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Frontiers in Bioengineering and... 2024Jones fractures frequently fail to unite, and adequate fixation stability is crucial. This study aimed to elucidate the biomechanical stability of various...
Jones fractures frequently fail to unite, and adequate fixation stability is crucial. This study aimed to elucidate the biomechanical stability of various intramedullary screw fixation constructs. Jones fracture model over the proximal 5th metatarsal of artificial bone was created in all specimens. Six groups were divided based on varied screw constructs with different screw lengths, either 30 or 40 mm, including cannulated screws-C30 and C40 groups, one high-resistance suture combined with intramedullary cannulated screws (F.E.R.I. technique)-CF30 and CF40 groups, and second-generation headless compression screws (SG-HCS) -HL30 and HL40 groups. Mechanical testing was conducted sequentially, and the maximal force (N) and stiffness (N/mm) of all constructs were recorded. The maximal force (N) at 1.0 mm downward displacement in C30, C40, CF30, CF40, HL30, and HL40 groups were 0.56 ± 0.02, 0.49 ± 0.02, 0.65 ± 0.02, 0.49 ± 0.01, 0.68 ± 0.02, and 0.73 ± 0.02, respectively, and the stiffness (N/mm) in subgroups were 0.49 ± 0.01, 0.43 ± 0.01, 0.67 ± 0.01, 0.42 ± 0.01, 0.61 ± 0.01, and 0.58 ± 0.02, respectively. SG-HCS subgroups exhibited greater maximal force and stiffness than conventional cannulated screws. Screws of 30 mm in length demonstrated better stability than all 40 mm-length screws in each subgroup. In C30 fixation, the stiffness and maximum force endured increased by 1.16 and 1.12 times, respectively, compared with the C40 fixation method. There were no significant differences between CF30 and SG-HCS groups. Only the F.E.R.I technique combined with the 4.5 mm cannulated screw of 30 mm in length increased the biomechanical stability for Jones fractures. These biomechanical findings help clinicians decide on better screw fixation options for greater stability in Jones fractures, especially when large-diameter screws are limited in use. However, this biomechanical testing of intramedullary screw fixation on Jones fracture model lacks clinical validation and no comparisons to extramedullary plate fixations. Moving forward, additional clinical and biomechanical research is necessary to validate our findings.
PubMed: 38751865
DOI: 10.3389/fbioe.2024.1389127 -
Biomimetics (Basel, Switzerland) Dec 2023This study utilized the mallard's foot as the subject, examining the bone distribution via computed tomography (CT) and analyzing pertinent parameters of the...
This study utilized the mallard's foot as the subject, examining the bone distribution via computed tomography (CT) and analyzing pertinent parameters of the tarsometatarsal bones. Additionally, gross anatomy methods were employed to elucidate the characteristics of the toes and webbing bio-structures and their material composition. Biologically, the mallard's foot comprises tarsometatarsal bones and 10 phalanges, enveloped by fascia, tendons, and skin. Vernier calipers were used to measure the bones, followed by statistical analysis to acquire structural data. Tendons, originating in proximal muscles and terminating in distal bones beneath the fascia, facilitate force transmission and systematic movement of each segment's bones. Regarding material composition, the skin layer serves both encapsulation and wrapping functions. Fat pads, located on the metatarsal side of metatarsophalangeal joints and each phalanx, function as cushioning shock absorbers. The correlation between the force applied to the tarsometatarsal bones and the webbing opening angle was explored using a texture analyzer. A simplified model describing the driving force behind the webbing opening angle was introduced. Furthermore, we designed a bionic foot, contributing a foundational reference for anti-sinking bionic foot development.
PubMed: 38132531
DOI: 10.3390/biomimetics8080592 -
International Journal of Surgery Case... Feb 2024Myxoma, a benign and uncommon tumor, is primarily characterized by undifferentiated spindle cells and a myxoid matrix with muscular infiltration. While the intramuscular...
INTRODUCTION
Myxoma, a benign and uncommon tumor, is primarily characterized by undifferentiated spindle cells and a myxoid matrix with muscular infiltration. While the intramuscular form is predominant, the juxta-articular variant is rare, especially in the foot. Juxta-articular myxomas had a heightened risk of recurrence post-surgical excision, emphasizing the need for effective management strategies.
