Sesamoid Research Articles

Could the Prevalence and Distribution of Os Supratrochleare Dorsale and Patella Cubiti be the Key to Accurate Diagnosis?

The aim of this study was the prevalence of patella cubiti and os supratrochleare dorsale, and to detect the differences between genders. In the study, direct radiographs of 1646 people (959 females and 687 males), who presented to Fırat University Hospital between 01.01.2016 and 31.01.2019 and had elbow joint radiographs, were evaluated retrospectively. Of the radiographs evaluated, 346 were right and left elbow radiographs of the same people, 689 were just right elbow radiographs, and 611 were only left elbow radiographs. The prevalence of os supratrochleare dorsale was 2.08% (20 in 959 women) in women, 2.62% (18 in 687 men) in men, and 2.3% (38 in 1646 people) in total. The prevalence of patella cubiti was found to be 0.42% (4 in 959 women) in women, 1.31% (9 in 687 men) in men, and 0.79% (13 in 1646 people) in total. In addition, the prevalence of both sesamoid bones only in the left elbow and in both elbows was determined with and without separation according to male-female genders. We are of the opinion that knowing the prevalence and distribution of these sesamoid bones will help with establishing early and correct diagnoses for patients who present with complaints, such as elbow extension limitation and pain in the elbow area.

Equine Podotrochlear Apparatus - Histologic Characterization

Background: The navicular syndrome may be associated with alterations in other podotrochlear apparatus components, such as the deep digital flexor tendon, collareral sesamoid and distal sesamoid ligaments, podotrochlear bursa and distal sesamoid bone. However, the clinical significance and nature of these changes are not well understood, many of descriptive reports about distal sesamoid bone lesions are rarely accompanied by a complete and comprehensive comparison with animals of the control group. The aim of this study was to described histologically findings of the podrotrochlear apparatus components, allowing the understanding of the inserts and their microscopic appearance, thus providing the future recognize of their alterations.Materials, Methods & Results: Fourteen samples of the podotrochlear apparatus were taken out of 44 equine thoracic limbs specimens, separated at the radiocarpal joint of Crioulo and Thoroughbred horses, with an average age of 6.0-year-old, coming from a private clinic in southern Brazil. The thoracic limbs specimens were refrigerated at 4ºC at the clinic and then they were sent to the University Federal of Santa Maria (UFSM). Once at the University laboratory, the specimens were dissected to isolate the podotrochlear apparatus from each one. Subsequently, transversal and longitudinal samples from the distal sesamoid bone, deep digital flexor tendo, distal sesamoid ligament, colateral sesamoid ligament, were collected and podotrochlear bursa which were processed at the Veterinary Pathology Laboratory of the UFSM and University Federal of Santa Catarina (UFSC). The tissues samples were fixed in a 10% formaldehyde solution for 14 days and routinely processed for histology. The samples were sectioned at 3 µm and stained using the hematoxylin-eosin (H-E) routine method. The bone samples, after fixation, underwent a decalcified process in a formic acid-sodium citrate aqueous solution and routinely processed for histopathology. Histologic tendons evaluation showed that it is arranged in honeycombs fascicles in a transverse section observation. The tendinous fibers have a more compact and aligned collagen fibers arrangement due to the dense connective tissue. The synovial membrane of the podotrochlear bursa is composed of a cubic pseudo conjunctival epithelium arranged with a layer of synoviocytes forming villi towards the lumen. This characterization is very similar to that of the synovial joint membrane. The collateral sesamoid ligament fibers are not perfectly aligned, occurring at their confluence in some areas accompanied by the dissection of adipose tissue. The distal sesamoide ligament fibers, composed by of loose connective tissue associated with synoviocytes and vascular stroma. The articular surface of the distal sesamoid bone is arranged in 3 layers of chondrocytes embedded in a hyaline matrix. There was a clear differentiation between the subchondral bone area and the fibrocartilage tissue in the palmar aspect of the distal sesamoid bone.Discussion: The morphophysiological characterization of the podotrochlear structures inside the hoof capsule it is important for the future recognition of abnormalities and the possible hypothesis that originates the podotrochlear syndrome. These changes have great clinical relevance and very often associated of distal limb lameness in horses. The normal macroscopic, ultrasonographic and radiographic images along with the histomorphometric study of the podotrochlear structures have contributed for the morphophysiological comprehension and consequently future interpretation of the podotrochlear structures diseases.Keywords: podotrochlear apparatus, distal sesamoide bone, deep digital flexor tendon, navicular syndrome, histological findings.

