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Journal of Anatomy Apr 2018Aspects of trabecular bone architecture are thought to reflect regional loading of the skeleton, and thus differ between primate taxa with different locomotor and... (Comparative Study)
Comparative Study
Aspects of trabecular bone architecture are thought to reflect regional loading of the skeleton, and thus differ between primate taxa with different locomotor and postural modes. However, there are several systemic factors that affect bone structure that could contribute to, or be the primary factor determining, interspecific differences in bone structure. These systemic factors include differences in genetic regulation, sensitivity to loading, hormone levels, diet, and activity levels. Improved understanding of inter-/intraspecific variability, and variability across the skeleton of an individual, is required to interpret properly potential functional signals present within trabecular structure. Using a whole-region method of analysis, we investigated trabecular structure throughout the skeleton of humans and chimpanzees. Trabecular bone volume fraction (BV/TV), degree of anisotropy (DA) and trabecular thickness (Tb.Th) were quantified from high resolution micro-computed tomographic scans of the humeral and femoral head, third metacarpal and third metatarsal head, distal tibia, talus and first thoracic vertebra. We found that BV/TV is, in most anatomical sites, significantly higher in chimpanzees than in humans, suggesting a systemic difference in trabecular structure unrelated to local loading regime. Differences in BV/TV between the forelimb and hindlimb did not clearly reflect differences in locomotor loading in the study taxa. There were no clear systemic differences between the taxa in DA and, as such, this parameter might reflect function and relate to differences in joint loading. This systemic approach reveals both the pattern of variability across the skeleton and between taxa, and helps identify those features of trabecular structure that may relate to joint function.
Topics: Anatomic Variation; Animals; Anisotropy; Body Patterning; Cancellous Bone; Female; Femur Head; Humans; Humeral Head; Locomotion; Male; Metacarpal Bones; Metatarsal Bones; Pan troglodytes; Statistics, Nonparametric; Talus; Thoracic Vertebrae; Tibia; Tomography, X-Ray Computed
PubMed: 29344941
DOI: 10.1111/joa.12776 -
Archives of Orthopaedic and Trauma... Apr 2023Although metatarsal fractures are common, the significance of previous epidemiologic studies is limited to specific fracture entities, subpopulations, or heterogeneous...
INTRODUCTION
Although metatarsal fractures are common, the significance of previous epidemiologic studies is limited to specific fracture entities, subpopulations, or heterogeneous fracture aetiologies. The aim of the study was to assess the epidemiology of isolated metatarsal fractures in an adult population at a level-1 trauma centre.
MATERIALS AND METHODS
Radiological and clinical databases were searched for a five-year period. Eligible were all patients with acute isolated metatarsal fractures over the age of 18 years with radiographs in two planes available. Stress fractures, injuries affecting Lisfranc joint stability, and concomitant injuries to other regions than the metatarsals were excluded. Data collection included general demographics, mechanism of injury, season of the trauma and fracture details.
RESULTS
Out of 3259 patients, 642 patients met the inclusion criteria and were included for the analysis. The patients' mean age was 44.5 ± 18.9 years, 50.6% were female. 83.3% suffered an isolated, 16.7% multiple metatarsal fractures. Single metatarsal fractures occurred predominantly at the fifth metatarsal bone (81.3%), their frequency decreased with increasing age, with a seasonal peak during the summer. Patients suffering multiple metatarsal fractures were significantly older (51.6 ± 21.2 vs. 43.0 ± 18.1 years; p < 0.001) and the injury resulted significantly more often from a high-energy trauma (6.7% vs. 23.4%; p < 0.001). Multiple metatarsal fractures occurred evenly throughout all metatarsals but revealed a focus on female population with no seasonal differences.
CONCLUSION
Single metatarsal fractures predominantly occurred at the fifth metatarsal bone and showed a seasonal, gender and age dependency. Multiple metatarsal fractures were homogeneously distributed between the different metatarsals with distinct age-dependent gender differences.
LEVEL OF EVIDENCE
Level III.
