Radiographic appearance of sesamoid bones in the hands and feet of Malawian subjects.

Our aim was to determine the prevalence of sesamoid bones in adult black Malawians from radiographs of the hands and feet. A total of 255 radiographs from 85 men and 45 women aged 16-66 years were used: 126 of the hands and 129 of the feet. All the hand films revealed one sesamoid bone at the interphalangeal joint and two at the metacarpophalangeal joint of the thumb. All the foot films showed two sesamoid bones at the metatarsophalangeal joint of the big toe. Occasional sesamoid bones were found at the metacarpophalangeal and metatarsophalangeal joints of the index finger and the small toe, respectively. Only 4.8% of the hands had sesamoid bones at the metacarpophalangeal joint of the index finger, compared with reported percentages of between 35% and 64.2% in Caucasians. The present study also records, probably for the first time in Africans, an incidence of 10.8% of sesamoid bones occurring at the metatarsophalangeal joint of the small toe, which again is at variance with the reported range of 5.5-10% in Caucasians. This study provides anatomical data that will help in the diagnosis and management of disorders of sesamoid bones which are often overlooked in Africans.     

Prevalence of sesamoid bones in the interphalangeal joint of the thumb and fingers: A Radiographic Study

The prevalence of sesamoid bones in the hands has been reported in some previous articles. Most of them, however, have reported sesamoid bones of the metacarpophalangeal joint of the hand and of the interphalangeal (IP) joint of the thumb. The present study investigates the prevalence of sesamoid bones of the IP joint of the thumb and fingers. A retrospective review of radiologic views of the IP joints in the thumb or fingers was performed, including a total of 650 patients (1,096 thumbs or fingers). Sesamoid bones were found in the IP joint of the thumb at 67% (212 of 318), while the index, middle, ring, little fingers had sesamoid bones in the proximal interphlangeal (PIP) joint at 0% (0 of 172), 0.4% (1 of 244), 0.5% (1 of 183), and 1% (2 of 179), respectively. None of the four fingers had sesamoid bones in the distal IP joint. Previous articles have described the similar prevalence to the present study, of sesamoid bones of the IP joint of the thumb, while some others reported the different prevalence. About the PIP joint, no previous articles have found a sesamoid bone. Because the lateral X‐ray view is more accurate and suitable to evaluate sesamoid bones, we used the lateral one for the present study. The knowledge that sesamoid bones occurs at these rates in the thumb IP joint and finger PIP joints is helpful to differentiate chip fractures from sesamoid bones near the IP joint, including the PIP joint. Clin. Anat. 2013. © 2012 Wiley Periodicals, Inc.     

Incidence of accessory ossicles and sesamoid bones in the feet: a radiographic study of the Turkish subjects

Most accessory ossicles and sesamoid bones of the ankle and the foot remain asymptomatic; however, they have increasingly been examined in the radiology literature, because they can cause painful syndromes or degenerative changes in response to overuse and trauma. Our aim was to document a detailed investigation on the accessory ossicles and sesamoid bones of Turkish subjects in both the feet according to the sex, frequency and division of the bones, coexistence and bilaterality by radiography. A double-centered study was performed retrospectively to determine the incidence of the accessory ossicles and sesamoid bones in the ankle and foot. Accessory ossicles (21.2%) and sesamoid bones (9.6%) were detected by Radiographs of 984 subjects. The most common accessory ossicles were accessory navicular (11.7%), os peroneum (4.7%), os trigonum (2.3%), os supranaviculare (1.6%), os vesalianum (0.4%), os supratalare (0.2%), os intermetatarseum (0.2%). We observed bipartite hallux sesamoid in 2.7% of radiographs. Interphalangeal sesamoid bone of the hallux was seen in 2% of radiographs. Incidences of metatarsophalangeal sesamoid bones were found as 0.4% in the second digit, 0.2% third digit, 0.1% fourth digit and 4.3% fifth digit. We also identified the coexistencies of two different accessory ossicles as 6%, accessory ossicles and sesamoid bones as 7%, and bipartite sesamoid bones and sesamoid bones as 1.9%. Distribution of the most common accessory ossicles in male and female subjects was similar. We reported the incidence of accessory ossicles and sesamoid bones of the feet in Turkish adult population.     