The Prevalence of Accessory Ossicles, Sesamoid Bones, and Biphalangism of the Foot and Ankle: A Radiographic Study.

Background:Accessory ossicles, sesamoid bones, and biphalangism of toes are the most common developmental variations of the foot. These bones may be associated with painful syndromes; however, their clinical importance is not well understood because the reported prevalence varies widely. Therefore, we aimed to investigate these variants in Turkish subjects.Methods:A total of 1651 foot radiographs were retrospectively assessed. Radiographs of feet were examined regarding the prevalence, sex, and bilaterality of accessory ossicles, sesamoid bones, and biphalangism in Turkish subjects.Results:Accessory ossicles (26.1%) and sesamoid bones (8%) were detected. The most common accessory ossicles were os trigonum (9.8%), accessory navicular bone (7.9%), and os peroneum (5.8%). Also, we detected os supratalare (0.48%), os calcanei secundarium (0.42%) os subfibulare (0.42%), os supranaviculare (0.36%), os vesalianum (0.30%), os subtibiale (0.24%), os intermetatarseum (0.12%), and os subcalcis (0.12%). We observed bipartite hallux sesamoid in 1.8% and interphalangeal sesamoid bone of the hallux in 0.7% of radiographs. Incidences of metatarsophalangeal sesamoid bones were found as 0.6%, 0.06%, 0.6%, and 5.8% in the second, third, fourth, and fifth digit, respectively. We observed biphalangeal toe in 0.5%, 1.7%, 3.5%, and 37.6% in the second, third, fourth, and fifth toe, respectively.Conclusion:This study is the first detailed report on the incidence of the most common variants of the foot and ankle in a wide-ranging patients’ series in Turkish subjects. Our study’s findings will contribute to reducing misdiagnosis.Clinical Relevance:The results of this study may provide anatomical data that could help clinicians in the diagnosis and management of disorders that present with pain and discomfort in the feet. Knowledge of these variants is important to prevent misinterpreting them as fractures.

Painful Hallux Sesamoid: A Pictorial Review

AbstractSesamoids are small bony structures that are either partially or completely embedded in a tendon. Sesamoid bones are found at multiple places in body but most common sites are in foot, with the most consistent location being the metatarsophalangeal joint of great toe. Various pathologies affecting the sesamoid bones of hallux can be a cause of long-standing forefoot pain and discomfort. Imaging helps in diagnosis of these conditions at an early stage. Imaging also helps in differentiating these pathologies from normal variants like bipartite sesamoid bone.

Sesamoid excision during first metatarsophalangeal joint arthrodesis via a transarticular approach: A cadaveric study