Topics: Adult; Humans; Female; Middle Aged; Male; Metatarsal Bones; Retrospective Studies; Fractures, Bone; Fractures, Stress; Radiography; Foot Injuries; Metatarsus
PubMed: 35235028
DOI: 10.1007/s00402-022-04396-3 -
Sports Health 2022Stress fractures are caused by micro-trauma due to repetitive stress on bone, common in active individuals and athletes. Previous studies demonstrate that the...
BACKGROUND
Stress fractures are caused by micro-trauma due to repetitive stress on bone, common in active individuals and athletes. Previous studies demonstrate that the weightbearing bones of the lower extremities incur stress fractures most often, especially in women and older adults.
HYPOTHESIS
Prior literature does not quantify the difference in frequency of stress fractures among different genders, age groups, or body mass indices (BMIs). We hypothesized that older female patients would have higher rates of lower extremity stress fractures than male patients.
STUDY DESIGN
Epidemiological research.
LEVEL OF EVIDENCE
Level 3.
METHODS
Records of female and male patients with lower extremity stress fractures from 2010 to 2018 were identified from the PearlDiver administrative claims database using the International Classification of Diseases (ICD)-9/ICD-10 codes. Stress fractures were classified by ICD-10 diagnosis codes to the tibial bone, proximal femur, phalanges, and other foot bones. Comorbidities were incorporated into a regression analysis.
RESULTS
Of 41,257 stress fractures identified, 30,555 (70.1%) were in women and 10,702 (25.9%) were in men. Our sample was older (>60 years old) (37.3%) and not obese (BMI <30 kg/m, 37.1%). A greater proportion of female patients with stress fracture were older ( < 0.001) and had foot stress fractures ( < 0.001), while a greater proportion of male patients with stress fracture were younger than 19 years ( < 0.001) and had metatarsal ( < 0.001), hip ( = 0.002), and tibia stress fractures ( < 0.001).
CONCLUSION
Stress fractures commonly occur in women and older adults with low BMIs. Metatarsal and tibia stress fractures were the most common, and a greater proportion of women had foot stress fractures.
CLINICAL RELEVANCE
Our study examined the large-scale prevalence of different lower extremity stress fractures among a wide patient population sample of varying ages and BMIs. These findings can help clinicians identify active populations at greater risk for stress fracture injuries.
Topics: Female; Humans; Male; Aged; Middle Aged; Fractures, Stress; Risk Factors; Metatarsal Bones; Femur; Tibia
PubMed: 35243941
DOI: 10.1177/19417381221080440 -
Joint Diseases and Related Surgery 2020This study aims to evaluate the radiological and functional outcomes of hallux valgus patients treated with distal oblique metatarsal osteotomy technique.
OBJECTIVES
This study aims to evaluate the radiological and functional outcomes of hallux valgus patients treated with distal oblique metatarsal osteotomy technique.
PATIENTS AND METHODS
Twenty-six feet of 22 patients (4 males, 18 females; mean age 46.2±18 years; range, 16 to 70 years) who were diagnosed as hallux valgus between March 2013 and April 2016 and who underwent distal oblique metatarsal osteotomy were included in this retrospective study. American Orthopedic Foot and Ankle Society/Hallux Metatarsophalangeal-Interphalangeal Scale (AOFAS/HMIS) was used for clinical and functional evaluation. The hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), sesamoid position, first metatarsal length and forefoot bone and soft tissue width were measured for radiological evaluation.
RESULTS
The mean follow-up time was 33.1±9.8 months. The AOFAS/HMIS score increased significantly postoperatively (p=0.001). In the footwear section of the AOFAS/HMIS, the median preoperative score of 5 (range, 0-5) increased to 10 (range, 5-10) at the postoperative period (p=0.001). Hallux valgus angle, IMA, DMAA, and first metatarsal length significantly decreased when compared to preoperative measurements. Forefoot bone width also decreased significantly from 9.3 cm (range, 7.5-11.5 cm) to 8.8 cm (6.8-10.3 cm) (p=0.001).
CONCLUSION
Distal oblique metatarsal osteotomy is a safe method for hallux valgus deformity. Forefoot width reduction, decrease of soft tissue tension, sesamoid reduction, and plantar fascia relaxation are the crucial benefits of this method.
