Quiste óseo aneurismático en el cuboides de un niño de 13 años. Presentación de un caso clínico / Aneurysmal bone cyst of the cuboid. Case report and review of the literature

Se presenta un caso clínico poco frecuente de un quiste óseo aneurismático localizado en el cuboides de un niño de 13 años. Se llegó al diagnóstico mediante la tríada de síntomas, estudios por imágenes (radiografía, resonancia magnética) y anatomía patológica. El tratamiento consistió en el abordaje y curetaje minuciosos dentro de la lesión, el fresado de alta velocidad, la electrocauterización y el relleno con aloinjerto óseo liofilizado con chips cortico-esponjosos. Pese al diagnóstico tardío, la evolución clínica fue favorable con remisión completa de los síntomas y retorno a las actividades deportivas, sin recidiva local. Nivel de Evidencia: IV

A rare clinical case of an aneurysmal bone cyst located at the level of the cuboid in a 13-year-old boy is presented. The diagnosis was reached through clinical evaluation, imaging studies (radiograph-MRI), and a pathological anatomy analysis. Its treatment consisted of thorough intralesional curettage, high speed burring, electrocautery, and filling with lyophilized bone allograft with cortical/cancellous chips. Despite the late diagnosis, we would like to highlight the favorable clinical evolution of the patient, with ad integrum remission of the symptoms and return to his sport activities, without elements of local recurrence. Level of Evidence: IV

Application value of imaging examination in the diagnosis of Muller-Weiss disease / 中国骨伤

OBJECTIVE@#To analyze radiological characteristics of Muller-Weiss disease, evaluate the clinical value of the imaging examination in diagnosis of Muller-Weiss disease.@*METHODS@#The imaging data of 26 patients with Muller-Weiss disease were collected from September 2015 to August 2020, including 7 males and 19 females, aged 43 to 68 years old with an average of (52.7±4.6) years old. In the X-ray examination observed the shape and position of the navicular bone. The talar-first metatarsal angle(TFM) was measured on the weight-bearing anteroposterior radiograph. The arch angle and angle between mid-axis of talus and mid-axis of the first metatarsal(Meary angle) were measured on the weight-bearing lateral radiographs. The morphology, density, adjacent joint space and position of the navicular bone were evaluated by computed tomography(CT), and magnetic resonance imaging(MRI) was used to observe the shape, signal, cartilage and surrounding soft tissue changes of the navicular bone.@*RESULTS@#Among 26 patients, 21 cases were unilateral and 5 cases were bilateral;X-ray examination showed that the lateral part of navicular bone of foot was compressed and flattened, showing"comma like"or"drop like", navicular moved to the medial side, partial fragmentation of bone, peripheral articular hyperplasia, uneven density and narrowing of relationship gap. According to Meary angle and deformity degree of the affected foot on the lateral X-ray of the load-bearing foot, Maceira staging was performed. There were 0 cases in stageⅠ, 2 cases in stage Ⅱ, 11 cases in stage Ⅲ, 9 cases in stage Ⅳand 4 cases in stage Ⅴ. CT examination showed bone fragmentation, medial displacement of navicular bone and formation of the talocalcaneal joint. MRI examination showed the irregular shape and uneven signal of navicular bone, narrowing of joint space, talocalcaneal joint surface hyperplasia and cartilage destruction, tarsal joint effusion and swelling of surrounding soft tissue.@*CONCLUSION@#Muller-Weiss disease has specific imaging manifestation, and an accurate diagnosis can be made based on the patient's age, gender, and clinincal history. Preoperative imaging examination can stage the disease, help clinicians to formulate better surgical plans, and postoperative imaging examination can better evaluate the surgical effect.

