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.

Clinical effects of pretarsal orbicularis-tarsus fixation technique in double eyelidplasty / 中华医学美学美容杂志

Objective:To evaluate the aesthetic outcome of the pretarsal orbicularis-tarsus fixation technique in incisional double eyelid blepharoplasty.Methods:Postoperative results were evaluated from 798 patients who underwent the orbicularis-tarsus fixation blepharoplasty from January 2015 to December 2018. Based on an incisional maneuver, soft tissue was carefully removed to expose the superior edge of tarsus, then the pretarsal orbicularis oculi muscle was anchored on the tarsus. For skin closure, both skin margins, a small bite of subcutaneous tissue and the pretarsal fascia were interruptedly sutured to enhance cicatricial adhesion.Results:All patients successfully underwent double eyelidplasty using this modified technique. The follow-up period ranged from two to forty-six months, with a mean period of twenty months. Ninety-six percent of the patients were satisfied with postoperative outcomes. Twenty-two cases of palpebral fold asymmetry and ten cases of unsatisfactory fold formation near the inner canthus were encountered. However, all the defects had been well improved by minor revisions. No supratarsal crease drooping or disappearing, suture spitting out, scar hypertrophy or crease depression were observed postoperatively.Conclusions:The orbicularis-tarsus fixation method is a reliable technique for double eyelid plasty. It enables high feasibility and long-lasting result, with lower risk of postoperative complications.

Rhinosporidiosis of the tarsal conjunctiva.

Rhinosporidiosis is a rare infection caused by Rhinosporidium seeberi, an organism classified in its own class, mesomycetozoea. It commonly affects mucus membranes namely the nasal mucosa, pharynx and the conjunctiva. We present the case of an 8‑year‑old female who presented with a flat, red, vascular, fleshy, pedunculated mass arising from the tarsal conjunctiva of the right upper eyelid. The mass was completely excised. On histopathological examination, multiple sporangia were seen in various stages of degeneration, consistent with rhinosporidiosis. The diagnosis of rhinosporidiosis is based solely on its microscopic features, and the treatment is surgical excision. This condition is endemic in the temperate regions of the Indian subcontinent, but it has been known to occur even in the colder regions of North America and Eastern Europe. Although a rare clinical entity, the possibility of rhinosporidiosis must be borne in mind when evaluating any polypoidal conjunctival mass.

A Case of Intratarsal Keratinous Cyst of the Meibomian Gland

PURPOSE: To report a patient presenting with an intratarsal keratinous cyst of the Meibomian gland in the upper eyelid and a review of the relevant literature. CASE SUMMARY: A 65-year-old male presented with a right upper eyelid mass which started 5 months prior. The patient reported that the mass recurred several weeks prior even after incision and curettage procedure. The mass was 9 x 5 mm in size and located in the center of the right upper eyelid at the level of lid crease, fixed to the tarsus and a whitish elevated focus was observed at the palpebral conjunctival surface. The mass was excised under local anesthesia and originated from the tarsus. The histopathological examinations revealed an intratarsal keratinous cyst composed of stratified squamous epithelium without keratohyalin granules and filled with keratin. The immunohistochemical studies showed positive staining results for cytokeratin 5/6, epithelial membrane antigen, and carcinoembryonic antigen. CONCLUSIONS: Intratarsal keratinous cyst of the Meibomian gland should be considered as a differential diagnosis of a recurrent tarsal mass.

Effects of over the lower edge of the tarsal joint continuous suture fixation combined with orbital entire complex on eyelid epicanthus / 中国基层医药