CASE PRESENTATION
We report the first description in the literature of a myxoma in the foot with bone invasion in a 59-year-old male with a ten-month history of a progressively enlarging antero-internal swelling near the base of the first metatarsal in the left foot. Clinical examination and imaging revealed erosive changes in the bone, prompting excision-curettage. Histopathological examination confirmed the presence of a juxta-articular myxoma, an exceptionally rare localization. The patient exhibited satisfactory outcomes at the 13-month follow-up.
DISCUSSION
Myxomas, primarily occurring around the knee, are infrequently found in the foot, with juxta-articular presentation being exceptionally rare. Traumatic causes and osteoarthritis are debated etiopathogenic factors. Radiologically, bone involvement is atypical, and magnetic resonance imaging aids in diagnosis. Treatment involves surgical excision, often requiring additional procedures. Juxta-articular myxomas, despite sharing characteristics with intramuscular myxomas, are distinguished by location and a higher recurrence rate.
CONCLUSION
This case contributes to the limited literature on myxomas localized in the foot, particularly with bone invasion. Histological diagnosis is crucial, and surgery is the mainstay of treatment despite the substantial recurrence risk. This report underscores the importance of vigilance in managing myxomas, especially in rare anatomical presentations, and advocates for ongoing research to enhance understanding and therapeutic approaches.
PubMed: 38184953
DOI: 10.1016/j.ijscr.2023.109210 -
Journal of Human Kinetics Apr 2024The goal of this study was to use the finite element (FE) method to compare and study the differences between bionic shoes (BS) and normal shoes (NS) forefoot strike...
The goal of this study was to use the finite element (FE) method to compare and study the differences between bionic shoes (BS) and normal shoes (NS) forefoot strike patterns when running. In addition, we separated the forefoot area when forefoot running as a way to create a small and independent area of instability. An adult male of Chinese descent was recruited for this investigation (age: 26 years old; body height: 185 cm; body mass: 82 kg) (forefoot strike patterns). We analyzed forefoot running under two different conditions through FE analysis, and used bone stress distribution feature classification and recognition for further analysis. The metatarsal stress values in forefoot strike patterns with BS were less than with NS. Additionally, the bone stress classification of features and the recognition accuracy rate of metatarsal (MT) 2, MT3 and MT5 were higher than other foot bones in the first 5%, 10%, 20% and 50% of nodes. BS forefoot running helped reduce the probability of occurrence of metatarsal stress fractures. In addition, the findings further revealed that BS may have important implications for the prevention of hallux valgus, which may be more effective in adolescent children. Finally, this study presents a post-processing method for FE results, which is of great significance for further understanding and exploration of FE results.
PubMed: 38736608
DOI: 10.5114/jhk/174311 -
Diagnostic and Interventional Radiology... May 2024To explore sonographic cortical bone thickness (CoT) as a potential indicator of bone mineral density (BMD) measured by dual-energy X-ray absorptiometry for screening...
PURPOSE
To explore sonographic cortical bone thickness (CoT) as a potential indicator of bone mineral density (BMD) measured by dual-energy X-ray absorptiometry for screening and diagnosing pediatric osteoporosis.
METHODS
A prospective study included 41 osteopenic or osteoporotic patients and 52 healthy children. Radius cortical thickness (R-CoT), tibial cortical thickness (T-CoT), and second metatarsal cortical thickness (M-CoT) were measured by B-mode ultrasound; CoT values were compared between groups and the correlation between BMD and CoT was examined.
RESULTS
There were no significant differences in R-CoT ( = 0.433), T-CoT ( = 0.057), and M-CoT ( = 0.978) values between the patient and control groups. No significant correlations were found between BMD T-scores and R-CoT (r = -0.073, = 0.490), T-CoT (r = -0.154, = 0.141), and M-CoT (r = 0.047, = 0.657) values.
CONCLUSION
Sonographic CoT values in children do not correlate with BMD values. Unlike in adults, sonographic CoT measurements do not appear to have a role in assessing BMD in the pediatric population.
Topics: Humans; Bone Density; Male; Child; Female; Ultrasonography; Prospective Studies; Absorptiometry, Photon; Cortical Bone; Adolescent; Osteoporosis; Radius; Tibia; Bone Diseases, Metabolic
PubMed: 38044613
DOI: 10.4274/dir.2023.232392 -
PeerJ 2024First metatarsophalangeal joint (MTP-1) arthrodesis is a commonly performed procedure in the treatment of disorders of the great toe. Since the incidence of revision...
BACKGROUND
First metatarsophalangeal joint (MTP-1) arthrodesis is a commonly performed procedure in the treatment of disorders of the great toe. Since the incidence of revision after MTP-1 joint arthrodesis is not insignificant, a medial approach with a medially positioned locking plate has been proposed as a new technique. The aim of the study was to investigate the effect of the application of a lag screw on the stability and strength of first metatarsophalangeal joint arthrodesis with medial plate.