Presencia de huesos accesorios del tarso: variantes anatómicas normales con potencialidad patológica / Presence of accessory bones of the tarsus: normal anatomical variants with pathological potential / Presença de ossos acessórios do tarso: variantes anatômicas normais com potencial patológico

El conjunto de patologías bajo el nombre de síndromes dolorosos de pie y tobillo engloban diferentes tendinopatías asociadas entre varios factores clínicos a la presencia de huesos accesorios tarsianos. La correcta identificación y diferenciación radiológica de estas variantes anatómicas en virtud de su capacidad de influir en la dinámica normal del tarso motivan el estudio de su incidencia. Nuestro objetivo es determinar la presencia de distintos huesos accesorios tarsianos en una muestra poblacional. Se expone el resultado de un estudio observacional retrospectivo en 240 pacientes entre 15 y 85 años de edad atendidos en un centro privado de la ciudad de Las Piedras, Canelones, con radiografías de pie y tobillo preexistentes en la base de datos institucional. Se determinó presencia de huesos accesorios tarsianos en 23 pacientes (9,58%), identificando hallazgos de Os Trigonum (1,66%), Proceso de Stieda (3.33%), Os Peroneum (2,93%) y Os Navicular (1,66%). Se presenta en tablas el análisis de frecuencia correspondiente y estudio de contingencia entre variantes encontradas, edad y sexo del paciente. El resultado de la investigación busca aportar al conocimiento de variantes anatómicas normales correlativas a procesos patológicos infradiagnosticados, desde el rol de la anatomía radiológica.

The group of pathologies under the name of foot and ankle pain syndromes encompass different tendinopathies associated among various clinical factors with the presence of accessory tarsal bones. The correct identification and radiological differentiation of these anatomical variants, by virtue of their ability to influence the normal dynamics of the tarsus, motivated the study of their incidence. Our objective is to determine the presence of different tarsal accessory bones in a population sample. Here we present the results of a retrospective observational study in 240 patients between 15 and 85 years of age, treated in a private health center in the city of Las Piedras, Canelones, with pre-existing ankle and foot x-rays in the institutional database. The presence of tarsal accessory bones was determined in 23 patients (9.58%), identifying findings of Os Trigonum (1.66%), Stieda Process (3.33%), Os Peroneum (2.93%) and Os Navicular (1, 66%). The corresponding frequency analysis and contingency study between the variants found, age and sex of the patient are exposed in tables. The result of the research seeks to contribute to the knowledge of normal anatomical variants correlative to under diagnosed pathological processes, from the role of radiological anatomy.

O grupo de patologias com a denominação de síndromes dolorosas no pé e tornozelo engloba diferentes tendinopatias associadas entre diversos fatores clínicos à presença de ossos acessórios do tarso. A correta identificação e diferenciação radiológica dessas variantes anatômicas em virtude de sua capacidade de influenciar a dinâmica normal do tarso motiva o estudo de sua incidência. Nosso objetivo é determinar a presença de diferentes ossos acessórios do tarso em uma amostra populacional. É apresentado o resultado de um estudo observacional retrospectivo em 240 pacientes entre 15 e 85 anos de idade atendidos em um centro privado na cidade de Las Piedras, Canelones, com radiografias de pé e tornozelo pré-existentes no banco de dados institucional. A presença de ossos acessórios do tarso foi determinada em 23 pacientes (9,58%), identificando achados de Os Trigonum (1,66%), Processo de Stieda (3,33%), Os Peroneum (2,93%) e Os Navicular (1,66%). A correspondente análise de frequência e estudo de contingência entre as variantes encontradas, idade e sexo do paciente são apresentados em tabelas. O resultado da pesquisa busca contribuir para o conhecimento das variantes anatômicas normais correlativas aos processos patológicos subdiagnosticados, a partir do papel da anatomia radiológica.

Osteonecrosis of the Intermediate Cuneiform: A Case Report / Osteonecrose do cuneiforme intermédio: Relato de caso

Abstract Osteonecrosis is a disease that rarely affects the bones of the foot. When present, it is more common in the talus and in the navicular. Cases of osteonecrosis of the intermediate cuneiform are extremely rare, and after a thorough bibliographic review, we found only five reports in the literature, all of them in pediatric patients. Below, we present the case of an adult patient with osteonecrosis of the intermediate cuneiform that was resistant to conservative treatment. Thus, we proposed a surgical approach with good results. Level of Evidence V; Therapeutic Studies; Expert Opinion.