Partite hallux sesamoid bones: Relationship with sesamoid bones at other metatarsophalangeal joints

Partite hallux sesamoids are clinically meaningful but their association with other sesamoids is not clear. The objective was to relate the prevalence of the partite hallux sesamoid bones to sesamoid bones at other metatarsophalangeal (MTP) joints. We conducted a retrospective review of plain radiographs of 7946 adult feet between November 2005 and September 2012 to identify partite hallux sesamoids and sesamoids at other MTP joints. Coexistence patterns of the partition and extra sesamoids were studied. Presence or absence of sesamoids at other MTP joints as well as sex and laterality were compared between the feet with and without partite hallux sesamoids using Pearson Chi‐square test. Association between age and partition was evaluated using Spearman's correlation coefficient. Overall partite prevalence rate is 6.82%, and coexistence with extra MTP sesamoids was 0.42%. One pattern was partition in hallux sesamoid only, and 4 patterns were coexistence with extra sesamoids. The prevalence rates of partite hallux sesamoids were 7.17% (508/7081) and 3.93% (34/865) in feet without and with extra sesamoids, respectively. The relative risk of 1.889 (95% CI, 1.325–2.693) of partite hallux sesamoids was noted in feet without than with extra sesamoids (Χ² = 12.759, P < 0.001). A negative correlation between age and distribution of partition was identified (r = ?0.061, P < 0.001). Partition of hallux sesamoid bones is a developmental variation, it can coexist with sesamoids at other MTP joints following a certain pattern; and its prevalence rate is almost twice higher in feet without than with extra MTP sesamoids. Anat Rec, 2017. © 2017 Wiley Periodicals, Inc. Anat Rec, 301:34–38, 2018. © 2017 Wiley Periodicals, Inc.     

Sesamoid and accessory bones of the hand--an epidemiologic survey in a Mediterranean population

The prevalence and distribution of sesamoid and accessory bones in the hands is quite variable between different populations and ethnic groups. However, there are no published data on their distribution in Mediterranean populations. Studies on the validity of radiographic assessment for the presence of these bones are also lacking. A retrospective review of 442 radiographs of adult patients was performed in order to assess the incidence of sesamoid and accessory bones in the hands of a Mediterranean population. Additionally, two independent observers reviewed 174 radiographs and used the Kappa parameter in order to assess the validity of radiographic interpretation of radiographs for the presence of those bones. There was an incidence of 99.5% sesamoid bones (n = 440) in the 1st metacarpophalangeal (MCP) joint, 42.3% in the 2nd MCP joint (n = 187), and 41.1% (n = 182) in the 5th MCP joint. The incidence in the 1st interphalangeal joints was 26.2% (n = 116). The incidence of sesamoid bones in the 1st, 2nd, and 5th metacarpophalangeal joints in a Mediterranean population was found to be similar to that of Arab and Caucasian populations, whereas their prevalence in the 1st interphalageal joint coincided more with Arab populations. Interobserver reliability of the interpretation of radiographs for the presence of sesamoid bones in the hand was good (Kappa > 0.68) in all locations, except for the 1st MCP joint. Further research is warranted to further elucidate the genetic and/or environmental reasons for the differences between those populations.     

Rotational movements in the foot of Galago senegalensis

The wide range of rotational movement found in the elongated foot of Galago senegalensis cannot be accounted for by movement at the subtalar joint. A gross and microscopic study of the intertarsal joints of this animal have revealed a discrete calcaneonavicular articulation between the shafts of these bones together with a pivot joint at the calcaneocuboid articulation. It is suggested that little movement occurs at the subtalar joint and that most of the rotation found is produced by a movement of the navicular and distal tarsal bones about an axis which passes through the attachment of the plantar calcaneonavicular ligament to the calcaneus, the calcaneal portion of the calcaneonavicular joint and the pivot of the calcaneocuboid joint. A comparison is made with the foot of Tarsius and with the rotational movements of the forearm.     

