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Fractures of the talus
Published in Maneesh Bhatia, Essentials of Foot and Ankle Surgery, 2021
Figure 17.1 demonstrates the superior view of the talus. This shows the lateral process of the talus which articulates with the lateral malleolus in the lateral gutter of the ankle joint as well as the subtalar joint inferiorly. Posteriorly, on either side of the flexor hallucis longus (FHL) tendon are the medial and lateral posterior tubercles. An os trigonum is an accessory bone found in 10% of individuals and is attached by a fibrous band to the posterior part of the talus. It is usually an incidental finding but can be mistaken for a posterior process fracture. Each of these anatomic parts may be fractured individually or in combination.
The ankle and foot
Published in Ashley W. Blom, David Warwick, Michael R. Whitehouse, Apley and Solomon’s System of Orthopaedics and Trauma, 2017
Orthotics can be very helpful but must correct the heel alignment out of valgus which results in a secondary elevation of the medial longitudinal arch and offloads the accessory bone. If symptoms persist, the accessory bone can be shelled out from within the tibialis posterior tendon (Type 2). If the medial arch is significantly flat, the tibialis posterior tendon can be used as a ‘hitch’ by reinserting it through a hole drilled in the navicular and suturing the loop with the foot held in maximum inversion (Kidner’s operation).
Musculoskeletal (including trauma and soft tissues)
Published in Dave Maudgil, Anthony Watkinson, The Essential Guide to the New FRCR Part 2A and Radiology Boards, 2017
Dave Maudgil, Anthony Watkinson
Os acetabuli is an accessory ossification centre at the superolateral aspect of the acetabulum. The linea aspera is a line found in the posterior distal third of the femur. Peritendonitis calcarea is an amorphous area of calcification overlying the greater trochanter. Os secundum is an accessory bone in the hand. The fovea capitis is found in the femoral head.
Intra-osseous tophaceous gout of a bipartite patella mimicking aggressive bone tumour
Published in Modern Rheumatology Case Reports, 2021
Fidelis Marie Corpus-Zuñiga, Keiichi Muramatsu, Ma. Felma Rayel, Yasuhiro Tani, Tetsuya Seto
The patella is one of those reported in literature as an atypical site for tophaceous gout. Several case reports were already written since 1955 (Table 1) [2–8]. Monosodium urate crystals become less soluble with lower temperatures, which could explain why gouty tophi often form in the distal end of an extremity such as the metatarsophalangeal joint of the first toes. The typical presentation of patellar gouty tophi usually involves the superolateral aspect of the patella, with noted involvement of the surrounding tendinous structures. The superficial nature and therefore lower temperature at the area of the patella could explain the formation of gouty tophi. The blood supply of the patella comes from a plexus of blood vessels [9]. The primary intraosseous blood supply of the patella has been described to flow in a retrograde fashion from distal to proximal, which is responsible for osteonecrosis of the superior fragment of the patella in cases of severely comminuted fractures [9]. In a bipartite patella, there is an avascular tissue interposed between the accessory bone and the main patellar bone fragment. This avascular tissue is composed mostly of fibrocartilage and less of fibrous and hyaline cartilage [10]. This alteration in the normal anatomy and blood flow in the patella could be one possible explanation as to why intra-osseous tophi of bipartite patellae often develops at the superolateral aspect of the patella.
Lateral ankle anatomical variants predisposing to peroneal tendon impingement
Published in Alexandria Journal of Medicine, 2018
Mahmoud Agha, Mohamed Saied Abdelgawad, Nasser Gamal Aldeen
Group A (181 (30.1%) patients):Different anatomical variants were seen in this group's patients; Overall 73 of them (30.1%) had Peroneal tendons injury (PTT). Straight and convex RMG was found in 48 patients (26.5%), PTT occurred in 19 of them (39.6%), Peroneus tubercle (PT) hypertrophy (>5mm) was found in 39 (21.6%) patients; 14 of them (35.9%) had PTT. Retrotrochlear eminence (>5mm) hypertrophy had been detected in 33 (18.3%) patients; 12 of them (36.4%) had PTT. Peroneus Quartus accessory muscle was seen in 15 (8.3%) patients; 7 of them (46.7%) had PTT. Low PB muscle Belly was found in 29 (16%) patients; 13 of them (44.9%) had tendinous injury. Os Peroneum (OP) accessory bone was in 17 patients (9.3%); 8 of them (47%) had tendinous injury. Group B included 196 (32.7%) patients who had normal ankle structures with no variants and subjected to lateral ankle trauma. PTT had been only recorded in 26 patients (18%). Group C included 223 (37.2%), who did ankle MRI for other types of ankle injuries (Table 3). Statistic comparison in between the two groups A&B was made through Fisher exact test had given a p value of 0; considering that the result is significant at p < .058 (Table 4).