Os Intermetatarseum: A Rare Variation of Great Relevance / Os Intermetatarseum: Una Rara Variación de Gran Relevancia

SUMMARY: The os intermetatarseum is an accessory bone located in the foot, usually between the first 2 metatarsals and the cuneiform bone. It can be presented as free, articulated or in a fused fashion. It is a very unusual variation found in less than 13 % of the population. A 27-year-old patient presented to the emergency service due to an ankle lesion. Physical exam showed pain and limited range of motion while supporting partial load. Radiographic imaging showed a bony trace near the base of the first and second metatarsals, diagnosed as the os intermetatarseum. Formation of this supernumerary bone begins as a separate ossification center. Most cases are asymptomatic; however, compression of the deep peroneal nerve branches by the os intermetatarseum can lead to pain. Some authors suggest that the presence of this bone may cause hallux valgus. The intermetatarseum can lead to diagnostic confusion, mainly related to Lisfranc fracture. Its origin is still little understood.

El os intermetatarseum es un hueso accesorio ubicado en el pie, generalmente entre los 2 primeros metatarsianos y el hueso cuneiforme. Puede presentarse de forma libre, articulada o fusionada. Es una variación muy inusual que se encuentra en menos del 13 % de la población. Paciente de 27 años que acude a urgencias por lesión en tobillo. El examen físico mostró dolor y rango de movimiento limitado mientras soportaba una carga parcial. Las imágenes radiológicas mostraron un rastro óseo cerca de la base del primer y segundo metatarsianos, diagnosticado como os intermetatarseum. La formación de este hueso supernumerario comienza como un centro de osificación separado. La mayoría de los casos son asintomáticos; sin embargo, la compresión de las ramas profundas del nervio fibular en el espacio intermetatarsiano puede provocar dolor. Algunos autores sugieren que la presencia de este hueso puede provocar hallux valgus. El hueso intermetatarsiano puede llevar a confusión diagnóstica, principalmente relacionada con la fractura de Lisfranc. Su origen aún es poco comprendido.

Modified mubarak technique for flexible flatfoot correction in children and adolescents / Técnica de mubarak modificado para correção do pé plano flexível de crianças e adolescentes

ABSTRACT Objective: To describe the technique, analyze possible radiographic correction and evaluate the clinical result of medial and plantar calcaneal displacement osteotomy associated with opening wedge cuboid osteotomy for flexible flatfoot correction. Methods: 23 patients (30 feet) diagnosed with flexible flat foot treated with plantar and medial calcaneal displacement osteotomy associated with opening wedge cuboid osteotomy were evaluated retrospectively. In the lateral radiographs calcaneal pitch and Meary's angle were the radiographic parameters evaluated; while the talonavicular coverage angle was evaluated in the anteroposterior radiographs. To assess the clinical outcome of the surgical procedure, the American Orthopedic Foot and Ankle Society Score (AOFAS) for the ankle and hindfoot was adopted. Results: The mean values of the evaluated angles and AOFAS score for ankle and hindfoot significantly improved when comparing pre- and postoperative values. Conclusion: Plantar and medial calcaneal displacement osteotomy associated with an opening wedge cuboid osteotomy is able to improve radiological and clinical parameters of child patients with flexible flatfoot. Level of Evidence III, Retrospective Comparative Study.

RESUMO Objetivo: Descrever a técnica, analisar possíveis correções radiográficas e avaliar o resultado clínico da osteotomia de deslocamento medial e plantar do calcâneo associada à osteotomia em cunha de adição do cuboide para correção do pé plano flexível de crianças. Métodos: Foram avaliados retrospectivamente 23 pacientes (30 pés) com diagnóstico de pé plano flexível tratadas com osteotomia de deslocamento plantar e medial do calcâneo associada à osteotomia em cunha de adição do cuboide. Os parâmetros radiográficos avaliados nas imagens em perfil foram o pitch do calcâneo e o ângulo de Meary, enquanto nas radiografias anteroposteriores o ângulo de cobertura do tálus. Para avaliar o resultado clínico do procedimento cirúrgico, foi adotado o escore da American Orthopaedic Foot and Ankle Society (AOFAS) para tornozelo e retropé. Resultados: Os valores médios dos ângulos avaliados e do escore AOFAS para tornozelo e retropé melhoraram significativamente na comparação dos resultados pré e pós-operatórios. Conclusão: A osteotomia de deslocamento plantar e medial do calcâneo associada à osteotomia em cunha de adição do cuboide é capaz de melhorar os parâmetros radiológicos e clínicos de crianças com pé plano flexível. Nível de Evidência III, Estudo Comparativo Restrospectivo.