METHODS
The bending tests in a testing machine were performed for models of the first metatarsal bone and the proximal phalanx printed on a 3D printer from polylactide material. The bones were joined using the locking titanium plate and six locking screws. The specimens were divided into three groups of seven each: medial plate and no lag screw, medial plate with a lag screw, dorsal plate with a lag screw. The tests were carried out quasi-static until the samples failure.
RESULTS
The addition of the lag screw to the medial plate significantly increased flexural stiffness (41.45 N/mm 23.84 N/mm, = 0.002), which was lower than that of the dorsal plate with a lag screw (81.29 N/mm, < 0.001). The similar maximum force greater than 700 N ( > 0.50) and the relative bone displacements lower than 0.5 mm for a force of 50 N were obtained for all fixation techniques.
CONCLUSIONS
The lag screw significantly increased the shear stiffness in particular and reduced relative transverse displacements to the level that should not delay the healing process for the full load of the MTP-1 joint arthrodesis with the medial plate. It is recommended to use the locking screws with a larger cross-sectional area of the head to minimize rotation of the medial plate relative to the metatarsal bone.
Topics: Arthrodesis; Metatarsophalangeal Joint; Bone Plates; Bone Screws; Extremities
PubMed: 38436033
DOI: 10.7717/peerj.16901 -
Medicine Dec 2023Various surgical treatments are available for a symptomatic AN, including percutaneous drilling (PD). PD is reportedly effective for ANs in skeletally immature children....
Various surgical treatments are available for a symptomatic AN, including percutaneous drilling (PD). PD is reportedly effective for ANs in skeletally immature children. However, no reports have described the foot alignment after PD in skeletally immature children. This study was performed to compare the radiographic parameters between the preoperative period and the final follow-up after PD for symptomatic ANs in skeletally immature children. From October 2013 to December 2020, PD was performed on 13 feet in 10 skeletally immature children. The patients comprised 5 boys and 5 girls with a mean age at surgery of 11.9 years. The mean follow-up period was 14.8 months. We measured 5 radiographic findings preoperatively and at the final follow-up: calcaneal pitch angle (CPA), talocalcaneal angle (TCA), talonavicular coverage angle (TNCA), anteroposterior talo-first metatarsal angle (ATMA), and lateral talo-first metatarsal angle (LTMA). Ten feet were assessed as excellent, 1 as fair, and 2 as poor. Ten unions (76.9%) were achieved among the 13 feet. The mean CPA improved from 16.4 ± 4.1 degrees preoperatively to 18.2 ± 3.4 degrees at the final follow-up, the TCA improved from 43.0 ± 3.7 to 45.2 ± 4.4 degrees, and the TNCA improved from 19.9 ± 4.4 to 15.4 ± 5.0 degrees (P < .05). The ATMA and LTMA were not significantly different between the preoperative period and final follow-up. We found that PD for symptomatic ANs in skeletally immature children was effective treatment, and some radiographic parameters showed significant differences between the preoperative period and final follow-up.
Topics: Male; Female; Child; Humans; Flatfoot; Radiography; Tarsal Bones; Osteotomy
PubMed: 38134109
DOI: 10.1097/MD.0000000000036643 -
Journal of Orthopaedic Surgery (Hong... 2024The hallux valgus deformity is made up of misaligned first metatarsal, hallux, and sesamoids. Their angular deformities are well-studied, but not their positional...
BACKGROUND
The hallux valgus deformity is made up of misaligned first metatarsal, hallux, and sesamoids. Their angular deformities are well-studied, but not their positional displacements. A few available reports claimed the proximal end of the proximal phalanx and sesamoids were not shifted medially along with the first metatarsal head. However, the general observation is otherwise. This study revisits the issue.
METHODS
A radiological study of 189 feet with and without the hallux valgus deformity was carried out to analyze the first metatarsal, hallux, and sesamoid positional changes in relation to the second metatarsal and among themselves. A total of 194 X-ray images with all relevant measurements that formed the raw database for this study were submitted for online viewing and reference.
RESULTS
There was a statistically significant change in the first metatarsal, hallux, and sesamoid positions of feet with hallux valgus deformity compared to normal feet. All have migrated medially but to different degrees. It was contrary to the past findings of no change in sesamoid and hallux positions.