Resumo A osteonecrose é uma doença que raramente afeta os ossos do pé. Quando presente, ela é mais comum no tálus e no navicular. Casos de osteonecrose do cuneiforme intermédio são extremamente raros, e após uma revisão bibliográfica minuciosa encontramos apenas cinco relatos na literatura, sendo todos eles em pacientes pediátricos. A seguir, apresentamos o caso de um paciente adulto com osteonecrose do cuneiforme intermédio resistente ao tratamento conservador. Portanto, propusemos uma abordagem cirúrgica com bom resultado. Nível de Evidência V; Estudos Terapêuticos; Opinião de Especialista.

Outcome of modified Kidner procedure with tendoscopy for the treatment of painful accessory navicular / 中国骨伤

OBJECTIVE@#To evaluate clinical efficacy of modified kidner procedure with tendoscopy in treating painful accessory navicular.@*METHODS@#From February 2014 to April 2019, 19 patients with painful accessory navicular were admitted, including 13 males and 6 females with a mean age of 26 years old (ranged from 14 to 58 years old), all of which were unilateral symptoms. The courses of disease ranged from 6 to 60 months. All patients received excision of accessory navicular and reconstruction of posterior tibial tendon insertion on navicular with anchor, and the tendoscopy were used to examin the posterior tibial tendon. American Orthopedic Foot and Ankle Society(AOFAS) midfoot score and visual analogue scale(VAS) were used to evaluate efficacy before operation and at the latest follow-up.@*RESULTS@#All the patientswere followed up, and the duration ranged from 12 to 73 months, with an average of (35.0±20.9) months. VAS score was 0.20±0.41 at the latest follow-up, showing significant difference when compared with preoperative score of 6.33±1.95(@*CONCLUSION@#The modified kidner procedure with tendoscopy is a good choice for the treatment of painful accessory navicular, which could obviously relieve foot pain, improve foot function, and has certain clinical efficacy.

Osteoblastoma con presentación atípica en cuboides / Osteoblastoma with atypical presentation in cuboid bone

Resumen: Introducción: El osteoblastoma es un tumor osteoblástico benigno, agresivo y poco frecuente. Su localización más frecuente es en elementos posteriores de la columna vertebral y el sacro. La presentación en cuboides es excepcional. Caso clínico: Masculino de 50 años que inició padecimiento en 2005, con dolor y aumento de volumen en región dorsolateral del mediopié. En las radiografías se observa injerto óseo y una lesión en cuboides, radiotransparente, heterogénea, multilobulada, con bordes irregulares que sobrepasa la cortical lateral. Se realizó angiotomografía donde se observó la lesión hipervascularizada; en la gammagrafía se observó captación del tecnecio 99 y en la resonancia magnética se reporta una lesión con cambios postquirúrgicos, quística, multilobulada. Se tomó biopsia transquirúrgica con abundante tejido fibroconectivo, osteoblastos, nidos de tejido osteoide e hipervascularidad del estroma, aumento de celularidad sin atipias y escasas células gigantes multinucleadas. Se clasificó Enneking 2. Se inició tratamiento con resección y curetaje del tumor, crioterapia y colocación de injerto tricortical en el defecto óseo. Mostró buena evolución postquirúrgica. A los tres años del procedimiento quirúrgico se encuentra sin datos de actividad tumoral y asintomático. A pesar de que el osteoblastoma no se presenta de forma habitual en cuboides, debe tomarse en cuenta como diagnóstico diferencial. Conclusión: Los tumores óseos, a pesar de tener localizaciones habituales, pueden presentarse en zonas poco frecuentes y por lo tanto, el estudio completo clínico radiográfico e histopatológico en cada paciente es fundamental.