Eficiencia de la técnica de Broström-Gould en el tratamiento quirúrgico de la inestabilidad lateral crónica de tobillo / Broström-Gould technique efficiency in chronic lateral ankle instability surgical treatment

Los déficits neuromusculares resultantes de las lesiones que comprometen al tobillo, facilitan la aparición de recidivas, por la afectación estructural que no sólo ocurre en los ligamentos, sino también en los nervios y tejido músculo-tendinoso, pudiendo provocar numerosas alteraciones asociadas que provocan inestabilidad crónica. El objetivo de este trabajo es analizar la eficiencia de la técnica de Broström modificada en pacientes con inestabilidad crónica del tobillo, atendidos en el Hospital Dr. Miguel Pérez Carreño y consulta privada entre noviembre 2016 y enero 2020. El tipo de investigación prospectiva, descriptiva, de campo clínico. La muestra la conformaron 31 pacientes. La edad promedio fue 34,4 años, la mayoría de género masculino, y con predominio en el tobillo derecho. Al aplicar la escala EVA en el pre y post quirúrgico, se observó disminución del grado de dolor postquirúrgico con una escala entre 0 y 4. La escala de Karlsson y Peterson aplicada en el lapso de 1 año después del período postquirúrgico a los pacientes, el 90 % estuvo entre 65 y 90 según escala que significa bueno y excelente. Entre la escala EVA y la de Karlsson y Peterson aplicados al año, se observó una relación entre la disminución del dolor y la buena y excelente evaluación funcional. La técnica de Broström modificada demostró tener muy buenos resultados en el tratamiento quirúrgico de la inestabilidad de tobillo(AU)

The neuromuscular deficits resulting from ankle injuries, make possible the appearance of recurrences, due the structural affectation that not only occurs in the ligaments, but also in nerves and muscle-tendon tissue, and can produce numerous associated alterations that cause ankle chronic instability. The objective is to analyze the efficiency of Broström modified technique in patients with chronic ankle instability, treated at the Dr. Miguel Pérez Carreño Hospital and private practice from November 2016 to January 2020. A prospective, descriptive and clinical study was made. 31 patients were included. The average age was 34,4 years, majority of male patients, and predominance of right ankle. When applying the VAS scale before and after surgery, a decrease in the degree of postoperative pain was observed with a scale between 0 and 4. The Karlsson and Peterson scale applied in the period of 1 year after the postoperative period to the patients, the 90% were between 65 and 90 according to a scale that means good and excellent. Between the VAS scale and the Karlsson and Peterson scale applied after one year, a relationship was observed between pain reduction and good and excellent functional evaluation. The modified Broström technique has shown to have very good results in the surgical treatment of ankle instability(AU)

Subtalar joint in neutral and relaxed positions for evaluation of medial longitudinal arch / Articulação subtalar em posições neutra e relaxada para avaliação do arco longitudinal medial

ABSTRACT Objective: The medial longitudinal arch is the main structure of load bearing and shock absorption of the foot. The evaluation of medial longitudinal arch, such as the navicular height, the medial longitudinal arch angle and the Feiss line should be performed with the subtalar joint in the neutral and relaxed position. Our study analyzed the correlation between the measurements of the subtalar joint in neutral and relaxed positions during the evaluation tests of the medial longitudinal arch. Methods: This is a cross-sectional study, in which 51 healthy volunteers (102 feet; 36 women; 28 ± 5 years, 1.66 ± 0.10 m; 24.5 ± 4.5 kg/m2) had their navicular height, medial longitudinal arch angle and Feiss line measured in the neutral and relaxed positions. The correlation between the measures was evaluated using Pearson's test. Results: A strong correlation of the 102 feet Feiss line measurements between neutral and relaxed positions (r = 0.81) was observed, and a moderate correlation between the medial longitudinal arch angle (r = 0.78) and between navicular height in neutral and relaxed positions (r = 0.76). Conclusion: The measurements of the longitudinal medial arch between the neutral and relaxed positions are strongly correlated. Therefore, it is not necessary to measure the medial longitudinal arch in both neutral and relaxed positions. Level of Evidence II, Diagnostic Studies - Investigating a diagnostic test.