Prevalence of sesamoid bones in the hands: 3D-reconstructed CT study

IntroductionThe prevalence of sesamoid bone in hand is known to be variable among populations of various geographic origins. Since counting with radiographs might be inaccurate due to superimposition of adjacent digits, we tried to overcome this obstacle using 3D-reconstructed CT in Korean patients. The purpose was to provide an accurate incidence of sesamoid bones using 3D-CT.MethodsSesamoid bones were examined in 427-CT images. 3D-CT images were analyzed by one observer and parts of hands (411-hands) were evaluated with radiograph to compare with CT results. Statistical analysis between the CT and radiograph results was performed.ResultsSesamoids of metacarpo-phalangeal (MP) joint of the thumb were always present on both radial and ulnar sides, except for 9-cases (2.1%) where they were not present on radial side and 6-cases (1.5%) where they were not present on ulnar side. MP joint of the little finger was the second most prevalent location (62.8%). The sesamoid of the index finger MP joint and thumb interphalangeal joint was observed in 44% and 42.4%, respectively. There was a rare incidence in the MP joints of middle and ring finger (0.7%). The incidence of sesamoid bone was statistically different between the two counting methods for the MP joints of index and little finger and thumb interphalangeal joint (P < 0.005).DiscussionWe could observe five frequent sesamoid bones in the MP joints of the thumb, index, and little finger, and the interphalangeal joint of the thumb in Korean individuals. 3D-CT images revealed the accurate incidences of hand sesamoid bones.     

An autosomal dominant syndrome of short stature with mesomelic shortness of limbs, abnormal carpal and tarsal bones, hypoplastic middle phalanges, and bipartite calcanei

This paper describes seven persons in a family affected with an autosomal dominant syndrome of short stature with mesomelic shortness of upper and lower limbs, abnormal carpal and tarsal bones, hypoplastic or absent middle phalanges of hands and feet, and delayed coalescence of bipartite calcanei. All affected relatives are of normal intelligence, are free of eye problems, and have a normal skull, spine, shoulders, and hips. The digits of the hands and feet are short, broad, and angulated. The hypoplastic or absent middle phalanges effectively result in one interphalangeal joint for each digit, with decreased mobility. The bones of the carpus and tarsus coalesce with increasing age. None of the previously described syndromes or brachydactylies encompasses the findings noted in this kindred.     

Incidence and ossification of sesamoid bones in the hands and feet: a radiographic study in an Arab population

The incidence and ossification of sesamoid bones in the hands and feet were studied in 922 radiographs (400 hands and 522 feet) in an Arab population from Bahrain, 5-83 years of age and consisting of 549 adults (393 men and 156 women) and 373 children (286 boys and 97 girls). All radiographs of the hand and foot in the adult population showed two sesamoid bones in the thumb metacarpophalangeal (MCP) joint and in the hallucal metatarsophalangeal (MTP) joint, respectively. Only 2.3% and 1.5% of hands showed sesamoids at the MCP joints of the middle and ring fingers respectively compared to a reported incidence of 7.1% for each digit in Caucasians. The incidence of sesamoids in the MTP joints of third and fourth toes (0.6% each) and inferior to the hallucal interphalangeal joint (3.1%) is probably the lowest reported so far in the literature. In the hands, ossification commenced first in the thumb sesamoids, at the age of 10 years in females and 11 years in males and was completed by the age of 13 and 14 years, respectively. In the feet, ossification began first in the hallucal sesamoids at the age of 8 years in females and 9 years in males and was completed by the age of 10 years in both sexes. The incidence and ossification of sesamoids in the hands and feet in the Arab population from Bahrain seem to differ considerably from reports in other populations. The clinical significance of our findings is discussed.     

Intrinsic proportions of the human tarsus: an original approach to tarsal biometry

Few precise biometrical data on human tarsal bones are available, and those published consist principally of linear and angular measurements made on dried bones or on radiographs. The material consisted of 86 complete adult human tarsi (dried bones). The tarsal proportions were determined using the relative tarsal weights (Weight of each of the seven tarsal bones/Weight of the total tarsus×100). The calcaneus was the greatest tarsal bone (41.95%), and the talus the second-largest (28.45%). The medial cuneiform, the cuboid, and the navicular had very similar proportions (7.00–8.38%), as did the intermediate and lateral cuneiforms (2.98% and 3.81%). The study of the ranks of each bone by decreasing proportion allowed the determination of individual variability. The posterior tarsal row was considerably larger (70.40%) than the anterior row (29.60%), resulting in an antero-posterior ratio of 0.42. The medial and lateral tarsal columns had quite similar proportions (50.63% and 49.37%), resulting in a latero-medial ratio of 0.98. The intrinsic tarsal proportions are fundamental biometrical data which seem to be of interest for a better characterization of the human foot in clinical practice and for quantitative approaches in functional and comparative morphology and in paleontology.     

