Sesamoid Research Articles

A Retrospective Study of Radiographic Anatomy of Wrist in Chinese Population

In wrist pathology, there is a need to establish the normal range of radiographic measurement parameters. Previous study showed that the contralateral wrist might not be valid as a reference for all parameters. There is a lack of literature describing the normal range of wrist radiographic parameters in literature. As a result, a retrospective study was carried out. Patients who underwent standard wrist x-rays during the period February 2012 to February 2013 (one single year) were retrospectively reviewed. 71 patients were included. Scapholunate angle was 54.7° (±6.5°). Scapholunate interval was 2.0 mm (±0.4 mm). Ulnar variance was +1.0 mm (±1.8 mm). Carpal height was 31.8 mm (±3.0 mm). Radial inclination was 25.1° (±2.1°). All 71 patients had 1 sesamoid bone at first metacarpal. 16.9% (12 out of 71) patients had positive cortical ring signs. All these parameters are valuable clinically, especially in monitoring of the wrist disease progression, in the design of wrist implants and for future clinical research.

Sesamoid Bones in the Soft Tissue of Neck as Incidental Finding on Multidetector Computed Tomography

Sesamoid Bones in the Soft Tissue of Neck as Incidental Finding on Multidetector Computed Tomography

A radiological study of anatomical variants of hallux sesamoids

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 & 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 & distribution of hallux sesamoids in1000 radiographs of the foot. Result: Hallux Sesamoid bones were seen plantar to first metatarsal head in 994 radiographs [99.4%], while the absence of Hallucal 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.

NEW IN THE PATELLA FRACTURES TREATMENT

In the literature there is a gap of publications about patella fractures management which is due to the absence of serious attention to the injuries of this largest sesamoid bone. In addition, in the world literature there is a lack of monographs and toolkits for the treatment of patients with these injuries, furthermore, in textbooks and traumatology manuals there are only a few template recommendations to the tactics of treating patients with this trauma. Meanwhile, patella fractures represent approximately 0.5-1.5% of all fractures, delayed union, formation of a false joint, and the emergence of patellofemoral arthrosis after these fractures is not uncommon. In the scientific literature on traumatology there is no unified, all-recognized classification of these fractures, which hinders the development of a single algorithm for the treatment of patients with patellar fractures. There are no contradictory views to the treatment of patella fractures without displacement; however, in relation to the treatment of patients with complex patella fractures, there are divergent views between the fracture fragments preservation to partial or even total patellectomy. In connection with the foregoing, We considered the issue of treating patients with patella fractures topical. Based on a thorough analysis of treatment results of 113 patients we provided a working classification based on the number of patellar fracture fragments (two-fragmentary, three-fragmentary, four-fragmentary, multi-fragmentary, upper and lower pole fractures). Based on this classification, traditional, modified and new methods of treating patients with patellar fractures were used. This is described in more detail in the forthcoming article.

Patella gigantism following traditional bonesetter treatment

The patella is the largest human sesamoid bone, lies within, and is an important component of the knee extensor mechanism. Tumors and tumor-like lesions of the patella are rare. Fractures of the patella are relatively uncommon and account for 1% of all musculoskeletal system fractures. These fractures can be managed by traditional bonesetters with attendant complications. To report a case of patella gigantism following a patella fracture which was treated by a traditional bonesetter. An 18-year-old male Nigerian presented with a 2-year history of anterior left knee swelling following a motorcycle accident. A diagnosis of closed patella fracture was made, but he declined orthodox treatment. Treatment had been from traditional bonesetters who were massaging the knee regularly for about 2 years. Clinical and radiographic examinations revealed an enlarged patella. He had patellectomy and reconstruction of the extensor mechanism of the left knee. The patella measured 22 cm × 18 cm and weighed 0.5 kg, which was regarded as a giant patella. Histopathological report of the excised patella revealed patella sclerosis. He made an uneventful recovery and presently walks about unaided. Patella gigantism can occur following treatment of patella fracture by traditional bonesetters. We recommend patellectomy and reconstruction of the extensor mechanism, whenever a giant patella is encountered.