RESUMO Objetivo: O arco longitudinal medial é a estrutura principal para suporte de carga e absorção de impacto no pé. Medidas para avaliação do arco longitudinal medial, como a altura navicular, o ângulo do arco longitudinal medial e a linha de Feiss devem ser realizadas com a articulação subtalar na posição neutra e relaxada. Este estudo analisou a correlação entre as medidas da articulação subtalar em posições neutra e relaxada durante os testes de avaliação do arco longitudinal medial. Métodos: Neste estudo transversal, 51 voluntários saudáveis (102 pés; 36 mulheres; 28 ± 5 anos, 1,66 ± 0,10 m; 24,5 ± 4,5 kg/m2) tiveram altura navicular, ângulo do arco longitudinal medial e linha de Feiss medida nas posições neutra e relaxada. A correlação entre eles foi avaliada pelo teste de Pearson. Resultados: Houve uma correlação muito forte das medidas de linha de Feiss de 102 pés entre a posição neutra e relaxada (r = 0,81) e uma correlação moderada entre o ângulo do arco longitudinal medial (r = 0,78) e altura navicular nas posições neutra e relaxada (r = 0,76). Conclusão: As medidas do arco medial longitudinal entre as posições neutra e relaxada estão fortemente correlacionadas. Não é necessário, portanto, medir o arco longitudinal medial nas posições neutra e relaxada. Nível de Evidência II, Estudos diagnósticos - Investigação de um exame para diagnóstico.

Epidemiology of injuries due to ankle sprain diagnosed in an orthopedic emergency room / Epidemiologia das lesões por entorse do tornozelo diagnosticadas em pronto atendimento de ortopedia

ABSTRACT Objective To use magnetic resonance imaging to assess the prevalence of foot and ankle ligament injuries and fractures associated with ankle sprain and not diagnosed by x-ray. Methods We included 180 consecutive patients with a history of ankle sprain, assessed at a primary care service in a 12-month period. Magnetic resonance imaging findings were recorded and described. Results Approximately 92% of patients had some type of injury shown on the magnetic resonance imaging. We found 379 ligament injuries, 9 osteochondral injuries, 19 tendinous injuries and 51 fractures. Only 14 magnetic resonance imaging tests (7.8%) did not show any sort of injury. We observed a positive relation between injuries of the lateral complex, syndesmosis and medial ligaments. However, there was a negative correlation between ankle ligament injuries and midfoot injuries. Conclusion There was a high rate of injuries secondary to ankle sprains. We found correlation between lateral ligament injuries and syndesmosis and deltoid injuries. We did not observe a relation between deltoid and syndesmosis injuries or between lateral ligamentous and subtalar injuries. Similarly, no relation was found between ankle and midfoot injuries.

RESUMO Objetivo Avaliar na ressonância magnética a prevalência das diferentes lesões ligamentares do tornozelo e do pé, bem como de fraturas não diagnosticáveis radiograficamente, em pacientes com queixa de entorse do tornozelo. Métodos Foram incluídos no estudo 180 pacientes consecutivos, com história de entorse do tornozelo, atendidos em um serviço de Atenção Primária no período de 12 meses. Os achados dos exames de ressonância magnética foram catalogados e descritos. Resultados Aproximadamente 92% dos pacientes apresentaram algum tipo de lesão na ressonância. Dentre as injúrias observadas, estavam 379 lesões ligamentares, 9 lesões osteocondrais, 19 lesões tendíneas e 51 fraturas. Apenas 14 ressonâncias magnéticas (7,8%) não mostraram qualquer tipo de lesão. Observamos relação positiva entre lesões do complexo lateral, sindesmose e medial. No entanto, houve correlação negativa entre lesões ligamentares do tornozelo e aquelas do mediopé. Conclusão Foi alta a ocorrência de lesões secundárias à entorse. Apontamos correlação entre as lesões ligamentares laterais com as sindesmodais e do deltoide. Não notamos relação entre as lesões do deltoide e da sindesmose, e nem entre as ligamentares laterais e a subtlalar. Também não foram observadas relações entre as lesões do tornozelo e as do mediopé.

Tarsal Navicular Fracture in a Parkour Practitioner, a Rare Injury - Case Report and Literature Review / Fratura do escafoide társico em um praticante de parkour, uma lesão rara - Relato de Caso e Revisão da Literatura

Abstract Tarsal navicular fractures, as well as other midfoot injuries, are rare, and can result in severe impairment if not properly treated. Parkour, a modern sport, is gaining popularity among young individuals in urban areas, and is prone to result in high-energy trauma, which is scarcely described in the literature. The following is a report of a rare case of tarsal navicular fracture in a 17-year-old male, sustained during parkour practice, which was treated successfully with open reduction and internal fixation. The description of the case emphasizes the challenges of its approach; the discussion highlights the treatment options and goals. The case should also raise awareness about the increasing occurrence of these uncommon lesions.