Sesamoids of the first metatarsophalangeal joint can be a source of residual pain after surgical intervention for hallux rigidus. Theoretically, after fusion of the first metatarsophalangeal joint there should be little to no motion at the metatarsosesamoid articulations; however in many cases significant arthritis disease of the sesamoids may create hypertrophy and pain. Residual motion about the sesamoid articulations could result in recalcitrant pain after joint arthrodesis. Previous studies have discussed surgical sesamoidectomy for treatment of painful sesamoid bones, while frequently advocating for ancillary incisions in an attempt to obtain direct visualization. The goals of this cadaveric study were to identify any observable motion of the sesamoid bones after simulated first MTP joint fusion and assess if adequate visualization of the sesamoid bones can be obtained for proper excision through a standard dorsomedial approach. Using live fluoroscopy, no residual sesamoid range of motion was noted after fusion fixation. We were able to perform successful total sesamoidectomy in all specimens (n = 10) via the transarticular approach, with only 1 incident of minor tendon injury. Total sesamoidectomy took an average of 2:10 minutes, and average incision length was 4.9 cm. Despite the cadaveric nature of the present study, our results confirm a lack of motion to the sesamoid articulations after arthrodesis of the first MTP joint. Furthermore, using the transarticular technique discussed in this study, we exhibited that the standard dorsomedial approach can be used for safe and efficient sesamoidectomy, when indicated in conjunction with first MTP joint arthrodesis.

Морфофункциональная характеристика мышц коленного сустава у представителей семейства кошачьих

The article presents the morphological and functional characteristics of the knee joint muscles in representatives of the feline family. When studying the structural and functional features of the knee joint, a comprehensive methodological approach was used, including fine anatomical dissection, biomechanical modeling with subsequent analysis of the studied structures and survey radiography. The objects of research were 10 cats of both sexes in the age range from 1 to 6 years, without pathologies of the musculoskeletal system, kept at home. Based on the conducted studies, both general patterns and specific features of the anatomical organization of the knee joint muscles in representatives of the feline family have been established. The revealed specific features are expressed in cats in the specific anatomical design of the tailor's muscle, consolidated with topographically conjugated fascial formations. A semi-webbed muscle, which is characterized by uneven development of its parts, as well as a slender muscle, the aponeurosis of which is involved in the formation of the achilles. Based on the results of biomechanical modeling, it was found that the features of the anatomical design of the knee joint muscles determine their functional purpose. It is shown that the strainer of the wide fascia of the thigh, being a multi-articular muscle, bends the hip, unbends and supinates the knee joint in synergy with the semi-tendon and popliteal muscles. The biceps femoral muscle in the limb support phase participates through its cranial head in the extension of the knee joint, and the slender muscle initiates its flexion and pronation. The revealed features of the distribution of sesamoid bones in the knee joint in a domestic cat may have an applied value in the issues of objective decoding of radiographic information, as well as differential diagnosis of arthropathies of the knee joint. The obtained normative data can be used in assessing the condition of the musculoskeletal system of the studied animals, deviations in its morphogenesis and deciphering the mechanism of myopathy development.

Functional outcome of tension band wiring in transverse patella fracture

Background: Patellar fractures constitute about 1% of all skeletal injuries resulting from either direct or indirect trauma. The subcutaneous nature of the patella makes it vulnerable to direct trauma, whereas violent contraction of the quadriceps results in indirect fractures of the patella. Patella is the largest sesamoid bone in the body and forms an integral part of the extensor mechanism of the knee joint. The functional outcome of patella fractures depends on age, the severity of the injury, treatment modality, anatomical reduction and restoration of articular congruity, post-operative rehabilitation. The study aims to assess the functional outcome of tension band wiring in transverse patella fracture. Materials and Method: This study was carried out at the Department of Orthopaedics, Navodaya Medical College, Raichur over a period of 2 years. In this study, 30 patients (23 male, 7 females) with transverse patella fracture were admitted and were treated by tension band wiring. Functional outcome was assessed as per knee pain score, good fellow grading for a range of motion. Results: A total of thirty patients were evaluated in our study, of which there were 23 males and 7 females. Out of which 24 patients had excellent results, 4 had good results and 2 had fair results. At the end of the 6th month, the majority of patients show excellent results according to good fellow grading range of motion. Conclusion: The tension band wiring is safe and effective in the management of transverse patella fracture because of the good stability of the implant and easier postoperative rehabilitation.