Radiography of the distal extremity of the manus in the donkey foal: Normal images and quantitative characterization from birth to 2years of age: A pilot study.

This study describes a radiographic survey of the anatomical development of the distal extremity of the manus in the donkey from 0 to 2years of age. The right distal limb of 10 donkey foals, born in the spring of 2012, underwent radiographs every month for the first 6months of age and every 3months during the following 18months. Latero-medial radiographs with and without barium marker at the coronary band and dorso-palmar radiographs with both front feet in weight bearing were obtained. The distal physis of the third metacarpal bone and the proximal physis of the proximal phalanx (phalanx proximalis) were closed at the mean age of 18.6months. The distal physis of the proximal phalanx appeared as a clear radiolucent line at 2weeks of age and was still subtly visible in some donkeys at 24months. The proximal physis of the middle phalanx (phalanx media) was closed at the mean age of 16.7months. The distal physis of this phalanx was visible at birth, but closed at 4days. The distal phalanx (phalanx distalis) was triangular at birth. At the age of 20-21months, the palmar processes (processus palmares) were both developed. The navicular bone (os sesamoideum distalis) was developed at the mean age of 9months. The proximal sesamoid bones (ossa sesamoidea proximalia) were seen in continuously development during the 24months. It seems that the physes in the distal extremity of the manus in the donkey close at an older age than the physes in the horse.

New anatomical information of the wukongopterid Kunpengopterus sinensis Wang et al., 2010 based on a new specimen.

The Wukongopteridae compose a non-pterodactyloid clade of pterosaurs that are the most abundant flying reptiles in the deposits of the Middle-Late Jurassic Yanliao Biota. Until now, five species of three genera and two additional unnamed specimens have been described. Here we report on a new material, IVPP V 23674, that can be referred to the wukongopterid Kunpengopterus sinensis due to several features such as a comparably short nasoantorbital fenestra, the dorsally rising posterodorsal margin of the ischium, and the very short first pedal phalanx of digit V relative to metatarsal IV. IVPP V 23674 provides the first view of a wukongopterid palate, which differs from all other pterosaurs by having a very large postpalatine fenestra and laterally compressed choanae, indicating that the evolution of the pterosaur palate was more complex than previously thought. Sesamoid bones at the dorsal side of manual unguals are present and are reported for the first time in a wukongopterid suggesting an arboreal life-style for these pterosaurs.

Equine Sesamoiditis: Report on one case

Sesamoiditis is the inflammation of the proximal sesamoid bones. The aetiopathogenesis of sesamoiditis is still open to discussion, while several therapeutic protocols have been put forward. This study presents the case of a l6year-old Dutch Warmblood gelding with sesamoiditis of the right forelimb. A right forelimb lameness (3/10), with a positive lower limb flexion test (5/10) was noted, and enlargement of the soft tissues of the right fore fedock. Based on the positive low four point nerve block, radiographic examination of the fedock revealed the presence of numerous radiolucent areas along the palmar aspect of the sesamoidean bones, but only minimal new bone formation on its base. An ultrasonographic evaluation of the suspensory ligament and the distal sesamoidean ligaments was made, something which did not detect any abnormalities. Phenylobutazone (4mg/kg i.v. SID) was administered for five days and, also, local hydrotherapy with cold water was used and the horse was given a 15- day box rest. The horse was re-examined three months following the initial inspection. The radiographic examination of the fetlock showed the same lesions with the initial examination. The second ultrasonographic evaluation, though, showed enlargement by 50% of the lateral branch of the suspensory ligament with loss of the normal outline. Moreover, anechoic areas were noted within the branch with calcification at its insertion site. To address the inflammation phenylobutazone (4mg/kg i.v.) was administered for ten days and, also, local hydrotherapy with cold water was used. Box-rest for 30 days was recommended. In the end of this period there was no inflammation in the fetlock region. A blister (TWYDIL liquid blister®) was used in order to resolve the chronic inflammation of the suspensory apparatus. The horse was then given three weeks of box rest and received correcting shoeing (egg- bar shoe with elevated heels and rolled- toe). It was then put in a gradually increasingexercise program.