Abstract: Introduction: Osteoblastoma is a benign, aggressive and rare osteoblastic tumor. Its most common location is in later elements of the spine and sacrum. The cuboid presentation is exceptional. Case report: A 50-year-old male who began her condition in 2005, with pain and increased volume in the dorsolateral region of the middle foot. X-rays show bone grafting and a cuboid lesion, radiotransparent, heterogeneous, multilobed, with irregular edges that exceeds the lateral cortical. Angiotomography was performed where hypervascularized injury was observed; bone scan showed uptake of technetium 99, and MRI reported an injury with post-surgical, cystic and multilobed changes. Trans surgical biopsy was taken, increased atypia-free cellularity and few multinucleated giant cells were reported and Enneking 2 qualified. Treatment was initiated with resection of the tumor, cryotherapy, and placement of tricortical graft in the bone defect. He exhibited good post-surgical evolution. At three years of the surgical procedure, he`s without tumor and asymptomatic. Although osteoblastoma does not usually occur in cuboid, it should be taken into account as a differential diagnosis. Conclusion: Bone tumors, despite having common locations, can occur in rare areas and therefore the complete radiographic and histopathological clinical study in each patient is critical.

Tratamiento con soportes plantares en la enfermedad de Müller-Weiss. Reporte preliminar / Treatment with plantar supports in Müller-Weiss disease. Preliminary report

Resumen: El objetivo de este trabajo es valorar la eficacia del tratamiento conservador con plantillas ortopédicas en la enfermedad de Müller-Weiss (EMW). El soporte plantar tiene como objetivo pronar el retropié e inmovilizar las articulaciones talonavicular y naviculocuneiforme o ambas a la vez como alternativa a la osteotomía valguizante de calcáneo y las artrodesis. Se analizan las características clínicas y radiológicas de 10 casos de EMW en ocho pacientes objeto del estudio y se valoran los resultados obtenidos. Se comenta el proceso de fabricación de los soportes plantares así como los materiales empleados. El tamaño de la muestra no es significativo; sin embargo, de manera preliminar, el tratamiento conservador es posible en determinados casos de la EMW para aliviar el dolor, mejorar la dinámica de la marcha y limitar la progresión de la enfermedad en el corto plazo.

Abstract: The objective of this work is to assess the efficacy of conservative treatment with orthopedic insoles in Müller-Weiss disease (EMW). The plantar support aims to pronounce the hindfoot and immobilize the talo-navicular, and naviculo-cuneiform joints or both at the same time, as an alternative to the valguizing osteotomy of the calcaneus and arthrodesis. The clinical and radiological characteristics of 10 cases of EMW in 8 patients under study are analyzed and the results obtained are evaluated. The manufacturing process of the plantar supports is commented, as well as the materials used. The sample size is not significant, however, preliminary, conservative treatment is possible in certain cases of EMW to relieve pain, improve gait dynamics and limit disease progression in the short-term.

Morphological and biomechanical implications of cuboid facet of the navicular bone in the gait / Implicaciones morfológicas y biomecánicas de la faceta cuboídea del navicular en la marcha

The cuboid facet of the navicular bone is an irregular flat surface, present in non-human primates and some human ancestors. In modern humans, it is not always present and it is described as an "occasional finding". To date, there is not enough data about its incidence in ancient and contemporary populations, nor a biomechanical explanation about its presence or absence. The aim of the study was to evaluate the presence of the cuboid facet in ancient and recent populations, its relationship with the dimensions of the midtarsal bones and its role in the biomechanics of the gait. 354 pairs of naviculars and other tarsal bones from historical and contemporary populations from Catalonia, Spain, have been studied. We used nine measurements applied to the talus, navicular, and cuboid to check its relationship with facet presence. To analyze biomechanical parameters of the facet, X-ray cinematography was used in living patients. The results showed that about 50 % of individuals developed this surface without differences about sex or series. We also observed larger sagittal lengths of the talar facet (LSAGTAL) in navicular bones with cuboid facet. No significant differences were found in the bones contact during any of the phases of the gait. After revising its presence in hominins and non-human primates, and its implication in the bipedalism and modern gait, we suggest that cuboid facet might be related with the size of talar facet and the position of the talonavicular joint. However, other factors such as geographical conditions, genetics and stressful activities probably affect its presence too.