Resumo As fraturas do escafoide társico, bem como outras lesões do médiopé, são raras e podem resultar em incapacidade grave se não forem tratadas adequadamente. Parkour, um esporte moderno, está ganhando popularidade entre os jovens em áreas urbanas, e é propenso a traumatismos de alta energia, sendo estes escassamente descritos na literatura. O presente relato trata de um caso de fratura rara do escafoide társico em um paciente do sexo masculino de 17 anos, ocorrida durante a prática de parkour, que foi tratada com sucesso, com redução aberta e fixação interna. A descrição do caso enfatiza os desafios na sua abordagem; a discussão destaca as opções de tratamento e seus objetivos. O caso também deve alertar sobre a ocorrência crescente dessas lesões incomuns.

Fratura por estresse do cuboide e do cuneiforme lateral ­ uma associação rara / Cuboid and lateral cuneiform stress fractures ­ a rare association

Fraturas por estresse são lesões que ocorrem devido a uma força de baixa intensidade, porém repetida sobre o osso por um longo período de tempo. Esta acomete mais militares e alguns atletas, porém sua incidência vem aumentando na população. Com exceção do calcâneo, estas lesões raramente acometem os ossos do tarso. Cuboide e cuneiforme lateral são dois ossos dessa região do mediopé com poucos relatos na literatura relativos à fratura por estresse. Estes apresentam uma sintomatologia em comum, com dor local, sensibilidade à palpação, possível edema e alterações de pele. Atualmente o melhor método diagnóstico é a ressonância magnética. São fraturas classificadas como de baixo risco e o tratamento é conservador aliado à terapia farmacológica.

Stress fractures are injuries that happen due to a low but repetitive force over the bone during a long period. It is more common in military personnel and in some athletes; however, its incidence has been rising among the population. With exception to the calcaneum, these injuries rarely happen in the tarsal bones. Cuboid and lateral cuneiform are two bones of the midfoot with few literature reports of a stress fracture. These present a common symptomatology with local pain, tenderness to palpation, possible edema and skin changes. Currently, the best diagnostic method is the magnetic resonance imaging. These fractures are classified as low risk and its treatment is conservative, allied to pharmacologic therapy.

Subtar arthroscopic debridment for the treatment of sinus tarsi syndrome: case series

SUMMARY OBJECTIVE: The objective of this study is to report the results of arthroscopic debridement of the subtalar joint in eight patients with Sinus Tarsi Syndrome (STS) refractory to conservative treatment. METHODS: This is a retrospective study of eight patients with STS who underwent subtalar arthroscopy for debridement of the sinus tarsi between January 2015 and January 2017 after six months of conservative treatment. All patients answered an epidemiological questionnaire and underwent functional evaluation with the Visual Analogue Pain Scale (VAS) and the American Orthopedic Foot and Ankle Society Score (AOFAS) in the preoperative and in the last evaluation (average of 12 months - 6-24 months). RESULTS: All patients showed severe synovitis in the region. Seven patients had remnants of the talocalcaneal ligaments and six of the cervical ligament. AOFAS increased by 30 points on average (51.75 in the preoperative period to 82.62 in the last follow-up) and the VAS decreased on average by 5 points (7.37 preoperatively to 2.12 in the last follow-up). These results were statistically significant with p = 0.043 and p = 0.032 respectively. Six patients described the result as excellent and two as good. No complications were reported. All patients returned to sports after six months of follow-up. CONCLUSION: The arthroscopic debridement of the subtalar joint is an effective and safe alternative in the treatment of STS refractory to conservative treatment. More studies, with a prospective methodology, are necessary to prove the results of this technique.

