-
Orthopaedics & Traumatology, Surgery &... Oct 2021Fifth metatarsal shaft osteotomy has demonstrated efficacy for bunionette. We adapted screwless 1st metatarsal scarf osteotomy to the 5th ray. The technique consists in...
Fifth metatarsal shaft osteotomy has demonstrated efficacy for bunionette. We adapted screwless 1st metatarsal scarf osteotomy to the 5th ray. The technique consists in short osteotomy, translation and diaphyseal bone-suture. We report the first 25 operated feet, with mean AOFAS score 58.4 preoperatively and 94.9 postoperatively at a mean 25 months' follow-up. These results were comparable to reported data, whatever the deformity.
Topics: Bunion, Tailor's; Hallux Valgus; Humans; Metatarsal Bones; Osteotomy; Prostheses and Implants; Treatment Outcome
PubMed: 33992833
DOI: 10.1016/j.otsr.2021.102960 -
Veterinary and Comparative Orthopaedics... Nov 2021The aim of this study was to create a feline reference database for the length, width and slenderness (length to width ratio) of metacarpal and metatarsal bones,...
OBJECTIVE
The aim of this study was to create a feline reference database for the length, width and slenderness (length to width ratio) of metacarpal and metatarsal bones, radius and tibia.
STUDY DESIGN
Radiographs of the radius, tibia, metacarpus and metatarsus were performed in domestic short hair cat cadavers ( = 40). Length and width of the aforementioned bones were measured in mature domestic shorthair cats and bone slenderness (length/width) and index ratios calculated.
RESULTS
A significant skeletal sex dimorphism exists in cats, with bones of the metacarpus, metatarsus, radius and tibia generally longer and wider in male cats compared with female cats, with differences frequently significant. The most significant difference was identified for the width of Mc5 ( = 0.0008) and the length and width of Mt5 ( = 0.0005). Index ratios for length and width of radius to metacarpal bones, and tibia to metatarsal bones, were not significantly different between male and female cats, except for Mc5. The index ratio for Mc5 was significantly higher in male cats ( = 0.002).
CONCLUSION
The present study provides insights into the normal length and width of distal forelimb and hind limb bones as well as bone index ratios in mature domestic shorthair cats. Using this information, it is now possible to quantitatively assess the relationship between these bones in domestic cats using radiography. This will assist not only with the diagnosis and categorization of skeletal abnormalities but can also guide surgical interventions of metacarpal and metatarsal bone fractures.
Topics: Animals; Cadaver; Cat Diseases; Cats; Extremities; Female; Male; Metacarpal Bones; Metatarsal Bones; Metatarsus
PubMed: 34488232
DOI: 10.1055/s-0041-1735289 -
Foot (Edinburgh, Scotland) Mar 2023Bone morphology is one of the factors involved in hallux valgus development. However, previous studies have not evaluated the overall bone shape in three dimensions....
Comparison of the three-dimensional bone morphology of the first proximal phalanx and first metatarsal between normal and hallux valgus foot using the homologous model technique.
Bone morphology is one of the factors involved in hallux valgus development. However, previous studies have not evaluated the overall bone shape in three dimensions. This study aimed to compare the overall shape of the first proximal phalanx and first metatarsal in hallux valgus with those of normal feet.Homologous models were created from computed tomography data of the first proximal phalanx and first metatarsal of 75 healthy men and 53 women in the control group and 10 men and 71 women in the hallux valgus group. Principal component analysis was performed to examine the differences in bone morphology between the control and hallux valgus groups. In men and women with hallux valgus, the proximal articular surface of the first proximal phalanx was characterized by a more lateral inclination and torsion of the pronated first metatarsal. Additionally, the first metatarsal head was characterized by a more lateral inclination in male hallux valgus. This study is the first to reveal the morphological characteristics of the first metatarsal and first proximal phalanx in hallux valgus as a whole bone using a homologous model technique. These characteristics are considered possible causes of hallux valgus development. The shapes of the first proximal phalanx and first metatarsal in hallux valgus were different from those in normal feet. This finding should be useful when considering the pathogenesis and treatment development for hallux valgus.
Topics: Humans; Male; Female; Hallux Valgus; Metatarsal Bones; Radiography; Foot; Lower Extremity
PubMed: 36796254
DOI: 10.1016/j.foot.2023.101968 -
Foot (Edinburgh, Scotland) Mar 2021The precise planning of metatarsal (MT) I length in hallux valgus surgery is important. However, currently no tool exists which allows the surgeon to reliably predict...
BACKGROUND
The precise planning of metatarsal (MT) I length in hallux valgus surgery is important. However, currently no tool exists which allows the surgeon to reliably predict this parameter.