Prevalence and distribution of sesamoid bones in the hand determined using digital tomosynthesis

The aim of this study was to identify the prevalence and distribution of sesamoid bones in the hand using digital tomosynthesis (DTS) in comparison to previous studies. Using conventional radiography (CR) and DTS, hand images (81 left and 100 right) taken at a tertiary hospital were retrospectively reviewed. The sesamoid bones were identified in the interphalangeal (IP) and metacarpophalangeal (MCP) joints of the thumb (I), and in the distal interphalangeal (DIP) and metacarpophalangeal (MCP) of index (II), middle (III), ring (IV), and little (V) fingers. Differences in number of sesamoid bones detected on CR and DTS were analyzed. Sesamoid bones were observed in MCP I (100%), MCP II (46%), MCP III (2%), MCP IV (2%), MCP V (53%), and IP I (53%) on CR. Using DTS, sesamoid bones were found more often in MCP I (100%), MCP II (54%), MCP III (2%), MCP IV (1%), MCP V (59%), and IP I (75%). Differences in the mean number of sesamoid bones detected on CR and DTS were statistically significant. Sesamoid bones in DIP joints were frequently observed on DTS, but rarely found on CR. Most sesamoid bones in the hand were detected in MCP I, II, V, and IP I joints, and were more often detected on DTS than CR. DTS is a reliable tool to evaluate bony structures in the hand. Clin. Anat. 30:608–613, 2017. © 2017 Wiley Periodicals, Inc.     

Skeletal anomalies in trisomy 21 as an example of amplified developmental instability in chromosome disorders: Histological study of the feet of 21 mid-trimester fetuses with trisomy 21

In a previous radiographic study on the feet of 71 adults with trisomy 12 we found, in comparisn to control individuals, an increased prevalence of biphalangeal toes and metatarsophalangeal sesamoid bones. The present histological study on the feet of 21 mid-trimester fetuses with prenatally diagonosed trisomy 21 confirms results of the earlier study. At both stages of development these minor bone anomalies have about the same frequency, thus suggesting 1) that they are selectively neutral, and 2) that they reflect a basic (innate) failure of ordered morphogenesis. Our observation that the normal spatial pattern skeletal variants is reproduced in trisomy 21 simply on a quantitavely higher level lends sound support to the hopothesis of amplified developmental instability in chromosome trisomies.     

Skeletal anomalies in trisomy 21 as an example of amplified developmental instability in chromosome disorders: a histological study of the feet of 21 mid-trimester fetuses with trisomy 21

In a previous radiographic study on the feet of 71 adults with trisomy 21 we found, in comparison to control individuals, an increased prevalence of biphalangeal toes and metatarsophalangeal sesamoid bones. The present histological study on the feet of 21 mid-trimester fetuses with prenatally diagnosed trisomy 21 confirms results of the earlier study. At both stages of development these minor bone anomalies have about the same frequency, thus suggesting 1) that they are selectively neutral, and 2) that they reflect a basic (innate) failure of ordered morphogenesis. Our observation that the normal spatial pattern of skeletal variants is reproduced in trisomy 21 simply on a quantitatively higher level lends sound support to the hypothesis of amplified developmental instability in chromosome trisomies.     

The dimensions of the tarsal sinus and canal in different foot positions and its clinical implications