Morphometric Analysis of Patella and Patellar Ligament in the Cadavers of Nepalese Origin

INTRODUCTION: The patella is the largest sesamoid bone in the body which develops within the tendon of the quadriceps femoris muscle. The patellar ligament is the continuation of distal part of the quadriceps femoris which finally ranges from the tip of patella to the tibial tuberosity of the tibia. The objectives of the study was to establish the morphometry of the Patella and Patellar ligament in correlation with gender and prevalence of types of patella. MATERIALS AND METHODS: The present study was conducted at the department of Anatomy of Nobel Medical College, Biratnagar, Nepal from Jan 2018 to June 2021. Twenty-six well embalmed adult cadavers (n=52) of known sex (13 Females and 13 Males) without any gross damage to the lower limbs were considered for the study. RESULTS: Out of the 52 limbs studied, the mean value of the length of patella, width of patella, thickness of patella in male were respectively 36.23±4.20mm, 37.15±6.09mm, 17.00±1.87mm. In female the values were 33.53±4.80mm, 34.53±6.07mm, 16.00±1.95mm which are highly significantly (p<0.005). In contrast it was also observed that the length of patellar ligament did not showed the significance differences between the male 45.92mm and female 44.92mm (p>0.05). So from here we can conclude that the morphometry of the patella plays an important role in the gender determination. CONCLUSIONS: The obtained data will be useful for the Comparative anatomy, Anthropology, Forensic Science and Evolutionary biology, anthropological records in context of Nepal and reference for the Orthopaedic surgeons in conducting the Knee replacement surgery as well.

Foot shape and radiographs of free-ranging Nubian giraffe in Uganda.

Foot health in zoo giraffe has been a topic of recent research, although little is known about the foot health of free-ranging giraffe. This study describes the foot shape and radiographic pathological changes in 27 young adult Nubian giraffe (Giraffa camelopardalis camelopardalis) from a translocation in Uganda (August 2017). Giraffe feet were observed to have a concave sole, the hoof wall was longest by the toe tip, and the weight-bearing surface of the foot was primarily along the periphery of the foot including hoof wall, parts of the heel, and the edge of the sole. Radiographs showed that pedal osteitis and sesamoid bone cysts were relatively uncommon (3/24 giraffe with osteitis, 1/24 giraffe with sesamoid cysts), and that no giraffe in the study had P3 joint osteoarthritis, P3 rotation, or P3 fractures. Radiographs consistently demonstrated a positive palmar/plantar angle with the sole of the hoof thicker at the heel than by the toe tip, with the non weight-bearing palmar/plantar angle measuring 1.6°- 4.3°. This is the first systematic review of foot shape and radiographs in free-ranging giraffe and demonstrates a low prevalence of foot pathologies. This study suggests qualitative differences in foot shape, foot health, radiographic anatomy, and foot pathologies when comparing free-ranging and zoo giraffe. Further research is needed to identify why these differences occur and whether husbandry modifications could help improve zoo giraffe foot health and prevent associated lameness.

In vitro motions of the medial and lateral proximal sesamoid bones under mid-stance load conditions are consistent with racehorse fracture configurations

Proximal sesamoid bone (PSB) fractures in racehorses are likely fatigue fractures that occur due to repetitive loads and stress remodeling. The loading circumstances that may induce damage in the PSBs are not well understood. The goal of this study was to determine in three-dimensions, PSB motions relative to the opposing metacarpal condyle during simulated mid-stance loads. Seven equine cadaveric forelimbs were axially loaded in a material testing system to simulate standing and mid-stance walk, trot, and gallop load conditions (1.8–10.5 kN). Joint angles were determined by tracking the positions of bone-fixed kinematic markers. Internal-external rotation, abduction–adduction, and flexion–extension of each PSB relative to the third metacarpal condyle were compared between loads and between PSBs using an ANOVA with Tukey-Kramer post hoc tests for pairwise comparisons. The medial PSB rotated externally and the lateral PSB apex abducted during limb loading. Medial PSB external rotation was significantly greater at the gallop load condition than at the walk or trot load conditions. The medial and lateral PSB motions observed in this study are consistent with location of fatigue damage and fracture configurations frequently seen in medial and lateral PSBs from Thoroughbred racehorses. Specifically, medial PSB external rotation is consistent with the development of an abaxial subchondral medial PSB lesion that is reported in association with medial PSB transverse fracture and lateral PSB abduction is consistent with axial longitudinal fracture of the lateral PSB.