An Uncommon Fracture of the Thumb: Two Cases of Sesamoid Fracture.

Fractures of the sesamoids of the thumb, which are usually overlooked in examination, are rare injuries. Localized swelling, pain, and restricted motion can develop in the thumb after the injury. The ulnar and radial sesamoid bones of the thumb are avascular structures with pretendinous location. Therefore, fractures have a predisposition to avascular necrosis. Good outcomes are obtained with early diagnosis and conservative treatment. Incorrect or delayed diagnosis can cause chronic pain. Thus, early diagnosis and treatment are very important for these fractures.[1] [2] With the aim of raising awareness of isolated thumb sesamoid fractures and emphasizing the importance of physical examination and radiologic evaluation in cases of thumb trauma, two cases are presented in this paper.

Morphology characteristics of sural bean bone and it's role in knee joint diseases

Fabella is a common sesamoid bone. In recent years, people have paid more attention to its anatomic location, distribution characteristics in crow, importance in stabilizing knee joint and related diseases. This article reviews the anatomy, distribution and the relationship between the calf bone and the knee joint diseases, so as to strengthen the attention of the bones in the diagnosis and treatment of knee diseases.

Designing, Manufacturing and Testing of a Piezoelectric Polymer Film In-Sole Sensor for Plantar Pressure Distribution Measurements

We have designed, manufactured, and tested a prototype of an in-sole plantar pressure sensor. The sensor is made of a piezoelectric polymer film (polyvinylidenefluoride, PVDF) with evaporated copper electrodes. The size and the location of measuring sites are carefully considered to produce a light-weighted, practical, and inexpensive matrix sensor for measurement of plantar pressure distribution. The sensor consists of eight measurement locations: hallux, first metatarsal head (under both sesamoid bones), metatarsal heads 2–5 and heel. The developed in-sole sensor was evaluated through piezoelectric sensitivity measurements and test measurements with subjects (used as a platform sensor). Average peak-to-peak pressures from 58 to 486 kPa were obtained in plantar pressure measurements. The in-sole sensor can be used to prevent pressure ulcers. Also other application areas for the sensor are available, e.g., rehabilitation and sports. The developed sensor enables unobtrusive and long-term plantar pressure measurements. In future, an option for manufacturing the PVDF in-soles may be printing of desired electrode pattern on PVDF material, that would allow fast production, and if needed, the production of even individual in-soles.

Partite hallux sesamoid bones: Relationship with sesamoid bones at other metatarsophalangeal joints.

Partite hallux sesamoids are clinically meaningful but their association with other sesamoids is not clear. The objective was to relate the prevalence of the partite hallux sesamoid bones to sesamoid bones at other metatarsophalangeal (MTP) joints. We conducted a retrospective review of plain radiographs of 7946 adult feet between November 2005 and September 2012 to identify partite hallux sesamoids and sesamoids at other MTP joints. Coexistence patterns of the partition and extra sesamoids were studied. Presence or absence of sesamoids at other MTP joints as well as sex and laterality were compared between the feet with and without partite hallux sesamoids using Pearson Chi-square test. Association between age and partition was evaluated using Spearman's correlation coefficient. Overall partite prevalence rate is 6.82%, and coexistence with extra MTP sesamoids was 0.42%. One pattern was partition in hallux sesamoid only, and 4 patterns were coexistence with extra sesamoids. The prevalence rates of partite hallux sesamoids were 7.17% (508/7081) and 3.93% (34/865) in feet without and with extra sesamoids, respectively. The relative risk of 1.889 (95% CI, 1.325-2.693) of partite hallux sesamoids was noted in feet without than with extra sesamoids (Χ2 = 12.759, P < 0.001). A negative correlation between age and distribution of partition was identified (r = -0.061, P < 0.001). Partition of hallux sesamoid bones is a developmental variation, it can coexist with sesamoids at other MTP joints following a certain pattern; and its prevalence rate is almost twice higher in feet without than with extra MTP sesamoids. Anat Rec, 2017. © 2017 Wiley Periodicals, Inc. Anat Rec, 301:34-38, 2018. © 2017 Wiley Periodicals, Inc.