METHODS
30 virtual 3-dimensional hallux valgus surgeries were performed on varied deformation models based on cadaveric feet scans. The shortening of the first ray during distal metatarsal I osteotomy for different osteotomy angles were measured. An algebraic 2-dimensional calculation was done and compared to the results obtained from the 3-dimensional models.
RESULTS
Inadvertent shortening of the first metatarsal bone can be as much as 8 mm depending on the amount of intermetatarsal angle (IMA) correction and osteotomy angle. Comparison of the 3 dimensional simulations and the 2 dimensional model resulted in a very strong correlation (R > 0.99 p < 0.00001). Based on our findings an anterior pointing osteotomy of approximately 10° is necessary to restore the length in distal metatarsal I hallux valgus surgery.
CONCLUSION
A slight misdirection of the osteotomy plane in distal hallux valgus surgery may result in relevant unwanted alterations in first metatarsal bone length and triangulation by eye is insufficient in this complex geometrical situation without appropriate planning. The present study provides surgeons a practical tool to plan and control the change of first metatarsal length during hallux valgus procedure through exact orientation of the osteotomy angle. If no alteration of length is intended, it may be generalized that an anterior direction of the cut relative to the second metatarsal bone will preserve the length of the first metatarsal bone.
Topics: Foot; Hallux Valgus; Humans; Metatarsal Bones; Osteotomy; Radiography
PubMed: 33516117
DOI: 10.1016/j.foot.2020.101774 -
Medicina (Kaunas, Lithuania) May 2023: Hallux valgus is one of the most common chronic foot complaints, with prevalences of over 23% in adults and up to 35.7% in older adults. However, the prevalence is... (Review)
Review
: Hallux valgus is one of the most common chronic foot complaints, with prevalences of over 23% in adults and up to 35.7% in older adults. However, the prevalence is only 3.5% in adolescents. The pathological causes and pathophysiology of hallux valgus are well-known in various studies and reports. A change in the position of the sesamoid bone under the metatarsal bone of the first toe is known to be the cause of the initial pathophysiology. : The relationships between the changes in the location of the sesamoid bone and each radiologically measured angle and joint congruency in the hallux valgus remain as yet unknown. Therefore, this study investigated the relationships of sesamoid bone subluxation with the hallux valgus angle, intermetatarsal angle, and metatarsophalangeal joint congruency in hallux valgus patients. The goal is to know the hallux valgus angle, the intermetatarsal angle, and metatarsophalangeal joint congruency's correlation with hallux valgus severity and prognosis by revealing the relationship between each measured value and sesamoid bone subluxation. : We reviewed 205 hallux valgus patients who underwent radiographic evaluation and subsequent hallux valgus correction surgery in our orthopedic clinic between March 2015 and February 2020. Sesamoid subluxation was assessed using a new five-grade scale on foot radiographs, and other radiologic measurements were assessed, such as hallux valgus angle, the intermetatarsal angle, distal metatarsal articular angle, joint congruency, etc. : Measurements of the hallux valgus angle, interphalangeal angle, and joint congruency exhibited high interobserver and intraobserver reliabilities in this study. They also showed correlations with sesamoid subluxation grade.
Topics: Adolescent; Humans; Aged; Hallux Valgus; Foot; Metatarsal Bones; Orthopedic Procedures; Sesamoid Bones; Retrospective Studies; Treatment Outcome
PubMed: 37241108
DOI: 10.3390/medicina59050876 -
The Journal of Foot and Ankle Surgery :... 2023Lateral column deterioration and subsequent loss of function poses a challenge for limb preservation in patients with Charcot neuroarthropathy (CN). Application of...
Lateral column deterioration and subsequent loss of function poses a challenge for limb preservation in patients with Charcot neuroarthropathy (CN). Application of "superconstructs" provides stability and clinical improvement to an often-ulcerated lateral foot. This study examines radiodensity in Hounsfield units (HU) to compare bone quality of lateral column fixation targets using computed tomography (CT) scans between patients with and without midfoot CN. A retrospective chart review identified control (nondiabetic, non-CN; n = 29) and midfoot CN (n = 21) groups. Patient demographics and medical history were collected. Two reviewers measured the mean HU of circular regions of interest centered on the fourth and fifth metatarsal heads as well as the anterior, middle, and posterior thirds of the calcaneus. Radiodensity was compared between groups, among calcaneal locations, Eichenholtz stages and Brodsky types. A p value ≤.05 was considered statistically significant. Age and body mass index were not significantly different between groups. The CN group exhibited greater HU than the control group at the metatarsal head and calcaneus (p < .001). The anterior calcaneus exhibited greater HU than the posterior calcaneus in the CN group (p = .02). The difference in HU was not statistically significant between Stages 0-1 and Stages 2-3 or midfoot Brodsky Types. Indirect bone density analysis revealed an increased density in CN compared to control patients with no significant difference between midfoot CN stages or types. The anterior calcaneus was the densest rearfoot bone among the CN patients, a result that may have implications in surgical fixation.