This study presents a reference for the dimensions of the tarsal sinus and canal in healthy adults in different foot positions to facilitate understanding of the kinematics of the subtalar joint, the effect of an implant, and other clinical issues. In a 3D CT stress test on 20 subjects, the right foot was forced into a neutral and eight different extreme foot positions while CT scans were obtained. The bones were segmented in the neutral foot position. The kinematics of the bones in the extreme positions were determined relative to the neutral position. The dimensions of the tarsal sinus and canal were calculated by determining the radii of the maximal inscribed spheres at 20 equidistant locations along an axis in 3D surface models of the tali and calcanei in each foot position. The radii were small on the medial side and increased laterally. Medial from the middle, the radii were small and not significantly different among the various foot positions. At the lateral side, the dimensions were affected mainly by eversion or inversion and less by dorsiflexion or plantarflexion. The pattern was reproducible among subjects, but there were between‐subject differences. The dimensions are mostly determined by rotation in the frontal plane. A pivot point was found medial from the middle. These data serve as a reference and model for predicting the effect of sinus implants and understanding such clinical problems as sinus tarsi syndrome. Between‐subjects differences have to be taken into account. Clin. Anat. 30:1049–1057, 2017. © 2017 Wiley Periodicals, Inc.     

Fetal development of the first metatarsophalangeal joint complex with special reference to the intersesamoidal ridge

In most individuals, plantar to the first metatarsal head, a more or less well developed crest separates the two furrows for the medial and the lateral sesamoid bones. In some instances, the absence of this crest has been observed in a previous study. This observation may be related to a pathological and/or an ontogenetic development. For the present examination, we have assumed the ontogenetic hypothesis. Twenty-two feet were examined at different developmental stages from week 12 to 38. The feet were prepared for examination using methods of plastination-histology. Sesamoids have already developed from the joint capsule by the first stage (12th week). Attachment bundles of collagenous fibers have deeply penetrated the cartilage of the sesamoids on their capsular side. Only some inner fibers of the muscular tendons join the sesamoids on their plantar side. The intersesamoid ligament is blended into the synovial tendon sheath of the flexor hallucis longus. The plantar crest has already developed in the fetal cartilage of the first metatarsal head as a strong ridge. With further growth, the surfaces become inwardly tapered on both sides of the ridge through the sesamoid bones, so that in the end the ridge results in a more or less clear crest. If the tapering of the furrows for the sesamoid bones proceeds too briskly or too far, this can result in an absence of the plantar crest. If the absence of this crest stands in relation to the formation of a Hallux valgus, this result would be a first indication of an developmentally based cause for this wide-spread disease of the foot.     

Arterial anatomy of the hallucal sesamoids

The aim of this study was to analyze the arterial supply of the sesamoid bones of the hallux. Twenty‐two feet from adult cadavers were injected with epoxide resin or an acrylic polymer in methyl methacrylate (Acrifix®) and subsequently processed by two slice plastination methods and the enzyme maceration technique. Afterwards, the arterial supply of the sesamoid bones was studied. The first plantar metatarsal artery provided a medial branch to the medial sesamoid bone. The main branch of the first plantar metatarsal artery continued its course distally along the lateral side of the lateral sesamoid and supplied it. The supplying arteries penetrated the sesamoid bones on the proximal, plantar, and distal sides. The analysis and cataloging of the microvascular anatomy of the sesamoids revealed the first plantar metatarsal artery as the main arterial source to the medial and lateral sesamoid bones. In addition, the first plantar metatarsal artery ran along the lateral plantar side of the lateral sesamoid bone, suggesting that this artery is at increased risk during soft‐tissue procedures such as hallux valgus surgery. Clin. Anat. 22:755–760, 2009. © 2009 Wiley‐Liss, Inc.     

Fabella prevalence rate increases over 150 years,and rates of other sesamoid bones remain constant: a systematic review

The fabella is a sesamoid bone located behind the lateral femoral condyle. It is common in non‐human mammals, but the prevalence rates in humans vary from 3 to 87%. Here, we calculate the prevalence of the fabella in a Korean population and investigate possible temporal shifts in prevalence rate. A total of 52.83% of our individuals and 44.34% of our knees had fabellae detectable by computed tomography scanning. Men and women were equally likely to have a fabella, and bilateral cases (67.86%) were more common than unilateral ones (32.14%). Fabella presence was not correlated with height or age, although our sample did not include skeletally immature individuals. Our systematic review yielded 58 studies on fabella prevalence rate from 1875–2018 which met our inclusion criteria, one of which was an outlier. Intriguingly, a Bayesian mixed effects generalized linear model revealed a temporal shift in prevalence rates, with the median prevalence rate in 2000 (31.00%) being ~ 3.5 times higher than that in 1900 (7.64%). In all four countries with studies before and after 1960, higher rates were always found after 1960. Using data from two other systematic reviews, we found no increase in prevalence rates of 10 other sesamoid bones in the human body, indicating that the increase in fabella prevalence rate is unique. Fabella presence/absence is due to a combination of genetic and environmental factors: as the prevalence rates of other sesamoid bones have not changed in the last 100 years, we postulate the increase in fabella prevalence rate is due to an environmental factor. Namely, the global increase in human height and weight (due to improved nutrition) may have increased human tibial length and muscle mass. Increases in tibial length could lead to a larger moment arm acting on the knee and on the tendons crossing it. Coupled with the increased force from a larger gastrocnemius, this could produce the mechanical stimuli necessary to initiate fabella formation and/or ossification.     