Tripartite Fracture of the Ulnar Sesamoid Bone of the Thumb

Tripartite Fracture of the Ulnar Sesamoid Bone of the Thumb

Absence of bony patella in the white-eared opossum (Didelphis albiventris): Morphology and diagnostic imaging.

Patella, the kneecap, is the best known and largest of the sesamoid bones and is present in the quadriceps femoris tendon. Typical patella appears in all extant mammals, with the exception of some marsupials and bats. No description about the white-eared opossum stifle was found in the available literature up to now. Thus, the knee joints of 16 Didelphis albiventris were examined by gross anatomy, histology, radiography and computed tomography images to determine the presence or absence of ossified patella in this animal. The most remarkable observation in white-eared opossum is the absence of a bony patella. The femoral trochlea is shallow, and the lateral gastrocnemius sesamoids are shown up in all opossums. The quadriceps femoris tendon is composed mainly of dense regular connective tissue with a classic fibrocartilage pad on the superficial surface of the tendon. The absence of a true patella seems to be typical for marsupials.

Prevalence and distribution of the fabella: a radiographic study in Turkish subjects.

The purpose of this study is to examine the plain knee radiographs in Turkish subjects in order to determine the prevalence of the fabella and analyse the differences between age, gender, laterality and its symmetry pattern. Bilateral antero-posterior and lateral knee radiographs of 500 patients (250 male and 250 female subjects, 1000 knee radiographs) were randomly selected from the clinical database and retrospectively evaluated. Data on patient age, gender, and knee laterality (right-left) were evaluated from hospital records. The differences between the sesamoid bones at a particular location and the side, sex and age groups were analysed. The overall prevalence of the fabella (unilateral or bilateral) was 22.8% (114 subjects). The fabella was present unilaterally in 38 (7.6%) subjects, while it was present bilaterally in 76 (15.2%) subjects. The prevalence of the fabella was similar between the body sides. The prevalence of the fabella was also similar between genders (unilateral or bilateral cases) and age groups. We examined the prevalence, symmetry pattern, age and gender differences in Turkish population. It is the first study performed on Turkish population with the largest sample in current literature. Prevalence of fabella is found to be 22.8% which is quite similar with other Caucasian ethnic populations.

Thumb Ossification Composite Index (TOCI) for Predicting Peripubertal Skeletal Maturity and Peak Height Velocity in Idiopathic Scoliosis: A Validation Study of Premenarchal Girls with Adolescent Idiopathic Scoliosis Followed Longitudinally Until Skeletal Maturity.