Topics: Humans; Retrospective Studies; Foot; Diabetic Foot; Metatarsal Bones; Calcaneus; Arthropathy, Neurogenic
PubMed: 36335049
DOI: 10.1053/j.jfas.2022.09.007 -
Scientific Reports Oct 2019The extent and patterns of Lisfranc joint complex disruption in subtle Lisfranc injuries have not been well clarified. We reviewed the direct intraoperative findings for...
The extent and patterns of Lisfranc joint complex disruption in subtle Lisfranc injuries have not been well clarified. We reviewed the direct intraoperative findings for 87 patients, examined computed tomography images that had been obtained preoperatively for 73 of the patients, and classified the injuries according to the Kaar et al. criteria as the transverse type (instability between the first cuneiform [C1] and the second metatarsal [M2] and between the second cuneiform [C2] and M2) or longitudinal type (instability between C1 and M2 and between C1 and C2). Our patients' injuries were classified as follows: longitudinal type (38%), transverse type (30%), transverse type and first tarsometatarsal (TMT) joint injury (20%), longitudinal type plus transverse type (7%), longitudinal type and first TMT joint injury (3%), and longitudinal type, transverse type, and first TMT joint injury (2%). In 11 patients, the longitudinal injury extended into the naviculo-first cuneiform joint. In 41 (56%) of the 73 patients for whom CT images were obtained, 1 or more fractures (not counting small avulsion fragments between C1 and M2) were found. Orthopedic surgeons should be aware of the various injury patterns possible in cases of subtle Lisfranc injury.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Female; Fractures, Bone; Humans; Joint Instability; Male; Metatarsal Bones; Middle Aged; Tarsal Bones; Tarsal Joints; Tomography, X-Ray Computed; Young Adult
PubMed: 31619712
DOI: 10.1038/s41598-019-51358-8 -
Acta Cirurgica Brasileira Sep 2019To investigate the effect of intermittent vibration at different intervals on bone fracture healing and optimize the vibration interval.
PURPOSE
To investigate the effect of intermittent vibration at different intervals on bone fracture healing and optimize the vibration interval.
METHODS
Ninety sheep were randomized to receive no treatment (the control group), incision only (the sham control group), internal fixation with or without metatarsal fracture (the internal fixation group), and continuous vibration in addition to internal fixation of metatarsal fracture, or intermittent vibration at 1, 2, 3, 5, 7 and 17-day interval in addition to internal fixation of metatarsal fracture (the vibration group). Vibration was done at frequency F=35 Hz, acceleration a=0.25g, 15 min each time 2 weeks after bone fracture. Bone healing was evaluated by micro-CT scan, bone microstructure and mechanical compression of finite element simulation.
RESULTS
Intermittent vibration at 7-day interval significantly improved bone fracture healing grade. However, no significant changes on microstructure parameters and mechanical properties were observed among sheep receiving vibration at different intervals.
CONCLUSIONS
Clinical healing effects should be the top concern. Quantitative analyses of bone microstructure and of finite element mechanics on the process of fracture healing need to be further investigated.
Topics: Animals; Finite Element Analysis; Fracture Fixation, Internal; Fracture Healing; Fractures, Bone; Metatarsal Bones; Random Allocation; Sheep; Vibration; X-Ray Microtomography
PubMed: 31531537
DOI: 10.1590/s0102-865020190070000002 -
BMC Veterinary Research Aug 2023Morphometric study of the bony elements of the appendicular skeleton in the ostrich was fully described and identified. The appendicular skeleton included the bones of...
BACKGROUND
Morphometric study of the bony elements of the appendicular skeleton in the ostrich was fully described and identified. The appendicular skeleton included the bones of the pectoral girdle, the wing, the pelvic girdle and the pelvic limb.