RESUMO OBJETIVO: O objetivo desse estudo é relatar os resultados do desbridamento artroscópico da subtalar em oito pacientes portadores da Síndrome do Seio do Tarso (SST) refratária ao tratamento conservador. MÉTODOS: Este é um estudo retrospectivo com oito pacientes com diagnóstico de STT que foram submetidos à artroscopia subtalar para desbridamento do seio do tarso entre janeiro de 2015 e janeiro de 2017, após seis meses de tratamento conservador. Todos os pacientes responderam questionário epidemiológico e foram submetidos à avaliação funcional com a Escala Visual Analógica de dor (EVA) e o American Orthopaedic Foot and Ankle Society Score (Aofas) no pré-operatório e na última avaliação, em uma média de 12 meses (6-24 meses). RESULTADOS: Todos os pacientes exibiram intensa sinovite na região. Sete pacientes tinham resquícios de ligamentos talocalcaneanos e seis do ligamento cervical. O Aofas aumentou 30 pontos em média (51,75 no pré-operatório para 82,62 no último seguimento) e a EVA diminuiu em média 5 pontos (7,37 no pré-operatório para 2,12 no último seguimento). Esses resultados foram estatisticamente significativos com p = 0,043 e p = 0,032, respectivamente. Seis pacientes descreveram o resultado como excelente e dois como bom. Nenhuma complicação foi relatada. Todos os pacientes retornaram ao esporte após seis meses de acompanhamento. CONCLUSÃO: O desbridamento artroscópico da subtalar é uma alternativa eficaz e segura no tratamento da SST refratária ao tratamento conservador. Mais estudos, com metodologia prospectiva, são necessários para comprovar os resultados da técnica.

Síndrome do osso navicular acessório / Accessory navicular bone syndrome

O osso navicular acessório, do qual foram descritas três variantes, é frequentemente considerado uma variação anatômica normal.É uma anomalia congênita em que a tuberosidade do navicular se desenvolve a partir de um centro de ossificação secundário e tem uma incidência estimada entre 2% e 14% com maior incidência em mulheres sendo bilateral em 50-90% dos casos. Nosso objetivo foi relatar um caso e revisar a literatura acerca desta lesão incomum, utilizando-se da revisão do prontuário, registro fotográfico do método diagnóstico e revisão da literatura. Mulher de 59 anos com dor no lado medial do pé esquerdo há dois anos, com piora ao andar. Exame físico com testes específicos do tornozelo negativos, sem hematoma ou edema. Nega torção, trauma e cirurgias. A ressonância magnética demonstra osso navicular acessório tipo II e osso navicular, ambos com edema. Estes achados com quadro clínico são compatíveis com síndrome do osso navicular acessório. Este relato demonstra a dificuldade de diagnosticar essa lesão, pois seu o exame físico é inespecífico, podendo simular patologias mais complexas, necessitando de exames complementares para seu correto diagnóstico (AU)

The accessory navicular bone, of which three variants have been described, is often considered as a normal anatomic and roentgenographic variant. Is a congenital anomaly in which the tuberosity of the navicular bone develops from a secondary ossification center and it has an incidence estimated between 2% and 14% with higher incidence in women being bilateral in 50-90% of the cases. Our aim was to report a case and review the literature about this uncommon lesion. We carried out a review of medical records, photographic record of diagnostic method, and review from the literature. A 59 years old woman with pain in the medial side of the left foot for two years. Refers worsening with walking. Physical examination with specific ankle negative tests, without bruise or edema. Denies torsion, trauma and surgeries. Magnetic resonance imaging demonstrates type II accessory navicular bone with edema and navicular bone edema. These findings with clinical complaint are compatible with accessory navicular bone syndrome. This report demonstrates the difficulty of diagnosing this lesion, since its physical examination is non-specific, and it can simulate more complex pathologies, requiring complementary tests for its correct diagnosis (AU)

Characterization of a bipartite medial cuneiform: micro-CT and anatomical study / Caracterización de un cuneiforme medial bipartito: micro-CT y estudio anatómico

A bipartite medial cuneiform is an anatomical variant consisting in a horizontal division of the bone. Previous descriptions of the joint type, obtained from archaeological material or clinical reports, are unclear. This study was conducted in a fresh-frozen left foot, which allowed studying the morphology of the ligaments after anatomical dissection. In addition a Micro-CT analysis was performed to elucidate the osseous structure supporting the articular surfaces. A complex ligamentous system was found between the two halves of the bipartite medial cuneiform. Two articular surfaces were observed between the two components. Hyaline cartilage was observed at the posterior surface, while fibrous tissue was found at the anterior surface. Micro-CT analysis revealed different osseous structures for each articular surface, thus proving the existence of two joint types. The finding of a bipartite medial cuneiform in a fresh-frozen specimen allowed us to perform an analysis of the soft-tissues and articular surfaces that shows the presence of hyaline cartilage and articular ligaments in the diarthrodial joint as well as the fibrous component of the synfibrosis. Micro-CT analysis further reinforces our morphological findings. Our results prove that two different joint types exist, which could help explaining the disparity of descriptions in the literature.