Significance of the preservation of ‘pseudo-thumb’ in fossil skeletons of giant panda (ailuropoda melanoleuca) in Shuanghe Cave, Guizhou Province, southern China

ABSTRACT The age when the giant panda (Ailuropoda melanoleuca) transitioned to a bamboo dominant diet has not been well established due to the lack of fossil evidence. In particular, a radial sesamoid bone, which acts as a ‘pseudo-thumb’, has been used as evidence of giant pandas’ adaptive evolution to bamboo specialised consumption, but no relevant fossil evidence has been reported thus far. Shuanghe Cave is the longest cave in Asia, and produced fossils of more than 20 giant pandas, including relatively intact fossil skeletons of two adult giant pandas. The uranium-series dating of the fossilised teeth of the two giant pandas indicates ages earlier than 102 ka and 49 ka. Tooth wear for both individuals is not apparent, indicating that they were young at the time of death. From the skeletal fossils, for the first time, a ‘pseudo-thumb’ fossil of a giant panda was discovered. Our morphological comparison indicated that as early as 100,000 years ago, giant pandas had evolved an enlarged radial sesamoid bone (pseudo-thumb) that is comparable to that of the modern pandas, suggesting that in the early Late Pleistocene at the latest, giant pandas possessed physical conditions allowing them to dexterously grab bamboo with their manuss.

Comparative evaluation of tomosynthesis, computed tomography, and magnetic resonance imaging findings for metacarpophalangeal joints from equine cadavers.

To describe the technique and assess the diagnostic potential and limitations of tomosynthesis for imaging of the metacarpophalangeal joint (MCPJ) of equine cadavers; compare the tomosynthesis appearance of pathological lesions with their conventional radiographic, CT, and MRI appearances; and evaluate all imaging findings with gross lesions of a given MCPJ. Distal portions of 4 forelimbs from 4 equine cadavers. The MCPJs underwent radiography, tomosynthesis (with a purpose-built benchtop unit), CT, and MRI; thereafter, MCPJs were disarticulated and evaluated for the presence of gross lesions. The ability to identify pathological lesions on all images was assessed, followed by semiobjective scoring for quality of the overall image and appearance of the subchondral bone, articular cartilage, periarticular margins, and adjacent trabecular bone of the third metacarpal bone, proximal phalanx, and proximal sesamoid bones of each MCPJ. Some pathological lesions in the subchondral bone of the third metacarpal bone were detectable with tomosynthesis but not with radiography. Overall, tomosynthesis was comparable to radiography, but volumetric imaging modalities were superior to tomosynthesis and radiography for imaging of subchondral bone, articular cartilage, periarticular margins, and adjacent bone. With regard to the diagnostic characterization of equine MCPJs, tomosynthesis may be more accurate than radiography for identification of lesions within subchondral bone because, in part, of its ability to reduce superimposition of regional anatomic features. Tomosynthesis may be useful as an adjunctive imaging technique, highlighting subtle lesions within bone, compared with standard radiographic findings.

Diagnosis, imaging, and potential morbidities of the hallux interphalangeal joint os interphalangeus.