RESULTS
The shoulder girdle of the ostrich included the scapula and coracoid bones. The scapula appeared as a flattened spoon-like structure. The coracoid bone appeared quadrilateral in outline. The mean length of the scapula and coracoid (sternal wing) were 15.00 ± 0.23 and 10.00 ± 0.17 cm, respectively. The wing included the humerus, ulna, radius, radial carpal bone, ulnar carpal bone, carpometacarpus and phalanges of three digits. The mean length of the humerus, radius, and ulna were 33.00 ± 0.46, 10.50 ± 0.40 and 11.50 ± 0.29 cm respectively. The carpometacarpus was formed by the fusion of the distal row of carpal bones and three metacarpal bones. Digits of the wing were three in number; the alular, major and minor digits. Os coxae comprised the ilium, ischium and pubis. Their mean lengths were 36.00 ± 0.82 cm, 32.00 ± 0.20 and 55.00 ± 0.2.9 cm, respectively. The femur was a stout short bone, that appeared shorter than the tibiotarsus. The mean length of the femur, tibiotarsus, and tarsometatarsus were 30.00 ± 0.23, 52.00 ± 0.50 and 46.00 ± 0.28 cm. Tibiotarsus was the longest bone in the pelvic limb. The fibula was a long bone (44.00 ± 0.41 cm) lying along the lateral surface of the tibiotarsus. The tarsometatarsus was a strong long bone formed by the fusion of the metatarsal (II, III, IV) and the distal row of tarsal bones. It was worth mentioning that metatarsal II was externally absent in adults.
CONCLUSIONS
In the appendicular skeleton of ostrich, there were special characteristic features that were detected in our study; the clavicle was absent, the coracoid bone was composed of a sternal wing and scapular wing, the ulna was slightly longer in length than the radius. The coupled patellae i.e., the proximal and distal patella were observed; and the ostrich pedal digits were only two; viz., the third (III) and fourth (IV) digits.
Topics: Animals; Struthioniformes; Scapula; Metatarsal Bones; Femur; Humerus
PubMed: 37542302
DOI: 10.1186/s12917-023-03665-6 -
Knee Surgery, Sports Traumatology,... Aug 2021The primary purpose of this study was to determine the union rate and time for surgical- and non-surgical treatment of stress fractures of the proximal fifth metatarsal... (Review)
Review
PURPOSE
The primary purpose of this study was to determine the union rate and time for surgical- and non-surgical treatment of stress fractures of the proximal fifth metatarsal (MT5). The secondary purpose was to assess the rate of adverse bone healing events (delayed union, non-union, and refractures) as well as the return to sports time and rate.
METHODS
A literature search of the EMBASE (Ovid), MEDLINE (PubMed), CINAHL, Web of Science and Google Scholar databases until March 2020 was conducted. Methodological quality was assessed by two independent reviewers using the methodological index for non-randomized studies (MINORS) criteria. The primary outcomes were the union time and rate. Secondary outcomes included the delayed union rate, non-union rate, refracture rate, and return to sport time and rate. A simplified pooling technique was used to analyse the different outcomes (i.e. union rate, time to union, adverse bone healing rates, return to sport rate, and return to sport time) per treatment modality. Additionally, 95% confidence intervals were calculated for the union rate, adverse bone healing rates, and the return to sport rate.
RESULTS
The literature search resulted in 2753 articles, of which thirteen studies were included. A total of 393 fractures, with a pooled mean follow-up of 52.5 months, were assessed. Overall, the methodological quality of the included articles was low. The pooled bone union rate was 87% (95% CI 83-90%) and 56% (95% CI 41-70%) for surgically and non-surgically treated fractures, respectively. The pooled radiological union time was 13.1 weeks for surgical treatment and 20.9 weeks for non-surgical treatment. Surgical treatment resulted in a delayed union rate of 3% (95% CI 1-5%), non-union rate of 4% (95% CI 2-6%) and refracture rate of 7% (95% CI 4-10%). Non-surgical treatment resulted in a delayed union rate of 0% (95% CI 0-8%), a non-union rate of 33% (95% CI 20-47%) and a refracture rate of 12% (95% CI 5-24%), respectively. The return to sport rate (at any level) was 100% for both treatment modalities. Return to pre-injury level of sport time was 14.5 weeks (117 fractures) for surgical treatment and 9.9 weeks (6 fractures) for non-surgical treatment.
CONCLUSION
Surgical treatment of stress fractures of the proximal fifth metatarsal results in a higher bone union rate and a shorter union time than non-surgical treatment. Additionally, surgical and non-surgical treatment both showed a high return to sport rate (at any level), albeit with limited clinical evidence for non-surgical treatment due to the underreporting of data.
LEVEL OF EVIDENCE
Level IV, systematic review.
Topics: Bone Diseases; Cartilage Diseases; Fractures, Bone; Fractures, Stress; Humans; Metatarsal Bones; Radiography
PubMed: 33615403
DOI: 10.1007/s00167-021-06490-2