies were re-interpreted. Follow-up information was obtained via a telephone questionnaire at a minimum of 6 months post-injury. A total of 11 horses met inclusion criteria. In three horses, the deep digital flexor tendon injury was only visible in the T2 fast spin echo sequence and contrast radiography improved diagnostic certainty. The most commonly affected area was between the distal border of the distal sesamoid bone and the facies flexoria of the distal phalanx (6/11, 55%). Six horses (60%) had an excellent outcome (5, show jumping; 1, general purpose) and returned to full athletic function. Five horses (40%) were sound but had not yet resumed full work at the time of follow-up. Findings indicated that the prognosis for return to soundness can be good for horses with solar penetration, deep digital flexor injury, and absence of synovial sepsis.

Fabella Syndrome Following De-Rotation Surgery to Correct a Femoral Malunion

Background:The fabella is a sesamoid bone situated within the lateral head of the gastrocnemius tendon, close to the lateral femoral condyle, and adjoined to the fabellofibular ligament. It is a normal variant, found in up to 87% of patients. Fabella Syndrome describes traditionally posterolateral knee pain, occurring due to biomechanical pressure of the fabella against the lateral femoral condyle. Given its rarity, its diagnosis is often overlooked. We present a case of Fabella Syndrome with a modified surgical excision technique and review of the literature.Methods and Results:A thirty-four-year-old man presented with posterolateral knee pain following de-rotation surgery to correct a femoral malunion, from a previous femoral shaft fracture. Due to the patient’s complex orthopaedic history, Fabella Syndrome was not initially diagnosed. Fabellectomy eliminated all symptoms of knee pain, with no limitations in knee function.Conclusion:Review of the literature identified ten publications (evidence level IV) describing Fabella Syndrome. This is the first reported case of Fabella Syndrome secondary to femoral de-rotation surgery. The authors recommend fabellectomy as a definitive treatment for Fabella Syndrome, in keeping with published literature.

Morphological, radiographic and computed tomographic evaluation of the metatarsophalangeal joint of the one-humped camel.

The camel digits have a complex structure with tendons, joints and ligaments. The objective of the study was to determine the anatomical features of the metatarsophalangeal joint and its puncture site in dromedary camel using anatomical dissection, radiography, computed tomography (CT) bone and soft tissue window scans and 3D reconstruction render volume of CT. The study used six adult camels of both sexes (three males and three females), aged 9-15years (Mean ± SD equal 11.80±2.59years). The camel fetlock possesses two metatarsophalangeal joints, left and right ones. The study described in detail the bony structures, ligaments and joint capsule of the metatarsophalangeal joint. The straight sesamoidean ligament was recorded in the studied one-humped camel joints. The joint capsule exhibited two recesses: dorsal and plantar recess. This is the first study to report the dorsal recess as triangular in outline with one proximal recess and two distal recesses, and the plantar recess as having two proximal recesses and one distal recess. The soft tissues examined around the fetlock were the proper extensor tendon, superficial, deep digital flexor tendon, digital scutum, collateral ligaments and sesamoidean ligaments. The plantar and dorsal pouches were the sites of joint injection. The present findings regarding joint injection indicate the plantar approach through plantar recess to fetlock to be preferable than the dorsal one as we used the proximal sesamoid bones and suspensory ligament as landmarks to inject easily.

MR imaging-anatomical correlation of the metatarsophalangeal joint of the hallux: Ligaments, tendons, and muscles

ObjectiveTo perform an MR imaging-anatomical correlation to elucidate the anatomy of muscles, tendons, and ligaments about the hallux as seen on MR imaging. Materials and methodsFour fresh and 4 embalmed cadaver specimens were used for this study. The embalmed specimens and one fresh specimen were dissected by three investigators. The fresh specimens were preserved deep frozen. They were thawed and imaged with a 3 T MR system. Proton density weighted images were obtained. The specimens were refrozen and sectioned with a band saw into 3 mm thick slices. ResultsMusculotendinous structures were equally well seen in the fresh and embalmed specimens. The capsular ligaments could best be studied in the fresh specimens. Proximal to the sesamoids the following muscle and tendon anatomy was delineated: the abductor hallucis tendon inserted on the medial sesamoid bone together with the medial belly of the flexor digitorum brevis; the adductor hallucis (transverse and oblique heads) inserted on the lateral sesamoid together with the lateral head of the flexor hallucis brevis. At the level of the sesamoid bones and distally, the ligaments making up the plantar plate were delineated, including the presesamoid band, the flexor hallucis longus pulley, the sesamometatarsal ligaments, the sesamophalangeal ligaments, and the capsular ligaments. ConclusionMRI allows for accurate assessment of the complex anatomy of the hallux. At the level proximal to the sesamoids the muscle and tendon insertions are well demonstrated. At the level of the sesamoids and distally, the ligaments making up ‘the plantar plate’ are well demonstrated.