El cuneiforme medial bipartito es una variación anatómica que consiste en una división horizontal del hueso. Las descripciones previas del tipo de articulación entre los dos fragmentos, obtenidas de material arqueológico o de reportes clínicos, son heterogéneas. Este estudio se llevó a cabo en un pie izquierdo disecado en fresco, lo que permitió analizar la morfología de los ligamentos. Adicionalmente se llevó a cabo un análisis con Micro-CT a fin de aclarar la estructura ósea de soporte de las superficies articulares. Un sistema ligamentoso complejo une las dos mitades del cuneiforme medial bipartito. Se observaron dos superficies articulares uniendo ambos componentes. En la superficie posterior se encontró cartílago hialino, en tanto que la superficie anterior presentaba tejido fibroso uniendo las superficies articulares. El análisis por Micro-CT mostró que la estructura ósea de soporte de cada una de las superficies articulares es diferente, confirmando la existencia de dos articulaciones distintas. El hallazgo de un cuneiforme medial bipartito en un espécimen fresco ha permitido el estudio de las partes blandas y superficies articulares, demostrando la presencia simultánea del cartílago hialino y los ligamentos propios de una diartrosis y del tejido fibroso propio de una sinfibrosis, lo que ha sido posteriormente corroborado por el análisis por Micro-CT. Nuestros resultados demuestran por tanto que se trata de dos articulaciones distintas, lo cual explica la disparidad de las descripciones en la literatura.

Atraumatic Insufficiency Fractures of the Tarsal Bones-An Unusual Cause of Recurrent Heel Pain in a Patient with Rheumatoid Arthritis: A Case Report

@#The incidence of insufficiency fractures is approximately 1% in rheumatoid arthritis patients. The predisposing factors are chronic inflammation, skeletal deformities, biomechanical stresses and osteoporosis. The medications used in the treatment of rheumatoid arthritis such as Glucocorticosteroids and Methotrexate also contribute to the development of osteoporosis and insufficiency fractures. A 68-year old lady who was suffering from rheumatoid arthritis and on long term Methotrexate was seen in the outpatient clinic with recurrent episodes of heel pain. Examination revealed diffuse tenderness around the heel with full range of ankle movements but painful limitation of subtalar joint movements. Radiographic examination of the ankle showed a highly suspicious fracture of the calcaneus and confirmed on MRI as an insufficiency fracture. She was treated successfully with oral bisphosphonates and moon boot brace. She presented after two years with recurrent episodes of heel pain. The plain radiograph and MRI scan confirmed an insufficiency fracture of the talus. She was treated nonoperatively with intravenous Zolendronic acid and bracing. In chronic rheumatoid arthritis patients especially on Methotrexate and Glucocorticoids a high index of suspicion of insufficiency fractures should be considered if they present with bone pain. MRI scan is the investigation of choice and is conclusive.

Improved anatomical locking plate internal fixation through tarsal sinus incision in treating Sanders III-IV calcaneal fractures / 中国骨伤

<p><b>OBJECTIVE</b>To investigate clinical effects of improved anatomical locking plate internal fixation through tarsal sinus incision in treating Sanders III and IV calcaneal fractures.</p><p><b>METHODS</b>From February 2015 to October 2016, 35 patients with Sanders III and IV calcaneal fractures treated by improved anatomical locking plate internal fixation through tarsal sinus incision were collected, including 22 males and 13 females aged from 22 to 68 years old with an average of (42.3±12.7) years old. According to Sanders classification, 23 patients were type III and 12 patients were type IV. Postoperative complications were observed, Bö hler angle and Gissane angle before and after operation were compared, and Maryland foot function scoring standard was evaluated at 12 months after operation.</p><p><b>RESULTS</b>All patients were followed up from 12 to 20 months with an average of (14.5±2.0) months, the length of incision ranged from 4.0 to 5.5 cm with an average of (4.7±0.4) cm. Superficial infection occurred in 1 patient, delayed union in 2 patients, gastrocnemius nerve injury in 1 patient. No complications such as steel plate exposure and fracture reduction loss occurred. Wound healing time ranged from 14 to 28 days with an average of(15.4±4.7) days, the fracture healing time ranged from 8 to 14 weeks with an average of (9.8±1.9) weeks. Bö hler angle increased from preoperative (9.81±14.28)° to 3 days after operation (26.35±11.04)°, and (25.96±10.79)° at 12 months after operation(<0.05). Gissane angle ranged from preoperative (122.54±16.79)° to 3 days after operation (120.85±11.88)°, and (120.62±11.44)° at 12 months after operation and had statistical meaning. Maryland score increased from 12.66±4.10 before operation to 92.20 ±7.82 at 12 months after operation, and 32 patients got excellent results, 2 good and 1 moderate.</p><p><b>CONCLUSIONS</b>Improved anatomical locking plate internal fixation through tarsal sinus incision in treating Sanders III and IV calcaneal fractures, which has advantages of less incision, less soft tissue injury, better fracture reduction and fixation, could receive good reduction and fixation. It is an effective method for Sanders III and IV fracture of calcaneus fracture.</p>