Topics: Adolescent; Adult; Aged; Female; Hallux Valgus; Humans; Metatarsal Bones; Middle Aged; Osteotomy; Range of Motion, Articular; Retrospective Studies; Treatment Outcome; Young Adult
PubMed: 32160500
DOI: 10.5606/ehc.2020.71298 -
Journal of Orthopaedic Surgery and... Nov 2018The Lisfranc joint has complex structures, and articular surfaces overlap on conventional X-ray radiographs. Hence, there is no available auxiliary examination for...
BACKGROUND
The Lisfranc joint has complex structures, and articular surfaces overlap on conventional X-ray radiographs. Hence, there is no available auxiliary examination for diagnosing related injuries. At present, few studies on the imaging of Lisfranc ligaments have been reported, and related imaging data are rare. Therefore, no imaging reference can be used for related diagnosis and repair operations. This study aims to observe and describe the morphology and structure of Lisfranc ligaments using magnetic resonance imaging (MRI), in order to provide imaging reference for the diagnosis and repair of Lisfranc joint injuries.
METHODS
MRI scanning was performed on 60 sides of normal feet of 30 healthy adult volunteers. In the MRI scanning on the Lisfranc joint, sagittal scanning was focused on the area between the lateral margin and medial margin of the Lisfranc joint, while oblique coronal scanning was focused on the area parallel to the Lisfranc joint clearance. After acquisition of MRI images, data were burned into a CD, and the morphology and structure of the Lisfranc ligament on the MRI image were observed and described. Hence, the imaging parameters of the Lisfranc ligament were acquired, providing an imaging reference for the diagnosis and repair of Lisfranc joint injuries.
RESULTS
By observing the obtained images of the Lisfranc ligament through appropriate MRI scanning, it was found that the Lisfranc ligament originates at the site 12.63 ± 1.20 mm from the lateral side of the base of the medial cuneiform bone, with a length of 8.02 ± 1.5 mm, a width of 2.53 ± 0.61 mm, a height of 6.96 ± 1.01 mm, forms an included angle of 46.79 ± 3.47° with the long axis of the first metatarsal bone, and finally ends at the base of the second phalanx. Detailed imaging parameters of the Lisfranc joint and ligament were obtained from the present imaging experiment, providing an imaging reference for the diagnosis and repair of Lisfranc joint injuries.
CONCLUSIONS
On the MRI images, the sagittal section can clearly display the corresponding situation of the Lisfranc joint bone and longitudinal arch of the foot, tolerably display the Lisfranc joint dorsal ligaments and metatarsal ligaments, and poorly display the Lisfranc ligament. The oblique coronal section can clearly display the transverse arch of the foot and clearly display the cross-section of the Lisfranc ligament. The oblique crosssection can clearly display the horizontal arch of the Lisfranc joint and more clearly display its surrounding ligaments and tendons, especially the entire Lisfranc ligament and its attachment points. This is an important section for the diagnosis of Lisfranc ligament injuries. This study provides a certain imaging reference for the MRI scanning, diagnosis, and repair of Lisfranc joint injuries. Further research with large sample size is still needed to confirm the conclusions.
Topics: Adult; Female; Foot; Humans; Ligaments, Articular; Magnetic Resonance Imaging; Male; Metatarsal Bones; Young Adult
PubMed: 30419938
DOI: 10.1186/s13018-018-0968-x -
Folia Morphologica 2023The aim of this study is to predict sex with machine learning (ML) algorithms by making morphometric measurements on radiological images of the first and fifth...
BACKGROUND
The aim of this study is to predict sex with machine learning (ML) algorithms by making morphometric measurements on radiological images of the first and fifth metatarsal and phalanx bones.
MATERIALS AND METHODS
In this study, radiologic images of 263 individuals (135 female, 128 male) between the ages of 27 and 60 were analysed retrospectively. The images in digital imaging and communications in medicine (DICOM) format were transferred to personal workstation Radiant DICOM Viewer programme. Length and width measurements of the first and fifth metatarsal and foot phalanx bones were performed on the transferred images. In addition, the ratios of the total length of the first proximal and distal phalanx and length of the first metatarsal and total length of fifth proximal, middle, and distal phalanx and maximum length of fifth metatarsal were calculated.