Evaluation of Sesamoid Bone Reduction in Hallux Valgus Patients Treated With Three Different Osteotomy

Aim:The aim of this study is to investigate the effect of three different osteotomies on sesamoid rotation in hallux valgus surgery. Patients and Method: 64 out of 108 patients between March 2012-January 2015 were included retrospectively. Procedure of distal chevron, proximal dome and lapidus was applied to 26,18 and 20 patients respectively. Mean age of patients was 46,6 (26-62) and mean time of follow-up was 17 months. Results: At the last follow - up of patients, the mean hallux valgus angle was 18.4º, intermetatarsal angle was 7.4 º, AOFAS score was 86.1, sesamoid rotation was 13,5. When three different osteotomies were compared in terms of preop and postop sesamoid rotation differences in terms of their ability to correct most sesamoid position within themselves, a significant difference was found in patients treated with lapidus osteotomy in terms of success of sesamoid reduction compared to both patients treated with proximal dome osteotomy (p: 0.02) and patients treated with distal chevron osteotomy (p: 0.000). There was no significant difference in the success rate of sesamoid reduction between patients with proximal dome and patients with distal chevron. (P = 0.242) Discussion: Patients treated with lapidus osteotomy; both sesamoid rotation angle changes and sesamoid reduction were found to be better than the other two osteotomy types. According to the study, we think that the lapidus procedure will give better results in patients with moderate and severe hallux valgus when sesamoid reduction is considered to be related to recurrence.

Sesamoidectomy for the Hallux Sesamoid Disorders

Category: Midfoot/Forefoot Introduction/Purpose: Studies have shown that sesamoidectomy provides good clinical outcomes and quick return to sporting activities, however, there is concern regarding the complications following resection of one or both sesamoid bones. The purpose of the current systematic review was to evaluate the current evidence on sesamoidectomy for the treatment of the hallux sesamoid disorders. Methods: A systematic search of MEDLINE, EMBASE and Cochrane Library databases was performed based on the PRISMA guidelines. Included studies were evaluated with regard to level of evidence (LOE) and quality of evidence (QOE) using the Coleman Methodology Score. Reporting outcome data, clinical outcomes, and percentage of patients who returned to sport at previous level were also evaluated. Results: Ten studies with total 196 feet were included. The weighted mean age was 36.6 ± 11.0 with a mean follow-up of 45.1 ± 19.3 months. The mean Visual Analogue Scale score improved from a mean score of 6.5 ± 0.3 to 1.2 ± 0.5. The mean postoperative AOFAS score was 92.7 ± 2.7. Six studies demonstrated that 94.4% of patients returned to sport, with 90.0% returning to previous level, at a mean of 11.8 ± 1.8 weeks. The mean hallux valgus angle increased from 13.1 ± 2.1 preoperatively to 14.8 ± 3.7 postoperatively (p=0.470), and the mean intermetatarsal angle increased from 8.7 ± 0.8 to 9.7 ± 0.8 (p=0.180) following medial sesamoidectomy. The overall complication rate was 22.5%, and further surgeries were required in 3.0%(Table). Conclusion: The current systematic review demonstrated that sesamoidectomy for the hallux sesamoids disorders yields good clinical outcomes and a high rate of return to sports activity in the short-term. It is important to note however the high complications rate after sesamoidectomy, with a 22.5% complication rate in the short-term follow-up.