The application of Herbert screw in the treatment of navicular bone fracture / 重庆医学

Objective To investigate the treatment of Navicular bone fracture with Herbert screw.Methods Twenty-three patients with Navicular bone fracture were collected.They were all conducted with CT scan diagnosis and type,the small incision and targeting wire was used in operation.The Herbert screw was used to fix with pressure,plaster was also used to fix.After operation,the activity training was executed gradually.Results We conducted follow-up of 6-18 months in 23 patients,with an average of 12 months.All patients got bone-healing,the healing time ranges from 7 to 10 weeks,with an average of 9 weeks.There was one case of screw penetrating cortical bone,and one case of mild deformity healing,among the other 23 cases there were no complications including infection,nonunion,necrosis,osteoarthritis'etc.Conclusion The treatment of Navicular bone fracture with Herbert screw fixation can get firm fixation,function training and healing early,and it's worth of clinical promotion.

Enfermedad de Müller-Weiss: un diagnóstico ignorado / Müller-Weiss Disease: An Ignored Diagnosis

La enfermedad de Müller-Weiss es una displasia del escafoides tarsiano producida en la infancia, pero sin síntomas hasta la edad adulta. No se considera una osteonecrosis del escafoides del adulto. Característicamente, el astrágalo está en varo y lateralizado, lo que genera una compresión en sentido anteroposterior de la porción externa del escafoides tarsiano. El compromiso suele ser bilateral. Las dos condiciones necesarias para el desarrollo de la enfermedad de Müller-Weiss son: retraso en la osificación del escafoides tarsiano y transferencia lateral de carga, en ocasiones favorecida por un primer metatarsiano corto. El varo del retropié y la morfología del escafoides son las características más frecuentes encontradas en los hallazgos radiológicos.

The Müller-Weiss disease is a tarsal navicular dysplasia developed in childhood which presents no symptoms until adulthood. Is not considered an adult osteonecrosis of the scaphoid. Characteristically, the talus is in varus and lateralized, generating anteroposterior compression of the outer portion of the tarsal navicular. There is often bilateral affection. The two necessary conditions for the development of Müller-Weiss' disease are: a delay in the ossification of the tarsal navicular and the lateral load transfer, which are favored by a short first metatarsal. The varus deviation of the hind foot and the tarsal navicular morphology are the two most commonly found radiological findings.

Luxación subastragalina lateral: presentación de un caso / Lateral subastragalar dislocation: a case report

La luxación subastragalina o aislada del astrágalo es extremadamente rara, provocada por traumatismos de alta energía que ocasionan graves alteraciones en la biomecánica del tobillo con frecuentes complicaciones que ensombrecen el pronóstico, sobre todo la variedad lateral, que en muchas ocasiones necesita de la reducción abierta para restablecer la integridad anatómica del tobillo.Caso clínico: se presenta un paciente de 54 años de edad con luxación subastragalina lateral, sin fracturas asociadas, pero con alteraciones vasculares y neurológicas que se restablecieron después de la reducción cerrada.Conclusiones: se realizó la reducción inmediata y se inmovilizó con un yeso corto por cinco semanas para evitar o reducir el índice de complicaciones tempranas o tardías, que acompañan a este tipo de lesión específicamente en esta variedad, que ofrece los peores resultados debido a la complejidad del daño anatómico

Subastragalar dislocation or isolated from astragalus is extremely rare, caused by high-energy trauma, producing serious disturbances in the biomechanics of the ankle with frequent complications which affect prognosis, mainly the lateral variety, often needing open reduction to restore the anatomical integrity of the ankle. Clinical case: a 54 year-old man patient with a lateral subastragalar dislocation is presented, neurovascular alterations were identified and these were recovered after closed reduction, there were no associated fractures. Conclusions: immediate closed reduction was performed and the ankle joint was immobilized with a short leg cast for 5 weeks in order to avoid or reduce the rate of early and late complications, which accompany this type lesion, mainly in this variety that show the worst results due to the complexity of anatomical damage

Coalizão tarsal cuboide-navicular / Cuboid-navicular tarsal coalition

Os autores apresentam caso de paciente do sexo feminino de nove anos de idade que apresentava dores no pé direito associadas à prática de atividades físicas. Após o diagnóstico de coalizão tarsal cuboide-navicular foi tratada cirurgicamente através de ressecção desta, com resolução dos sintomas. Realizam revisão da literatura e discutem a importância da adequada avaliação clínica e imagenológica dos casos das dores no pé nas crianças e adolescentes.