Hallux pain is a common entity with a differential diagnoses including hallux valgus, hallux limitus/rigidus, and gout and specifically at the interphalangeal joint (IPJ), flexor hallucis longus (FHL) tenosynovitis, and joint arthrosis. An under-recognized source of pain is the os interphalangeus, an ossicle typically located at the plantar aspect of the hallucal interphalangeal joint. This ossicle is radiographically visible in its ossified form in 2-13% of individuals, but can also be present as an ossified or non-ossified nodule in patients. The os interphalangeus may be centrally or eccentrically located, and although originally believed to be a sesamoid bone in the FHL tendon, it is an ossicle located in the joint capsule of the IPJ and separated from the tendon by a bursa. When the ossicle is absent, the bursa is also absent and the tendon is attached to the joint capsule. Infrequently, the os may be located eccentrically under the first IPJ and reflect persistence of one of the distal phalanx. Rarely, the os interphalangeus may be dorsal to the IPJ. The os interphalangeus is best evaluated on radiographs, ultrasound, and MRI. Pain is a result of altered mechanics with arthrosis or frictional effects with bursitis, tenosynovitis, or intractable plantar keratosis (IPK). The ossicle may also displace into a dislocated IPJ, preventing reduction. The os interphalangeus may be centrally or eccentrically located, and although originally believed to be a sesamoid bone. This has been found within the plantar joint capsule of the distal hallucal interphalangeal joint and separated from the tendon by a bursa. Uncommonly, the location may be plantar eccentric and reflect persistence of one of the ossification centers of the distal phalanx. Although the ossicle can be imaged with standard AP and lateral radiographs in many cases, in those cases of unexplained pain with no radiographically visible ossicle, and the presence of friction blisters, intractable plantar keratosis (IPK), hyper-extension of the IPJ, hallux limitus/rigidus, or metatarsophalangeal joint (MTPJ) arthrodesis, an MRI or CT should be considered to identify a non-ossified fibrocartilaginous node. This is of particular concern in a patient with a history of underling diabetes mellitus or other metabolic disorders associated with diminished pedal sensation where neurotrophic changes place them most at risk for complications associated with excessive plantar pressure. Pain is a result of altered biomechanics with arthrosis, or frictional effects causing bursitis, tenosynovitis, or IPK. The ossicle may also displace into a dislocated IPJ, preventing reduction. In this article, we will describe the anatomy and imaging appearance of the common os interphalangeus variants and associated complications including frictional effects, arthrosis, and IPK and discuss conservative and surgical management of a symptomatic ossicle.

Prevelance of Fabella: An MRI Study in The Eastern Anatolia Region of Turkey.

The fabella, which is generally located in the lateral head of the gastrocnemius muscle, is a sesamoid bone that articulates with the posterior face of the lateral femoral condyle. As traditional information, the prevalence of fabella is between 10-30% in the population and is usually present in both knees. The objective of this study was to investigate the knee MRIs in the Eastern Anatolia Region of Turkey subjects in order to assess the prevalence of the fabella and analyse the differences between gender, age and laterality and its symmetry pattern. This study was a retrospective study in patients older than 18 years whose knee MRIs were taken between February 2014 and February 2016. In this study, a total of 531 patients (290 females and 241 males) were included. The radiographs were examined by two orthopedic surgeons and the fabella was located. Later, an expert radiologist made the final decision and confirmed the results. The number of patients included in the study was 531. We detected os fabella in 59 (11.1%) patients. Of the 59 os fabella, 33 were in the right knee and 26 were in the left knee, 38 were female and 21 were male. In this study, we investigated the age and gender differences besides the prevalence and the symmetry pattern of the fabella in the Eastern Anatolia Region of Turkey's population. Prevalence of the fabella was found to be 11.1% which is different than previously published studies.