跟舟联合切除及趾短伸肌肌瓣置入手术治疗症状性跟舟联合的疗效分析

目的 探讨症状性跟舟联合患者跟舟联合切除及趾短伸肌肌瓣置入的手术疗效。方法 回顾性分析2016年2月-2018年3月北京同仁医院足踝外科9例(10足)症状性跟舟联合患者的临床资料。其中男6例、女3例,年龄11~63(平均30.3)岁,骨性联合2足、纤维性联合8足。患者均行跟舟联合切除及趾短伸肌肌瓣置入手术治疗,术后观察有无出现伤口感染、术区疼痛、跟舟联合复发、周围关节退变及足部畸形,比较患者手术前后疼痛视觉模拟评分(VAS)和美国足踝外科协会(AOFAS)踝-后足评分。结果 9例患者随访17~42个月,平均29.1个月。所有患者症状缓解,未出现伤口感染、复发、周围关节退变及后足力线异常。患者末次随访疼痛VAS为(1.50±0.97)分,较术前(4.30±1.49)分明显降低,差值3(2,3)分,差异有统计学意义(Z=2.859, P＜0.01);末次随访AOFAS评分为(90.40±7.04)分,较术前(77.30±7.66)分明显提高,差值(13.10±5.70)分,差异有统计学意义(t=7.262, P＜0.01)。所有患者对治疗结果表示满意。结论 对于症状性跟舟联合患者,保守治疗失败时可行手术治疗,跟舟联合切除后用趾短伸肌肌瓣置入可有效预防跟舟联合的复发,临床疗效肯定。     

What are the most accurate categories for mammal tarsus arrangement? A review with attention to South American Notoungulata and Litopterna

The arrangement of the tarsus has been used to differentiate afrotherian and laurasiatherian ungulates for more than a century, and it is often present in morphological matrices that include appendicular features. Traditionally, it has two states: (i) an alternating tarsus, where proximal elements are interlocked with central and distal elements positioned like the bricks of a wall; and (ii) a serial tarsus, where elements are not interlocked. Over the years, these states became synonymous with the presence or absence of an astragalocuboid contact. Within the South American order Notoungulata, a third disposition was recognized: the reversed alternating tarsus, associated with a calcaneonavicular contact. This state was considered to be a synapomorphy of ‘advanced’ Toxodontia families (Notohippidae, Leontiniidae and Toxodontidae), but a further inspection of its distribution shows that it occurs throughout Mammalia. Additionally, it overlaps the serial tarsus condition as originally defined, and it probably has no functional or phylogenetic significance. Calcaneonavicular and astragalocuboid contacts are non‐exclusive, and their presence within a species, genus or family is not constant. Serial and alternating imply movements of the articulations of the mid‐tarsus in the transverse axis, while reverse alternating refers to a small calcaneonavicular contact that sometimes occurs in a serial condition or to a significant displacement of the tarsal articulations in a different (proximodistal) axis. The proximodistal arrangement of the joints could be functionally significant. Two new states are observed and defined: (i) ‘flipped serial’, present in Macropodidae, in which the calcaneocuboid articulation is medially displaced and significantly larger than the astragalonavicular contact, but the relationships between proximal and central elements are one to one; and (ii) ‘distal cuboid’, an extreme proximodistal displacement of the astragalonavicular joint. Serial and alternating, as originally defined (i.e. without any reference to which bone contacts which), seem to be the best states for classifying tarsal arrangement though as the disposition of distal or central bones in relationship to proximal bones.