Objective To investigate the continuous suture through the lower edge of the tarsal joint fixation orbital reconstructive eyelid superfluous skin treatment efficacy.Methods 50 cases of abject epicanthus clinical data were retrospectively analyzed from June 2009 to June 2013 in our hospital by the hospital ethics committee approved,which had a total of 100 eyes.According to the numbering method,they were randomly divided into control group and observation group,each 50 cases.Control group was given through the lower edge of the tarsal continuous suture fixation,while the observation group was treated on the basis of control group combined with joint orbital entire complex treatment.Therapeutic effects were compared,pain,treatment before and after each measurement indicators and lower eyelid skin complications and so on.Results After treatment,the control group redundant lower eyelid skin correction,eyelash contact with the cornea and corneal epithelial healing of eye damage were respectively 39 (78.00％),10 (20.00％) and 43 (86.00％),while the observation group were 49 (98.00％),1 (2.00％) and 50 (100.00％),the above parameters were statistically significant differences (x2 =5.559,16.839,3.840,P ＜ 0.05,P ＜ 0.01) ; According to VAS pain score,VAS scores before and after treatment were statistically significant (t =5.271,12.593,P ＜0.05,P ＜ 0.01),and the observation group after treatment VAS scores after treatment compared with the control group,the difference was statistically significant(t =4.399,P ＜ 0.05) ; Before and after treatment from the eyelid folds distance,flat as the lower eyelid away from the eye position,head lower eyelid skin flap in eyelid,head tilt eyelashes,inner canthal angle,outer canthal angle,inner canthal folds,palpebral fissure height,head of small tears on the pitch,orbicularis muscle eyelid width,eyelid orbicularis muscle thickness and orbital orbicularis muscle thickness differences were statistically significant,and the observation group after treatment with these indicators compared to the control group after treatment,the differences were statistically significant (t =4.292,5.828,4.135,5.099,4.723,5.002,6.717,8.092,7.038,8.056,3.129,7.043,P ＜ 0.05) ; the course of treatment in both groups would be lower eyelid retraction,ectropion and eyelid scar concurrent disease control group complication rate was 20.00％,which was significantly higher than that of the observation group(6.00％),the difference was significant statistical significance(x2 =13.283,P ＜ 0.01).Conclusion Over the lower edge of the tarsal joint continuous suture fixation treatment of orbital reconstructive eyelid superfluous skin effect is significant,with low complication rate,which is worth to be promoted in clinical and applied.

Fractura bilateral de calcáneo: reporte de un caso / Bilateral calcaneus fracture: case report

Las fracturas del calcáneo representan aproximadamente 2% de todas las fracturas del cuerpo humano y 60% de las fracturas del tarso. Menos del 7% son bilaterales. Las fracturas intra-articulares desplazadas (Sanders Tipo IV) son el resultado de traumatismos de alta energía, usualmente debido a precipitaciones o accidentes automovilísticos. Es una lesión compleja que se asocia con elevados índices de incapacidad cuando no es tratada de forma correcta y oportuna. Se trata de paciente masculino, de 38 años de edad, quien presenta una fractura bilateral de calcáneo Sanders tipo IV, manejada quirúrgicamente, mediante reducción directa, reconstrucción anatómica del calcáneo, osteosíntesis con placa anatómica y artrodesis subtalar. Las fracturas del calcáneo siguen siendo un gran reto para el cirujano ortopedista y traumatólogo debido a la controversia en cuanto a su manejo. El diagnóstico preciso y precoz, basado en estudios imagenológicos, es necesario para una adecuada caracterización de la fractura, planificación preoperatoria y resolución quirúrgica(AU)

Calcaneal fractures represent approximately 2% of all fractures of the body and 60% of fractures of the tarsus. Less than 7% are bilateral. The displaced intra-articular fractures (Sanders type IV) are the result of high energy trauma, usually because of rainfall or auto accidents. It is a complex injury that is associated with high rates of disability when not treated properly and timely. The case of male 38-year-old man presented with bilateral calcaneal fractures Sanders type IV, which were managed surgically by direct reduction of the calcaneus and anatomical reconstruction píate fixation and anatomic subtalar arthrodesis. Calcaneal fractures remain a major challenge for orthopedic surgeons and trauma due to controversy regarding their management. The early and accurate diagnosis based on imaging studies, it is necessary for proper characterization of the fracture, preoperative planning and surgical resolution(AU)

Calcinosis Cutis at the Tarsus of the Upper Eyelid

Calcinosis cutis involves the inappropriate deposition of calcium within the dermis layer of the skin, and is often associated with rheumatoid disease. A 42-year-old woman presented for evaluation of a hard palpable mass on the left upper eyelid. After everting the eyelid, a large papillomatous mass with a broad base was identified on the superior area of the tarsus. The lesion was partially excised posteriorly under local anesthesia, and pathologists identified the mass as calcinosis cutis. The patient had no systemic or trauma history, and the serum levels of calcium and phosphorous were normal. Idiopathic calcinosis cutis should be included in the differential diagnosis for a protruding papillomatous mass of the tarsal plate, and surgical debulking could be a viable option for large protruding lesions, although more follow-up is necessary to monitor regrowth.