La faceta cuboídea del hueso navicular es una carilla plana e irregular, presente en primates no humanos y en algunos de nuestros ancestros. En humanos modernos, no siempre está presente y es descrita como "un hallazgo ocasional" por la bibliografía. Hasta la fecha, no hay suficientes datos acerca de su incidencia en poblaciones antiguas y contemporáneas, ni una explicación biomecánica sobre su presencia o ausencia. El objetivo de nuestro estudio fue evaluar la frecuencia de la faceta cuboídea en poblaciones recientes y antiguas, su relación con las dimensiones de los huesos tarsales y su rol en la biomecánica de la marcha. Fueron estudiados 354 pares de naviculares y otros huesos del tarso provenientes de colecciones osteológicas de Cataluña, España. Aplicamos nueve medidas aplicadas al talus, navicular y cuboides para corroborar su relación con la presencia de la faceta. Para analizar sus parámetros biomecánicos, se empleó X-ray cinematography en pacientes hospitalarios. Los resultados mostraron que alrededor de un 50 % de los individuos desarrollaron esta carilla, sin diferencias entre sexos o series. Además, observamos que la longitud sagital de la faceta talar (LSAGTAL) es mayor en aquellas muestras con faceta cuboídea. No hay diferencias significativas en el contacto de los huesos en ninguna de las fases de la marcha. Después de revisar su presencia en primates no humanos, su implicancia en el bipedismo y en la marcha moderna, sugerimos que la faceta cuboídea podría estar relacionada con el tamaño de la faceta talar y la posición de la articulación talo-navicular. Sin embargo, otros factores como las condiciones geográficas, genética y stress ocupacional también podrían afectar su presencia.

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.

Luxación expuesta de la primera y segunda cuña y fractura in situ de la tercera cuña del pie: caso clínico y revisión de la literatura / Exposed dislocation of the first and second cuneiform bones and fracture in situ of the third cuneiform bone of the foot: Clinical case and literature review

Resumen: Antecedentes: La fractura y la luxación aislada de los huesos cuneiformes son un evento no muy frecuente y sólo pocos casos han sido reportados en la literatura. Este tipo de eventos se presenta como una variación de las lesiones de Lisfranc. El presente reporte muestra un caso clínico poco frecuente de un paciente con luxación de la primera y segunda cuña y fractura in situ de la tercera cuña del pie izquierdo. Caso clínico: Mujer de 49 años de edad, que presentó traumatismo severo del dorso del pie con exposición de tejido óseo y blando como consecuencia de atropellamiento. La paciente fue sometida a cirugía en el Servicio de Urgencias, donde se realizó aseo quirúrgico, desbridamiento, reducción de la luxación de la primera y segunda cuña y fijación percutánea con clavillos Kirschner de 2.0 mm. Resultados: Posterior a la cirugía, la paciente se reportó con buen estado en general, orientada, sin facie de dolor, estable, consciente, sin huellas de sangrado activo por la herida y con presencia de clavillos Kirschner en adecuada posición. Discusión: Se recomienda una inspección exhaustiva de la lesión a través del análisis de las imágenes de rayos X, tomografía computarizada o imágenes de resonancia magnética, especialmente en lesiones no expuestas, pues con ello se puede aplicar el tratamiento adecuado y lograr una pronta recuperación del paciente.