Prevalence, Coincidence and Distribution Patterns of Sesamoid Bones of the Hand

Prevalence, Coincidence and Distribution Patterns of Sesamoid Bones of the Hand

Functional outcome of early movement of knee in transverse patellar fractures treated by modified tension band wiring

Background: The patella is the biggest sesamoid bone of the human frame located in front of the knee. Patellar fracture account for about one percent of all fractures and are most common within the age group of 20–50 years. Modified tension band wiring is the excellent for displaced transverse fractures. The principle of TBW is that tension forces at fracture site are converted to compression force. Materials and Method: This is a prospective study. This study was carried out at Sri aurobindo medical college and Pg institute during the period of January 2020 to May 2021. The functional status of the knee was analyse. Open reduction and internal fixation of the fractures were done by modified tension band wiring within 1week of fracture. Result: The mean age of the patients was 33.70 ± 6.73 years with a range from 23 to 49 years. There were 8 (40%) females and 12 (60%) males i, showing a male predominance. In 8 (40%) patients sustained injury due to fall and in 12 (60%) patients sustained injury due to road traffic accident. Conclusion: The modified tension band wiring is simple with a short period of learning curve, safe, inexpensive and effective technique in transverse fracture of patella because of good stability of implant, early joint mobilization with minimum complications and with easier post-operative rehabilitation.

Treatment of Fabella syndrome with arthroscopic fabellectomy: a case series and literature review

BackgroundThe fabella is a sesamoid bone in the posterolateral capsule of the human knee joint. In quadrupedal mammals, the fabella is believed to have a role similar to the patella in redirecting extension forces of the knee joint from one point to another. In bipeds, the fabella is not touching the back of the bent knee, and therefore the role in redirecting forces declines. Posterolateral knee pain can be associated with the irritation between the fabella and lateral femoral condyle, a phenomenon also known as fabella syndrome. In cases that are unresponsive to conservative management, surgical fabellectomy can be a successful treatment option. Among the surgical approaches, open resection is most commonly seen. There are also literature reporting arthroscopic-assisted open resection, but seldom mentioned the all-arthroscopic fabellectomy.Case presentationWe present 3 patients with a long history (> 12 month) of posterolateral knee pain under suspicion of different pain origins. The diagnosis of fabella impingement was eventually made by ruling out of other causes. All the patients underwent all-arthroscopic fabellectomy for diagnosis and treatment. Investigations of the resected fabella suggested chronic impingement with apparent osteophyte formation and cartilage wearing of the articular side. All patients have been continually followed up at our outpatient department and reported to be pain free after the procedure.ConclusionsIn the patients presenting posterolateral pain, fabella syndrome cannot be ignored due to its relative higher presence in Asian population. In our experience, the all-arthroscopic fabellectomy offers a smaller wound size, less post-operative pain, fewer days of hospitalization and quicker time to rehabilitation for the patients with chronic posterolateral knee pain caused by fabella syndrome.

Sesamoid bones also show functional adaptation in their microanatomy-The example of the patella in Perissodactyla.

The patella is the largest sesamoid bone of the skeleton. It is strongly involved in the knee, improving output force and velocity of the knee extensors, and thus plays a major role in locomotion and limb stability. However, the relationships between its structure and functional constraints, that would enable a better understanding of limb bone functional adaptations, are poorly known. This contribution proposes a comparative analysis, both qualitative and quantitative, of the microanatomy of the whole patella in perissodactyls, which show a wide range of morphologies, masses, and locomotor abilities, in order to investigate how the microanatomy of the patella adapts to evolutionary constraints. The inner structure of the patella consists of a spongiosa surrounded by a compact cortex. Contrary to our expectations, there is no increase in compactness with bone size, and thus body size and weight, but only an increase in the tightness of the spongiosa. No particular thickening of the cortex associated with muscle insertions is noticed but a strong thickening is observed anteriorly at about mid-length, where the strong intermediate patellar ligament inserts. The trabeculae are mainly oriented perpendicularly to the posterior articular surface, which highlights that the main stress is anteroposteriorly directed, maintaining the patella against the femoral trochlea. Conversely, anteriorly, trabeculae are rather circumferentially oriented, following the insertion of the patellar ligament and, possibly also, of the quadriceps tendon. A strong variation is observed among perissodactyl families but also intraspecifically, which is in accordance with previous studies suggesting a higher variability in sesamoid bones. Clear trends are nevertheless observed between the three families. Equids have a much thinner cortex than ceratomorphs. Rhinos and equids, both characterized by a development of the medial border, show an increase in trabecular density laterally suggesting stronger stresses laterally. The inner structure in tapirs is more homogeneous despite the absence of medial development of the medial border with no "compensation" of the inner structure, which suggests different stresses on their knees associated with a different morphology of their patellofemoral joint.