A radiological study of anatomical variants of hallux sesamoids

Abstract Background and Aims: Hallux sesamoid bones forms an integral part of the first metatarsophalangeal joint for stability during weight bearing. Hallux sesamoids are paired bones located on the plantar aspect of the first metatarsal head within the flexor hallucis longus tendon. Hallucal sesamoids vary in shape and size; can be single, double, bipartite and multipartite. Traumatic insult to the hallux sesamoids can lead to fracture &amp; dislocation, while majority of symptomatic hallux sesamoids can be treated non-surgically; certain specific injuries require a high index of suspicion, careful management, and surgical intervention. Hence present study was taken up to know the incidence, presence/absence, number and partition of hallux sesamoid to enlighten the surgeons and radiologists in early diagnosis and treatment of cases presenting with history of trauma, pain and fractures of foot. Methods: Retrospective radiographic study on the incidence, anatomical variants &amp; distribution ofhallux sesamoids inlOOO radiographs ofthe foot. Result: Hallux Sesamoid bones were seen plantar to first metatarsal head in 994 radiographs [99.4%], while the absence ofHallucal sesamoids were noted in 6 radiographs [0.6%], Single Hallucal sesamoid were noted in 9 radiographs [0.9%], medial bipartition was noted in 20 radiographs [2%], lateral bipartition was noted in 15 radiographs [1.5%]. Conclusion: Knowledge regarding hallux sesamoids helps us in differentiating the various conditions arising out of fractures of foot bones with overlapping signs and symptoms, from actual involvement of sesamoid bone itself, which assists in the early diagnosis and management of foot pathologies.

Factors influencing medial sesamoid arthritis in patients with hallux valgus deformity

Category: Midfoot/Forefoot Introduction/Purpose: The importance of preoperative evaluation of the position and degree of arthritic changes of the medial sesamoid bone before hallux valgus correction is emerging. This is an observational study to evaluate the magnetic resonance imaging (MRI) findings of hallux valgus deformity, and assess the severity of and identify the factors that influence the arthritic changes in medial sesamoid-metatarsal (mSM) joints. Methods: We reviewed weight-bearing anteroposterior radiographs, forefoot axial radiographs and MR images of 514 feet of 405 patients who underwent hallux valgus correction. On MRI, the degrees of the arthritic changes in the first metatarsophalangeal (MTP) and mSM joints were categorized into 5 classes. Binary logistic regression analysis was performed to identify the factors affecting the arthritic changes. Results: The binary logistic regression analysis showed that advanced age, more lateralized position of medial sesamoid bone on forefoot axial radiograph, and higher MRI grade of arthritic change of the 1st MTP joint were significant factors contributing to medial sesamoid arthritis (P &lt;0.001, 0.001. 0.006, respectively). Conclusion: Medial sesamoid arthritis can be assessed using MRI. The position of medial sesamoid bone on forefoot axial radiographs can strongly help predict the possibility of mSM joint arthritis.

Modified Scarf osteotomy for hallux valgus deformity in rheumatoid arthritis

Category: Midfoot/Forefoot Introduction/Purpose: For severe hallux valgus (HV) deformity in rheumatoid arthritis (RA) cases, arthrodesis of the 1st metatarsophalangeal (MTP) joint has been recommended. However, with the progress of medical treatment of RA, joint preservation surgery has recently been performed. This study aimed to investigate the clinical and radiographic outcomes of modified Scarf osteotomy with medial capsule interposition for RA cases, including severe 1st MTP joint destruction, and to evaluate risk factors for recurrence. Methods: A retrospective observational study of 76 cases (60 patients) [mean follow-up period: 35.3 months (24-56 months)] that underwent the modified Scarf osteotomy was performed. Japanese Society for Surgery of the Foot (JSSF) RA foot ankle scale scores, hallux scale scores, and a self-administered foot evaluation questionnaire (SAFE-Q) were evaluated, along with preoperative and postoperative radiographic parameters. Results: The mean JSSF RA foot and ankle and hallux score improved significantly (RA: preoperative: 52.2, final follow-up: 76.9, hallux: preoperative: 38.2, final follow-up: 74.5). Recurrence (hallux valgus angle (HVA) &gt;20°) occurred in 12 feet (15.8%). Preoperative DAS28-CRP (Disease activity score evaluated on 28 joints-C-reactive protein), intermetatarsal angle between the first and second metatarsal bone (M1M2A), and M1M5A, as well as HVA, M1M2A, M1M5A, and Hardy grade at 3 months after surgery, were significantly greater in the recurrence group. There was a significant negative correlation between preoperative DAS28-CRP and JSSF RA foot and ankle scores at final follow-up (ß = -0.39: p=0.02), while there was a significantly positive correlation between preoperative DAS28-CRP and HVA at the final follow-up (ß = 0.44: p=0.001). Conclusion: The modified Scarf osteotomy with medial capsule interposition for HV deformity improved clinical and radiographic outcomes in RA cases with severe 1st MTP joint destruction. Increased preoperative M1M2A and M1M5A, incomplete reduction of the sesamoid bone, HVA, M1M2A, and M1M5A at 3 months after surgery should be kept in mind for recurrence. The preoperative DAS28-CRP score was associated with clinical and radiographic outcomes after surgery.