RESULTS
As a result of machine learning algorithms, highest accuracy, specificity, sensitivity, and Matthews correlation coefficient values were found as 0.85, 0.86, 0.85, and 0.71, respectively with decision tree algorithm. It was found that accuracy rates of other algorithms varied between 0.74 and 0.83.
CONCLUSIONS
As a result of our study, it was found that sex estimation was made with high accuracy rate by using machine learning algorithms on X-ray images of the first and fifth metatarsal and foot phalanx. We think that in cases when pelvis, cranium and long bones are harmed and examination is difficult, bones of the first and fifth metatarsal and foot phalanx can be used for sex estimation.
Topics: Humans; Adult; Middle Aged; Metatarsal Bones; Retrospective Studies; X-Rays; Radiography; Algorithms
PubMed: 35607870
DOI: 10.5603/FM.a2022.0052 -
Medicina (Kaunas, Lithuania) Jun 2023Contrary to Lisfranc joint fracture-dislocation, ligamentous Lisfranc injury can lead to additional instability and arthritis and is difficult to diagnose. Appropriate... (Review)
Review
Contrary to Lisfranc joint fracture-dislocation, ligamentous Lisfranc injury can lead to additional instability and arthritis and is difficult to diagnose. Appropriate procedure selection is necessary for a better prognosis. Several surgical methods have recently been introduced. Here, we present three distinct surgical techniques for treating ligamentous Lisfranc employing flexible fixation. First is the "Single Tightrope procedure", which involves reduction and fixation between the second metatarsal base and the medial cuneiform via making a bone tunnel and inserting Tightrope. Second is the "Dual Tightrope Technique", which is similar to the "Single Tightrope technique", with additional fixation of an intercuneiform joint using one MiniLok Quick Anchor Plus. Last but not least, the "internal brace approach" uses the SwiveLock anchor, particularly when intercueniform instability is seen. Each approach has its own advantages and disadvantages in terms of surgical complexity and stability. These flexible fixation methods, on the other hand, are more physiologic and have the potential to lessen the difficulties that have been linked to the use of conventional screws in the past.
Topics: Humans; Ligaments, Articular; Fractures, Bone; Fracture Fixation, Internal; Metatarsal Bones; Sutures
PubMed: 37374337
DOI: 10.3390/medicina59061134 -
Clinics (Sao Paulo, Brazil) Nov 2016To compare ultrasound propagation velocity with densitometry in the diaphyseal compact cortical bone of whole sheep metatarsals.
OBJECTIVE:
To compare ultrasound propagation velocity with densitometry in the diaphyseal compact cortical bone of whole sheep metatarsals.
METHODS:
The transverse ultrasound velocity and bone mineral density of 5-cm-long diaphyseal bone segments were first measured. The bone segments were then divided into four groups of 15 segments each and demineralized in an aqueous 0.5 N hydrochloric acid solution for 6, 12, 24 or 36 hours. All measurements were repeated after demineralization for each time duration and the values measured before and after demineralization were compared.
RESULTS:
Ultrasound velocity and bone mineral density decreased with demineralization time, and most differences in the pre- and post-demineralization values within each group and between groups were significant: A moderate correlation coefficient (r=0.75956) together with a moderate agreement was determined between both post-demineralization parameters, detected by the Bland-Altman method.
CONCLUSION:
We conclude that both ultrasound velocity and bone mineral density decrease as a result of demineralization, thus indicating that bone mineral content is of great importance for maintaining the acoustic parameters of cortical bone, as observed for cancellous bone. Ultrasound velocity can be used to evaluate both compact cortical bone quality and bone mineral density.
Topics: Animals; Bone Demineralization Technique; Bone Density; Cortical Bone; Densitometry; Metatarsal Bones; Osteoporosis; Sheep; Time Factors; Ultrasonography
PubMed: 27982167
DOI: 10.6061/clinics/2016(11)07 -
Journal of Orthopaedic Surgery and... Feb 2021This study was performed to investigate the change in the bony alignment of the foot after tendo-Achilles lengthening (TAL) and the factors that affect these changes in...