Informasi Anatomi Radiograf Dengan Dan Tanpa Penyudutan Tabung Sinar-X Pada Pemeriksaan Pedis Proyeksi AP

Background: On radiographic examination, the direction of the beam affects the anatomical image of the object produced. Pedis examination of the AP projection is a radiographic examination that uses two directions of beam. The direction of beam is with and withhout X-ray tube angulation. This research aims to compare radiograph anatomy information with and without X-ray tube angulation on pedis examination of the ap projection.Methods: This type of research is qualitative research with a descriptive approach. Data was obtained by making radiographs using with and without X-ray tube angulation using object phantom. The radiographic imaging of the pedis were observed by ten respondents, consist of radiology specialist t and resident radiology specialist, by giving questionnaires. Then the data obtained will be processed by being described and analyzed.Results: The result of the research showed different of x-ray tube angulation on the pedis examination on AP projections is the use of 100 angles because they get a high score. As well as the use of angle 100 chepalad can visualize both the interphalangeal joint space, metatarsophalangeal joint space, tarsometatarsasl joint space, joint space between the navicular and cuneifrome appear open, navicular, and cuboid. While the use of an angle of 00 can show the sesamoid bone and three cuneiform bones quite well. The angle of the beam direction is 100 chepalad so that the direction of the beam is perpendicular to the metatarsal bone so that there is no distortion in the metatarsal bone image. If the case is a fracture without having to prioritize the joint space, then the examination without an angle can be done because it is easier and saves time.Conclusion: AP projection of the pedis radiograph with the use of an angle 100 chepalad and without the use of posterior tube angulation with the posterior beam toward the heel produces different anatomical information. The most optimal anatomical information is generated by the use of a 100 chepalad.

English

BACKGROUND Patella is the largest sesamoid bone in the human body, which plays important role in biomechanics of the knee. It is one of the few bones without periosteal surrounding. Fracture of patella constitute almost 1 % of all skeletal injuries with high prevalence in age group of 20 - 50 years. Fracture of patella may be due to direct/indirect force. Direct force often results in displaced or comminuted fractures. Fracture caused by indirect mechanisms result from a violent contraction of quadriceps muscle with knee flexion. Most of the patella fractures are combination of direct and indirect forces. Most significant effects of fracture patella are loss of continuity of the extensor mechanism of the knee and potential incongruity of the patellofemoral articulation. Treatment option includes reconstruction of entire patella or partial patellectomy and tendon repair or total patellectomy with extensor mechanism repair. Advancement in surgical techniques treatment option being shifted from patellectomy to reconstruction, preservation, and restoration of extensor mechanism. The purpose of this study was to evaluate the functional outcome of transverse fracture of patella treated with tension band wiring. METHODS This prospective study was done among 35 patients, who sustained transverse patellar fractures and were admitted in Department of Orthopaedics, Government Medical College, Thrissur from 01 October 2019 to 01 October 2020. Functional and clinical outcome was assessed at 2 weeks, 4 weeks, 3 months, and 6 months using Goodfellow’s scoring system. RESULTS The mean age was found to be 43 years, males were predominant. In 62.86 % of study population, right side was involved. In 63 % of study population, fracture occurred due to road traffic accidents (RTA). Average union was achieved in 11 - 13 weeks. Functional outcome was excellent to good in 85.71 % of study population. CONCLUSIONS Transverse fracture of patella can be treated with modified tension band wiring without much complications and early weight bearing is possible with good functional outcome. KEYWORDS Transverse Fracture Patella, Prospective Study, Tension Band Wiring, Good Fellows Score