CONCLUSIONS
We agree with past findings that the metatarsus primus varus deformity is directly related to the failed medial metatarsosesamoid ligament. We also believe in the failure of the deep 1-2 transverse metatarsal ligament responsible for the sesamoid migration.
Topics: Humans; Hallux Valgus; Hallux Varus; Foot; Radiography; Hallux; Metatarsal Bones
PubMed: 38369475
DOI: 10.1177/10225536241233474 -
BMC Musculoskeletal Disorders Oct 2023Idiopathic flexible flatfoot is a common condition in children which typically improves with age and remains asymptomatic. However, the condition can sometimes be more...
BACKGROUND
Idiopathic flexible flatfoot is a common condition in children which typically improves with age and remains asymptomatic. However, the condition can sometimes be more severe, and cause mechanical impairment or pain. The aim of the study was to perform a prospective clinical, radiological, podoscopic and pedobarographic assessment (static and dynamic) of subtalar titanium screw arthroereisis for the treatment of symptomatic, idiopathic, flexible flatfeet.
METHODS
A prospective, consecutive, non-controlled, cohort, clinical follow-up study was performed. In total, 30 patients (41 feet), mean age 10 (6 to 16 years), were evaluated. Clinical and standing radiological assessments, static and dynamic pedobarography, as well as podoscopy, were performed before surgery and at final follow-up.
RESULTS
Treatment was associated with significant improvements in heel valgus angle, radiographic parameters (lateral and dorso-planar talo-first metatarsal angle, calcaneal inclination angle, talar declination angle, longitudinal arch angle) and podoscopic parameters (Clark's angle, Staheli's arch index and Chippaux-Smirak index). Significant increases were noted for lateral loading, forefoot contact phase and double support / swing phase, and reduced medial loading (dynamic pedobarography), as well as lateral midfoot area and loading, but decreased were observed for medial forefoot loading (static pedobarography). Four patients reported persistent pain in the sinus tarsi region (six feet), and in one case, the implant was replaced for a larger one due to undercorrection. No overcorrections or infection complications were noted in the study group.
CONCLUSIONS
Subtalar arthroereisis is a minimally-invasive and effective surgical method for treating symptomatic, idiopathic, flexible flatfeet; it has an acceptable complication rate with good early clinical results.
LEVEL OF EVIDENCE
II b.
Topics: Humans; Child; Flatfoot; Titanium; Follow-Up Studies; Prospective Studies; Pain; Bone Screws
PubMed: 37858058
DOI: 10.1186/s12891-023-06937-2 -
Foot (Edinburgh, Scotland) Sep 2023Lateral column (LC) instability occurs in adult acquired flatfoot deformity (AAFD). Differential ligament contribution to LC stability is unknown. The primary aim was to...
Lateral column (LC) instability occurs in adult acquired flatfoot deformity (AAFD). Differential ligament contribution to LC stability is unknown. The primary aim was to quantify this by using cadaver sectioning of lateral plantar ligaments. We also determined the relative contribution of each ligament to dorsal translation of the metatarsal head in the sagittal plane. 17 below-knee cadaveric specimens, preserved by vascular embalming method, were dissected to expose plantar fascia, long/short plantar ligaments (L/SPL), calcaneocuboid (CC) capsule and inferior 4th/5th tarsometatarsal (TMT) capsule. Dorsal forces of 0 N, 20 N and 40 N were applied to the plantar 5th metatarsal head after sequential ligament sectioning in different orders. Pins provided linear axes on each bone, allowing relative angular bone displacements to be calculated. Photography and ImageJ processing software were then used for analysis. The LPL (and CC capsule) had the greatest contribution to metatarsal head motion (107 mm) after isolated sectioning. In the absence of other ligaments, sectioning these resulted in significantly increased hindfoot-forefoot angulation (p ≤ 0.0003). Isolated TMT capsule sectioning demonstrated significant angular displacement even when other ligaments remained intact (with intact L/SPL, p = 0.0005). CC joint instability required both LPL and capsular sectioning for significant angulation to occur, whilst TMT joint stability was largely dependent on its capsule. The relative contribution of static restraints to the lateral arch has not yet been quantified. This study provides useful information on relative ligament contribution to both CC and TMT joint stability, which may in turn improve understanding of surgical interventions used to restore arch stability.
Topics: Humans; Plantar Plate; Foot; Ligaments, Articular; Ligaments; Metatarsal Bones; Cadaver; Biomechanical Phenomena
PubMed: 36966558
DOI: 10.1016/j.foot.2023.102003