Background:Accurate skeletal maturity assessment is important to guide clinical evaluation of idiopathic scoliosis, but commonly used methods are inadequate or too complex for rapid clinical use. The objective of the study was to propose a new simplified staging method, called the thumb ossification composite index (TOCI), based on the ossification pattern of the 2 thumb epiphyses and the adductor sesamoid bone; to determine its accuracy in predicting skeletal maturation when compared with the Sanders simplified skeletal maturity system (SSMS); and to validate its interrater and intrarater reliability.Methods:Hand radiographs of 125 girls, acquired when they were newly diagnosed with idiopathic scoliosis prior to menarche and during longitudinal follow-up until skeletal maturity (a minimum of 4 years), were scored with the TOCI and SSMS. These scores were compared with digital skeletal age (DSA) and radius, ulna, and small hand bones (RUS) scores; anthropometric data; peak height velocity; and growth-remaining profiles. Correlations were analyzed with the chi-square test, Spearman and Cramer V correlation methods, and receiver operating characteristic curve analysis. Reliability analysis using the intraclass correlation (ICC) was conducted.Results:Six hundred and forty-five hand radiographs (average, 5 of each girl) were scored. The TOCI staging system was highly correlated with the DSA and RUS scores (r = 0.93 and 0.92, p < 0.01). The mean peak height velocity (and standard deviation) was 7.43 ± 1.45 cm/yr and occurred at a mean age of 11.9 ± 0.86 years, with 70.1% and 51.4% of the subjects attaining their peak height velocity at TOCI stage 5 and SSMS stage 3, respectively. The 2 systems predicted peak height velocity with comparable accuracy, with a strong Cramer V association (0.526 and 0.466, respectively; p < 0.01) and similar sensitivity and specificity on receiver operating characteristic curve analysis. The mean age at menarche was 12.57 ± 1.12 years, with menarche occurring over several stages in both the TOCI and the SSMS. The growth remaining predicted by TOCI stage 8 matched well with that predicted by SSMS stage 7, with a mean of <2 cm/yr of growth potential over a mean of <1.7 years at these stages. The TOCI also demonstrated excellent reliability, with an overall ICC of >0.97.Conclusions:The new proposed TOCI could provide a simplified staging system for the assessment of skeletal maturity of subjects with idiopathic scoliosis. The index needs to be subjected to further multicenter validation in different ethnic groups.

Prevalence and distribution of sesamoid bones and accessory ossicles of the foot as determined by digital tomosynthesis

We previously reported that digital tomosynthesis (DTS) is a reliable tool for evaluating bony structures of the hand. The current study aimed to identify the prevalence and distribution of sesamoid bones and accessory ossicles of the foot using DTS and to compare the results to those of conventional radiography (CR). Foot images (DTS, 213; CR, 44) of 213 patients taken at a tertiary hospital were retrospectively reviewed. Sesamoid bones were identified in the metatarsaophalangeal (MTP), distal interphalangeal (DIP) and interphalangeal (IP) joints of the great (I), second (II), third (III), fourth (IV), and fifth (V) toes. Accessory ossicles were observed in the midfoot and hindfoot. The mean number of sesamoid bones and accessory ossicles was 3.9 ± 1.3 for the left foot and 3.7 ± 1.0 for the right foot on CR; and 3.9 ± 1.4 for the left foot and 3.9 ± 1.3 for the right foot on DTS. Sesamoid bones were observed in MTP I (100%), MTP II (5%), MTP III (2%), MTP IV (2%), MTP V (14%), and IP (68%) on CR. Sesamoid bones were observed in MTP I (100%), MTP II (8%), MTP III (1%), MTP IV (2%), MTP V (25%), and IP I(65%) on DTS. Among accessory ossicles, the most common bone identified was os tibiale externum (23% on CR and 33% on DTS) andos peroneum (14% on CR and 21% on DTS), and os trigonum (32% on CR and 0.5% on DTS). DTS was useful for finding sesamoid bones and accessory ossicles, although there were some limitations in observing the hindfoot. Clin. Anat. 30:1072-1076, 2017. © 2017 Wiley Periodicals, Inc.