BACKGROUND
This study was performed to investigate the change in the bony alignment of the foot after tendo-Achilles lengthening (TAL) and the factors that affect these changes in patients with planovalgus foot deformity.
METHODS
Consecutive 97 patients (150 feet; mean age 10 years; range 5.1-35.7) with Achilles tendon contracture (ATC) and planovalgus foot deformity who underwent TAL were included. All patients underwent preoperative and postoperative weight-bearing anteroposterior (AP) or lateral (LAT) foot radiographics. Changes in AP talo-1st metatarsal angle, AP talo-2nd metatarsal angle, LAT talo-1st metatarsal angle, and calcaneal pitch angle and the factors affecting such changes after TAL were analyzed using lineal mixed model.
RESULTS
There were no significant change in AP talo-1st metatarsal angle and AP talo-2nd metatarsal angle after TAL in patients with cerebral palsy (CP) (p = 0.236 and 0.212). However, LAT talo-1st metatarsal angle and calcaneal pitch angle were significantly improved after TAL (13.0°, p < 0.001 and 4.5°, p < 0.001). Age was significantly associated with the change in LAT talo-1st metatarsal angle after TAL (p = 0.028). The changes in AP talo-1st metatarsal angle, AP talo-2nd metatarsal angle, and calcaneal pitch angle after TAL were not significantly associated with the diagnosis (p = 0.879, 0.903, and 0.056). However, patients with CP showed more improvement in LAT talo-1st metatarsal angle (- 5.0°, p = 0.034) than those with idiopathic cause.
CONCLUSION
This study showed that TAL can improve the bony alignment of the foot in patients with planovalgus and ATC. We recommend that physicians should consider this study's findings when planning operative treatment for such patients.
Topics: Achilles Tendon; Adolescent; Adult; Age Factors; Calcaneus; Child; Child, Preschool; Female; Flatfoot; Humans; Male; Metatarsal Bones; Tenotomy; Young Adult
PubMed: 33557891
DOI: 10.1186/s13018-021-02272-1 -
Annals of the Royal College of Surgeons... Jan 2022Akin osteotomies are commonly fixed with a screw or staple. Hardware-related symptoms are not uncommon. We compared the outcomes and costs of the two implants. (Comparative Study)
Comparative Study
INTRODUCTION
Akin osteotomies are commonly fixed with a screw or staple. Hardware-related symptoms are not uncommon. We compared the outcomes and costs of the two implants.
METHODS
We evaluated 74 Akin osteotomies performed in conjunction with first metatarsal osteotomy for hallux valgus. The osteotomy was fixed with a headless compression screw in 39 cases and a staple in 35 cases. We looked at the implant-related complications, removal of metalwork, revision, non-union and cost. Pre- and postoperative hallux valgus interphalangeal (HI) angles and length of the proximal phalanx were measured.
RESULTS
There was 100% union, no failure of fixation, no revision surgery and no delayed union in either group. The radiological prominence of screws was significant (=0.02), but there was no significant difference in soft-tissue irritation (=0.36) or removal of implants (=0.49). Two cortical breaches (5.8%) occurred in staple fixation and 4 (10.2%) in screw fixation (not statistically significant (NS), =0.50). The mean improvement in HI angle was 4.3° with screw fixation and 4.1° with staple fixation (NS, =0.69). The mean shortening of the proximal phalanx was 2.5mm with screw fixation and 2.3mm with staple fixation (NS, =0.64). The total cost was £1,925 for staple fixation and £4,290 for screw fixation.
CONCLUSIONS
Staple and screw fixation are reproducible modalities with satisfactory outcomes, but screw fixation is expensive. We conclude staple fixation is a cost-effective alternative.
Topics: Bone Screws; Female; Hallux Valgus; Humans; Male; Metatarsal Bones; Middle Aged; Osteotomy; Retrospective Studies; Sutures
PubMed: 34323127
DOI: 10.1308/rcsann.2021.0029