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Clearing the Cervical Spine
Published in Kajal Jain, Nidhi Bhatia, Acute Trauma Care in Developing Countries, 2023
Apinderpreet Singh, Rajesh Chhabra, Pravin Salunke
Plain radiograph of the cervical spine in lateral and anteroposterior view always remains the first-line investigation. An additional open mouth odontoid (OMO) view can also be obtained for adults and children above 9 years of age. OMO view provides no further information for younger children and can be avoided. The clinician should be cautious so as to not confuse fractures with synchondroses, particularly in younger age groups.
The Anatomy of Joints Related to Function
Published in Verna Wright, Eric L. Radin, Mechanics of Human Joints, 2020
Cartilaginous joints are described as primary or secondary. The primary form (synchondrosis,Fig. 1B) consists of a thin plate of cartilage (the epiphysial or growth plate) interposed between separate centers of ossification in a growing bone. The synchondrosis provides the essential mechanism by which growth in length occurs in bones: bone matrix, being rigid, renders direct interstitial growth impossible. Once the need for growth ceases, in humans synchondroses become obliterated to form synostoses. Cartilage is strong in compression but relatively weak in tension and shear (2). Shear forces occur particularly at the ends of bones, adjacent to joints, where movement occurs and ligaments and muscles are predominantly attached, and are counteracted by complex interlocking contours on the opposing surfaces of the synchondrosis. Thus, even when a powerful shear force is acting in parallel with the epiphysial plate as a whole, there are regions that are, if not perpendicular, oblique to the force and thus better able to resist separation of the two osseous elements. Where powerful tensile forces act across a synchondrosis (e.g., beneath the tibial tuberosity), the cartilage is replaced by collagen fibers (3), which are very strong in tension (2). Despite these biomechanical defenses, slipped and fractured epiphyses are not uncommon injuries in childhood.
Fundamentals
Published in Clare E. Milner, Functional Anatomy for Sport and Exercise, 2019
Cartilaginous joints are those in which the articulating bones are connected by cartilage. They do not have a joint cavity. The amount of movement possible at cartilaginous joints varies from immovable to highly movable, with synchondroses being immovable and symphyses being slightly or highly movable. A synchondrosis is a joint where the bones are firmly connected by hyaline cartilage (see articulating surfaces). Examples include the epiphyseal (growth) plates in the long bones of the extremities and sternocostal synchondroses between the sternum (breastbone) and the anterior end of the ribs in the thoracic cage (see thoracic region – joints). The second type of cartilaginous joint is a symphysis, in which the bones are connected by fibrocartilage. In these joints, hyaline cartilage is present on the articulating parts of the bone. These joints are somewhat movable and include the intervertebral joints. The fibrocartilaginous intervertebral disc connects the vertebral bodies and acts as a shock absorber within the vertebral column (see thoracic region – joints). Another example is the pubic symphysis on the anterior aspect of the pelvis (see lumbar spine and pelvis – bones). This joint becomes quite flexible prior to childbirth to enable the infant to pass more easily through the birth canal.
Possible predictive clinical and radiological markers in decision making for surgical intervention in patients with Chiari Malformation type 1
Published in Neurological Research, 2022
Ulaş Yuksel, Veysel Burulday, Suleyman Akkaya, Selcuk Baser, Mustafa Ogden, Aslihan Alhan, Bulent Bakar
The pathogenesis of CM type 1 is unclear, but while cerebellum structures continue to develop normally, the narrow posterior fossa cannot accommodate them, resulting in herniation of the cerebellar tonsil into the spinal canal and obstruction of CSF flow. The presence of the cerebellar tonsils 3–5 mm below The McRae line is defined as CM type 1. However, some authors consider 10 mm herniation as CM [2]. It has been shown that posterior fossa volume and some morphometric measurements can be of guidance in CM type 1. Karagoz et al stated that the posterior fossa volume of CM type 1 patients was 16% less than that of the control group [14]. Regarding the developmental retardation of the occipital bone, the distance between the basion and the spheno-occipital synchondrosis is shorter in CM 1 patients. A short clivus has also been associated with CM type 1 [15]. The smaller posterior fossa volume in CM type 1 patients has been explained by a shorter supraoccipital height [16]. These pathological changes damage the cerebellum, brain stem, spinal cord, lower cranial nerves, and upper cervical nerves, leading to clinical symptoms [11,17]. The most common symptom in symptomatic patients is headache, which may increase with Valsalva. In these patients, headaches can sometimes occur in the form of migraines. Other symptoms seen in patients may be sensory dysfunction such as cloak-like paresthesia or motor dysfunction including muscle atrophy and myelopathic findings, cerebellar dysfunction and ataxia, nausea, dysphagia, and apnea [18].
A rare case of thumb polydactyly with metacarpophalangeal joint synostosis
Published in Case Reports in Plastic Surgery and Hand Surgery, 2019
Michael Finsterwald, Sebastian Guenkel
In the world literature we only found 14 documented cases of thumb malformations with metacarpophalangeal synostosis or interphalangeal symphalangism (Table 1) predominantly from Asia, specifically Saudi Arabia [9,10], Iran [11], Turkey [12] and Japan [13] indicating a potential genetic background. Al-Qattan [10] reported five patients (2.2%) in his study of 228 hands of which only one (0.4%) was a metacarpophalangeal synostosis. Of these five patients three were previously published by Al-Aithan et al [9] and all showed interphalangeous symphalangism. One patient with metacarpophalangeal synostosis and two distal phalanges radially was described by Afshar [11]. Six cases of cartilaginous symphalangism in children were published by Takagi et al [13], three of which were metacarpophalangeal synchondrosis. Boutros et al [14] and Ciloglu et al [12] each reported one case of interphalangeal symphalangism.
Invasive diagnostic and therapeutic measures are unnecessary in patients with symptomatic van Neck–Odelberg disease (ischiopubic synchondrosis): a retrospective single-center study of 21 patients with median follow-up of 5 years
Published in Acta Orthopaedica, 2021
Kristian Nikolaus Schneider, Lukas Peter Lampe, Georg Gosheger, Christoph Theil, Max Masthoff, Robert Rödl, Björn Vogt, Dimosthenis Andreou
Van Neck–Odelberg disease (VND) is a self-limiting skeletal phenomenon characterized by an asymptomatic or symptomatic uni- or bilateral overgrowth of the pre-pubescent junction between the inferior pubic ramus and ischium, which can be seen on radiographs during skeletal maturation (Figure 1) (Herneth et al. 2004, Wait et al. 2011, Mixa et al. 2017). The condition was first described in the 1920s by Odelberg and Van Neck, who classified it as a “disease” (Odelberg 1923, van Neck 1924). Today, however, VND is considered a physiological normal variant of the ischiopubic synchondrosis (IPS) that is usually obliterated between late childhood and early adolescence by bony fusion or synostosis (Herneth et al. 2000, Mixa et al. 2017).