The authors present a case of a 9-year-old female patient who presents with complaints of pain in her right foot associated with physical activities. After the diagnosis of an osseous cuboid navicular coalition she was treated surgically with resection of the coalition, with symptoms resolved. The literature is reviewed and the importance of adequate physical examination and image exams to investigate foot pain in children and teenagers is discussed.

Imaging findings of tarsal chondroblastoma / 中华放射学杂志

Objective To analysis the imaging features of the chondroblastoma in the tarsal bone. Methods The locations of 134 cases of pathologically confirmed chondroblastoma were retrospectively analyzed. Eleven of them were in tarsal bones and their X-ray and CT findings were analyzed. Results Of the 11 cases of tarsal chondroblastoma, 6 were in talus, 3 were in calcaneus and 2 cases were in navicular bones. They were examined by the X-ray and 5 cases had additional CT scans. The common locations were the posterior portion of the talus and calcaneus. The X-ray findings included expansive destruction (10/11), mild osteosclerosis (11/11), bone ridge (9/11), articular facet destruction (7/11) and spot or patching calcification(6/11). The imaging findings of CT included articular facets destruction (5/5), bone ridge (5/5) and spot or patching calcification (2/5). Conclusion The talus and the calcaneus are the frequently involved location of tarsal chondroblastoma. Its X-ray and CT findings are characteristic but not exclusive.

Surgical treatment of the cuboid fractures / 中华创伤杂志

Objective To explore the operative methods of open reduction and fixation for the cuboid fractures. Methods The study involved 12 patients with cuboid fractures treated from October 2006 to October 2008. There were seven males and five females, at average age of 38.5 years (range 18-70 years). All patients had closed fractures, including 10 with compression fracture and two with sagittal fractures. The surgical treatments included open reduction, internal fixation by plate, screw or K-wire.Results Ten patients were followed up for 15 months on average ( range 12-24 months), which showed one stage wound healing, with mean time of bone union for 10 weeks ( range 8-15 weeks). No infection was found in any patient. The weight load walk began at 12 weeks ( range 8-18 weeks), with no obvious pain. According to American orthopaedic foot and ankle society (AOFAS) midfoot scale, the mean score was 88.6 (range 73-100). Conclusion Anatomic reduction and stable internal fixation of the cuboid fractures is the key point for recovery of foot form, stabilization and function of the feet.

Supervivencia de un implante de silastic para cúpula radial en localización atípica / Survival of a silastic implant for radial cupula in atypical localization / Survie d´un implant de silastic pour coupule radiale en localisation atypique

Las prótesis de silastic en un principio fueron creadas para aliviar y resolver el dolor en las afecciones de pequeñas articulaciones como las interfalángicas, los huesos del carpo, del codo, etc., en los pacientes con artritis reumatoidea. En este trabajo se utilizó una prótesis de cúpula radial en la articulación astragaloescafoidea del pie para sustituir el escafoides necrosado que además le producía mucho dolor al paciente como consecuencia de una fractura de dicho hueso. La sustitución del escafoides por la prótesis de silastic dio muy buenos resultados.

The silastic protheses were created at first to relieve pain in the affections of small joints, such as the interphalangeal joints, the bones of the carpus, of the elbow, etc., and in the patients with rheumatoid arthritis. A prosthesis of radial cupula was used in the astragaloscaphoid articulation of the foot to replace the necrotic scaphoid that produced a lot of pain as a consequence of a fracture of this bone. The replacement of the scaphoid by the silastic prothesis gave good results.

Au début, les prothèses de silastic ont été créées pour soulager et supprimer la douleur dans les affections de petites articulations telles que les interphalangiennes, les os du carpe, du coude, etc., chez les patients atteints d´arthrite rhummatoïde. Dans ce travail, une prothèse de coupole radiale a été utilisée dans la articulation astragalo-scaphoïdienne du pied pour remplacer le scaphoïdenécrosé, entraînant en outre beacoup de douleur au patient en conséquence d´une fracture de cet os. La sustitution du scaphoïde par la prothèse de silastic est parvenue à de très bons résultats.