Abstract: Backgrounds: The isolated fracture/dislocation of the cuneiform bones is a not very frequent event and only a few cases have been reported in the literature. This type of event is presented as a variation of the Lisfranc injuries. The present report shows a rare clinical case of a patient with dislocation of the first and second cuneiform bones and fracture in situ of the third cuneiform bone of the left foot. Case report: A 49-year-old female patient presented severe traumatism of the dorsum of the foot with bony and soft tissue exposure as a result of a car accident. The patient underwent surgery in the emergency department consisting of surgical cleaning, debridement, reduction of dislocation of the first and second cuneiform bones and percutaneous fixation with 2.0 mm Kirschner wires. Results: After the surgery, the patient was found to be in good general condition, oriented without pain, stable, conscious, without traces of active bleeding from the wound and with the presence of Kirschner wires in an appropriate position. Discussion: An exhaustive inspection of the injury is recommended through the analysis of X-ray images, CT scans or magnetic resonance imaging, especially in unexposed lesions in order to apply the appropriate treatment and be able to achieve a prompt recovery of the patient.

Mycobacterium bovis Osteitis Following Immunization with Bacille Calmette-Guérin (BCG) in Korea

BACKGROUND: Mycobacterium bovis Bacille Calmette-Guérin (BCG) osteitis, a rare complication of BCG vaccination, has not been well investigated in Korea. This study aimed to evaluate the clinical characteristics of BCG osteitis during the recent 10 years in Korea. METHODS: Children diagnosed with BCG osteitis at the Seoul National University Children's Hospital from January 2007 to March 2018 were included. M. bovis BCG was confirmed by multiplex polymerase chain reaction (PCR) in the affected bone. BCG immunization status and clinical information were reviewed retrospectively. RESULTS: Twenty-one patients were diagnosed with BCG osteitis and their median symptom onset from BCG vaccination was 13.8 months (range, 6.0–32.5). Sixteen children (76.2%) received Tokyo-172 vaccine by percutaneous multiple puncture method, while four (19.0%) and one (4.8%) received intradermal Tokyo-172 and Danish strain, respectively. Common presenting symptoms were swelling (76.2%), limited movement of the affected site (63.2%), and pain (61.9%) while fever was only accompanied in 19.0%. Femur (33.3%) and the tarsal bones (23.8%) were the most frequently involved sites; and demarcated osteolytic lesions (63.1%) and cortical breakages (42.1%) were observed on plain radiographs. Surgical drainage was performed in 90.5%, and 33.3% of them required repeated surgical interventions due to persistent symptoms. Antituberculosis medications were administered for a median duration of 12 months (range, 12–31). Most patients recovered without evident sequelae. CONCLUSION: Highly suspecting BCG osteitis based on clinical manifestations is important for prompt management. A comprehensive national surveillance system is needed to understand the exact incidence of serious adverse reactions following BCG vaccination and establish safe vaccination policy in Korea.

Isolated Dorsal Dislocation of Intermediate Cuneiform: A Case Report / 대한족부족관절학회지

An isolated dislocation of the intermediate cuneiform bone is a rare midfoot injury. This paper reports a case of a 60 year old man who fell from a height with his foot in the plantar flexed position. An isolated dorsal dislocation of the intermediated cuneiform was confirmed. Good results were obtained after an open reduction and internal fixation with a Lisfranc screw and Kirschner wire.

Palpebral Conjunctival and Tarsal Stromal Tumor

No abstract available.

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.

Muscular Variations of Extensor Digitorum Brevis Muscle Related with Anterior Tarsal Tunnel Syndrome / 체질인류학회지

During routine dissection, additional muscular head of extensor digitorum brevis muscle attaching to the third toe and accessory muscle perforated by the branch of the deep peroneal nerve were observed in the right foot of a 71-year-old male cadaver. The additional muscular head originated from the dorsal surface of cuboid bone, and ran parallel with the third tendon of the extensor digitorum brevis muscle. It was conjoined with the third tendon of extensor digitorum brevis at the middle of its course. The accessory muscle was a small muscle which was covered with the muscle belly of the extensor hallucis brevis muscle. It originated from the dorsal surface of the calcaneus, and inserted to the lateral one-third of transverse retinacular band. These two variants were innervated by the branches of deep peroneal nerve. The branches of deep peroneal nerve were compressed under the tendon of extensor hallucis brevis and around the site where the nerve branch perforated the small muscle. The clinical significances of these variations and tendon of extensor hallucis brevis muscle were discussed.