Evolución de lesiones podales en lechones lactantes / Evolution of injuries in the limbs of suckling piglets

En un estudio de pseudocohortes se inspeccionaron los miembros craneales y caudales de 3142 lechones lactantes de 5 a 27 días de vida, para evaluar prevalencia de lesiones y su evolución, clasificándolas por edad y región anatómica. El trabajo se desarrolló en un establecimiento porcino de crianza intensiva, de ciclo completo, todo adentro-todo afuera, con 1200 madres totales y un promedio de 50 partos semanales, con una edad de destete promedio de 24 días. De los 3142 lechones, 249 (7.92%) no presentaron lesiones, en los restantes 2893 (92.8%) se observaron 8415 lesiones, correspondiendo 3869 (46%) a fibrosis, 4314 (51.20%) a heridas y 232 (2.8%) a artritis. De ese total 5165 (61.4%) correspondieron a los carpos, 737 (8.8%) a los tarsos y 2513 (29.9%) a las pezuñas. En lechones de 5-9 días de edad las heridas representaron el 73.8% del total de lesiones, las que tuvieron dos formas de evolución, hacia la fibrosis o la artritis. Esta evolución de las heridas mayormente tiende a la fibrosis en el carpo y a la artritis en el tarso. Se concluye que los miembros de lechones en maternidad presentan alta prevalencia de lesiones bilaterales desde la edad temprana y principalmente en los miembros craneales.

The purpose of this work was to study the prevalence, evolution and type of lesions occurring in the front and back legs of 3142 suckling piglets from 5 to 27 days of age, also classifying ithem according to age and anatomical region. From the total 3142 piglets, 249 (7.92%) did not have any visible lesions. In the other 2893 (92.08%) piglets, a total of 8415 different lesions were observed. Over this total, an amount of 3869 (46%) piglets showed fibrosis, 4314 (51.20%) had different type of injuries and 232(2.8%) presented arthritis. Over the total of 8415 lesions, 5165 (61.4%), 737 (80.8%), and 2513 (29.9%) had lesions on the carpus, tarsus and hoofs, respectively. Injuries represented 73.8% of the total lesions in 5 to 9 days old piglets, which evolved either towards fibrosis or arthritis. Fibrosis was the product of evolution on lesions mainly in the carpus, whereas arthritis evolved mainly in the tarsus.

Correction of Epiblepharon by Excision of Redundant skin and Pretarsal orbicularis muscle without tarsal fixation

PURPOSE: To evaluate the effect of the excision of redundant skin and pretarsal orbicularis muscle without tarsal fixation on the correction of the congenital epiblepharon. METHODS: We performed the surgery on 115 patients, 220 eyes from January 1996 to December 1999, and evaluated the functional, and cosmetic result. Surgical treatment included excision of redundant skin and pretarsal orbicularis muscle without tarsal fixation and simple skin suture technique. RESULTS: The mean age of the group was 7.2+/-6.8 years. There were 45 males and 70 females. Following the average follow up period of 18.4+/-4.5 months (minimum was 12 months), 212 eyes (96.4%) showed satisfactory result in functional and cosmetic aspect with of 8 eyes (3.6%) showed undercorrection early postoperativey but none underwent reoperation due to recurrences. CONCLUSIONS: This operative technique resulted in a good cosmetic and functional result.

Coaliciones tarsiales / Tarsal coalitions / Coalitions du tarse

Se presenta una serie de 32 pacientes con coaliciones tarsiales congénitas tratados por el autor. Se exponen los antecedentes históricos de la relación pie plano/coaliciones tarsiales, así como las distintas denominaciones por las que éstas han sido designadas, sus características anatomopatológicas, clasificación, sintomatología clínica, patogenia y tratamiento. Se describen los resultados obtenidos con estos pacientes y se concluye que las coaliciones subastragalinas con alteraciones congénitas son las de peor pronóstico.

It is presented a series of 32 patients with congenital tarsal coalitions treated by the author. The historical background of the relationship flatfoot/tarsal coalitions are exposed as well as the different denominations given to them, their anatomopathological characteristics, classification, clinical symptomatology, pathogeny, and treatment. The results obtained with these patients are described, and it is concluded that the subastragalar coalitions with congenital alterations are those with de worst prognosis.

On présente une série de 32 patients avec coalitions congénitales du tarse traitées par l'auteur. On expose les antécédents historiques du rapport pied plat/coalitions du tarse, ainsi que les différentes dénominations par lesquelles ont été désignées leurs caractéristiques anatomo-pathologiques, classification, symptomatologie clinique, pathogénie et traitement. On décrit les résultats obténus chez ces patients et on conclut que les coalitions sous-astragalines avec des troubles congénitales sont celles avec le pire pronostic.