Distribution of Sesamoid Bones in the Hand—A Study in the Chinese Population: 研究中國人的手部籽骨分佈

ObjectiveTo report the prevalence and distribution of hand sesamoid bones in Chinese ethnic group and its left-right symmetry. MethodsA retrospective study involving hand radiographs taken in patients admitted to United Christian Hospital from January 2011 to June 2014. Exclusion criteria included previous hand fracture, inadequate radiological views and those of non-Chinese ethnic group. ResultsA total of 307 hand radiographs (162 left and 145 right; 181 males and 126 females) in 266 patients were reviewed. Bilateral hand radiographs were available in 41 patients. Their mean age (± standard deviation) was 48.8 ± 11.3 years (range, 25–69 years). The total number of sesamoid bones identified was 1,641. Sesamoid bones were found at the first metacarpophalangeal joint (MCPJ) at a rate of 100%, while the prevalence at the second MCPJ, third MCPJ, fourth MCPJ, fifth MCPJ as well as the first interphalangeal joint (IPJ) was 59.0%, 2.93%, 0%, 47.6% and 28.0%, respectively. Bilateral hand radiographs showed 100% symmetrical distribution of sesamoid bones on right and left sides. ConclusionThis is the first study in Hong Kong to report prevalence of sesamoid bones in the Chinese Population and identify the symmetry of sesamoid bones in bilateral hands. The result revealed that the Chinese ethnic group had a higher prevalence of sesamoid bones at the 2nd and 3rd MCPJ when compared with other ethnic groups. The distribution of sesamoid bones was symmetrical in bilateral hands.

Thoroughbred fatality and associated jockey falls and injuries in races in New South Wales and the Australian Capital Territory, Australia: 2009–2014

Monitoring racehorse fatality and associated jockey falls provides benchmarks for intervention strategies. The aims of this study were to describe the incidence of and reasons for fatalities in Thoroughbred horses during flat races in the Australian Capital Territory and New South Wales (NSW), Australia, and to describe reported jockey falls and injuries associated with racehorse fatalities. A cohort study identified all racehorse fatalities reported through Racing NSW for the 2009–2010 to 2013–2014 racing seasons. Risks of racehorse fatality, fatal musculoskeletal injury, spontaneous death (as distinct from euthanasia) and racehorse fatality associated jockey falls and injuries were calculated using Poisson regression. A total of 167 horse fatalities were reported, with an overall incidence of 0.59 deaths/1000 starts. Forty-nine reasons for horse fatality were reported, although post-mortem examinations were conducted on only 52/165 (31.5%) horses. Musculoskeletal injury accounted for 144/167 (86.2%) fatalities, with an incidence of 0.52/1000 starts. Fractures comprised 96/167 (57.5%) fatalities, with the fetlock or proximal sesamoid bones being the most common fracture location, comprising 36/96 (37.5%) fractures. Only 22/166 (13.3%) racehorse fatalities were due to spontaneous death, representing an incidence of 0.08/1000 starts. A total of 50 racehorse fatality associated jockey falls were reported (incidence of 0.18/1000 starts), with 32 reported jockey injuries (incidence of 0.12/1000 starts). Most racehorse fatality associated jockey injuries occurred to the limbs (17/32, 53.1%), particularly the upper limb. The estimates for both horse fatality and associated jockey injury were comparable with previous estimates from other jurisdictions internationally.

Evaluation of occurrence of sesamoid bones in the lower extremity radiographs

The purpose of this study was to examine the plain AP radiograph of foot and lateral radiograph of knee in order to determine the prevalence and size of sesamoid bone in different part of foot and on the posterior aspect of the knee joint. A cross-sectional study was performed in Department of Radiology and Imaging, Tribhuvan University Teaching Hospital from July to September 2014. A total of 206 radiographs of foot (55) and knee (155) were collected. 121 (58.7%) were female and 85 (41.3%) were male. The most common site of sesamoid bone in foot was in the first metatarsal joint (96.4%) whereas the sesamoid bone in knee joint, fabella was found in 12.3% of total cases. The prevalence is more common in female than in male. The length and breadth of the sesamoid bones were measured and then area of bones was calculated. The size of medial and lateral sesamoid bone in the first MTP Joint was measured 0.6225 cm2 and 0.8261 cm2 respectively. The mean size of sesamoid bone of knee, fabella was 0.2818 cm2.