Brachymetatarsia with accessory navicular in right foot: A rare coincidental finding / 中华创伤杂志(英文版)

A 33 years old female patient presented with posttraumatic pain in the right foot for which radiographs of the right foot was advised. No fracture was detected on radiographs and patient was managed conservatively on medications and posterior splint immobilization. We found coincidentally a short fourth metatarsal and an accessory navicular bone in the right foot radiographs. After 3 weeks of immobilization, she underwent mobilization of the right foot, weight bearing and intensive physio- therapy for 6 weeks. After two months of injury she was still complaining of pain on the plantar aspect of right foot which was diagnosed as metatarsalgia and operated on by excision of the neuroma present in the 3rd web space of the right foot. After surgery she was completely relieved of pain and could do activities well related to the right foot.

Fractures of the Tarsal Bone

Fractures of the tarsal bone, such as the navicular, cuboid, and cuneiform, are very rare. These injuries can lead to serious walking difficulties due to pain and deformity of the foot with delayed diagnosis of tarsal bone fractures during an injury to multiple lower extremities. The diagnosis can be done on simple radiographs. Sometime weight bearing radiographs or stress radiographs may be needed for further evaluation. Computed tomography is the most widely available diagnostic tool. Navicular and cuneiform account for the medial column of the foot, whereas cuboid for the lateral column. The treatment of tarsal bone fractures is primarily conservative management, but operative treatment is recommended for intra-articular displacement, dislocation, or shortening of the medial or lateral column of the foot. The operative treatments include screw fixation, plate fixation, or external fixation. Complications include malunion, nonunion, posttraumatic arthritis, avascular necrosis, and deformity of the foot. Tarsal bone fracture has to be evaluated carefully to prevent serious complications.

Alterações radiográficas do aparato podotroclear de equinos da Polícia Militar de Minas Gerais sem sinais clínicos de doença do osso navicular / Radiographic changes in the podotroclear apparatus from Minas Gerais State Military horses without clinical signs of navicular disease

Os objetivos deste experimento foram identificar e associar alterações radiográficas do aparato podotoclear de equinos do Regimento de Cavalaria Alferes Tiradentes da Policia Militar do estado de Minas Gerais sem histórico e sinais clínicos de doença do osso navicular. Foi avaliado um total de 33 equinos, de ambos os sexos, com idade entre 10 e 20 anos. Os dígitos torácicos foram radiografados de forma padronizada nas projeções lateromedial (LM), dorsoproximal palmarodistal 65º (DPPD) e palmaroproximal palmarodistal (SK). A radiopacidade medular aumentada em projeção SK foi a principal alteração radiográfica detectada. Essa alteração foi associada a maior número de invaginações sinovais, a maior espessura de cortical em relação à medular em exposição SK e a maior relação corticomedular em exposição LM (P<0,05). Esses achados indicam uma predisposição da população equina para desenvolver a síndrome do osso navicular, possivelmente associada ao trauma repetitivo promovido pelo constante trabalho em piso duro.

The aims of this study were to identify and associate radiographic changes of podotoclear apparatus in horses from the Tiradentes Calvary Regiment of the Military Police of Minas Gerais State without history and clinical signs of navicular disease. 33 horses from both sexes, aged between 10 and 20 years were evaluated. The thoracic digits were radiographed in a standardized manner in lateralmedial (LM), palmaroproximal-distodorsal 65o(DPPD) and palmaroproximal-distopalmar (SK) projections. The increased medullary radiopacity in SK projection was the main radiological change detected and was associated with a higher number of synoval invaginations, increased cortical thickness in relation to medulla in SK exposure and increased corticomedullar in LM exposure (P < 0.05). These findings indicate a predisposition of this population to develop navicular syndrome, which is possibly associated with repetitive trauma promoted by constant work on hard floors.